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125 Cards in this Set
- Front
- Back
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Size of kidneys? |
4 inches long and 3 inches wide |
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Are male or female kidneys bigger? |
Male |
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What kind of plane and degree are the kidneys on and why? (Upper pole and medial border) |
Longitudinal. 20 degree. Because psoas muscles getting thicker causing the kidneys to be angled in at the top. |
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Location of kidneys? |
Midway between xiphoid process and iliac crest. Retroperitoneal. |
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The very most proximal part of the ureters are ____ but they come back in and are considered _____ |
Retroperitoneal. Intraperitoneal. |
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Do the kidneys move? |
Yes. Never frozen in one position. |
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What happens to the kidneys when we stand up? |
They drop a little bit |
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When we breathe we expect the diaphragm to push the kidneys _____ and when you exhale the kidneys move _____ |
Down. Up. |
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When the kidneys drop into the pelvis / more than expected |
Nephroptosis |
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How much are the kidneys technically supposed to drop? |
One inch |
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Nephroptosis happens when? |
Old age when connective tissue breaks down |
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When a fetus is developing the kidneys kidneys are located in the pelvis and as the fetus develops the kidneys come up to their normal location. What's it called when the kidneys don't move up into that normal location |
Ectopic kidney |
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System functions of the kidneys? |
Production and elimination of urine |
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Urinary system anatomy? |
2 kidneys, 2 ureters, 1 bladder, 1 urethra |
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Four functions of the kidney? |
Remove nitrogenous wastes, regulate water levels, regulate acid base balance, regulate electrolyte balance |
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Right kidney has how many poles? |
2 |
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Left kidney has how many poles? |
3 |
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Where the arteries enter the kidney and the veins leave the kidney. Also includes renal pelvis, proximal part of ureter, and lymphatic system. |
Hilum |
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Which pole of the kidney is more lateral to the other? |
Lower pole |
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Which pole is more medial? |
Upper pole |
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Outermost party that completely encloses all the parts of the kidney |
Fibrous capsule |
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Arterioles and veinules are within this |
Cortex |
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Drain the urine from the cortex |
Medulla (renal pyramids) |
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Separate the individual medulla |
Renal columns |
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At the individual point of the medulla |
Renal papilla |
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Spaces inbetween the medulla |
Renal sinuses |
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Where the urine flows from the papilla |
Minor calyx |
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Formed by the minor calyces coming together |
Major calyx |
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Formed by the minor and major calyces |
Renal pelvis |
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Sends the urine down to the bladder |
Ureters |
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Filters things out from the blood |
Glomerulus |
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Which arteriole of the nephron takes blood in? |
Afferent |
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Which arteriole in the nephron takes bloods away and put the rest into the capillaries? |
Efferent |
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The way through the nephron? |
Through the arterioles, Proximal convoluted tubule, descending limb, loop of henle, ascending limb, distal convoluted tubule, collecting tubule, into renal papilla, minor calyx |
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long system passageway for the urine to flow from the kidneys to the bladder
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ureters
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____ and ____ create the flow of urine
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peristalsis and gravity
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where the renal pelvis turns into the ureter and begins to go down. narrow portion of the ureter. kidney stones get stuck here first.
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UpJ (ureteropelvic junction)
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where the large iliac artery and vein are over the ureter pressing against it. second place stones get stuck.
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pelvic brim
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ureter comes from posterior side of the bladder and comes back into. last place stones get stuck.
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UVJ (ureterovesical junction)
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size of the bladder?
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designed to expand and fold down.
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position of the bladder?
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infraperitoneal
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capacity / how much the bladder can hold
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350-500ml
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muscle folds that let the bladder expand
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ruage
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attach the bladder to the pelvic floor
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trigone
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emptying your bladder
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micturition / voiding
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oragns of the urinary systems that are retroperitoneal
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kidneys and ureters
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organs in the urinary system that are infraperitoneal
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urinary bladder, urethra, male reproductive organs
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bowel prep for an IVU/IVP. why?
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nothing by mouth for atleast 8 hours (from midnight on). because they may get nervous and their stomach my churn and if they throw up they'll have nothing to throw up, decreasing likely hood of aspiration.
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dressing for an IVP/IVU?
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dress like an abdomen image and empty bladder because the exam will be about an hour with lots of contrast media
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flank pain?
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back area pain
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indications / pt history for an IVP/IVU
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flank pain, difficulty with urination, bladder pain, kidney stones that's moved
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supplies for IVU/IVP
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gloves, tape. syringes, gauze, turnicate, needles, contrast media, bandaids, emesis basin
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common contradictions for IVP/IVU
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contrast media allergy, renal failure, multiple myeloma, pheochromocytoma, diabetes, Glucophage, anuria, severe hepatic or renal disease, CHF, sickle cell anemia
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what do you do with your pts if they've had a reaction to this type of exam before?
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send them to ultrasound
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kidneys aren't working
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renal failure
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malignant tumor of the plasma cells in the bone marrow
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multiple myeloma
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adrenal gland tumor
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pheochromocytoma
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abnormally shaped red blood cells and cant carry oxygen throughout the body, compromising renal function
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sickle cell anemia
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what happens if they are diabetic when going through an IVP/IVU
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ask them what meds they are taking and if theyre in the family of Glucophage they cant take the medicine until 48 hours after the injection
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why use ureteric compression?
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enhance pelvicalyceal system and proximal ureters. more complete exam of collecting system.
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how to give ureteric compression?
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2 air filled paddles on the outer pelvic brim
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holds contrast media up inside the kidneys so that we can get a really good look within that area
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ureteric compression
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can you use ureteric compression on larger people?
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no
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when to not to ureteric compression?
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ureteric stone, abdominal mass, AAA, recent abdominal surgery, recent abdominal trauma,
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if you can use uteric compression whats the alternative?
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trendlenberg
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uses gravity at least 15 degree and keeps all the urine and contrast media up in the system even longer
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trendlenberg
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is the IVU/IVP exam function or non functional?
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timed functional
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purpose of the IVU/IVP?
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visualization of entire urinary tract, visualize collecting system, assess function, evaluate for pathology or anaomolies
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IVU procedure steps?
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scout KUB, scout nephotomogram (determining fulcrum level), CM injection and time begins, nephrograms, 5 minute images, 10-15 minute images, 20minuts OBLs, post void KUB, erect or delayed films.
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alternatives to the routine?
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post release or "spill" images, erect for bladder, delayed images, hypertensive IVU.
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why take a spill image as alternative?
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kidneys spilling urine. want to catch this right away. lay them down, let go of compression, take picture right away.
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why take erect of bladder as an alternative?
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to see if the bladder drops below the level of the pubis. elderly people or women with lots of kids.
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why take delayed images as alternative?
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if kidneys are functioning right
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when take pictures for an hypertensive IVU?
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1minute, 2 minute, 3 minute, 30 seconds
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very special type of imaging where the tube and the ir move in unison to create a blurred image. cr?
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nephrotomogram. midway between the iliac crest and the xiphoid tip
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AP images 5, 10, and 15 minutes
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spill images
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20 minute image? cr? image criteria?
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posterior oblique with a 30 degree oblique. cr at iliac crest and vertebral column. need kidneys down but don't have to have pubis.
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why do the oblique image?
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best demonstrate the upside kidney and the downside ureter
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post void positioning?
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want recumbent because it forces the CM out of the kidneys and into the ureters
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what can be shown in an erect post void?
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enlarged prostate gland, prolapsed bladder, tumor in the bladder
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why do we take the erect post void?
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to see if there are residual urine left in the bladder
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image that is focused on the kidneys themselves in alternative image. very clean and smooth.
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neprogram
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kidney with two renal pelvises and ureters is what?
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congenital anaomoly
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special kidney stone. named after the antlers on animals. very dense and significant. fills in the kidneys
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staghorn calculus
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multiple cysts in the kidneys effecting both kidneys at the same time and is hereditary
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polycystic kidney disease
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what type of procedure is a retrograde urography /pyelography
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operative procedure, nonfunctional
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what is the point of a retrograde urohraphy / pyelography?
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to look up from the bladder all the way into the kidneys
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why is a retrograde urography / pyelography a nonfunctional exam?
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because we already know there is a problem and were still injecting CM to get a better look
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use this in order to go up into the bladder through the urethra. port so they can slide the catheter into it.
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cystoscope
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long hollow plastic tubes to inject contrast media in
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catheter
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start at the distal end where the ureters connect to the sphincter and force it up the wrong way
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retrograde administration
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what do we use that allows us to turn xray on when told to do so and take image when told to do so
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mobile c arm
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pt position for a retrograde urography/pyelography?
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lithotomy (legs in stirups) sterile drapes from shoulder to hips and then sterile drapes over the legs.
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solid metal structure tube
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cystoscope
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two ports on the cystoscope are for what?
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light source and suction tube for fluid or to irrigate
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everyone but the doctor is where?
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on the side of the pt
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image what first for a retrograde urography/pyelography?
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bladder and then up
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do you often know whether its one kidney or the other if youre doing the retrograde urography/ pyelography?
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yes
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what type of exam is a retrograde cystography?
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non functional exam of the urinary bladder. need informed consent.
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why do a retrograde cystography?
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trauma with blood in the urine and see whats going on and if there is a bladder tumor.
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how is contrast given in a retrograde cystography?
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through iv and gravity.
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how much contrast goes into these exams?
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150-500ml
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prep for cystography?
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no bowel prep, remove clothes from waist down, empty bladder
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why empty a bladder for a cystography?
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because if the pts bladder is full then the contrast media will be diluted
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images taken for a cystography?
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KUB, AP axial, posterior obliques, lateral (optional)
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why use a 10-15 caudal angle on the ap axial cystography
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to remove pubis from bladder
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degree of rotation for a posterior oblique cystography?
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45-60 degrees
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what are we interested in on a posterior oblique?
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sphincters where they connect into the bladder being patent. if they aren't working they will allow contrast to flow up the ureter but we wont know which one until AP is taken.
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why the lateral in a cystography is not usually a thing
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because of gonadal dose
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in a lateral position of a cystography where does the bladder move
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anteriorly
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VCUG is what type of exam?
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functional exam of bladder, urethra, distal ureters
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VCUG common info?
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void. usually on little girls. need informed consent
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positions for VCUG?
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females AP. males 30 degree RPO.
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why do we want them to void?
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to see urethra
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whats it called when the urine goes back up from the bladder? and whats that mean?
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ureteral reflux. look and watch where it stops.
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retrograde urethrography is done for who? and why?
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males because only their urethra is long enough. 30 degree RPO always. need consent
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whats used in a retrograde urethrography?
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brodeny clamp
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Complete cessation of urine secreted by the kidneys |
Anuria |
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Bacteria in the urine |
Bacteriuria |
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Blood in the urine |
Hematuria |
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Diminished amounts of urine excreted |
Oliguria |
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Glucose in the urine |
Glucosuria |
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Passage of large amounts of urine |
Polyuria |
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Protein in the urine |
Proteinuria |
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Excess urea, creatinine, other nitrogenous end products of protein and amino acid metabolism |
Uremia |
