Welcome to Scribd, the world's digital library. Read, publish, and share books and documents. See more
Download
Standard view
Full view
of .
Look up keyword
Like this
9Activity
0 of .
Results for:
No results containing your search query
P. 1
Genitourinary System

Genitourinary System

Ratings:

4.0

(1)
|Views: 676 |Likes:
Published by sarguss14

More info:

Published by: sarguss14 on Feb 20, 2009
Copyright:Attribution Non-commercial

Availability:

Read on Scribd mobile: iPhone, iPad and Android.
download as DOC, PDF, TXT or read online from Scribd
See more
See less

02/01/2013

pdf

text

original

GU LECTURE
Kidney Ureter Bladder : KUB
\ue000KUB is variously called as plain film or scout
film. It is done preliminary to IVP.
\ue000Difference in x-ray attenuation between the

kidneys and the enveloping perirenal fat in plain films provides a crude index of renal anatomy and pathologic changes

\ue000Preliminary to IVP
\ue000Since IV contrast can hide the calculi (same x-

ray density as contrast) it serves as the film of reference for all subsequent films done after injection of contrast material.

\ue000Good to pick up calcifications. Observe for
calcification overkidney, ureters, bladder
regions and rest of the abdomen
\ue000Can identify distended bladder
\ue000Can identify abdominal and pelvic masses.
Observe renal outline for size and mass
density.
\ue000Incidental non diagnostic findings on KUB may
alert the physician to the possibility of urinary
tract injury
\ue000In trauma fracture of vertebrae, ribs or pelvis
alerts you to GU tract injury.
\ue000Psoas obliteration and concavity of spine
towards the side of pathology.
\ue000Abnormal air collections suggestive of renal or
peri-renal abscess
Intravenous Pyelogram (IVP)
\ue000
IVP is a radiological test that uses contrast to
outline the kidneys, ureters and bladder.
\ue000Also known as intravenous urogram
Utility
\ue000Useful for evaluating the anatomy of the
kidneys, ureters and bladder
\ue000One can detect function when no contrast is
excreted

\ue000absence of renal function .
\ue000absence of perfusion to a kidney
\ue000Useful to identify urinary tract obstruction
\ue000Useful to evaluate reno-vascular disease

Common indications

\ue000Renal colic
\ue000Hematuria
\ue000Recurrent urinary tract Infections
\ue000Suspected reno-vascular hypertension

Disadvantages
\ue000Labor and time intensive \u2013 it may take up to 6
hours to complete in the severe obstruction
\ue000It requires placement of an intravenous line.
\ue000Requires a bowel preparation for optimal
results
\ue000Involves intravenous injection of potentially
allergic and mildly nephrotoxic contrast
\ue000Nonionic contrast agents have lowered the
incidence of adverse reactions.
\ue000IVP's are not useful in patients with renal
dysfunction.
\ue000Newborns
rarely
have
sufficient

renal concentrating ability to allow the kidneys to be seen on an x-ray.

\ue000Hydration is important
\ue000May aggravate renal failure
Retrograde Pyelogram
\ue000Like IVP, retrograde pyelography relies on
contrast medium to produce detailed X-ray
images of the urinary tract.
Utility
\ue000Defines ureters and collecting systems
\ue000While newer diagnostic techniques have

replaced this test for many functions, retrograde pyelography may still yield better definition of the upper urinary tract, particularly the ureter and kidney collecting syst

Indications
\ue000Commonly performed when IVP produces an

inadequate picture. Useful to study urinary tract obstruction when further clarification of nature of ureteral obstruction is required

\ue000It
also
complements
cystoscopy

while investigating a patient with hematuria or recurrent or suspected cancer.

\ue000Detects small lesions in the collecting system
E.g. Transitional cell carcinoma
Limitations
\ue000Contrast complications
\ue000May aggravate an existing urinary tract
infection
or
triggering
one
from
the
catheterization.
Voiding cystourethrogram (VCUG)
\ue000Children with urinary tract infections.
\ue000Refluxis detected if contrast is seen to
flow in retrograde fashion up the
ureters from the bladder.
\ue000Pelvic trauma where rupture of the bladder or
urethra is suspected.
\ue000If
the
bladder
is

ruptured, extravasation of contrast will be seen outside the bladder in the pelvis or abdomen.

\ue000If urethra is ruptured, there is
extravasation into the perineum
\ue000Patients with suspected bladder outlet
obstruction
\ue000Obstructions or strictures or injury of
the urethra can be seen on the x-rays
taken during voiding.
Limitations
\ue000Insertion of the catheter is painful.
\ue000While conventional voiding cystograms are still

necessary to evaluate the male urethra for posterior valves and bladder trauma, the majority of reflux studies today are done effectively with radionuclide cystography.

ULTRASOUND
1
\ue000The use of high-frequency sound waves to

produce real-time images, provides a simple and painless way to examine the kidney, bladder, prostate and scrotum

Advantages

\ue000Non-invasive test
\ue000Requires no preparation
\ue000No pain
\ue000Provides

accurate
anatomic
information,
including dimensions
\ue000No radiation risk
\ue000Avoiding the potential allergic and toxic
complications of contrast media.
\ue000Can be used on individuals with poor kidney
function in whom contrast cannot be given

\ue000No complications
\ue000Can be done at bedside
\ue000Relatively economical exam

Utility
\ue000Helpful in defining renal, bladder and prostate
anatomy
\ue000It is the test of choice to exclude Urinary tract
obstruction
\ue000US can, in the majority of cases, diagnose
hydronephrosis.
\ue000Good for evaluating Kidney size
\ue000Good to distinguish between cysts and solid
mass.
\ue000Good to localize kidney for biopsy
Common indications

\ue000Renal mass / Abdominal mass
\ue000Renal colic
\ue000Recurrent Urinary tract infections
\ue000Chronic renal failure
\ue000Acute glomerulonephritis
\ue000Hematuria

Renal CT
\ue000CT scanning combines X-rays and computer to
produce precisely detailed cross-sectional
images of the genito urinary system.
\ue000Utility
\ue000A CT scan is helpful in delineating the
characteristics of anatomy and function
of Kidneys
\ue000Three-dimensional reconstructions of
the kidney and blood supply provide
"road maps" for planning surgeries.
INDICATION
\ue000Ultra fast CT is considered preferable to KUB
for detection of suspected stones
\ue000If ultrasound evaluation is equivocal for a cyst,
or is suggestive of malignancy

\ue000In evaluating solid abdominal masses
\ue000Hematuria
\ue000Local staging of cancer Kidney to allow

definitive surgical management if needed
\ue000Renal artery and vein evaluation
DISADVANTAGES
\ue000Requires placement of an intravenous line for
IV contrast.
\ue000Exposes patient to radiation.
\ue000Contrast toxicity or allergy
\ue000Most young children require sedation to
undergo a CAT scan.
\ue000CAT scans are relatively expensive
MRI
\ue000MRI is as good as CT or better in characterizing
lesions of kidney and prostate.
\ue000Because of its ability to show soft tissues in

exquisite detail, MRI can detect disease and evaluate renal vasculature and inferior vena cava

\ue000MRI can delineate a cyst from a solid mass.
\ue000In can identify the spread of kidney cancer into
the renal vein, inferior vena cava and perirenal
area (Staging).
Indication
\ue000When contrast CT cannot be done
\ue000MRI is useful to evaluate vascular lesions
Disadvantages

\ue000Expensive
\ue000Limited availability
\ue000MRI has limited applicability for the urinary

tract since the non-specificity of its signals makes it ineffective in detecting calcifications and bladder abnormalities.

\ue000Patients with pacemakers, aneurysm clips, ear
implants and metallic pieces in vital body
locations cannot be imaged safely
ADRENALS
Adrenal Adenoma
\ue000Incidence in the population is 2-8%
\ue000Diagnosis is often made as an incidental
finding on CT examination.
\ue000In patient with no known primary, an adrenal
mass is almost always a benign adenoma
\ue000In a patient with a known neoplasm, especially

lung cancer, an adrenal mass is problematic and diagnosing a metastasis versus an adenoma is critical for prognosis

CT findings
\ue000Size greater than 4 cm tend to be metastases
or adrenal carcinoma
\ue000Heterogeneous
appearance
and
irregular
shape
are
malignant
characteristics
\ue000Homogeneous
and
smooth
are
benign
characteristics.
\ue000Intracellular lipid in adenoma results in
low attenuation on CT
\ue000Little intracytoplasmic fat in metastases results
in high attenuation on non-enhanced CT

\ue000Non-enhanced CT (NECT)
\ue000Threshold 10 HU
\ue000Sensitivity 79%, specificity 96%

\ue000Contrast-enhanced CT (CECT)
\ue000Because majority of CT examinations in
oncology use IV contrast, the %
washout is useful after 10 minutes.
\ue000Adenomas have greater than 50%
washout after 10 minutes
\ue000Washout can also be used on adrenal
masses that measure > 10 HU on NECT
\ue000Alternative is to do MR or PET
2
Adrenocortical carcinoma
\ue000rare malignancy with a poor prognosis.
\ue000reported incidence:
2 cases per million
persons.
\ue000tumors frequently are large, measuring 4-10
cm in cross-sectional diameter.

\ue000arise from the adrenal cortex
\ue000bilateral in up to 10% of patients.
\ue000Approximately 50-80% are functional tumors,

with most causing Cushing syndrome.
Endocrine syndromes associated with adrenocortical
carcinoma

\ue000Cushing syndrome
\ue000Virilization and precocious puberty
\ue000Feminization
\ue000Primary hyperaldosteronism

CT findings

\ue000Large mass (>4 cm)
\ue000Central necrosis or hemorrhage
\ue000Heterogeneous enhancement
\ue000Invasion into adjacent structures
\ue000Venous extension into the renal vein or inferior

vena cava
Adrenal metastases
\ue000Unilateral adrenal mass or enlargement
Small masses (<1 cm) - Adenoma,
ganglioneuroma, hyperplasia, metastasis, and
pheochromocytoma
Large masses (>4 cm) - Carcinoma of

adrenal cortex; cyst or pseudocyst; hematoma; infection; inflammation (eg, tuberculosis, histoplasmosis); metastasis (eg, lung or breast related);

myelolipoma;

neuroblastoma, ganglioneuroblastoma, or ganglioneuroma; pheochromocytoma (eg, multiple endocrine neoplasia)

\ue000Bilateral adrenal enlargement
Common causes - Hemorrhage (eg, in infants,

trauma, bleeding disorder), histoplasmosis, hyperplasia, metastasis (eg, lung or breast related), neuroblastoma, and tuberculosis

Uncommon causes - Addison disease,
adenomas,
amyloidosis,
carcinomas

(eg, multiple, primary), infection (ie, others), lymphoma,

pheochromocytoma

(multiple endocrine neoplasia), and Wolman disease (eg, familial xanthomatosis)

CT findings
\ue000appear as focal masses or distortion of the
contour of the adrenal gland.
\ue000smaller than 3 cm may be homogeneous.
\ue000Larger lesions may have central necrosis or

hemorrhage. These lesions are heterogeneous and may have thick enhancing rims. They may also invade contiguous organs such as the kidneys.

\ue000Attenuation values of less than 10 HU on
unenhanced
Pheochromocytomas
\ue000CT
\ue000large tumors (often >3 cm),
\ue000they are usually round or oval masses
with an attenuation similar to that of
the liver
\ue000Larger lesions frequently demonstrate
necrosis, hemorrhage, and fluid-fluid
levels.
\ue000As a result, they often appear
inhomogeneous.
\ue000Calcification is rare, but it is reported

KIDNEYS
Acute Pyelonephritis
Etiology

o
Inflammation of the renal parenchyma and
renal pelvis due to an infectious source
o
Most often secondary to an ascending lower
urinary tract infection from gram-negative

bacteria
E. coli
Klebsiella
Proteus
Pseudomonas.

o
Exception is S. aureus, which is spread
hematogenously
Pathologic Causes
o
Vesicoureteral reflux
o
Obstruction in the collecting system usually
due to a calculus
Complications
o
Abscess
o
Emphysematous pyelonephritis
Most often occurs in diabetics
Can produce gas in the collecting
system and renal parenchyma.
Radiographic Imaging Findings
o
Enlarged kidneys (U/S and CT)
o
Hydronephrosis (U/S and CT)
o
Wedge shaped areas of low attenuation
secondary to decreased perfusion (CT)
o
Loss of the ability to distinguish the
corticomedullary border (CT)
o
Perinephric stranding (CT)
Emphysematous Pyelonephritis

Acute, fulminant, necrotizing infection of kidney and perirenal tissues associated with gas formation which may be life-threatening

\u2022
Organism
o
E. coli (vast majority of cases)
o
Klebsiella pneumoniae (9%)
o
Proteus mirabilis
o
Pseudomonas
o
Enterobacter
o
Candida
o
Clostridia (exceptionally rare)
\u2022
Location
o
Most are unilateral
o
5-7% bilateral
\u2022
Types
o
Type I (33%)
\u2022
Streaky or mottled gas in
interstitium
of

renal parenchyma radiating from medulla to cortex

3

Activity (9)

You've already reviewed this. Edit your review.
1 hundred reads
1 thousand reads
marsan12 liked this
marsan12 liked this
ifer_rn4705 liked this
Michelle Tunnell liked this
filchibuff liked this

You're Reading a Free Preview

Download
scribd
/*********** DO NOT ALTER ANYTHING BELOW THIS LINE ! ************/ var s_code=s.t();if(s_code)document.write(s_code)//-->