DMS; Urinary System
Order by
81 terms
Terms | Definitions |
|---|---|
 Components Organs of the Urinary System | 1. 2 Kidneys 2. 2 Ureters 3. 1 Urinary Bladder 4. 1 Urethra |
| Which kidney is lower than the other? | The right kidney is lower than the left |
| What organ is the renal sinus not a part of? | The kidney |
| What are enzymes dependent of? | They are pH dependent |
| What organs remove Urea creatinine? | The kidneys |
| What is the ideal pH of your urinary system? | Alkaline level of 7.2 |
| What is the perirenal space surrounded by? | The gerota's Fascia |
| Location and Anatomical Relationships of the Kidney | 1. Retroperitoneal, Perirenal space between the 12th thoracic and the 4th lumbar vertebrae 2. Lumbar and hypochondriac regions 3. Both kidneys are lateral to the spine 4. The left kidney is lateral to the aorta and the right kidney is lateral to the IVC 5. Both kidneys are inferior, posterior and latyeral to the adrenal glands 6. The left kidney is inferior, posterior and medial to the spleen 7. The left kidney is more superior in position than the right kidney 8. The right kidney is posterior to the adrenal, liver, Morison's pouch, second part of duodenum and the right colic flexure (hepatic flexure), posterior and inferior to the liver and gallbladder 9. Both kidneys are anterior to the psoas muscle, quadratus lumborum muscle and transversus abdominus muscle; part of the transversus abdominis muscle is lateral to the kidneys |
| Size and Shape of the Kidney | 1. Bean-shaped 2. Concave medial (hilum) and convex lateral surfaces 3. Adult 9-13 cms. Long, 4-5 cm wide and 2-3 cm AP. Neonatal kidney is about 3-4 cm long, 2-3 cm wide and 2 cm AP |
| Coverings of the Kidneys - Gerota's Fascia | Outermost: connective tissue anchoring the kidneys to the surrounding structures and the abdominal wall |
| Coverings of the Kidneys - Perinephric Fat | Protects and holds the kidney firmly in place; this is also called the fat of Zuckerkandl |
| Coverings of the Kidneys - Paranephric fat | Outside or around the Gerota's fascia |
| Coverings of the Kidneys - Renal or True Capsule | Fibrous transparent connective tissue surrounding the renal parenchyma providing a barrier against trauma and spread of infection from the surrounding tissues. This layer is part of the kidney |
| Regions and Divisions of the Kidney - Cortex | Outermost division 1. Contents: (parts of the nephron) a. Renal Corpuscle: Glomeruli (capillary network) and the Bowman's capsule b. Convoluted tubules: proximal and distal 2. Columns of Bertin: Cortical extensions between the pyramids |
| Regions and Divisions of the Kidney - Medulla | Innermost Division 1. 8 to 18 pyramids containing the loops of Henle and collecting tubules |
| Sonographic Appearance of the Cortex | The cortex is hyperechoic to the medulla and hypoechoic to the liver |
| Sonographic Appearance of the Pyramid | The pyramid is hypoechoic to the renal cortex and renal sinus and anechoic if filled with urine |
| Sonographic Appearance of the Arcuate vessels | The Arcuate Vessels mark the corticomedullary boundary |
| Renal Sinus | An echogenic area on ultrasound representing a hollow chamber. |
| The Renal Sinus contains: | 1. Major (infundibulum) and minor calyces: Collects urine from the collecting tubules of the nephrons 2. Renal pelvis: funnel shape collecting urine from the major calyces 3. Blood vessels: Renal artery and veins 4. Fats 5. Lymphatics 6. Nerves |
| Renal Hilum | The entrance to the renal sinus |
| The Renal Hilum Contains: | 1. Renal artery 2. Renal vein: Commonly anterior to the renal artery 3. Ureter |
| Blood Supply for the Kidneys starts in the renal artery from AORTA to... | 1. Segmental artery (in the renal sinus) 2. Interlobar artery 3. Arcuate artery 4. Interlobular artery > afferent arteriole > glomeruli > efferent arteriole > peritubular capillaries (also called vasa recta) to 5. Interlobular vein 6. Arcuate vein 7. Interlobar vein 8. Segmental vein (in the renal sinus) --> Renal vein to IVC |
| Blood Supply to the Renal Artery Originates from the _____ and the Renal Vein connects to the _____. | Aorta; IVC. |
| What is the formula for Resistive Index? | Peak Systole - Peak Diastole / Peak Systole |
| Resistive Index of less than 0.7 is indicative of | Good perfusion |
| Resistive Index of greater than 0.7 indicates | Decreased perfusion |
| Direct Artery for Resistive Index | Renal Artery |
| Indirect Artery for Resistive Index | Arcuate Artery |
| Resistive Index is a reliable diagnostic sign for: | 1. Adult arteriosclerosis 2. Fibromuscular hyperplasia of the distal renal artery in younger adults especially in women |
| Six Functions of the Kidney | 1. Excretion of urine a. Water b. Salts c. Nitrogenous wastes *Urea *Creatinine *Uric acid 2. Maintenance of fluid and electrolyte balance 3. Regulation of blood pressure 4. Regulation of volume, composition of pH of body fluids 5. Secretion of Erythropoetin (Hormone also produced in liver) 6. Secretion of Renin (Enzyme) |
| Mechanisms of Urine Formation | 1. Glomerular Filtration: Fluid and substances move from the blood in the glomeruli to the Bowman's capsule 2. Tubular Reabsorption: Fluid and substances move from tubules to the blood in the peritubular capillaries 3. Tubular Secretion: Fluid and substances move from the blood in the peritubular capillaries to the tubules |
| Nephron and its parts | Nephron is the functional unit of the kidney 1. Glomeruli (Blood) 2. Bowman's Capsule 3. Proximal Convoluted Tubule 4. Descending Loop of Henle 5. Loop of Henle 6. Ascending Loop of Henle 7. Distal Convoluted Tubule 8. Collecting Tubules |
| Juxtaglomerular Apparatus - Macula Densa | Densely packed tall epithelial cells of the distal convoluted tubules. Detects changes in the concentrations of sodium, potassium and chloride ions |
| Juxtaglomerular Apparatus - Juxtaglomerular Cells | Vascular smooth muscle cells in the walls of the afferent arterioles. Produces renin when stimulated by sympathetic nerves and baroreceptors in the afferent arterioles |
| Renin-angiotensin System | 1. Renin catalyzes the conversion of angiotensinogen to angiotensin 1 2. ACE or Angiotensin Converting Enzymes catalyzes the conversion of angiotensin I to angiotensin II 3. Angiotensin 2 produce the following effects a. Constricts arterioles causing an increase in blood pressure b. Causes release of aldosterone increasing sodium reabsorption in the distal convoluted tubules causing water retention which can increase blood pressure 3. Causes increased ADH secretion decreasing urine formation leading to increase in blood volume 4. Stimulates the thirst center causing an increase in blood volume |
| Mechanisms of Urine Formation - Glomerular Filtration | 1. Fluid in the glomeruli is forced across the membrane into the Bowman's capsule 2. Hydrostatic pressure of 60mmHg up to 90mmHg in the glomeruli forces the fluid to filter in the Bowman's capsule 3. Opposing pressures *20 mmHg of pressure in the Bowman's capsule *30 mmHg of osmotic pressure in the glomeruli 4. Net pressure of 10 mmHg 5. Filtrate contains water, salts, glucose, urea and amino acids 6. Causes of abnormal filtration *Weak heart producing a weak hydrostatic pressure *Stone causing obstruction (Increase pressure in Bowman's) *Decreased blood proteins decreasing the osmotic pressure in the glomeruli 7. Glomerular filtration rate *125 ml/min *180 liters/day *Urine output o 1 liter/day (95% water) |
| Mechanisms of Urine Formation - Tubular Reabsorption | 1. Transport of substances from the tubules across the tubular epithelial wall into the blood of the peritubular capillaries 2. Low peritubular capillary pressure 3. Highly permeable peritubular capillary 4. Major site of reabsorption is the proximal convoluted tubule 5. Substances reabsorbed *Glucose, amino acids, proteins (small molecular size) *Water and electrolytes *Electrolytes: Sodium and Potassium *Calcium and Vitamins 6. Distal convoluted tubule and the collecting ducts are almost impermeable to water 7. Hormones like aldosterone and ADH stimulate the reabsorption of sodium and water |
| Mechanisms of Urine Formation - Tubular Secretion | 1. Transport of substances from the peritubular capillaries into the renal tubules 2. Creatinine is secreted in the proximal convoluted tubules 3. Potassium and Hydrogen ions are secreted passively mainly in the distal convoluted tubule 4. Urea and uric acid are also secreted |
| Urine Composition | 1. Water: Urine is mostly water 2. Organic substances: Substances containing Carbon 3. Inorganic substances: Like electrolytes |
| Papillary Duct | Receive the urine from the collecting ducts of the nephron |
| Papilla | Apex of the pyramids |
| Calyces | Cup-like structures in the renal sinus |
| Minor Calyces | Numbers 8-18; receive the urine from the papillary ducts |
| Major Calyces | Numbers 2-3; receive urine from the minor calyces; also called infundibulum |
| Renal Pelvis | Dilated proximal portion of the ureter |
| Ureters | A tubular structure connecting the renal pelvis to the urinary bladder 1. 25 to 30 cms long parallel to the vertebral column 2. Courses anterior to the common iliac vessels 3. Enter the posterior wall of the bladder 4. Transport urine by peristaltic muscular contractions of the muscularis wall layer 5. Not seen by ultrasound |
| Bladder | A hollow muscular organ in the pelvic cavity |
| Location of the Bladder | 1. True pelvis 2. Anterior to the rectum in males 3. Anterior to the uterus in females 4. Posterior to the symphisis pubis 5. Superior to the prostate gland in males 6. Anterior to the seminal vesicles in males |
| Wall Layers of the Bladder | 1. Mucosa: Transitional epithelial tissues (most echogenic) 2. Submucosa: Connective tissue and elastic fibers 3. Muscular: Smooth muscles (detrusor muscle & least echogenic) 4. Serosa: Fibrous connective tissues and parietal peritoneum on the superio surface |
| Capacity of the Bladder | 600 mL, but the desire to urinate will start at 150 mL |
| Volume formula for the bladder | Length x height x width x 0.5 |
| Pre-voidal volume | Before voiding |
| Post-voidal Volume | After voiding |
| Residulal volume formula | Post-voidal volume / Pre-voidal volume x 100 |
| Normal Residual Volume is... | 20% or less |
| Urethra | The most distal part of the urinary tract 1. Male urethra: 20 cm long a. Prostatic urethra: Passes through the prostate gland b. Membranous urethra: Passes through the urogenital diaphragm and surrounded by the external urethral sphincter c. Penile urethra: Surrounded by the corpus spongiosum of the penis 2. Female urethra: Anterior to the ... |
| What is the difference between acute (uremia) and chronic renal failures? | Azotemia |
| What is the hormone AN or atrial natriuretic peptide? | Vasodilator & a protein secreted by heart muscle cells |
| What organ do high ammonia levels come from? | The liver |
| What organ do high urea levels come from? | The kidneys |
| What is B.U.N.? | 1. Blood Urea Nitrogen 2. A waste product of protein catabolism 3. Formed in the liver from ammonia (NHB) 4. Elevated in the blood if kidney function is impaired or there is an increased protein catabolism |
| What organ can remove B.U.N.? | The skin |
| What is the only organ that can remove creatinine? | The kidneys |
| Creatinine | 1. Serum creatinine is a good and accurate index for measuring glomerular filtration 2. A waste product of muscle energy metabolism during muscle contraction 3. Not reabsorb by the tubules of the nephron 4. Serum creatinine levels are more specific and sensitive in establishing renal impairment than BUN 5. Creatinine can be measured in the urine and blood 6. A decreased urine creatinine or an increased in blood creatinine is an indication of impairment of renal function |
| WBC | 1. White Blood Cell Count 2. Leukocytosis can be an indication of urinary tract infection 3. Differential count identifies the type of white blood cell that is abnormal |
| Hemoglobin | A protein inside the RBC that binds with oxygen *Hemoglobin in the urine is a sign of red blood cell destruction |
| Hematocrit | The percentage of red blood cells in the blood *Hematocrit decreases if there is bleeding due to trauma or disease |
| Urinalysis | 1. Hematuria is blood in the urine; gross or microscopic 2. Urine pH: Important in management of bacteriuria and renal calculi 3. Specific Gravity: Measurement of kidney's ability to concentrate urine; usually low in renal failure, glomerulonephritis and pyelonephritis 4. Proteinuria can be an indication of glomerular damage 5. Culture and sensitivity |
| Urine pH | 1. pH is the acidity or alkalinity of the urine 2. Acidity is the amount of hydrogen ions in the urine; the more hydrogen donors, the higher is the acidity, the lower is the pH number 3. Urinary calculi form in abnormal pH 4. Chronic renal failure and renal tubular acidosis are associated with alkaline urine. Why? Diabetes. |
| Renal Tubular Acidosis | A form of metabolic acidosis resulting from inability of the kidney to reabsorb bicarbonate or failure to secrete acid. This makes the urine more alkaline because of bicarbonate and the blood more acidic |
| Urine Specific Gravity | 1. The measurement of the amount of dissolved substances in the urine 2. Excessive fluid intake or lack of sweating causes a decrease in the urine specific gravity 3. The specific gravity is low in renal failure, GPN and pyelonephritis or diseases that cause tubular damage |
| Diagnostic Imaging | 1. IVP: Intravenous Pyelography especially in patients presenting with renal colic due to nephrolithiasis 2. Arteriography: Visualization of the arteries using injected contrast materials and x-ray 3. Computerized Tomography: Computer and x-ray for patients with renal colic and no history of nephrolithiasis 4. Nuclear Medicine: Injection of tracer substances into the blood 5. Ultrasound |
| Sonography - Seven Indications for Ultrasound | 1. Abnormalities in the urine like blood, white blood cells 2. Flank pain 3. Abdominal pass 4. Dysuria (Painful urination) 5. Frequency of urination 6. Renal transplant monitor 7. Allergy to contrast materials used in IVP (Intravenous Pyelography) |
| Sonography - Patient's Preparation | 1. Patient should be adequately hydrated to visualize the intrarenal collecting system (pyramids) 2. Generally a patient is given nothing by mouth prior to ultrasound or IVP if necessary; sonography of the kidney does not generally require NPO 3. Patient is scanned in supine or decubitus position although a prone position can also be used 4. Curvilinear for abdominal scan and phased array for intercostal scan |
| Landmarks | 1. Psoas & Quadratus Lumborum muscles are poserior to the kidneys. Transversus abdominis is posterior and lateral to the kidneys. Do not include these muscles when measuring the kidneys 2. Blood vessels a. IVC is medial to the right kidney b. Aorta is medial to the left kidney c. Renal veins and arteries in the hilum 3. Soft tissue organs a. Rt. Lobe of Liver is anterior, superior and lateral to the superior pole of the right kidney. Duodenum & Hepatic Flexure are also anterior to the right kidney b. The spleen is anterior, superior and lateral to the left kidney. Stomach & Splenic Flexure are also anterior to the left kidney c. Tail of Pancreas is medial and anterior to the left kidney 4. Potential space for fluid accumulation: Morrison's pouch between the right lobe of the liver and the right kidney |
| Techniques | 1. Breathing technique for subcostal scanning 2. Variation in respiration 3. Intercostal approach for the superior poles (raise arms above the head) 4. Decubitus position 5. Adjust the TGC to acquire a uniform setting for the entire image |
| Protocol | 1. Always do a prescan 2. You must know your lab protocol at this time 3. Delineate the renal cortex from the medulla 4. Identify the pyramids and the columns of Bertin |
| Protocol Images - Longitudinal Sections | 1. Medial showing hilum 2. Medial with renal sinus and hilum 3. Mid with renal sinus 4. #3 with long and AP measurements 5. Lateral with pyramids and sinus 6. Lateral without pyramids and sinus |
| Protocol Images - Transverse Sections | 7. Superior pole without sinus 8. Superior pole with some renal sinus 9. Mid (C-figure): hilum and vessels 10. #9 with width measurements 11. Inferior pole with renal sinus 12. Inferior pole without renal sinus NOTE: The kidney goes down on the screen as you go superior and up on the screen as you go inferior. Why? You may be required to do a Doppler using the renal artery or the arcuate arteries |
| Sonographic Appearance | 1. Smooth and well-defined outer borders; echogenic renal capsule 2. The renal parenchyma (cortex and medulla) surrounds the fatty echogenic renal sinus 3. The renal sinus is hyperechoic to the renal parenchyma and pancreas 4. Renal medulla contains the hypoechoic to anechoic pyramids 5. Columns of Bertin between pyramids are isoechoic to the rest of the cortex; do not mistake the columns for a mass 6. The cortex is homogeneous and hypoechoic to the liver and spleen 7. The renal veins are usually anterior to the renal arteries at the renal hilum 8. The crura of the diaphragm lie posterior to the renal arteries. Identified as lacking in pulsations and demonstrating a Doppler flow 9. The renal pelvis is usually posterior to the blood vessels at the renal hilum and is echogenic when collapse 10. The ureters are not normally seen 11. Measure the length and AP on sagittal and the width on transverse 12. Measure the cortical thickness if necessary or required by the departmental protocol |
First Time Here?
Welcome to Quizlet, a fun, free place to study. Try these flashcards, find others to study, or make your own.