Urinary System PDF

CHAPTER 6 Urinary System 1. Kidney Agenesis/Atresia 9. Renal Calculi 2. Kidney Hypoplasia 10. Vesicoureteral Reflux 3. Renal Abscess 11. Renal Cell Carcinoma 4. Renal Cysts 12. Wilm’...

CHAPTER 6 Urinary System 1. Kidney Agenesis/Atresia 9. Renal Calculi 2. Kidney Hypoplasia 10. Vesicoureteral Reflux 3. Renal Abscess 11. Renal Cell Carcinoma 4. Renal Cysts 12. Wilm’s Tumor 5. Polycystic Kidneys 13. Ureteral Diverticula 6. Horseshoe Kidneys 14. Bladder Diverticula 7. Duplicate Collecting Systems 15. Phleboliths 8. Ectopic Kidneys 16. Transitional Cell Carcinoma Kidney Agenesis or Atresia:  A congenital defect where an organ is not formed is called atresia.  In this particular instance, kidney atresia would be the congenital absence of a kidney.  These patients often have other congenital defects as well and there is no treatment. Kidney Hypoplasia:  Hypoplasia refers to an organ that has a diminished growth.  This can be a congenital defect or the result of a chronic infection.  In this particular instance, the diminished growth of a kidney would be referred to as kidney hypoplasia.  There is no treatment for this condition. Renal Abscess:  A bacterial infection is usually the etiology for the formation of a renal abscess.  The origin may be from sepsis (blood infections) or from bacteria that has worked their way up from the bladder.  Treatment includes antibiotic therapy and in some instances, the aspiration of fluid from within the abscess. Renal Cysts:  A cyst is a fluid filled, non vascular sac that can form anywhere in the body.  In this particular instance, the cyst has formed on and is attached to the outside of the kidney.  This is the most common unifocal mass found on a kidney.  They are found in greater than 50% of the population that is 50 years or older.  Ultrasound is the imaging modality of choice for their diagnosis.  Most kidney cysts resolve on their own and are no cause for concern. Polycystic Kidney Disease (PKD):  This is a hereditary disease that is characterized by the presence of multiple cysts within the kidneys.  Unlike renal cysts, polycystic kidneys lose function.  As the cysts expand, they put pressure on the nephrons which will ultimately cause an obstruction and a decrease in urine production.  PKD can also affect the liver and pancreas.  This disease can be diagnosed with an IVP, CT scan, and ultrasound which is the modality of choice.  Treatment in advanced stages of PKD includes dialysis and kidney transplants. Horseshoe Kidneys:  Horseshoe kidneys is a congenital disease where the lower poles of both kidneys fuse causing both collecting systems to sit at an angle.  This odd angle has a propensity to produce stagnant urine that can eventually become infected.  If no infection is present, their presence will produce no discernable signs and symptoms.  There is no cure for this condition other than treating the symptoms. Duplication of Collecting Systems:  The most common congenital anomaly of the urinary system is a duplication of the collecting systems.  This is a defect where two ureters and one renal pelvis are present.  The ureters may join or enter the bladder separately.  This condition can be either unilateral or bilateral and usually does not require treatment. Ectopic Kidneys:  An ectopic kidney is a congenital defect where the kidney is located in an abnormal position within the body.  In most cases, this will have no affect on urine production but they may cause infections and kidney stones in some individuals.  A common course of action is to just treat the symptoms that may be caused as a result of an ectopic kidney. Renal Calculi:  The presence of a kidney stone is the most common indication for an IVP  Kidney stones that develop within the collecting system may become lodged in the following areas: 1. The connection of the proximal ureter to the kidney which is called the ureteropelvic junction (UPJ).  Within the ureter. 2. The connection between the ureter and the bladder which is called the ureterovesical junction (UVJ).  Within the bladder.  Within the urethra.  Up to 80% of all kidney stones are made of calcium (radiopaque) and the rest are from uric acid (radiolucent).  The common symptoms of kidney stones are as follows:  Flank Pain  Hydronephrosis (from the obstruction)  Pyonephrosis (infection)  Hematuria (blood in the urine)  Treatment includes:  Pain Medications  Increase Fluids (to “flush” the stone)  Lithotripsy  Surgery Vesicoureteral Reflux (VUR):  Vesicoureteral reflux is characterized by an abnormal flow of urine from the bladder back into the ureter.  This can be caused as a result of a hereditary condition, a bladder infection, or from bladder dysfunction.  Symptoms include the following:  Cystitis  Nephritis  Polyuria  Dysuria  Pyuria  Hematuria Hydroureter/Hydronephrosis  This condition is commonly diagnosed by using a voiding cystourethrogram (VCUG).  The underlying cause of a urinary track infection in approximately one third of all children is VUR.  VUR is usually corrected with antibiotic therapy but surgery may be indicated in severe cases. Renal Cell Carcinoma:  Renal cell carcinoma is the most malignancy of the kidneys.  Unlike with renal cysts, there is vascular perfusion which originate at the renal tubules.  Renal cell carcinoma has a propensity to metastasize to the lungs, brain, liver and bone.  Common symptoms include flank pain, hematuria, and an abdominal mass.  Unfortunately, these symptoms often do not present until the cancer is in an advanced stage.  As a result, renal cell carcinoma has a very high mortality rate.  Treatment usually consists of nephrectomy. Wilm’s Tumor:  Wilm’s tumor is also referred to as a neproblastoma.  It is the most common abdominal neoplasm of infancy and early childhood with an average onset of three years old.  Wilm’s tumor produces a large, palpable abdominal mass  It has a propensity to metastasize to the lungs, liver, and skeletal system.  Early detection and treatment results in a nearly 90% five year survival rate. Ureteral Diverticula:  A diverticulum is an outpouching that occurs due to a weakening in the lining of, in this particular instance, the ureter.  This is not to be confused with a neoplasm which is an actual growth that usually develops in towards the lumen of the of the structure that is is attached to.  Ureteral diverticula may also be the source of future infections or may, in some instances, trap kidney stones.  They are best demonstrated during an RPG.  Other than antibiotics to combat infection, there is no treatment for ureteral diverticula. Bladder Diverticula:  Bladder diverticula can be hereditary, caused by an enlarged prostate, or the result of a chronic bladder infection.  They may also be the source of future infections or may, in some instances, trap kidney stones.  Other than antibiotics to combat infection, there is no treatment for bladder diverticula. Phleboliths:  A phlebolith is nothing more than small, usually round, calcified valve within a vein that surround the urinary bladder.  They are sometimes mistaken for kidney or bladder stones and have no clinical importance. Transitional Cell Carcinoma (TCC):  TCC makes up 90% of all urinary bladder cancers.  It is a metastatic cancer that is mostly seen in men after the age of 50.  TCC is clearly related to some industrial chemicals and to smoking.  The primary symptom is painless hematuria.  An IVP will demonstrate a filling defect in the area of the trigone but a cystoscopy if the method of choice for diagnosis.  Treatment includes surgery, radiation therapy, and chemotherapy.  CHAPTER 7 Reproductive System 1. Colovaginal Fistula 2. Dermoid 3. Ovarian Cyst 4. Pessary Colovaginal Fistula:  A fistula is an abnormal passageway between two structures that do not normally connect.  A fistula can from between two adjacent structures or between an organ and the surface of the body.  A colovaginal fistula is a case where a passageway has been created between the vagina and the rectum. Dermoid:  A dermoid is a type of teratoma (benign cyst) that contains developmentally mature skin that can take the following forms: 1. Hair, Teeth, Nails 2. Cartilage 3. Thyroid Tissue 4. Sebaceous Secretions (oil)  A dermoid can account for up to 25% of all ovarian tumors but can occur in other areas of the body as well. In some instances, surgical removal may be indicated. Ovarian Cyst:  A cyst is a fluid filled sac that can form anywhere in the body.  In this particular instance, the cyst has formed on and is attached to the outside of the ovary.  The most common type of cyst to form on the ovary is called a functional cyst. Pessary:  A pessary is a prosthetic device that can be inserted into the vagina to support its internal structure.  It is often used in the case of urinary incontinence and a vaginal or pelvic organ prolapse.  They can also be used as a contraceptive device.