Urinary Bladder PDF

URINARY BLADDER GROUP 5  1. Dysuria or frequency of micturition. INDICATIONS 2. Haematuria (wait until bleeding has stopped). 3. Recurrent infection (cystitis) in adults; acute infection in ch...

URINARY BLADDER GROUP 5  1. Dysuria or frequency of micturition. INDICATIONS 2. Haematuria (wait until bleeding has stopped). 3. Recurrent infection (cystitis) in adults; acute infection in children. 4. Pelvic mass. 5. Retention of urine. 6. Pelvic pain. PREPARATIONS 1. Preparation of the patient. The bladder must be full. Give 4 or 5 glasses of fluid and examine after one hour (do not allow the patient to micturate). Alternatively, fill the bladder through a urethral catheter with sterile normal saline: stop when the patient feels uncomfortable. Avoid catheterization if possible because of the risk of infection. 2. Position of the patient. The patient should lie supine but may need to be rotated obliquely. 3. The patient should be relaxed, lying comfortably and breathing quietly. 4. Lubricate the lower abdomen with coupling agent. Hair anywhere on the abdomen will trap air bubbles so apply coupling agent generously. 5. Choice of transducer. Use a 3.5 MHz transducer for adults. Use a 5 MHz transducer for children or thin adults.  SCANNING TECHNIQUE Start with transverse scans from the pubic symphysis upwards to the umbilicus. Follow with longitudinal scans, moving from one side of the lower abdomen to the other. These scans will usually be sufficient, but it is not always easy to see the position of the lateral and anterior walls of the bladder and patients may nave to de turned s0-40 to see an area more clearly. Any area that appears abnormal must be viewed in several projections. After scanning, the patient should empty the bladder and should then be rescanned.  PATHALOGIES OF THE URINARY BLADDER 1. Bladder Calculi: Stones causing 6. ransitional Cell Carcinoma: shadowing. Common bladder cancer type. 2. Trabeculation: Thickened bladder 7. Bladder Hematoma Blood wall due to chronic obstruction. accumulation from trauma. 3. Diverticula: Outpouchings of the 8. Bladder Wall Thickening: Indicative bladder wall. of inflammation or malignancy. 4. Ureterocele: Cystic dilation at the 9. Ectopic Ureters: Abnormal ureter ureter's entry. placement. 5. Adenocarcinoma: Malignant tumors 10. Bladder Sediment: Echogenic of glandular origin. particles in urine. PATHOLOGIES BLADDER CALCULI  PATHOLOGIES DIVERTICULA TRABECULATION  ANATOMY OF THE URINARY BLADDER 1. Anechoic Urine Fluid-filled, 6. Prostate Gland (males) Surrounds appears dark on ultrasound. the bladder neck. 2. Bladder Wall Layers Mucosa, 7. Uterus (females) Located muscularis, and adventitia. posteriorly to the bladder. 3. Trigone Area Region where 8. Seminal Vesicles (males) ureters enter and urethra exits. Positioned posterior to the bladder. 4. Ureteral Papillae Small 9. Vesico-Ureteric Junctions Points projections at ureter openings. where ureters enter bladder. 5. Pubic Symphysis Landmark for 10. Bladder Dome Superior part of bladder location. the bladder, typically rounded.  NORMAL BLADDER The full urinary bladder appears as a large, echo-free area arising out of the pelvis. Start by assessing the smoothness of the interior wall of the bladder and its symmetry in transverse section. The thickness of the bladder wall will vary with the degree of distention but should always be approximately the same all around the bladder. Any local area of thickening is abnormal. Look also for trabeculation (see pp. 178-179). When distended, the normal bladder wall is less than 4 mm thick. After scanning, the patient should empty the bladder (Fig. 120c). Normally, there should be no residual urine: if there is, the quantity should be estimated. Measure the transverse diameter (T) of the bladder in centimetres, multiply it by the longitudinal diameter (L) in centimetres and then by the AP diameter in centimetres. Multiply the total by 0.52. This measures the residual urine in millilitres (cubic centimetres).  ABNORMAL BLADDER It is important to scan for: 1. Variation of the bladder wall thickness and trabeculation. 2. Asymmetry of the bladder. 3. Cystic masses in or outside the bladder (ureterocele or diverticulum). 4. Solid masses within the bladder or at the base of the bladder.  GENERALIZED THICKENING OF THE BLADDER WALL 1. In men, bladder wall thickening is usually the result of prostatic obstruction (Fig. 12la). If suspected, check the prostate (Fig. 124c, p. 183): exclude hydronephrosis by scanning the ureter and the kidneys. Search for associated diverticula: these project outwards but are only visible if over 1 cm in diameter. Diverticula are usually echo-free with good sound transmission (Fig. 121b). Sometimes the opening of a diverticulum can be demonstrated: diverticula may collapse or increase in size after micturition. 2. Severe, chronic infection/cystitis. The inner wall of the bladder may be thickened and irregular (Fig. 121c). Check the rest of the renal tract for dilatation. 3. Schistosomiasis. The bladder walls may be thickened, with 4. Very thick trabeculated bladder walls in children may result increased echogenicity and scattered dense (bright) areas due to calcification from outlet obstruction caused by urethral valves or The calcification varies and may be urogenital diaphragm. throughout ineateral od dite dinesnot prees, Threat into n on the bladder Poor bladder emptying indicates superimposed active infection, or prolonged or recurrent infection. The extent of the calcification does not indicate the activity of the schistosomal infection, and calcification may decrease in the later stages. However, the bladder wall usually remains thickened and does 5. A thickened bladder wall may occur in a neurogenic not easily distend. There may also be hydronephrosis bladder and will usually be associated with uretero-hydronephrosis. COMMON CAUSES OF BLADDER DISTENTION ARE: Enlargement of the prostate. Urethral stricture in the male. Urethral calculus in the male. Bruising of the urethra in the female ("honeymoon urethritis"). A neurogenic bladder from damage to the spinal cord. Urethral valves or diaphragm in newborn infants. Cystocele in some patients. THANK YOU!