Urinary System Part 1 PDF

Urinary System Objectives Describe the function of the urinary system. Explain the blood supply of kidneys. Explain the function of the nephron. Describe the location of the kidneys, ureters, urethra and urinary bladder. 2  Objectives List hormones and labo...

Urinary System Objectives Describe the function of the urinary system. Explain the blood supply of kidneys. Explain the function of the nephron. Describe the location of the kidneys, ureters, urethra and urinary bladder. 2  Objectives List hormones and laboratory values associated with the kidneys and explain the function of each Describe the size of kidneys, ureters, urethra, urinary and bladder. Describe the sonographic appearance of the urinary system Describe associated physicians, diagnostic tests, and laboratory values for the kidneys. 3  Urinary Anatomy The urinary system includes: Two kidneys A ureter for each kidney A urinary bladder A urethra Kidneys and ureters make up the upper urinary tract Urinary bladder and urethra form the lower urinary tract 4 Renal Anatomy Kidneys are retroperitoneal organs that lie one on each side of the spine between the peritoneum and back muscles The kidney has a lateral convex and a medial concave border The liver displaces the right kidney inferiorly; hence, it is located lower than the left kidney and has a slightly shorter ureter LOCATION & CHARACTERISTICS Retroperitoneum Near the posterior body wall Below diaphragm Protected by ribs Between 1st & 3rd Lumbar Vertebrae Right kidney is lower than left kidney With deep inspiration the kidney moves downward 1 inch Are dark red Surrounding Structures Anterior to right kidney: adrenal gland, liver, MORISON’S POUCH, 2nd part of the duodenum and rt colic flexures Posterior to right kidney: diaphragm, psoas muscle, quadratus lumborum, transverse abdominis muscles, 12th rib & nerves Anterior to left kidney: adrenal gland, spleen, stomach, pancreas, lt colic flexure & jejunum coils Posterior to left kidney: same as right but also add the 11th rib INDICATIONS FOR EXAM Azotemia (high nitrogen) Urinary tract infection (UTI) Assessment of mass visualized Palpable mass on radiography, CT scans Elevated serum creatinine, Assessment of non-visualization BUN levels of kidney on intravenous pyelogram (IVP) Severe flank pain Assessment of enlarged or small Hematuria kidney Proteinuria Uncontrollable Hypertension – Oliguria Renal Artery Stenosis Trauma or post-surgical complications Normal Measurements Structure Length Diameter Thickness Adult kidney 9-12 cm 4-6 cm 2.5-4.0 cm Neonatal 3.5-5.0 cm 2-3 cm 1.5-2.5 cm kidney Ureters 28-34 cm 6 mm NA Bladder NA NA 3-6 mm Female 4 cm NA NA urethra Male urethra 20 cm NA NA Copyright © 2016 by Elsevier Inc. All Rights Reserved. 10 SIZE, SHAPE & SONOGRAPHY Measurements 9-12 long, 5 wide & 2.5 cm thick Bean Shaped Smooth outer contours surrounded by reflected echoes of perirenal fat Sonography: Cortex is hypoechoic compared to the hyperechoic sinus. Echogenic renal sinus due to collecting system. (pelvis, calyces, renal vessels, fat & lymphatics) More sonolucent is the cortex and pyramids, cortex being more echogenic than the pyramids Arcuate vessels: bright echoes at corticomedullary junction  Sonography Sagittal - smooth contours of renal capsule. Always want to see both upper and lower poles in the sagittal view. Transverse - upper and lower pole are round, hilum is indented by sinus. Always want to document the medial and lateral aspects of the kidney in the transverse view. Renal Anatomy Four layers surrounding kidney: Pararenal fat Pararenal body Perirenal fascia Perinephric fascia Gerota’s Fascia Perinephric fat Adipose capsule Renal capsule True capsule Fibrous capsule Anterior Pararenal Space Contains Pancreas Duodenal sweep Ascending and transverse colon Perirenal Space Contains Kidneys Adrenal glands Perirenal fat Ureters Renal vessels Prevertebral vessels Retroperitoneal nodes CONTAINED BY GEROTA’S FASCIA SEPARARTING IT FORM THE PARAENAL (ant & post) SPACE. Posterior Pararenal Space Is between the renal fascia and transversalis fascia, it contains fat and is of variable size. Does not contain solid organs.  Sonographic Appearance of the Kidneys Adult Renal capsule Hyperechoic thin, continuous, highly reflective line visualized along periphery of kidney Renal cortex Midgray or medium- to low-level homogeneous echo pattern Hypo- to isoechoic to normal liver or spleen 17 Sonographic Appearance of the Kidneys Adult Renal medulla (what we see as the pyramids) Triangular, round, or blunted anechoic areas when urine filled and are otherwise not visible Anechoic pyramids have a distinctive and readily identifiable appearance Renal sinus Hyperechoic, ovoid central portion of the kidney 18 Scanning the kidneys Sagittal Transverse We see SUPERIOR to We see medial to lateral INFERIOR In regards to the kidneys that is In regards to the kidneys that is the upper pole to the lower pole. the upper pole to the lower pole. But we SCAN superior and But we SCAN medial to lateral inferior We document We document Sag Medial, Sag Mid, Sag Lateral Trv UP, TRV Mid, TRV LP Sonographic Appearance of the Kidneys Pediatric Renal cortex Hyperechoic relative to cortex in adult kidney Renal medulla Easily visible Anechoic 20 Sonographic Applications Renal size Detection and composition of renal masses and cysts Urinary system obstruction Renal abscess Renal hematoma Enlarged ureters Urinary bladder masses Renal transplantation Doppler evaluation of renal blood flow abnormalities Ultrasound-guided biopsies of renal parenchyma or masses Ultrasound-guided fluid aspirations 21 Laboratory Values Test Normal Increase Decrease Blood nitrogen urea 26 mg/dL Indication of renal (BUN) disease Creatinine 1.1 mg/dL Indication of renal disease Glomerular filtration 90 or above Indication of renal rate disease Specific gravity 1.1001-1.025 Kidneys are preserving water 22 Associated Tests Intravenous pyelogram (IVP) Computed axial tomography IVP is an x-ray exam that uses dye to outline the kidneys, ureters and bladder.. The dye shows up well on the x-ray and outlines your organs. IVP is used to diagnose why a patient has blood in their urine, or pain in their side/lower back. Kidney stone Enlarged prostate Tumors in the kidney, ureters or urinary bladder Scarring from UTI Birth defects of the urinary tract. Can identify ectopic kidneys 23 Physiology of the Urinary System The kidneys are excretory organs that maintain the body’s chemical equilibrium through excretion of urine, a waste product Ureters carry urine to the urinary bladder for temporary storage Urine is excreted from the bladder to outside of the body through the urethra 24 Functions of the Kidneys Urine production Homeostasis (maintenance of normal body physiology) Detoxification Blood pressure regulation Removes waste from blood Maintenance of the correct balance of pH, minerals, iron, and salt levels in blood Adjusts the amount of water & electrolytes leaving the body so it equals the amount entering the body: Maintains salt & H20 Renin-angiotensin system influences blood pressure & blood volume. 25 Functions of the Kidneys Functional unit of the kidney is the nephron There are over a million microscopic nephrons in each kidney. Nephron moves metabolic products from areas of high concentration to areas of low concentration This is accomplished through osmosis 26 Detailed Urinary Anatomy  Renal Anatomy Renal parenchyma consists of two areas: Cortex Medulla (what we see as pyramids) 28 Renal Anatomy Renal cortex Outer portion Contains the renal corpuscle and the proximal and distal convoluted tubules of the nephron 29 Renal Anatomy Medulla Inner portion Consists of 8 to 18 medullary pyramids, which contain the loops of Henle 30 Renal Anatomy Medullary pyramids Apex Narrow tip Sits within a minor calyx Base Abuts the renal cortex Renal Anatomy Columns of Bertin Bands of cortical tissue Separate the medullary pyramids Renal lobes Portion of the kidney that consists of a single pyramid bordered by arteries and veins 32 Renal Anatomy Renal sinus Central portion of the kidney Houses the renal artery and vein, fatty fibrous tissue, nerves, and lymphatics 33  Renal Anatomy Collecting system Infundibulum Minor and major calyces Renal pelvis Upper expanded end of ureter Receives urine from major calyces 34 Renal Anatomy Renal hilum Medial portion of the renal sinus, where the renal artery enters the kidney and the renal vein and ureter exit 35 Summary Kidneys have 3 distinct regions: Cortex: area from capsule to base of pyramids Medulla: area where pyramids are located Pelvis: flat and funnel-shaped area continuous with the ureter. Pelvis is located in the sinus. Kidney Vasculature Main renal arteries Arise from the abdominal aorta Segmental Interlobar Arcuate Interlobular Renal veins Drain into inferior vena cava Left renal vein receives blood from left suprarenal and gonadal veins 37 Quadratus Lumborum & Psoas Muscles The quadratus lumborum is wider cranial/cephalad than QL is posterior to caudad. Arises from the 13th rib kidney and attaches to the vertebral transverse process before fusing into the iliac crest. The psoas is frequently made of both the psoas major and minor. Originate from the lumbar vertebrae and transverse process Psoas is posterior and insert into the lesser to ureter trochanter of the femur. Ureter Anatomy Ureters begin in the kidney as the renal pelvis and end posteriorly at the trigone portion of the urinary bladder Composed of three layers of tissue: An inner mucosal layer A medial layer of longitudinal and circular smooth muscle An outer fibrous layer Ureteral peristalsis transports urine to the urinary bladder 39 Ureter’s and Urinary Bladder Urinary Bladder Anatomy Elastic, muscular sac that collects urine from ureters before it is excreted through the urethra Consists of the posterior base (trigone area) and neck, which communicates with the urethra Bladder wall is 3-6 mm in thickness 41 Urinary Bladder Anatomy Consists of four layers of tissues Inner mucosa Submucosa Muscularis Outer serosa 42 PVR: Post Void Residual Volume Amount of urine left in the bladder after the patient voids Volume = length x width x height x 0.52 Normal bladder wall should be 3-6 mm. Normal post void