urogenital system

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prenatal us is capable of dx many anomalies of the gu system; in the presence of__ the tech should carefully search the renal areas and the bladder to determine if an obstruction is present that may lead to the diminished production of a.f. on the other: oligohydramnios, maternal drug usage, renal pelvis
both the urinary and gential systems develop from the intermeidate mesoderm that extends along the length of the dorsal body wall of the embryo, and the excretory ducts of both systems initally enter a common cavity called the __. the __ duct first serve: cloaca, mesonephric, males
as the embryo bends and folds in the horizontal plan during the fourth week, the intermediate __ forms a longitudinal mass on both sides of the ao called the __ ridge; both urinary and genital systems develop in these ridge; kidneys form __. the nephrog: *mesoderm *urogenital ridge *first *gonadal ridge
3 sets of excretory organs (kidneys) develop in embryo: only the __ set reamin as permanent kidneys. the __ forms first and is nonfunctional. the __ forms second and is functional for a short period of time and then the permanent ones are called __: *three *pronephros *mesonephros *metanephros
the permanent kidneys begin to develop early in the fifth week of life, although they don't function propertly and produce urine until the __ week. urine formation continues to fill the amniotic cavity throughout fetal life. the kidneys don't function w: *11th *placenta
the permanent kidneys develop from two different sources: the __ and the __.: metanephric diverticulum aka ureteric bud and metanephric mesoderm
this gives rise to the ureter, renal pelvic, calyces, and collecting tubules (the ends of the tubes form metanephric vesicles): ureteric bud
the kidneys initially lie very close together in the pelvis. gradually they __ into the ab and become separated from one another in the renal fossa by the ninth week: migrate
kidneys normally complete their migration by the __ week of gestation. in some cases, one of the kidneys may remain in the pelvic cavity, whereas the other migrates into the posterior __ of the ab: *ninth *flank
forms when the inferior pole of the kidneys fuse while they are in the pelvis. more common in males: horseshoe kidney
other variations of horseshoe kidney result in __ where there is abnormal renal position. the left migrates to the right side and is located on the opposite side of the ureteral orifice. the left kidney is going toward the right and is inferior to the r: crossed renal ectopia
occurs when the kidney lies outside its normal position in the renal fossa, usually in the area of the pelvis: renal ectopia
early in development the urinary bladder is continuous with the ____which is part of the umbilical cord that is continuous with the bladder and helps form the bladder. it regresses to become a fibrous cord known as the __: allantois, urachus
this cord, or ligament extends from the apex of the bladder to the umbilicus.: allantois
if the lumen of the allantois persists as the urachus forms, a __ develops which causes urine to drain from the bladder to the umbilicus. if only a small part of the lumen of the allantois persists, it's called ___. if a larger portion of the lumen pers: *urachal fistula *urachal cyst *urachal sinus (bigger than cyst)
with __ the fetal kidneys have been documented as early as 9 weeks. the fetal kidneys and bladder may be seen by 13 weeks. at this time, the kidneys appear bilateral __ structures in the paravertebral region (lumbar region adjacent to spine). also at: *EV *hyperechoic *sonolucent
by 18-20 weeks the kidneys are slightly hyperechoic which means they are becoming more ___. by 25 weeks, it is possible to distinguish the renal cortex from the __, outline the renal capsule clearly and see a central __ area in the renal sinus region.: *hypoechoic *medulla *echogenic
the kidneys should be evaluated by assessing their ___, texture and size. normal anatomic structures of thekidney include the relatively homogeneous __ and parenchyma, echogenic __ and __, and anechoic renal pelvis. kidney texture that appears significa: *anatomy *cortex *pyramids *calyces *echogenic
a small amount of urine may be seen in the renal pelvis in the normal fetus, measuring in it AP diameter <__ mm. upper limits of normal for fetus younger than 33 weeks is __mm and fetuses greater than 33 weeks is __: 5,4,7
a renal pelvis diameter meausured in AP direction in trv plane that exceeds __ to __ mm is considered abnormal. the size of the fetal kidneys may be assessed by measuring the length, width, height of the kidney. the __ closely correlates with GA of fetu: *10-15 *length *1
the __ is normally visualized in all fetuses. failure to observe is may indicate severe renal abnormality when accompanied by oligohydramnios. the wall should be thin (<2mm). color doppler can be used to determine the ureteral jet entering the base: fetal bladder
incomplete fusion of the urogenital folds may cause abnormal opening of the urethra along the ventral aspect of the penis. occurs in one in every 300 infants. the abnormal uretral orifice m ay be near the glans penis (glandular) or farther away (penile): hypospadias
fluid in scrotal sac; this occurs in the male fetus and is seen as an accumulation of serous fluid surrounding the testicle resulting from a communication with the peritoneal cavity; this may be unilateral or bilateral lesions and are usually benign. a s: hydrocele
in the male the testes remain near the deep inguinal rings until the 28 week. thye descend through the inguinal canals and enter the scrotum before birth. failure to complete the descent results in undescended testes. can't be dx until after birth beca: cryptorchidism
means the virtual absence of the kidneys. occurs when the ureteric buds fail to develop or when they degenerate before they can induce the metanephric mesoderm to form nephrons. unilateral usually (bilat is not compatible with life): renal agenesis
may be assoc with uterine anomalies in females and testicular hypoplasia or agenesis or hypospadias in males; the contralateral kidney may be hypertrophied to compensate for the absent kidney; more common in males: renal agenesis
fetal anomalies found in association include cardiac defects, musculoskeletal disorders, cns anomalies, gi anomalies; in renal agensis the adrenal glands may be large and may mimic the kidneys (look for the pelvis and calyces): renal agenesis
sono appears the kidneys and bladder are not visual; a.f. is absent or severely decreased (oligo) because urine isn't produced; nonvisualization of kidneys within renal fossa nor bladder; abnormally small thorax and pulmonary hypoplasia: renal agenesis
heterogeneous group of heritable, developmental, acquired disorders; the potter classification attempts to cover most of the renal cystic conditions in the prenatal period: renal cystic disease
not compatible with life; is characterized by bilat renal agenesis, oligohy, pulmonary hypoplasia, abnormal facies (hypertelorism, low set ears, micrognathia, broad nasal bridge (big nose)and malformed hands and feet (sirenomelia); the ologo-hypoplastic l: classic potter's syndrome
4 types of cystic renal anomalies: 1: auto-rec infantile 2: multicystic kidneys 3: auto-dom adult 4: renal dysplasia, obstructive kidney disease
auto-rec disorder that affects the fetal kidneys and liver; most commonly, abnormal kidneys may be found in assoc with liver cysts; the most severe forms are those found prenatally; in this disease the collecting tubules or the kidney are microscopically: IPKD
sono appears as individual cysts are not identified; instead the kidneys are massively enlarged because of hundreds of dilated tubules; enlargement of the kidneys may not occur until the 24th week of gestation; in some cases the kidneys are so massive tha: IPKA
this condition occurs when error take place in determining male or female sexuality, hermaphroditism: ambiguous genitalia
is rare condition in which both ovarian and testicular tissues are present; the internal and external genitalia are variable; most fetuses have a normal karyotype, but some are mosaics (46XX, 46XY). the tech must be careful in making the differential of: true hermaphrodite
causes enlarged clitoris that looks like penis but is really a female; the most common cause is congenital virilizing adrenal hyperplasia, which causes masculinization of the external genitalia (enlarged clitoris, abnormalities of the urogenital sinus and: female pseudohermaphroditism
really male; there are variable external and internal genitalia depending on the development of the penis and the genital ducts: male pseudohermaphroditism
may occur in the female fetus; this mass often appears as multiseptatted and bilat; the ovarian mass results from maternal hormonal stimulation and is usually benign; the mass may twist on itself and may lead to torsion, rupture, or intestinal obstruction: ovarian cyst
not genetic but a developmental problem; most common cystic renal disease in neonatal; 2nd most common ab mass w/i neonate after hydronephrosis; distinguish from hydronephrosis because this is non-communicating where as hydronephrosis is: multicystic dysplasia (potter II)
in this condition, renal tissue is replaced by cysts of varying sizes that are found throughout the kidney cortex; most common form of renal cystic disease in childhood; kidney borders are difficult to define because of distorted renal outline; affected k: multicystic dysplasia (potter II)
sono appears as non-communicating cysts of variable size; no distinct renal pelvis and parenchyma; renal size may be normal, hypoplastic, or enlarged; severe oligohydramnios if bilat; unilateral will have okay a.f. becuase the functional kidney will compe: multicystic dysplastic (potter II)
one multicystic dysplastic and one renal agenesis is __: lethal
auto-dom disease may be differentiated in a fetus when there is a family history or polycystic kidneys, liver, or both; cystic dilation of nephrons; bilat only; cystic functional kidneys; the fetal kidneys appear large and echogenic, and rarely cysts may: APKD
a.f. volume is normal; assoc anomalies include encephalocele suggestive of m-g syndrome in the presence of bilat renal cystic disease, polydactyly and severe oligohydramnios; also may be assoc with ureteral atresia: APKD
conversely the visualization of bilat enlargement of the kidneys may prompt a renal and liver work-up in the parents to exclude this disorder; only when assoc with m-g syndrome will you have oligo, otherwise you have normal a.f. vol.: APKD (type III)
sono appears as large kidneys with hyperechoic parenchyma; size may be symmetric; normal bladder is seen which is how you distinguish it from type I; occasionally, macroscopic cysts may be seen in echogenic kidney: APKD (III)
can be bilat or unitlat; obstruction that causes cysts; acquired; secondary to obstruction in the first of early second trimester; this condition is caused by early renal obstruction; unilat disease can be caused by pelviureteral or vesicoureteral junctio: renal cystic dysplasia (IV)
sono appears the fetal kidneys appear small and echogenic with cortical peripheral cysts; if the disease is bilat, look for early bladder outlet obstruction, bilat hydronephrosis, a thick-walled bladder, and severe oligo; the renal cortex is dysplastic an: renal cystic dysplasia (IV)
the urinary tract may be obstructed at the junction of the ureter entering the renal pelvis (upj) or at the juction of the ureter as it enters the bladder (UVS) or at the level or the urethra (__): megacystic
is the most common fetal anomaly; urinary tract obstruction varies, depending on the site and extent of blockage; renal dysplasia often occurs and represents cystic changes within the renal tissue; may occur as unilat or bilat: hydronephrosis
dilation of the renal pelvis occurs in response to a blockage of urine at some junction of the urinary system; most common is UPJ; blocked urine is unable to pass the obstruction, and as urine is continually produced, it will back up into the kidney; comm: hydronephrosis
sono its appearance varies according to the severity of the underlying obstruction; an anterioposterior renal pelvid diamter greater than 5-10 mm of TRV kidney is seen; rim of parenchyma is preserved; calyceal distention with central pelvis communication: hydronephrosis (has grades 1-4)
hydronephrosis grades: 1. __ dilation 2. __ and __ dilation 3. __ and __ dilation 4. __ dilation and renal parenchyma __: 1. renal pelvis 2. renal pelvis and mild calyceal 3. renal pelvis and all calyces 4. calyceal, thinning
__ renal hydronephrosis commonly results from an obstruction at uPJ: unilateral
the most common reason for hydronephrosis in the neonate; this obstruction occurs at the junction between renal pelvis and ureter; only half of these disorders are found during early childhood; early prenatal detection may improve long-term renal function: UPJ obstruction
causes includes abnormal bends or kinks in the ureter, adhesions, abnormal valves in the ureter, abnormal outlet shape at the JPJ, or absence of the longitudinal muscle that is imperative to the normal extretion of urine from the kidney; usually unilat, a: UPJ obstruction
sono appears there is a collection of urine located medially within the renal pelvis that communicates with the calyces (caliectasis); the ureter, bladder, and a.f. volume are usually normal; no dilation distal to obstruction: UPJ obstruction
commonly presents with dilation of the ureter (megaureter); duplicating collecting system with ureterocele will cause it; megaureter may result from a primary ureteral defect (stenotic ureteral valves or fibrosis) or may occur secondary to obstruction at: UVJ obstruction
other defects, such as duplication of the renal collecting system, are common and may be differentiated prenatally; when a dilated upper renal pole is observed with a normal lower pole, an obstructed duplicated collecting system may be indicated; this may: UVJ obstruction
a __is a cystic dilation of the intravesical (bladder) segment of the distal ureter; an __ is one that doesn't insert near the posterolateral angle of teh trigone of the bladder; in females it may insert in the vaginal, vestibule, or uterus. in males, it: *ureterocele *ectopic ureter *secondary obstruction to ureterocele or ectopic ureter
obstruction that results in hydronephrosis, hydroureters, or dilation of the bladder and posterior urethra; the entity occurs only in male fetuses and is manifested by the presence of a valve in the posterior urethra; keyhole outpouch of dilated urethra;: posterior urethral valves obstruction
as a result, urine is unable to pass through the urethra and into the amniotic fluid. this causes a back-up of urine in the bladder, ureter, and in the most severe cases, the kidneys; severe oligohydramnios is a classic finding in the complete obstructio: posterior urethral valves obstruction
sono appears as dilated bladder, dilated posterior urethra, hydroureters, and hydronephrosis and dysplasia is seen; oligohydramnios, fetal ascites, and distension of the ab is visualized; when the sono signs occur in the female fetus, abnormalities of the: posterior urethral valve-obstruction
this syndrome may be called the urethral obstruction malformation complex; the condition consists of: cryptorchidism, agenesis fo ab wall muscle, megaureters, and bladder outlet obstruction caused by urethral anomalies such as atresia, stenosis valves, or: prune belly syndrome (eagle-barret syndrome)
the ab is extremely distended compared with the small thoracic cavity. the dilated ureters and bladder appear as numerous cystic lesions within the distended ab cavity; sono appears as oligo, mild to sever bilat hydronephrosis, fetal ascites, and hypopla: prune belly syndrome (eagle barret syndrome)
assoc with posterior urethral valve syndrome: prune belly syndrome
what is the triad of prune belly syndrome: cryptorchidism, agenesis of the ab wall muscle; bladder outlet obstruction
rare disorders, such as __ atresia, may cause a massively dilated bladder (prune-belly). the disorders generally are associated with adequate to increased amounts of a.f. and a normal bladder: urethral atresia
the most common renal tumor; sonographically observed as large, single, solid masses originating from the kidney; hydramnios is a typical manifestation; the opposite kidney is usually normal; therefore prognosis is excellent with surgical removal of the a: mesoblastic nephroma (hamartoma)
an adrenal tumor which may be observed prenatally above the kidney; these tumors have varying echo patterns and are associated with liver and placental mets: neuroblastoma
the prenatal differential of nephroblastomatosis (pre-malignant precursor of wilm's tumor) has been reported; bilateral renal enlargement with calcifications and shadowing observed: nephroblastomatosis

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