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Abdominal Pathology: Urinary System, Hernias, Appendix - Test 3, Exams of Pathology

Virginia State University (VSU)Pathology

A comprehensive overview of abdominal pathology, focusing on the urinary system, hernias, and the appendix. It includes detailed descriptions of various conditions, their causes, symptoms, and diagnostic imaging findings. Particularly useful for students of medicine and healthcare professionals seeking to enhance their understanding of abdominal pathology.

Typology: Exams

2024/2025

Available from 12/26/2024

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Abdominal Pathology Urinary system, Hernias,
Appendix Test 3
1.-retroperitoneal
-measures 9-12cm (kidneys should be within 2cm of each other)
-outer cortex is more hypoechoic
-renal fascia=gerotas fascia
-functioning unit of kidney=nephron: Kidney Anatomy
2.-obstruction
-flank mass
-renal abscess
-hematuria
-flank pain
-difficulty voiding: Reasons to ultrasound kidney
3.: Hytrophied Column of bertin
4.-triangular, echogenic are in cortex due to partial fusion during
embryonic stage: Junctional parenchyma defect
5.Indentation between the calyces giving the kidneys a lobulated appearance-
: fetal lobulation
6.2 echogenic regions separated by parenchymal tissue, can be complete
or incomplete: Duplex collecting system
7.Failure of kidney to form: renal agenesis
8.Incomplete development of the kidney; small: renal hypoplasia
9.-incomplete duplication
-most common congenital anomaly in neonates
-2 collecting systems, 2 ureters, 1 entrances into bladder: supernumerary
10.-failure to ascend into the renal fossa
-most common=pelvic kidney
-can also be found in thorax or abdomen
-crossed renal ectopia= both kidneys on the same side and fused together: -
renal ectopia
11.-the fusion of the lower( or upper) poles of kidneys during fetal
develop- ment
-the isthmus lies anterior to the spine
-may simulate large pelvic mass or enlarged lymph node: Horseshoe kidney
12.-renal sinus lipomatosis is excessive fatty infiltration of the renal pelvis
-considered an anatomic variant common in 6th/7th decades of life
-is associated with obesity or a disease that cause parenchymal atrophy and
destruction: Renal sinus lipomatosis (fibrolipomatosis)
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Abdominal Pathology Urinary system, Hernias,

Appendix Test 3

1.-retroperitoneal -measures 9-12cm (kidneys should be within 2cm of each other) -outer cortex is more hypoechoic -renal fascia=gerotas fascia -functioning unit of kidney=nephron: Kidney Anatomy 2.-obstruction -flank mass -renal abscess

  • hematuria -flank pain -difficulty voiding: Reasons to ultrasound kidney 3.: Hytrophied Column of bertin 4.-triangular, echogenic are in cortex due to partial fusion during embryonic stage: Junctional parenchyma defect 5.Indentation between the calyces giving the kidneys a lobulated appearance- : fetal lobulation
  1. 2 echogenic regions separated by parenchymal tissue, can be complete or incomplete: Duplex collecting system 7.Failure of kidney to form: renal agenesis 8.Incomplete development of the kidney; small: renal hypoplasia 9.-incomplete duplication -most common congenital anomaly in neonates -2 collecting systems, 2 ureters, 1 entrances into bladder: supernumerary 10.-failure to ascend into the renal fossa -most common=pelvic kidney -can also be found in thorax or abdomen -crossed renal ectopia= both kidneys on the same side and fused together: - renal ectopia 11.-the fusion of the lower( or upper) poles of kidneys during fetal develop- ment -the isthmus lies anterior to the spine -may simulate large pelvic mass or enlarged lymph node: Horseshoe kidney 12.-renal sinus lipomatosis is excessive fatty infiltration of the renal pelvis -considered an anatomic variant common in 6th/7th decades of life -is associated with obesity or a disease that cause parenchymal atrophy and destruction: Renal sinus lipomatosis (fibrolipomatosis)

2 / 17 13.Kidneys may be enlarged, having thinned cortex, and increased adipose tissue within the sinus that can have varied appearance (anechoic to densely echogenic) -can mimic infection, atrophy, hydronephrosis: Renal sinus lipomatosis (fi- brolipomatosis) on ultrasound 14.-separation of normal renal sinus by interconnected fluid filled calyces -often seen with urinary tract obstruction but they are not necessarily synony- mous (can also be seen in peds patients with vesicoureteral reflux) -can be deceiving(over hydration) check bladder: hydronephrosis 15.-flank pain

  • n&v
  • fever -painful urination -hematuria: hydronephrosis symptoms 16.-small soft tube -placed in ureter -each end is shaped like a pigtail -one end is in collecting system and the other end is in the bladder -holds the ureter open and maintains proper drainage or urine -temporary: Ureteral stents 17.- Arteriovenous malformation
  • Congenital megacalyces
  • Extrarenal pelvis
  • Papillary necrosis
  • Parapelvic cysts
  • Persistent diuresis
  • Reflux
  • Renal artery aneurysm: Conditions that mimic hydronephrosis 18.-Hx of infection -previous of urinary tract problems
  • HTN -family hx -renal cystic disease: Who is at risk for renal disease? 19.-flank pain
  • hematuria
  • polyuria
  • fever
  • urgency -weight loss -elevated BUN

4 / 17 34.-renal stones -malignant solid or cystic masses often demonstrate calcifications -linear vascular calcifications may be seen with renal artery atherosclerosis and vascular malformation: Urinary tract calcifications 35.parenchymal calcifications, usually of the medulla, affecting both kidneys -can be metastatic -appears as increased echogenicity of the cortex and medullary pyramids -most commonly seen with: chronic glomerulonephritis, sickle cell disease: - Nephrocalcinosis 36.An abrupt decrease in renal function -potentially reversible: acute renal failure 37.-hypotension

  • CHF
  • infection
  • disease -renal mass or cyst -urinary tract obstruction: Acute renal failure caused by 38.acute tubular necrosis: Most common medical renal disease to produce renal failure 39.death of cells that form the renal tubules -sonographic finding: bilaterally enlarged kidneys with hyperechoic pyramids; can revert back to normal appearance and function with treatment: What is acute tubular necrosis 40.Loss of renal function due to a disease, usually parenchymal disease -common disease leading to chronic renal failure: diabetes, renal vascular disease: Chronic renal failure 41.-increase BUN -high urine protein -elevated creatinine
  • HTN -decreased urine output -edema: Chronic renal failure symptoms 42.Diffusely small, echogenic kidney with loss of normal anatomy: Sonograph- ic appearance of chronic renal failure 43.Most common renal mass -may be acquired or inherited -can be solitary or multiple, usually asymptomatic: Simple cysts kidney 44.-septations, thick walls, calcifications, internal echoes, mural nodularity -cannot exclude malignancy: Complex kidney cyst

5 / 17 45.-renal sinus cyst -doesn't communicate with the collecting system -many have irregular borders bc it may compress adjacent structures -can be misdiagnosed as hydronephrosis: Parapelvic cyst 46.autosomal dominant genetic disorder -abdominal cyst and tumors -renal and pancreatic cyst -abnormalities include: cerebellar hemangioblastomas: von Hippel-Lindau dis- ease 47.-an autosomal dominant genetic disorder -associated with renal lesions: multiple renal cyst , angiomyolipomas: Tuber- ous sclerosis Renal masses 48.Occurs in approximately 1-2% of simple renal cyst -usually due to hemorrhage or infection at some point -can be malignant -on US : layered, egg shell thin cyst wall is hyperechoic: Mural Calcification 49.-in a renal cyst or calyceal diverticulum is quite common -represents small calcium crystals, usually occurs after inflammatory process and urine flow stasis -on US: layering (mobile) linear band of hyperechoic echoes with reverb artifacts: Milk of calcium 50.autosomal dominant and autosomal recessive: 2 types of polycystic kidney disease 51.-also called infantile polycystic disease -fairly rare genetic disorder -causes renal failure -sonographic features: echogenic, enlarged kidneys due to multiple micro- scopic cysts: Autosomal recessive polycystic kidney disease 52.Fairly common genetic disorder -enlarged kidneys with multiple asymmetrical cysts varying in size and loca- tion -leads to end stage renal disease: Autosomal dominant polycystic kidney disease 53.-can be asymptomatic

  • pain
  • HTN -palpable mass
  • hematuria -UTI: Autosomal dominant polycystic kidney disease symptoms

7 / 17 -weight loss

  • anemia -increased RBC count -hematuria (painless)

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  • hypercalcemia -increased BUN and creatinine -palp mass -edema: Symptoms of neoplasm (renal) 67.-most common renal neoplasm(85% of all) -more common in males -associated with von hippel lindau disease, and tuberous sclerosis: Renal cell carcinoma 68.Hematuria, flank pain and palpable mass: Symptoms of RCC 69.-isoechoic- hyperechoic solid mass(can also appear as a complicated cystic mass) -possibly heterogeneous due to hemorrhage and necrosis -internal vascularity -possible hyperechoic rim -internal calcification: Sonographic findings RCC 70.-most common renal tumor to involve the renal pelvis, ureter, and bladder -most commonly affecting the renal pelvis -more common in men than women, usually later in life Symptoms: gross or microscopic hematuria, flank pain Appearance: hypoechoic mass, collecting system with low vascularity: Tran- sitional cell carcinoma, sonographic findings and symptoms 71.-rare -highly invasive Symptoms: chronic irritation, gross hematuria, palpable obstruction from kidney stones: Squamous cell carcinoma and symptoms 72.-malignant tumor arising from urothelial lining of renal pelvis, ureter, blad- der or urethra -2 types: TCC, squamous cell carcinoma: Urothelial carcinoma 73.-rare, bilateral, multiple nodules -enlarged hypoechoic: renal lymphoma and sonographic appearance 74.Common in late stage, multiple hypoechoic masses with ill defined mar- gins: Mets in kidney 75.-Wilms tumor -most common abdominal malignancy in children (90% are under age of 5) -much more common with horseshoe kidney Symptoms: flank mass, hematuria, fever, anorexia, edema: Nephroblastoma and symptoms 76.It's in the other kidney: If you have RCC in one kidney what should you suspect?

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  • complications:

11 / 17 Rejection, acute tubular necrosis, obstruction, hemorrhage/ infarction, malig- nancy: renal transplant evaluation 88.-placed in iliopelvic region(RLQ) -baseline usually obtained with days after tx occurs evaluating for: renal size, fluid collections, echotexture, hydronephrosis: Renaltx 89.-hematomas: appearance depends on age, can appear solid

  • abscess
  • urinomas -lympoceles: Fluid collections (renal) 90.can have various appearances, look out for: -enlarged, hypoechoic pyramids -increased echogenicity of the cortex -distortion of renal outline
  • patchy -atrophy: Rejection of renal tx 91.-need biopsy Can have complications: Diagnosis of rejection 92.Uterocele Stricture: Common issues with the ureter 93.-cyst like enlargement of the lower end of the ureter -cause by congenital or acquired stenosis of the distal end of the ureter: Ute- rocele 94.Due to :
  • fibrosis -inflammatory disease
  • tuberculosis -impacted ureteral stone -radiation: Stricture
  1. -ultrasound is not the imaging modality of choice for evaluating the bladder (cystoscopy) -bladder walls should be smooth and thin (should measure less than 6mm in AP) -ureteral jets should be obtained if concerned for obstruction -if suspect hydronephrosis but bladder is full, have them urinate: Lower urinary tract( bladder and ureters) 96.Complete duplication is rare, more commonly a type of septation divides the bladder into 2 unequal cavities: Bladder duplication 97.Rare, usually diagnosed in Utero, still born: Bladder agenesis

13 / 17 -fever, mass, dropping hematocrit -linear transducer can be of assistance in determining if hematoma is arising from sup abd wall: Bladder flap hematoma

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  1. US is not normally used to evaluate -only seen if abnormal or mass: Adrenals visualization
  2. -triangular or crescent shaped area superior to kidney -function: produce hormones for: maintain metabolic processes, regulate salt and water balance, "fight or flight", estrogen and testosterone: Adrenal gland
  3. Usually deal with imbalance of hormones: Adrenal disease
  4. adrenocortical insufficiency -atrophy of adrenal cortex -decreased production of cortisol Symptoms: sodium retention, edema, increased plasma, fatigue, muscle and bone weakness: Addisons disease
  5. -excessive secretion of sex hormones and adrenal androgens -caused by adrenal tumor or hyperplasia Symptoms: ambiguous genitalia, masculine traits: Adrenogenital syndrome
  6. -excessive secretion of aldosterone Causes: cortical adenoma, adrenal hyperplasia, adrenal carcinoma Symptoms: muscle weakness, HTN, abnormal EKG: Conn's syndrome
  7. -excessive secretion of cortisol Causes: adrenal hyperplasia, cortical adenoma, ACTH Symptoms: truncal obesity, pencil thin extremities, HTN, renal stones: Cushing syndrome
  8. -adrenal cyst -adrenal tumors (adenoma) -myelipomas, hemangiomas, lipomas: Adrenal benign findings
  9. -most common primary adrenal tumor -usually non functioning -often times found in Older patients it's HTN or diabetes -well defined, round, hypoechoic homogenous mass: Adrenal adenoma
    • rare -usually due to severe trauma or infection -more common in neonates during delivery due to the adrenal glands being very vascular and larger in a neonate: Adrenal hemorrhage
  11. -adrenals are 4th most common site for Mets -usually from lung or breast -bilateral involvement is common -nonspecific sonographic appearance: Metastasis
  12. -primary tumors are rare and may be hyper or hypofunctional -hyper functional more common in females -may be caused by cushings, conns r adrenogenital syndromes

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  • diarrhea -signs of inflammation, such as elevated WBC and fever -acute appendicitis can occur at any age but is more prevalent at younger ages: Symptoms acute appendicitis
  1. -acute gastroenteritis -mensenteric lymphadenitis in children -ruptured ectopic pregnancy -right ovarian torsion: differential diagnosis
  2. -graded compression -linear or curved array -scan in TRV RLQ, scan from liver to pelvis -apply gentle, gradual pressure to ant abdominal wall -identify the cecal tip the spots muscle and external iliac vessels -appendix lies ant to structures: Appendicitis on ultrasound
  3. <6mm -small amount of fluid or gas may be seen within the lumen -On trv plane it looks like a target: Measurements appendix
  4. -thickened wall >3mm -diameter > 6 or 7 mm
  • noncompressible -free fluid -abscess: Ultrasound findings of appendicitis
  1. gross enlargement of the appendix from accumulation of mucoid sub- stance within the lumen: Mucolocele
  2. Fecaliths or calculate in the appendix: Appendiocoliths
  3. protrusion of a peritoneal-lined sac through a defect in the weakened abdominal wall -most common areas of weakness are the umbilical area and the femoral and inguinal rings: Abdominal hernia
  4. -if edema develops or if the opening constricts to the extent that the protrusion cannot be placed back into position -strangulation of the bowel can also occur in an incarcerated hernia that is not surgically repaired in a timely manner
  • bowel can become necrotic and require resection: Complications of abdominal hernia
  1. -demonstration of an abdominal wall defect -presence of bowel loops and mesenteric fat in a lesion -exaggeration of the lesion with strain (valsalva) -reducibility of the lesion by gentle pressure: Hernia sonographic criteria

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  1. indirect, direct, femoral: Types of inguinal hernias
  2. -sonographer must depend on the bony landmarks of the pelvis -the inferior epicanthic artery must be located -musculature must be identified: How to find the anatomy of hernia
  3. -landmark for proper location to evaluate for hernia -branch of the external iliac a -use power to visualize: Inferior epigastric artery
  4. -common femoral artery(CFA) and vein (CFV) -insertion of inferior epigastric artery -spermatic cord: Inguinal hernia
  5. -area defined by the edge of the rectus abdominis muscle, the inguinal ligament and the inferior epigastric artery -imperative to image this area for direct and indirect hernias: Hasselbach's triangle
  6. -occur just below inguinal ligament -occurs from a weakening in the femoral canal -the function of this canal is to allow the femora vein to expand when neces- sary -more common in females -most common sign is a lump in groin: Femoral hernia
  7. -these hernias protrude thru a weakening in the transversalis fasica -they originate medically to the inferior epigastric artery -abdominal walls weaken with age so direct hernias are more common in middle aged and elderly patients: Direct hernia
  8. -can occur at any age due to the congenital component -results from the failure of the embryonic closure of the internal inguinal ring -this is the most common cause of groin hernias -these arise from the top of the inguinal canal lateral to the inferior epigastric artery -can herniate into the labia major is: Indirect hernia