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Chapter 16
Urinary System and Venipuncture
153
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Graduate
05/15/2011

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Term
The kidneys and ureters are located in the ____________ space
Definition
retroperitoneal
Term
The ________ glands are located directly superior to the kidneys
Definition
suprarenal (adrenal)
Term
Which structures create a 20 degree angle between the upper pole and lower pole of the kidney?
Definition
psoas major muscles
Term
What is the specific name for the mass of fat that surrounds each kidney?
Definition
Adipose capsule of perirenal fat
Term
What degree of rotation from supine is required to place the kidneys parallel to the IR?
Definition
30 degree
Term
Which two landmarks can be palpated to locate the kidneys?
Definition
Halfway between the xiphoid process and the iliac crest
Term
Which term describes an abnormal drop of the kidneys when the patient is placed erect?
Definition
nephroptosis
Term
List three functions of the urinary system:
Definition
1. remove nitrogenous waste
2. regulate water levels in the body
3. regulate acid-base balance and electrolyte levels of the blood
Term
a buildup of nitrogenous waste in the blood is called:
Definition
uremia
Term
the longitudinal fissure found along the central medial border of the kidney is called the _______
Definition
hilum
Term
the peripheral or outer portion of the kidney is called the ______
Definition
cortex
Term
the term that describes the total functioning portion of the kidney is _________
Definition
renal parenchyma
Term
the microscopic functional and structural unit of the kidney is the ________
Definition
nephron
Term
which structure of the medulla is made up of a collection of tubules that drain into the minor calyx?
Definition
renal pyramids
Term
what is another (older) name for glomerular capsule?
Definition
Bowman capsule
Term
T/F:The glomerular capsule and proximal and distal convoluted tubules are located in the medulla of the kidney.
Definition
False - located in the cortex
Term
T/F: The efferent arterioles carry blood to the glomeruli.
Definition
False - afferent
Term
Which two processes move urine through the ureters to the bladder?
Definition
peristalsis and gravity
Term
which one of the following structures is located most anterior as compared with the others?
-proximal ureters
-kidneys
-urinary bladder
-suprarenal glands
Definition
urinary bladder
Term
what is the name of the junction found between the distal ureters and urinary bladder?
Definition
ureterovesical junction
Term
what is the name of the inner, posterior region of the bladder formed by the two ureters entering and the urethra exiting?
Definition
trigone
Term
what is the name of the small gland found just inferior to the male bladder?
Definition
prostate gland
Term
the total capacity for the average adult bladder is:
Definition
350 - 500 ml
Term
which one of the following structures is considered to be most posterior?
-ovaries
-urethra
-vagina
-kidneys
Definition
kidneys
Term
Why is the term IVP incorrect in describing a radiographic examination of the kidneys, ureters, and bladder following intravenous injection of contrast media?
Definition
An IVP (intravenous pyelogram) is the study of the renal pelvis
Term
What is the correct abbreviation for the examination of the kidneys, ureters, and bladder following intravenous injection of contrast media
Definition
Intravenous urogram (IVU)
Term
Which specific aspect of the kidney is visualized during an IVU?
Definition
the collecting system of the kidney
Term
What is a common pathologic indication for an IVU?
Definition
Hematuria
Term
Which one of the following conditions is described as a rare tumor if the kidney?
Definition
Pheochromocytoma
Term
Presence of gas in urine
Definition
Pneumouria
Term
Backward return flow of urine
Definition
Urinary reflux
Term
Excess urea and creatinine in the blood
Definition
Uremia
Term
Complete cessation of urinary secretion
Definition
Anuria
Term
Passage of a large volume of urine
Definition
Polyuria
Term
Act of voiding
Definition
Micturition
Term
Inability to void
Definition
Retention
Term
Diminished amount of urine being excreted
Definition
Oliguria
Term
presence of glucose in urine
Definition
glucosuria
Term
constant or frequent involuntary passage of urine
Definition
urinary incontinence
Term
absence of functioning kidney
Definition
renal agenesis
Term
indicated by presence of uremia, oliguria, or anuria
Definition
acute renal failure
Term
enlargement of the prostate gland
Definition
benign prostatic hyperplasia
Term
fusion of the lower poles of kidneys during the development of the fetus
Definition
horseshoe kidney
Term
inflammation of the capillary loops of the glomeruli of the kidney
Definition
glomerulonephritis
Term
artificial opening between the urinary bladder and aspects of the large intestine
Definition
vesicorectal fistula
Term
a large stone that grows and completely fills the renal pelvis
Definition
staghorn calculus
Term
increased blood pressure to the kidneys due to atherosclerosis
Definition
renal hypertension
Term
normal kidney that fails to ascent into the abdomen but remains in the pelvis
Definition
ectopic kidney
Term
multiple cysts in one of both kidneys
Definition
polycystic kidney disease
Term
rapid excretion of contrast media
Definition
renal hypertension
Term
mucosal changes within bladder
Definition
cystitis
Term
bilateral, small kidneys with blunted calyces
Definition
chronic bright disease
Term
irregular appearance of renal parenchyma or collecting system
Definition
renal cell carcinoma
Term
signs of abnormal fluid collections
Definition
vesicorectal fistula
Term
abnormal rotation of the kidney
Definition
malrotation
Term
elevated or indented floor of bladder
Definition
BPH
Term
signs of obstruction of urinary system
Definition
renal calculi
Term
a condition characterized by regions or areas of subcutaneous swelling due to allergic reaction to food or drugs is termed:
Definition
angioedema
Term
contraction of the muscles within the walls of the bronchi and bronchioles, produces a restriction of air passing through them, is a condition called ____________
Definition
bronchospasm
Term
loss of consciousness due to reduced cerebral blood flow
Definition
syncope
Term
a trademark name for a diuretic drug is:
Definition
lasix
Term
an eruption of wheals (hives) often due to hypersensitivity to food or drugs is a condition termed:
Definition
urticaria
Term
What type of renal calculi is often associated with chronic urinary tract infections?
Definition
staghorn calculi
Term
T/F: the patient should void before a IVU to prevent possible rupture of the bladder if compression is applied.
Definition
TRUE
Term
What is the primary purpose of ureteric compression
Definition
to enhance filling of the pelvicalyceal system with contrast media
Term
List the 6 conditions that could contraindicate the use of ureteric compressions:
Definition
1. possible ureteric stones
2. abdominal mass
3. abdominal aortic aneurism
4. recent abdominal surgery
5. severe abdominal pain
6. acute abdominal trauma
Term
When does the timing for an IVU start?
Definition
at start of injection of contrast media
Term
List the 5 step imaging sequence for the routine IVU:
Definition
1. 1 minute nephrogram or nephrotomography
2. 5 minute full KUB
3. 10-15 minute full KUB
4. 20 minutes posterior R and L oblique positions
5. Postvoid (prone PA or erect AP)
Term
What is the primary difference between a standard and a hypertensive IVU?
Definition
hypertensive requires a shorter span of time between projections
Term
in which department are most retrograde urograms performed?
Definition
surgery (inpatient or outpatient facility)
Term
T/F: a retrograde urogram examines the anatomy and function of the pelvicalyceal system
Definition
false - nonfunctional
Term
T/F: the brodney clamp is used for male and female retrograde cystourethrograms
Definition
FALSE - males only
Term
Which of the following involves a direct introduction of the contrast media into the structure being studied?
Definition
Retrograde urogram
Retrograde cystogram
Retrograde urethrogram
Term
Which of the following alternative imaging modalities is not routinely being used to diagnose renal calculi?
Definition
MRI
Term
T/F: Urinary studies on pediatric patients should be scheduled early in the morning to minimize the risk for dehydration.
Definition
TRUE
Term
T/F: Nuclear medicine is highly effective in demonstating signs of vesicoureteral reflux
Definition
TRUE
Term
T/F: the number of retrograde urography procedures for urethral calculi has been reduced as a result of the increased use of CT
Definition
True
Term
Who should the technologist contact if he or she has difficulty placing the needle into the vein of a pediatric patient during IVU?
Definition
phlebotomist or physician
Term
T/F: the patient does not require extensive bowel preparation before a CT scan for renal calculi
Definition
TRUE
Term
which imaging modality is used to detect subtle tissue changes following a renal transplant?
Definition
MRI
Term
what are the 4 reasons a scout projection is taken before the injection of contrast media for an IVU?
Definition
1. verify patient prep.
2. determine whether exposure factors are acceptable
3. verify positioning
4. detect any abnormal calcifications
Term
what kv range is recommended for an IVU?
Definition
70-75 kv
Term
which ionization chambers should be activated for an AP scout projection
Definition
upper R and L chambers
Term
T/F: both the female midline does and the female gonadal does for an average unshielded AP projection for an IVU are in the 100-200 mrad range.
Definition
FALSE - 30-50 mrad
Term
T/F: male and female patients should have the gonads shielded for an AP scout projection.
Definition
FALSE - not females, it would obscure anatomy
Term
T/F: Tomograms taken during an IVU with an exposure angle of 10 degrees or less are called zonography
Definition
true
Term
How many tomograms (zonograms) are usually produced during a routine IVU?
Definition
3
Term
At what stage of an IVU is the renal parenchyma best seen?
Definition
within 1 minute following injection
Term
where is the CR centered for a nephrotomogram?
Definition
midway between the xiphoid process and the iliac crest
Term
which specific position, taken during an IVU, will place the left kidney parallel to the IR?
Definition
RPO
Term
How much obliquity is reuired for the LPO/RPO projections taken during an IVU?
Definition
30*
Term
which position will best demonstrate possible nephroptosis?
Definition
Erect position
Term
How will an enlarged prostate gland appear on a postvoid radiograph taken during an IVU?
Definition
the prostate gland will indent the floor of the bladder
Term
Where should the pneumatic paddle be placed for the uretic compression phrase of an IVU?
Definition
just medial to the ASIS and lateral to the spine (placed over the outer pelvic brim)
Term
what can be done to enhance filling of the calyces of the kidney if ureteric compression in contraindicated?
Definition
place the patient in a 15* Trendelenburg position
Term
what specific anatomy is examined during a retrograde ureterogram?
Definition
primarily the ureters
Term
what specific anatomy is examined during a retrograde ureterogram?
Definition
primarily the ureters
Term
a retrograde pyelogram is primarily a nonfunctional study of the ________
Definition
renal pelvis, major and minor calyces of the kidneys
Term
what CR angle is used for the AP projection taken during a cystogram?
Definition
10-15 caudad
Term
T/F: for a lateral cystogram, both the male and female dose are in the 100 (+or-50) mrad range.
Definition
TRUE
Term
which specific position is recommended for a male patient during a voided cystourethrogram?
Definition
30* RPO
Term
The kidneys are _____ structures
Definition
Retroperitoneal
Term
The ureters enter the ________ aspect of the bladder
Definition
posterolateral
Term
the kidneys lie on the _________ (anterior or posterior) surface of each psoas major muscle.
Definition
anterior
Term
The kidneys lie at a _______ angle in relation to the coronal plane.
Definition
30*
Term
The three constricted points along the length of the ureters where a kidney stone is most likely to lodge are:
Definition
ureteropelvic junction; uretovesical junction; near brim of pelvis
Term
An abnormal drop of more than ______ inches or ______ cm in the position of the kidneys when the patient is erect indicates a condition termed nephroptosis
Definition
2 inches or 5 cm
Term
The buildup of nitrogenous waste in the blood creates a condition called:
Definition
uremia
Term
How much urine is normally produced by the kidneys in 24 hours?
Definition
1.5 liters
Term
the renal veins connect directly to the:
Definition
inferior vena cava
Term
the 8 to 18 conical masses found within the renal medulla are called the:
Definition
renal pyramids
Term
the major calyces of the kidneys unite to form the:
Definition
renal pelvis
Term
the microscopic init of the kidney (of which there are more than 1 million in each kidney) is called the:
Definition
nephron
Term
T/F: the loop of henle and collecting tubules are located primarily in the medulla of the kidney.
Definition
TRUE
Term
T/F: about 50% of the glomerular filtrate processed by the nephron is reabsorbed into the kidneys venous system
Definition
FALSE - 99% is reabsorbed
Term
The inner, posterior triangular aspect of the bladder that is attached to the floor of the pelvis is called the:
Definition
trigone
Term
Under what circumstances should a pregnant patient have an IVU performed?
Definition
when benefit of the procedure outweigh the risk of radiation exposure
Term
List the two classes of iodinated contrast media used for urinary studies:
Definition
ionic and non-ionic
Term
The normal range of creatine in an adult is:
Definition
0.6 to 1.5 mg/dl
Term
how long must a patient be withheld from taking Metformin following an iodinated contrast media procedure?
Definition
48 hours
Term
Which of the following conditions is considered high risk for an iodinated contrast media procedure?
-hematuria
-pheochromocytoma
-diabetes mellitus
-hypertension
Definition
pheochromocytoma
Term
What is the best course of action for a patient experiencing a mild level contrast media reaction?
Definition
observe and reassure the patient
Term
which of the following is an example of a vasovagal reaction?
-itching
-angioedema
-cardiac arrythmias
-urticaria
Definition
cardiac arrythmias
Term
A true allergic reaction to iodinated contrast agents is classified as an:
Definition
Anaphylactic reaction
Term
Tachycardia (>100 beats/min) is a symptom of a _______ type of reaction
Definition
moderate reaction
Term
brachycardia (<50 beats/min) is a symptom of a ______ type of reaction
Definition
severe
Term
which of the following drugs may be given to minimize the risk for acute renal failure following a contrast media procedure?
Definition
lasix
Term
metformin is a drug given to patients with:
Definition
diabetes
Term
which one of the following drugs can be given as part of the predication protocol before an iodinated contrast media procedure?
Definition
prednisone
Term
excretion of a diminished amount of urine in relation to the fluid intake is the general definition for
Definition
oliguria
Term
constant or frequent involuntary passage of urine is termed
Definition
urinary incontinence
Term
the absence of a functioning kidney is called
Definition
renal agenesis
Term
complete cessation of urinary secretion by the kidneys is termed
Definition
anuria
Term
T/F: Adult forms of polycystic disease are inherent.
Definition
TRUE
Term
Hypernephroma is another term for
Definition
Renal cell carcinoma
Term
Extravasation is classified as an _________ reaction
Definition
Organ-specific
Term
Laryngeal swelling is classified as a
Definition
severe level reaction
Term
Hot flashes are classified as
Definition
side effect
Term
which vein is not normally selected for venipuncture during an IVU
Definition
axillary
Term
at what angle is the needle advanced into the vein during venipuncture?
Definition
20-45 degrees
Term
How long should the venipuncture site be cleaned with an alcohol wipe before needle insertion
Definition
30 seconds
Term
how high should the tourniquet be placed above the puncture site?
Definition
3-4 inches (8-10 cm)
Term
T/F: Bladder carcinoma is 3x more common in males than females
Definition
TRUE
Term
Which condition my produce hydronephrosis?
Definition
renal obstruction
Term
which pathologic indication is an example of a congenital anomaly of the urinary system?
Definition
ectopic kidney
Term
T/F: the patient should void before the IVU to prevent dilution of the contrast media in the bladder
Definition
TRUE
Term
What is the normal range for a patients BUN?
Definition
8-25 mg/100 ml
Term
at what timing sequence during an IVU are the oblique projections taken?
Definition
20 minutes following injection
Term
Which projections best demonstrate the renal parenchyma? When should it (they) be taken?
Definition
Nephrogram or Nephrotomography; immediately after completion of injection
Term
Which procedure may require a Brodney Clamp?
Definition
Retrograde urethrogram on a male patient
Term
What specific body position will place the RIGHT kidney parallel to the IR?
Definition
30 degree LPO
Term
T/F: The gonadal dose for the AP postvoid projection is higher for male patients than for female patients.
Definition
FALSE - higher for female
Term
T/F: The retrograde ureterogram will demonstrate the ureters, renal pelvis, and major and minor calyces.
Definition
FALSE - primarily the ureter
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