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Urinary System Prefinals
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Urinary System Is the production of urine and its elimination from the body. Functions: Remove nitrogenous wastes Regulate water levels in the body. Regulate acid-base balance and electrolyte levels of the blood.
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Procedures: Urography Ivu or excretory urography Hypertensive IVU
Percutaneous renal puncture Retrograde urography Retrograde cystography Voiding cystourethrography Retrograde urethrography
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Urography General term for radiologic investigations of the renal drainage. Or collecting system are performed by various procedures.
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Excretory, or Intravenous Urography Retrograde Pyelography
2 – methods routinely employed of filling the urinary canals with contrast medium Excretory, or Intravenous Urography Retrograde Pyelography
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Excretory, or Intravenous Urography
most frequently employed method, in which the contrast agent is routinely administered intravenously.
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Retrograde Pyelography
contrast medium is introduced directly into the canals by means of catheterization – ureteral catherterization for contrast filling of the upper urinary tracts.
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Percutaneous Antegrade Urography
Contrast solution is introduced directly into pelvicalyceal system by means of puncture of the renal pelvis. It is seldom used method of introducing contrast media to the kidney
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Preparation of Patient
General Use: Low-residue diet for 1 – 2 days to prevent gas formation caused by excessive fermentation of the intestinal contents. A light evening meal Costive bowel action, a non-gas forming laxative the evening before the examination. NPO after midnight on the day of examination. For retrograge urography, patient is often requested to force water(4-5 glassfuls) for severe hours before examination.
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IVU or Excretory Urography (commonly known as IVP)
most common radiographic examination of urinary system. Visualizes the minor and major calyces, renal pelves, ureters and urinary bladder – following an intravenous injection of contrast medium.
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Purpose: Visualize the collecting portion of the U.S.
Assess the functional ability of the kidneys.
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Clinical Indications Abdominal or pelvic mass
Renal or ureteral calculi Kidney trauma Flank pain Hematuria or blood in the urine Hypertension Renal failure Urinary tract infections
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Contraindications Hypersensitivity to contrast media
Anuria (non passage of urine) multiple myeloma diabetes severe hepatic or renal disease congestive heart failure Pheochromocytoma (rare tumor that arise outside the adrenal gland) sickle cell anemia (another type of anemia)
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IVU – basic routine scout radiograph & 15mins test dose before injection injection of contrast media basic filming routine 1 – min.(nephrogram or nephrotomogram) 5 – min. AP supine L2) 10mins RPO & LPO positions 15 – min. AP supine or PA prone (to provide compression in the abdomen 20 – min posterior obliques (alternatives) Full bladder (10x12” pelvis 1” below ASIS) post-void ( prone or erect)
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1-5mins
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5-10 mins
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10 mins
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Prone 15 mins
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Full Bladder
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Post Void
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Ureteric Compression Method utilized to enhance filling of the pelvicalyceal system and proximal ureters. It allows the renal collecting system to retain the contrast medium longer for more complete study.
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Ureteral Compression The Ureteral Compression Device is used in excretory urography. The belt fits around the waist of the patient so that he may be repositioned quickly for studies at any angle
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Contraindications: Possible ureteric stones Abdominal mass
Aortic abdominal aneurysm Recent abdominal surgery Severe abdominal pain Acute abdominal trauma
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Hypertensive IVU one special type of IVU.
This is done on patients with high blood pressure to determine if the kidneys are the caused of the hypertension. Procedure: (sequence) 1 min 2 min 3 min 30 seconds additional radiographs
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A hypertensive IVU was commonly requested to screen for Renovascular Hypertension.
This consisted of 30-second and 1-, 2-, 3-, and 5-minute radiographs at the beginning of IVU, which were frequently referred to as “minute-sequence films.” The rationale for this study was that physiologic changes caused by the renal arterial stenosis would be demonstrated on early-phase excretion radiographs.
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Percutaneous Renal Puncture
Radiologic procedure for the investigation of renal masses. It is used to differentiate cysts and tumors of the renal parenchyma. Introduced by Lindblom It is replaced by the advent of ultrasounography.
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Retrograde Urography Is a nonfunctional radiographic examination of the urinary system which contrast medium is introduced directly into pelvicalyceal system via catheterization.
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Procedure: Modified Lithotomy Position
knees are flexed over stirrups of the adjustable leg supports.
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* 3 – routine radiographs*
Preliminary radiographs ( showing the ureteral catheters in position) The pyelogram The ureterogram
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Positioning Routine Additional AP for Ureteral Catheters 14x17 film
AP for pyelogram 14x17 film AP for Urography film Additional RPO LPO Lateral – for demonstration of anterior displacement of kidneys or ureters Cross table – for demonstrating of ureteropelvic region with hydronephrosis patients.
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Retrograde Cystography
Another nonfunctional urinary system examination. Radiographic examination of the urinary bladder following installation of an iodinated contrast medium via a urethral catheter.
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Procedure: contrast material is allowed to flow in by “gravity only” – using an asepto syringe or drip infusion. 150 – 500 cc’s of contrast media to be instilled into the bladder.
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AP with 15 degrees caudal angulation Both posterior obliques
Routine positions: AP with 15 degrees caudal angulation Both posterior obliques
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Positioning AP projections of the bladder and proximal part of the urethra with 15 degrees caudal angle. Oblique projections of degrees, with perpendicular CR, or a 10 degrees angulations if needed. AP projections with degree cephalic angulation to demonstrate, the shadow of the prostate above that of the pubic bones. Lateral positions, to demonstrate the anterior and posterior bladder walls and base of the bladder.
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Chassard-Lapine method or “Squat shot”, is used to obtain an axial image of the posterior surface of the bladder and the lower end of the ureters. AP projections, with a degrees tilt of the table to allow the filled bladders to stretch superiorly, where it will not superimpose the ureters.
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Voiding Cystourethrography
Study of the urethra and evaluate the patients ability to urinate. Trauma or involuntary loss of urine are common clinical indiactions.
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Retrograde Urethrography
Perform on the male patient to demonstrate the full length of the urethra. Contrast medium is injected into distal urethra until the entire urethra is filled in retrograde fashion.
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Procedure: Brodney clamp – special device for injection of the c+ medium w/c is attached to distal penis. 30 degs RPO – is the position of choice.
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Summary Ivu or excretory urography Hypertensive IVU
Percutaneous renal puncture Retrograde urography Retrograde cystography Voiding cystourethrography Retrograde urethrography
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