URINARY OBSTRUCTION ::
Mainly stones, tumor In the kidney: the calyces maybe obstructed by tumor, TB, inflammation, malignancy, stones. Renal pelvis tumors (e.g. transitional cell CA) usually cause no obstruction. Ureter: 1. Intraluminal: stones, sloughed papillae, Nood clots. 2. luminal: tumors, pelviureteric junction nervous supply defect ( st rs 3. extra luminal: retroperitoneal fibrosis, fibroid, hugc ovarian cyst, . In bladder: post urethral valve, tumor of prostate or bladder, stone ,ureterocele , schistosoinisis.
Complications of diverticulum in bladder:
1. Infiction. 2. Stone. 3. Malignant changes. RENAL MASS. It could be single or multiple masses: (in adult) Single mass: include:-Turnors renal cell ca. -Renal cyst. -Hypernephrorna. -In children: WiIm’s tumor that could be (unilateral or bilateral). Multiple: -polycystic kidney disease -multiple renal cortical cyst. -multiple hydatid cyst -multiple renal abscesses. -multiple rnetastsis. -lymphoma (lymphoctic infiltration - diffuse - mass. *Because of the close anatomical relationship of the adrenal gland to kidney, neuroblastoma can be confused with Wilm’s tumor in children. * Investigation of normal cortical tissue into the renal medulla (sometimes called a renal pseudotumor) may produce the sign of locaiizcd mass. Investigations: this is done by:- 1-U/S - simple non invasive (displays the kidney and outline) By U/S: -the cyst appears echolucent (echofree), through transmission round, very thin wall well defined mass. -a cyst shows clear echoes from the front and back wall with no intervening echoes and enhanced echoes behind the cyst. A solid lesicn also shows echoes from front and back wall but there are also numerous echoes arising within the mass. 2-TV U: -Basic sign of renal mass: 1. Bulging of the renal outline .sometimes the outline is indistinct so that the bulge can not be appreciated I. 2. Displacement of major and minor calyces. 3. Increase in renal size: particularly if the mass is at the upper or lower pole where it is bulk adds to the renal length. -having Dx the presence of a mass an attempt may be to Dx its nature.
* Sign suggesting a cyst: (or benign lesion) 1. No opacification of the mass. 2. Clear cut border between the mass and the adjacent parenchyma. 3. A claw of parenchyrna pulled out by the mass. *
Sings suggesting a malignant tumor: - 1. Opacification of any part of the mass. 2. Indistinct border between the mass and adjacent nephrogrm. 3. Any solitary mass in a young child. 4. Calcification in the mass --particularly if the calcification is more than just a thin line at the periphry -with good quality nephrotomography, it is impossible to be 85- 90% accurate in diagnosing the nature of renal mass, however the main object of the IVU is to detect renal masses since U/S cam improve the accuracy to 95% or more.
*Polycystic disease: Bilateral lesion It is autosomal dominant disease run in families ,starts at birth , but the presentation of symptoms appear in 35- 50 years old ,why at this age? Answer — because the mass will increase in size and cause pressure effect like: -Pain due to its size. -When it press on the artery-renal art stenosis —hypertension -When it press on the ureter -hydronephrosis. -When it press on the renal pelvis - that cause stone or infection. We investigate by -IVU. -U/S. -CT scan infection of the kidney : which involve : 1-Acute_pylonephritis : It is usually chic bacterial infection from organisum which enter urinary system via the urethra. Clinical feature : In childrcn:-in females especially - In males with posterior . Urethral valve that cause stagnation may lead to reflux. In adults: -diabte.s. – Steroid - stones immunocompromised patients. -catheterization 2-chronic pyelonephritis :recrrent infection ,this often bilaterally The radiological sign : 1. Local reduction in renal parenchymal with (scar formation). 2. Dilatation of the calyx in the scarred areas is the result of destruction of. the pyramid. 3. Overall reduction in renal size is partly. due local loss of renal substances and partly because the scarred areas donot grow. 4. Dilatation of the affected collecting system may be seen due to reflux. 5. Vesico-Uretr:c reflnx: may be demonstrated at micturating cystography. It is believed that scarring only occurs with severe reflux forcing infected urine into the kidney substance via the collecting ducts. the severity of the reflux diminishes as the child get older - ___ Ix: 1. U/S - not very characteristic. we see:.. —enlargement of the kidney - - -decrease , echogenicitv of the cortex because of oedema. 2. IVU — in most cases the renal function is normal In most cases the IVU is normal even during the acute attack. In very severe cases with supparation in the kidney the calyceal system is compressed by the swelling of the renal substances and the concentration of the contrast on the affected side is reduced, in a few cases no pyelogram may be seen at all, but a retrograde pylogram shows a normal collecting system CONGENITAL DISEASE OF THE KIDNEY :-
1- Horseshoe kidney: - seen by IVU, CT. Usually fusion of the lower poles of kidney, sometimes the kidney remain fused and both lie on the same side of die abdomen , this is known as : crossed fused ectopia.
2- Ectopic Kidney: - during fetal development the kidneys ascend within the abdomen and if this ascent did not happen —ectopic kidney, mostly in pelvis. Such kidney is short and travel directly to bladder. Chronic pvlonephritis . hydronephrosis and calculi are all common in cctopic kidncy. Ix-IVU
3- Urelrocele: Dilatation of the lower ureter due to narrow uretric orifice there are 2 forms: ectopic uretrocele : It is always associated with substantial obstruction , it occurs in patients with complete uretric iuplication, the ureter daahing the up, er noiety being the ore with an ectopic insertion , the dilated distal ureter may bulge into the bladder discovered in adults
4— Bifid collecting system:— Commonest congenital .. anomaly, it may be unilateral or bilateral the ureter cross the lower one and inserted near bladder neck or may be inserted outside the bladder e.g: vagina , urethra such urethra are known as ectopic & frequently get obstructec.
5- Rotated kidiiey: - one or both kidneys may point forward instead of medially , the pelvis and calices are seen more on end than usual , it may be confused with displacement by a retroperitoneal mass.
6- polycystic kidneys : Mentioned before The disease often results in hypertension and interfere with function causing renal failure. The radiological signs of polycystic disease are: Both kidneys are very enlarged with poorly visualized outlines, since the kidney is now largely composed of cyst ,the renal (utline can no longer be identified . the recognition of increased size depends largely on noting the increased distance between the calyces . The calyces are grossly streached and distorted by the cyst. • On high dose nephrotorngraphy the nephrogram may show multiple lucencies due to the cyst . the dx can be readily confirmed by U/S.
7- medullary sponge kidney. It is cystic dilatation of the collecting tubules in the pyramids are enlarged and the contrast pooling in the dilated tubules looks like a collection of dots ,rarely more than 3 mm in diameter within the papillae , calculi may form within the dilated potion of the tubules and on plain film the appearance are then indistinguishable from other causes of nephrocalcinosis. It is asymptomatic disease, unless the calculi have formed the symptoms and problems become those of calculous disease. diverticula of urinary bladder is a congenital malformation of urinary bladder which is liable for infection, stones and tumors.