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Ivu

  1. 1. Urinary System • Often called the excretory system • • • • Two kidneys Two ureters One urinary bladder One urethra
  2. 2. 2 bean shaped bodies situated behind peritoneum Asymmetrical - left is slightly longer and narrower than right Why Rt kidney slightly lower than Lt kidney? Liver Lie in an oblique plane Normally extend from T-12 to L3 Kidneys
  3. 3. Kidney Function • Remove waste products from blood • Maintain fluid and electrolyte balance • Secrete substances that affect blood pressure • How much urine excreted per day? 1 - 2 liters
  4. 4. Kidneys (cont’d) • Minor calyces unite to form major calyces • Major calyces unite to form renal pelvis • Renal pelvis then drains into ureters • Hilum - longitudinal slit in medial border for transmission of blood vessels, nerves, lymphatic vessels, and ureter
  5. 5. Kidneys (cont’d) • Essential microscopic components of kidney called nephrons • How many nephrons per kidney? about 1 million
  6. 6. Nephrons Collecting ducts drain into minor calyx
  7. 7. Adrenal Glands Cannot be seen on plain radiographs Not part of urinary system Chiefly responsible for regulating stress response through adrenaline etc
  8. 8. Ureters • Two tubes 10 - 12 “ long • Retroperitoneal • Extend from renal pelvis • Enter bladder at ureteral orifice • How is urine moved through ureters? – peristalsis
  9. 9. Urinary Bladder • Musculomembranous sac situated immediately posterior and superior to symphysis pubis of pelvis • Serves as Urine reservoir
  10. 10. Urinary Bladder • How much fluid can bladder hold? – up to 500 mL • Urethral orifice located in bladder neck • Area between ureteral openings and urethral orifices is trigone
  11. 11. Urethra • • • • • • • • Carries urine from bladder to? exterior of body How long is it in females? About 1.5′′ In males? About 7′′ to 8′′ Sphincter at neck of bladder controls flow Male urethra contains following parts: – Prostate – Membranous area – Spongy area
  12. 12. Prostate • Gland surrounding proximal part of male urethra • Considered part of male reproductive system, but due to location, often described with urinary system • Prostate secretes fluid that mixes with seminal fluid to create ejaculate
  13. 13. Radiography of Urinary System aka Urography Radiographic investigation of renal drainage or collecting system
  14. 14. IVU- Intravenous Urogram ! Formerly known as IVP-Intravenous pyelogram! – pyelo refers to renal pelvis and calyces only – study also shows ureters, bladder, and sometimes urethra
  15. 15. Indications For Urography • Demonstrate physiologic function and structure of urinary system • Evaluate abd. Masses, renal cysts and tumors • Stones • Pyelonephritis (Inflammation of kidney) • Hydronephrosis (distension of renal pelvis and calyces with urine) • Effects of trauma • Pre-op evaluation • Renal hypertension
  16. 16. Contraindications • Inability to filter contrast medium from blood • Allergy to contrast • Abnormal BUN and Creatinine levels
  17. 17. Preparation Of Pt • Pt should follow low residue diet for 1-2 days prior to exam • laxative taken day before • NPO after midnight • Pts with multiple myeloma, high uric acid levels, or diabetes should be well hydrated before IVP exam – Dehydration leads to increased risk of renal failure
  18. 18. Patient preparation: • Bowel is purged with strong laxative and gas-absorbent tabs. • Patient should take nothing by mouth after midnight on the day of examination.
  19. 19. Contrast Media • Must be used to visualize urinary tract • Iodinated, water-soluble contrast administered intravenously to examine system • Antegrade filling
  20. 20. Contrast Media • Excretory urography (IVU) generally uses a 50 to 70% iodine solution • Lower concentrations for bladder studies due to large amount required to fill bladder (30%) • Non-ionic contrast is generally used – More expensive, but– Patients less likely to have reactions with nonionic
  21. 21. Contrast Media and Adverse Reactions • Crucial not to leave pt alone for first 5 minutes after injection! • Mild reactions – warmth – flushing – hives, Nausea/Vomiting, respiratory edema (accumulation of fluid in lungs) • Severe reactions – Anaphylactic shock (sudden allergic response associated with a sudden drop in blood pressure and difficulty breathing). Can lead to death in a matter of minutes)
  22. 22. Injection Procedure • • • • Obtain allergy history Explain exam to pt Prepare contrast and supplies (sterile tech.) Assist radiologist as necessary – or • Perform injection if IVcertified
  23. 23. Injection Supplies (cont.d) • • • • • • • Tourniquet IV arm board Towels Emergency kit Alcohol wipes, swabs Contrast 19-22 G needle, butterfly or angiocath for infusion • Extension tubing • Tape or clear-type dressing
  24. 24. IVU Procedure • Scout – KUB • Contrast is injected • Timed sequence of films obtained until bladder begins to fill– Immediate image of kidneys – 5 minute image of abd. or kidneys – Compression applied
  25. 25. Ureteral Compression • Applied over distal ends of ureters • Inhibits flow of urine into bladder • Distends renal pelvis and calyces • Compression device should be centered at ASIS
  26. 26. Ureteral Compression • As much compression as pt can tolerate! • Should not be applied when: – stones, abd. mass or aneurysm, colostomy, suprapubic catheter, recent abd. surgery or trauma • (Because of improvement of contrast agents, compression no longer generally used) (cont’d)
  27. 27. IVU Procedure cont’d • Tomograms are obtained once bladder is filled – Pt is measured, divide number by 3, cuts begin there • Pt. measures 30cm, beginning cuts at 10cm • Release compression slowly • Have pt void, and obtain post-void film
  28. 28. Radiation Protection • Radiographer is responsible! • Gonadal shield - if it does not interfere with examination objective • Close collimation • Avoid repeat exposures • Shield males for all urinary studies, except when urethra is of primary interest
  29. 29. Radiation Protection • Shield females when IR centered over kidneys • Rule out chance of pregnancy before examination (Emergency cases may not allow time)
  30. 30. Radiographic Positions IVU
  31. 31. AP Projection-IVU • KUB • (All exposures at end of expiration for any urinary system study)
  32. 32. AP Projection- IVU (cont’d) Must include entire KUB region Should include prostatic region on older males
  33. 33. AP Projection Variations • Trendelenberg – Lower head 15 - 20 degrees – Helps demonstrate lower ureters • Upright – Center lower - organs change position • Prone – Demonstrates ureteropelvic region – Fills obstructed ureter in cases of hydronephrosis (distension of renal pelvis and calyces with urine)
  34. 34. AP Oblique Projections - RPO/LPO • Patient is supine • Patient rotated to 30 degrees • CR to iliac crest, 2 in. lateral to midline – Center to side up
  35. 35. AP Oblique Projections - RPO/LPO • Elevated kidney will be parallel to cassette • Kidney closest to cassette will be perpendicular • Entire KUB region must be included
  36. 36. AP Axial Bladder • CR( similar to coccyx projection) – Angled 10 to 15 degrees caudad to center of IR – Enters 2′′ above upper border of pubic symphysis
  37. 37. AP Axial Bladder (excretory method)
  38. 38. AP Oblique Bladder • Pt position – 40- to 60-degree – RPO or LPO depending on physician preference
  39. 39. AP Oblique Bladder CR – Perpendicular to center of IR – CR 2′′ above upper border of pubic symphysis and 2′′ medial to upper ASIS – If bladder neck and proximal urethra is of interest, 10-degree caudal angle of CR will project pubic bones below them
  40. 40. Lateral Bladder • Patient position – Lateral recumbent, right or left side • Part position – Knees flexed – MCP aligned to midline • CR to midcoronal plane at 2 in. above symphysis pubis
  41. 41. Lateral Bladder – Demonstrates anterior/posterior bladder walls – Base of bladder – Any vesicovaginal or vesicorectal fistulae

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