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Ivu
- 1. Urinary System • Oftencalled the excretory system • • • • Two kidneys Two ureters One urinary bladder One urethra
- 2. 2 bean shapedbodies 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. Kidney Function • Removewaste products from blood • Maintain fluid and electrolyte balance • Secrete substances that affect blood pressure • How much urine excreted per day? 1 - 2 liters
- 4. Kidneys (cont’d) • Minor calycesunite 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. Kidneys (cont’d) • Essentialmicroscopic components of kidney called nephrons • How many nephrons per kidney? about 1 million
- 6. Nephrons Collecting ducts drain intominor calyx
- 7. Adrenal Glands Cannot beseen on plain radiographs Not part of urinary system Chiefly responsible for regulating stress response through adrenaline etc
- 8. Ureters • Two tubes10 - 12 “ long • Retroperitoneal • Extend from renal pelvis • Enter bladder at ureteral orifice • How is urine moved through ureters? – peristalsis
- 9. Urinary Bladder • Musculomembranous sacsituated immediately posterior and superior to symphysis pubis of pelvis • Serves as Urine reservoir
- 10. Urinary Bladder • Howmuch fluid can bladder hold? – up to 500 mL • Urethral orifice located in bladder neck • Area between ureteral openings and urethral orifices is trigone
- 11. Urethra • • • • • • • • Carries urine frombladder 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. Prostate • Gland surrounding proximalpart 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. Radiography of UrinarySystem aka Urography Radiographic investigation of renal drainage or collecting system
- 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. 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. Contraindications • Inability tofilter contrast medium from blood • Allergy to contrast • Abnormal BUN and Creatinine levels
- 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. Patient preparation: • Bowel ispurged with strong laxative and gas-absorbent tabs. • Patient should take nothing by mouth after midnight on the day of examination.
- 19. Contrast Media • Mustbe used to visualize urinary tract • Iodinated, water-soluble contrast administered intravenously to examine system • Antegrade filling
- 20. Contrast Media • Excretoryurography (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. Contrast Media andAdverse 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. Injection Procedure • • • • Obtain allergyhistory Explain exam to pt Prepare contrast and supplies (sterile tech.) Assist radiologist as necessary – or • Perform injection if IVcertified
- 23. Injection Supplies (cont.d) • • • • • • • Tourniquet IVarm 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. 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. Ureteral Compression • Appliedover distal ends of ureters • Inhibits flow of urine into bladder • Distends renal pelvis and calyces • Compression device should be centered at ASIS
- 26. Ureteral Compression • Asmuch 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. 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. Radiation Protection • Radiographeris 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. Radiation Protection • Shieldfemales when IR centered over kidneys • Rule out chance of pregnancy before examination (Emergency cases may not allow time)
- 30.
- 31. AP Projection-IVU • KUB •(All exposures at end of expiration for any urinary system study)
- 32. AP Projection- IVU(cont’d) Must include entire KUB region Should include prostatic region on older males
- 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. 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. 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. 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. AP Axial Bladder(excretory method)
- 38. AP Oblique Bladder •Pt position – 40- to 60-degree – RPO or LPO depending on physician preference
- 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. Lateral Bladder • Patientposition – 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. Lateral Bladder – Demonstrates anterior/posterior bladderwalls – Base of bladder – Any vesicovaginal or vesicorectal fistulae