The kidneys and ureters are part of the ____ system.
urinary
The organ that removes waste products from the blood is the ______
kidney
The gland that sits on the superior pole of each kidney is the ______ gland.
suprarenal
Blood vessels, nerves, and the ureter enter a kidney through an opening known as the ___
hilum
In the average (sthenic) person, the superior pole of the kidney is located at the ___ vertebral level.
T12
The microscopic functional unit of the kidney is the _____
nephron
Nephron units are found in the layer of renal tissue known as the ____
cortex
The proximal portion of a nephron consisting of a double-walled membranous cup is the ______ capsule.
glomerular
A glomerulus branches off the ____ artery.
renal
A cluster of blood capillaries surrounded by a Bowman capsule is a ________
glomerulus
The blood vessel entering a glomerular capsule is the ____ arteriole; the blood vessel leaving a glomerular capsule is the ____ arteriole.
afferent; efferent
The fluid that passes from the glomerulus to the glomerular capsule is ____
filtrate
Urine from collecting ducts drains into minor ____
calyces
Major calyces unite to form the expanded, funnel-shaped renal ____
pelvis
The long tubes that transport urine from the kidneys are the _____
ureters
Ureters transport urine from the kidneys to the ______
bladder
The musculomembranous tube that conveys urine from the urinary bladder to outside the body is the ______
urethra
The gland that surrounds the proximal part of the male urethra is the ______
prostate
Which renal structure filters the blood?
A. glomerulus
Which urinary excretory duct conveys urine from the bladder to outside the body?
B. urethra
Which body organ filters blood and produces urine as a by-product of waste material?
C. kidney
At which vertebral level is the superior border of the kidneys usually found?
D. T12
Which of the following is an excretory examination used to demonstrate the upper urinary tract?
B. intravenous urography
Which examination has the ability to produce a radiographic image demonstrating renal cortical tissue well saturated with contrast medium?
B. intravenous urography
Which projection best demonstrates the mobility of the kidneys?
D. AP projection with the patient upright
In intravenous urography, what is the purpose of applying compression pads over the distal ends of both ureters?
A. to retard the flow of opacified urine into the bladder
Which of the following is not a reason for obtaining a scout radiograph with the patient recumbent for excretory urography?
A. to demonstrate the mobility of the kidneys
For excretory urography, what should an adult patient do just before getting on the examination table?
B. empty the bladder
What is the purpose of obtaining an AP projection radiograph of the kidneys 30 seconds after the bolus injection of a contrast medium in excretory urography?
B. to demonstrate opacified renal cortex
What is the purpose of tilting the patient and table 15 to 20 degrees toward the Trendelenburg position for the AP projection during excretory urography?
D. to demonstrate distal ureters
How many degrees should the patient be rotated for AP oblique projections, posterior oblique positions, during excretory urography?
A. 30
For intravenous urography of a child, what should the patient be given when the scout radiograph shows an excessive amount of intestinal gas overlying the kidneys?
D. 12oz of a carbonated beverage
Which examination requires that the patient be placed on a special urographic-radiographic examination table?
A. Retrograde urography
Which renal structures are not demonstrated during retrograde urographic examinations?
A. nephrons
In addition to the AP projection, which projection would most likely be included in the radiographs for retrograde urography?
D. AP oblique projection
What is the purpose of tilting the table 10 to 15 degrees toward the Trendelenburg position for retrograde urography?
C. to prevent a contrast medium from escaping the kidneys
What is the purpose of raising the head of the table 35 to 40 degrees for retrograde urography?
D. to demonstrate the ureters
Which condition would most likely be demonstrated during a voiding cystography?
B. ureteral reflux
For the AP axial projection of the bladder, how many
degrees and in which direction should the central ray be directed?
B. 15 degrees caudal
For retrograde cystography, which projection should be performed to demonstrate the anterior and posterior walls of the bladder?
A. recumbent lateral projection
For cystourethrography with an adult male patient, to which level of the patient should the IR be centered?
C. pubic symphysis
For cystourethrography with an adult male patient, which of the following should be used to obtain a radiograph while the patient is urinating?
A. recumbent AP oblique projection
Write out the expanded form for VCUG
Voiding Cystourethrogram
Write out the expanded form for IVU
Intravenous Urogram
The radiographic investigation of the renal drainage system is accomplished by various procedures classified under the general term _____
urography
Which two terms refer to the excretory urogram examination?
D. intravenous urography and intravenous pyelography
How soon after the injection of a contrast medium are symtoms of a reaction most likely to occur?
Immediately or within 20 minutes
What are the preps for an IVU exam per Liz in lecture?
NPO 6 hours prior
Light bowel prep
What identification data should be included on every post-injection radiograph?
Patient data
side marker
time interval
position indicator
how long after the completion of the contrast medium injection does the contrast agent usually begin to appear in the renal pelvis?
B. 2 to 8 minutes
How long after the injection of the contrast medium does the greatest concentration usually appear within the kidneys?
B. 15 to 20 minutes
A postvoiding radiograph is usually the last radiograph taken to demonstrate which structure(s)?
A. bladder
True or false. Preliminary (scout) radiographs are most often obtained with the patient supine?
True
Which procedure should be performed if the bladder is not seen in the AP projection to demonstrate the entire urinary system?
C. make a seperate AP projection radiograph of the bladder
Into which position should the patient be placed when beginning to position for either type of AP oblique projection?
A. supine
When performing the AP oblique projection, right posterior oblique (RPO) position, which kidney will be parallel with the plane of the IR?
a. left
b. right
a. left
Approximately how many degrees should the patient be rotated from the supine position to an oblique position to demonstrate renal and urinary structures? (Pertaining to AP oblique projections)
C. 30 degrees
Which structure should be centered to the grid for the AP oblique projection, left posterior oblique (LPO) position?
B. vertebral column
To which level of the patient should the IR be centered? (Pertaining to AP oblique projections)
C. iliac crest
Where should the central ray enter the patient? (Pertaining to AP oblique projections)
B. 2 inches (5 cm) lateral to the midline on the elevated side
True or false. Retrograde urography is performed on a regular x-ray table.
False
At the beginning of the retrograde urographic examination, the patient should be placed in the modified _____ position.
C. Lithotomy
Who should inject the contrast medium in a retrograde urographic exam?
B. Urologist
List the three AP projection radiogrpahs that usually comprise a retrograde urographic examination.
Preliminary radiograph showing catheter insertion
Pyelogram
Ureterogram
Why might the head of the x-ray table be lowered 10 to 15 degrees during the retrograde pyelography procedure?
To retard the excretion of the contrast medium from the kidney, the filling of the renal pelvis is enhanced
Which retrograde urographic radiograph sometimes requires that the head of the table be elevated 35 to 40 degrees?
B. Ureterogram
After necessary AP projections are made, which oblique positions are often used for oblique projections?
A. RPO and LPO
Which breathing instructions should be given to the patient?
B. suspend breathing after expiration
What are the 5 different radiographic procedures that we learned in lecture?
IVU-intravenous urogram
Cystogram
VCUG-voiding cystourethrogram
Urethrogram
Retrograde urogram
List these from first to last if they were all ordered to be done (one is done in the OR):
IVU-intravenous urogram
Cystogram
VCUG-voiding cystourethrogram
Urethrogram
Retrograde urogram
1st-Urethrogram
2nd-VCUG-voiding cystourethrogram
3rd-Cystogram
Last-IVU-intravenous urogram
OR-Retrograde urogram
What is the prep for a Cystogram? (Liz's lecture)
Empty bladder
What is the prep for a VCUG? (Liz's lecture)
empty bladder
What is the prep for a Urethrogram? (Liz's lecture)
No prep
Name the areas of interest for an IVU. (Liz's lecture)
Kidneys
Ureter
Bladder
Name the area of interest for a Cystogram. (Liz's lecture)
Bladder
Name the areas of interest for a VCUG. (Liz's lecture)
Bladder
Urethra
Name the area of interest for a Urethrogram. (Liz's lecture)
Urethra
Name a diagnosis for having an IVU? (Liz's lecture)
Obstruction (in the ureters)
Ureteral stenosis
Name a diagnosis for having a Cystogram. (Liz's lecture)
urinary retention
reflux
Name a diagnosis for having a VCUG. (Liz's lecture)
Urinary retention
Reflux
Name a diagnosis for having a Urethrogram. (Liz's lecture)
Stenosis (blockage)
What is reflux? (Liz's lecture)
When urine goes back up the ureters
During a VCUG, does the patient void during the procedure or after the procedure? (Liz's lecture)
During the procedure
What are the 5 rights of drug administration? (Contrast Studies Article)
right drug
right amount/dosage
right patient
right time
right route
What radiographic procedure always shows hardware? (Liz's lecture)
Retrograde urogram
List some Enteral routes. (Contrast Studies Article)
oral (easiet, safest)
rectal (primarily used for large intestine)
nasogastric tubes
ostomy sites
List a Parenteral Routes. (Contrast Studies Article)
Intravenous injection (most dangerous)
Which of the following is not considered a right of drug administration?
D. right administrator
The radiologic technologist should read the medication label __ time(s) before the medication is administered to verify the right medication has been selected.
A. 3
Which laboratory values should a technologist check before administering iodinated contrast?
C. creatinine and BUN
Identifying a patient by ____ is not an acceptable practice for verifying patient identification.
A. looking at the name above the patient bed
Enteral methods of contrast administration include:
1. through ostomy sites
2. rectal
3. oral
A. 1, 2, and 3
After receiving barium sulfate as part of a small bowel series, patient should be told to ____ and that their stools may be____.
A. increase fluid/fiber intake; white colored
Patients receiving contrast through a nasogastric (NG) tube should be placed in the ____ position.
A. fowler
_____ is the most frequently occuring serious complication of a barium enema.
D. rectal perforation
Which of the following patients are not at an increased risk for rectal perforation during a contrast enema study?
A. patients who have normal bowel functions
To aid the process of tip insertion, it is recommended to insert the enema tip during ____ when the patient's abdominal muscles relax.
D. expiration
The retention balloon should only be inflated after the ____ has been inserted_____.
B. cuff; beyond the anal sphincter
When performing a barium enema, the enema bag should be hung no higher than ___ inches above the table.
C. 24 to 30
Many imaging departments and hospitals carry a ____ for contrast administration through a patient's ostomy opening.
A. colostomy irrigation kit
Which method of contrast administration is the most dangerous parental route?
A. intravenous route
Which of the following is true regarding both ionic and nonionic iodinated contrast?
C. they both contain iodine
Which of the following questions is not a typical question to ask a patient to elicit the needed information to determine iodinated contrast risk?
C. do you have a family history of cancer?
Patient reactions from IV contrast are most likely to occur ___ after injection of the contrast.
B. within the first minute
Patient side effects associated with injected ionic contrasts include ____ and a warm, flushed feeling.
C. a metallic taste in the mouth
What steps should a technologist take if a patient experiences a mild reaction after contrast injection?
1. instruct patient to breathe slowly and relax
2. monitor the patient for progression of symptoms
3. provide a cool washcloth and reassuring words
A. 1, 2 and 3
Severe reactions that are considered life-threatening include convulsions, giant hives, cardiopulmonary arrest and severe bradycardia.
a. true
b. false
b. false
Name some mild reactions to contrast.
nausea
vomiting
anxiety
lightheadedness
syncope
headache
itching
sneezing
Name some moderate reactions to contrast.
hypertension or hypotension
dyspnea
giant or excessive hives
tachycardia
mild laryngeal edema
wheezing
Name some severe reactions to contrast.
convulsions
arrhythmias
cardiopulmonary arrest
unresponsiveness
severe hypotension
severe bradycardia
What are the functions of the kidneys?
Remove waste products from the blood
Maintain fluid and electrolyte balance
Secrete substances that affect blood pressure and other important kidney functions
They also excrete urine, a life preserving function because homeostasis depends on it
Kidneys also influence blood pressure
What is the function of the urinary system?
The urinary system filters the blood and extracts from it the waste products carried in the circulatory system
Where may pathology occur in the kidneys?
Structural breakdown in the glomerulus and capsule.
Physiologic failure of the cells of the tubules.
The urinary system includes:
2 kidneys
2 ureters
1 bladder
1 urethra
Which kidney is usually slighter lareger? The right one or the left one?
Left kidney
How much fluid can an adult bladder hold?
500 mL
What is narrowing or contraction of a passage?
stenosis
What is a condition preventing normal flow of urine through the urinary system?
renal obstruction
What is fusion of the kidneys, ususally at the lower poles?
horseshoe kidney
What allows the contrast medium to enter the kidneys in the normal direction of flow?
Antegrade filling
What allows the contrast medium to enter the kidneys in against the direction of flow?
Retrograde filling
List the criteria for an AP or PA projection for an IVU or urogram
Entire renal outlines
Bladder and pubic symphysis
No motion
Short scale of radiographic contrast clearly showing contrast medium in the renal area, ureters, and bladder
Compression device, if used, centered over the upper sacrum and resulting in good renal filling
Vertebral column centered on the radiograph
No artifacts from the elastic in the patient's underclothing
Prostatic region inferior to the pubic sumphysis on older male patients
Time marker
PA projection showing the lower kidneys and entire ureters
Superimposing intestinal gas in the AP projection moved for the PA projection
List the criteria for an AP oblique projection RPO and LPO position for an IVU or urogram
Evidence of proper collimation
Patient rotated approximately 30 degrees
No superimposition of the kidney remote from the IR on the vertebrae
Entire down-side kidney
Bladder and lower ureters on 14x17 IR if patient's size permits
Time marker
List the criteria for a Lateral projection for an IVU or urogram
Evidence of proper collimation
Entire urinary system
Bladder and pubic symphysis
Short scale of contrast clearly showing contrast medium in the renal area, ureters, and bladder
No rotation of the patient (check pelvis and lumbar vertebrae)
