Urinary system 1
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Transcript of Urinary system 1
Advance Radiographic Advance Radiographic TechniqueTechnique
Urinary tract investigationsUrinary tract investigations
11 / /I.V.UI.V.U
22 / /Retrograde pyelogramRetrograde pyelogram
33 / /AntegradeAntegrade
44 / /CystogramCystogram
55 / /UrethrogramUrethrogram
66 / /MCUGMCUG
77 / /AngiographyAngiography
Anatomy of the urinary Anatomy of the urinary systemsystem
11 / /two kidneystwo kidneys
22 / /two ureterstwo ureters
33 / /urinary bladder + urethraurinary bladder + urethra
Anatomy of the urinary Anatomy of the urinary systemsystem
Anatomy of the urinary Anatomy of the urinary systemsystem
Intravenous urography (IVU)Intravenous urography (IVU)
Contrast examination for urinary tractContrast examination for urinary tract
IndicationsIndications
a. Congenitala. Congenital
b. Acquiredb. Acquired
Contra indicationContra indication
a. Absolute contra indicationa. Absolute contra indication
b. Relative contra indicationb. Relative contra indication
Contrast mediaContrast media
11 / /UrographinUrographin
22 / /OmnipaqueOmnipaque
33 / /OthersOthers
Patient preparationPatient preparation
11 / /Caster oilCaster oil
22 / /DisflytealDisflyteal
33 / /EucarbonEucarbon
44 / /light dietlight diet
55 / /patient fasting at least 4hrs before patient fasting at least 4hrs before the procedurethe procedure
Before to start the Before to start the procedureprocedure
11 / /Check the Check the ultrasound reportultrasound report
22 / /Check the blood Check the blood ureaurea
Before to start the Before to start the procedureprocedure
The patient should void just before the The patient should void just before the examination for the following two examination for the following two reasonsreasons::
11 / /a bladder that is too full could a bladder that is too full could rupture, especially if compression is rupture, especially if compression is applied early in the examapplied early in the exam..
22 / /urine already present in the bladder urine already present in the bladder dilutes the contrast mediumdilutes the contrast medium..
Procedure of routine normal Procedure of routine normal IVUIVU::
11 / /plain filmplain film
Procedure of routine normal Procedure of routine normal IVUIVU::
* *Insertion of butter Insertion of butter flyfly
* *Injection of contrast Injection of contrast mediamedia
Procedure of routine normal Procedure of routine normal IVUIVU::
22 / /Immediate film Immediate film (nephrogram film)(nephrogram film)
Procedure of routine normal Procedure of routine normal IVUIVU::
33 / /Early excretion Early excretion film (5 min)film (5 min)
Procedure of routine normal Procedure of routine normal IVUIVU::
* *CompressionCompression
Procedure of routine normal Procedure of routine normal IVUIVU::
Compression is contraindicatedCompression is contraindicated::
. .After recent abdominal surgeryAfter recent abdominal surgery
. .After renal traumaAfter renal trauma
. .If there is a large abdominal massIf there is a large abdominal mass
. .When the 5 min film shows already When the 5 min film shows already distended calycesdistended calyces
. .Patient with IVC filterPatient with IVC filter
Procedure of routine normal Procedure of routine normal IVUIVU::
44 / /1010 min film for min film for p.c.s & upper p.c.s & upper ureterureter
Procedure of routine normal Procedure of routine normal IVUIVU::
55 / /Release film to Release film to show the whole show the whole urinary tract urinary tract including the full including the full bladderbladder
Procedure of routine normal Procedure of routine normal IVUIVU::
66 / /full bladder filmfull bladder film
Procedure of routine normal Procedure of routine normal IVUIVU::
77 / /post micturition post micturition filmfilm
IVU with less films which IVU with less films which means less radiationmeans less radiation
11 / /IVU in pregnancy (not early IVU in pregnancy (not early pregnancy)pregnancy)
22 / /IVU in follow upIVU in follow up
33 / /IVU in emergencyIVU in emergency
Some time in childrenSome time in children
IVU with less films which IVU with less films which means less radiationmeans less radiation
* *Plain filmPlain film
* *1515 –– 2020 min filmmin film
. .No compressionNo compression
. .No compression and no preparation in No compression and no preparation in pregnancy and emergencypregnancy and emergency..
Extra films/ extra radiationExtra films/ extra radiation
11 / /IVU in renal hypertensionIVU in renal hypertension..22 / /obstruction or stricture ( we take delayed obstruction or stricture ( we take delayed
films) afterfilms) after: : 1/2hr1/2hr
1hr1hr 2hrs2hrs 6hrs6hrs
12hrs12hrsIf no function we take retrograde If no function we take retrograde pyelographypyelography . .
Retrograde pyelograpgyRetrograde pyelograpgy
If the IVU fails to show P.C.S and upper If the IVU fails to show P.C.S and upper ureterureter..
Retrograde pyelograpgyRetrograde pyelograpgy
Contra indicationContra indication
11 . .Infection of the lower UTInfection of the lower UT..
22 . .Large vesical or urethral stoneLarge vesical or urethral stone..
Retrograde pyelograpgyRetrograde pyelograpgy
Contrast mediaContrast media
Diluted water soluble CMDiluted water soluble CM
Retrograde pyelograpgyRetrograde pyelograpgy
ProcedureProcedure The Pt comes with catheterThe Pt comes with catheter::
11 . .Plain KUB to show the position of the Plain KUB to show the position of the catheter and radiopaque calcificationcatheter and radiopaque calcification..
**injection of the CM (under screening)injection of the CM (under screening)22 . .Pt supine head down to fill the PCSPt supine head down to fill the PCS..33 . .Raised Pt head and take radiograph Raised Pt head and take radiograph
for ureter and pulling the catheter outfor ureter and pulling the catheter out..
Retrograde pyelograpgyRetrograde pyelograpgy
Retrograde pyelograpgyRetrograde pyelograpgy
CASESCASES