Genitourinary System Imaging- Based Overview of Anatomy and Embryology. Sameer Ahmed, MS IV 9/8/11
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1 Genitourinary System Imaging- Based Overview of Anatomy and Embryology Sameer Ahmed, MS IV 9/8/11
2 ObjecDves Review very high- yield concepts Anatomy test + USMLE Step 1 GU Embryology How it relates directly to common pathology Radiographic imaging Brief overview of normal and abnormal findings
3 Overview 2 Main topics: Urinary system ReproducDve system Both develop from the intermediate mesoderm Excretory ducts of both systems à cloaca
4 Part One: URINARY SYSTEM
5 4 th week Cranial to caudal Nephrotomes Forms and regresses within 1 week Mesonephros developing Pronephros TW Sadler, Langman s Medical Embryology 9 th Edition, 2004
6 Mesonephros Glomerulus at medial end Bowman s capsule around glomerulus Mesonephric duct laterally Urogenital ridge Gonadal ridge Disappears by 2 nd month in females ParDally remains in males to form genital system TW Sadler, Langman s Medical Embryology 9 th Edition, 2004
7 Metanephros Permanent kidney 5 th week Metanephros = Glomerulus to distal convoluted tubule Ureteric bud = collecdng ducts, major/minor calyces, renal pelvis, and ureter TW Sadler, Langman s Medical Embryology 9 th Edition, 2004
8 Molecular RegulaDon Epithelial- Mesenchymal interacdons Epithelium of the ureteric bud from the mesonephros interacts with the mesenchyme of the metanephric blastema Complex two- way signaling process of reciprocal inducdon. TW Sadler, Langman s Medical Embryology 9 th Edition, 2004
9 Renal Anatomy hzp:// hzp://
10 Ureters Retroperitoneal Crosses posteriorly to gonadal vessels Crosses bifurcadon of the common illiac art. ObstrucCon points: - Ureteropelvic jnct. - Pelvic brim over distal end of common illiac - Ureterovesicular jnct. hzp://imueos.wordpress.com/page/13/
11 Kidney- Ureter- Bladder (KUB) hzp://fi.wikipedia.org/wiki/tiedosto:kub_stone.jpg
12 CT Urogram: Non- contrast
13 CT Urogram: CorDcomedullary Phase
14 CT Urogram: Nephrographic Phase
15 CT Urogram: Excretory Phase
16 CT Urogram: Excretory Phase ajronline.org radiographics.rsna.org
17 MPR and 3D ReconstrucDons
18 MPR and 3D ReconstrucDons hzp://
19 CT Angiogram
20 Renal Ultrasound
21 What s Abnormal?
22 Wilms Tumor Typically in children MutaDon in WT1 gene on chromosome 11 Defect in reciprocal induccon system WAGR syndrome: - Aniridia - Hemihypertrophy - Wilm s tumor
23 PoZer s Sequence MalformaDon of the ureteric bud Bilateral renal agenesis Oligohydramnios Limb deformades Facial deformades Pulmonary hypoplasia
24 What s Abnormal?
25 PosiDon of Kidney TW Sadler, Langman s Medical Embryology 9 th Edition, 2004
26 What s Abnormal?
27 Braveheart, Paramount Pictures, 20 th Century Fox
28 What s Abnormal?
29 Horseshoe Kidney Which vascular structure would prevent its ascent into the abdomen?
30 Horseshoe Kidney
31 Division of the Cloaca 5 th Week 7 th Week 8 th Week TW Sadler, Langman s Medical Embryology 9 th Edition, 2004
32 Urogenital Sinus Undifferentiated Male TW Sadler, Langman s Medical Embryology 9 th Edition, 2004
33 Urethra Urethral epithelium from endoderm Everything else is splanchnic mesoderm ProliferaDon of the prostacc urethra in 3 rd month - Male: prostate gland - Female: urethral and paraurethral glands TW Sadler, Langman s Medical Embryology 9 th Edition, 2004
34 Urachal fistula: persistent allantois - Urine drains from umbilicus Urachal cyst: Part of allantois persists and secretes fluid resuldng in cysdc diladon Bladder Defects
35 Bladder Defects
36 Bladder Defects
37 Bladder Defects Bladder exstrophy: ventral body wall defect in which the bladder mucosa is exposed
38 Part Two: REPRODUCTIVE SYSTEM
39 Gonads No M/F disdncdon Dll week 7 Genital ridge: epithelium and mesenchyme Germ cells in ridge around week 6 TW Sadler, Langman s Medical Embryology 9 th Edition, 2004
40 Primordial Germ Cell MigraDon Travel: yolk sack (wk 3) à genital ridges (wk 6) Gonads only develop if cells arrive (inducdon) PrimiCve sex cords form prior to arrival of cells Week 3 Week 6 TW Sadler, Langman s Medical Embryology 9 th Edition, 2004
41 Influence of Primordial Germ Cells TW Sadler, Langman s Medical Embryology 9 th Edition, 2004
42 TesDs Development TesCs Cords: form from primidve sex cords Rete TesCs: at hilum of gland Tunica albuginea: thickens to separate tesds cords from surface epithelium Sertoli cells: derived from surface epithelium and lie between tesds cords IntersCCal cells of Leydig - Produce testosterone
43 Influence of Primordial Germ Cells TW Sadler, Langman s Medical Embryology 9 th Edition, 2004
44 Influence of Primordial Germ Cells TW Sadler, Langman s Medical Embryology 9 th Edition, 2004
45 Ovary Development PrimiDve sex cords replaced by vascular stroma Surface epithelium proliferates to form corccal sex cords Sex cordsà cell clusters (4 mo) PrimiDve germ cells develop into oogonia (5 mo) Epithelial cellsà follicular cells
46 Genital Duct Development TW Sadler, Langman s Medical Embryology 9 th Edition,
47 Internal Genitalia at Glance
48 What you should know!
49 What s Abnormal?
50 Uterine and Upper Vaginal DuplicaDons radpod.org
51 Uterine and Upper Vaginal DuplicaDons radpod.org
52 External Genitalia Development Male: Dihydrotestosterone -Genital tubercle becomes the glans penis -Urethral folds become the phallus -Labioscrotal swellings become the scrotum. Female: Estrogen -Genital tubercle becomes the clitoris -Urethral folds become the labia minora -Labioscrotal swellings become the labia majora
53 Defects in Male Genitalia Hypospadias: -Failure of urethral folds to close Epispadias: -Faulty positioning of genital tubercle -Associated with bladder exstrophy
54 Descent of Testes Gubernaculum azached at caudal pole of tesds Factors controlling descent: - Increased intra- abdo pressure - Shortening of gubernaculum Deep & superficial inguinal rings Processus vaginalis Inguinal canal allows passage into scrotum
55 Layers of TesDs Some Damn Englishmen Call It Testes Skin, Dartos, External sprematic fascia, Cremaster muscle, Internal spermatic fascia, Tunica vaginalis
56 Clinical Correlates Indirect inguinal hernia: lateral to IE artery Failure of processus vaginalis to close IntesDnes pass through both rings into scrotum Usually seen in male infants Direct inguinal hernia: medial to IE artery IntesDnes pass directly through abdominal wall Through superficial inguinal ring only Covered by external spermadc fascia Hydrocele: Processus vaginalis open, cysts form, cysts secrete fluid that builds up
57 Clinical Correlates
58 QuesCons? Med School Advice: - Buy a copy of First- Aid for USMLE Step 1 now à learn over two- year period - Read Apps of Steel by Donna Magid ( and plan ahead - Use VerCcal Advisory: Deans, College Advisors/Dr. Magid, and other students - Have fun in med school the Cme flies by! Futurama, Matt Groening, 20 th Century Fox Television
59
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