Abdominal Ultrasound- Part 1 – quizzes for starter

   For those who are writing the SPI- Ultrasound physics exam. I have notes for sale it is about 1500  multiple choices sets for ARDMS -spi exam = 50 USA DOLLARS. I study those notes and passed my exam 670/700 . If you want to buy i can copy the notes and send them to you in e mail or by mail   you can reach me atdrsteveramsey@gmail.com . I will also include some of the ideas about the 12 simulation questions.  The payment with  PayPal      to drsteveramsey@gmail.com ,  fetal gender , Saad Ismail   

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These 50 ABD US  question of abdominal us anatomy for ardms starter.

http://drsquiz.com.au/quizzes/living-anatomy-with-ultrasound/living-anatomy-with-ultrasound–abdomen-quiz-1-50-qu/

also must read these guide lines for the abd us ardms test; log to this site

https://books.google.ca/books?id=1sgzJozepOsC&pg=PR17&lpg=PR17&dq=www.abdominal+ultrasound+exam+free+quiz+questions&source=bl&ots=F1g3u5lJtv&sig=ys5P9w0EMrWHk4Y2pe52-W-sWMw&hl=en&sa=X&ved=0ahUKEwjEhJ2As4nKAhUDkx4KHY6gAJIQ6AEISTAJ#v=onepage&q&f=false

These are some of the mc questions to check yourself for abdominal us.

Schistosomiasis

-One of the most common parasitic infections in humans & major cause of portal hypertension in endemic areas 
– eggs react liver via portal vn inciting granulomatous resulting in peri portal fibrosis
-U/S: occluded intrahepatic portal vn, thickening and increased echogenicity of portal

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Acute Hepatitis

-this form of hepatitis is known as “starry night” 
-hypoechoic enlarged liver
-can cause elevated ALT,AST, conjugated and unconjugated bilirubin

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Chronic Hepatitis

This form of hepatitis causes liver to become hyperechoic and small with decreased echogenicity of portal walls

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Sonographic findings related to AIDS

What DZ is associated with: Pneumocystis carinii, fatty liver infiltration, hepatomegaly, hepatitis, Non-hodgkin’s Lymphoma, Candidiasis, Cholangitis, Acalculous Cholecystitis, and Kaposi’s Sarcoma?

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Pneumocystis carinii and it causes diffuse, non-shadowing, hyperechoic foci.

What is the most common organism causing infection in AIDS patients and what effect does it have on the liver?

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Fatty Infiltration

this is the accumulation of triglycerides within hepatocytes.

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Glycogen Storage Dz

genetically aquired disorder that results in excessive deposition of glycogen in the liver. It is associated with fatty infiltration and hepatic adenomas.

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Focal fatty infiltration, cavernous hemangiomas, echogenic metastasis, or hepatic lipoma.

What could be a differential diagnosis of hyperechoic masses within the liver include?

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Cirrhosis

What is a diffuse process of fibrosis and distortion of normal liver architecture. With this Dz there is initially liver enlargement then with repeated insult, liver atrophy occurs along with portal hypertension an hepatic encephalopathy.

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Hepatitis C

What is the leading cause nation wide

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>13mm

What portal diameter is suggestive of portal hypertension?

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True

T/F ? Does cirrhosis patients have a high incidence of HCC?

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Caput Medusa

What are tortuous collaterals seen around the umbilicus called?

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Hepatofugal

What direction is normal for the RPV and LPV to travel in a patient with a TIPS?

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Biliary atresia

What would be an indication/reason for a child to need a liver transplant?

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Cavernous transformation of PV

What are seen as numerous worm-like venous collaterals that are parallel to a thrombosed portal vein called?

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Budd-Chiari Syndrome

What is a disorder that is typically seen in young females on BCP, that causes hepatic vein obstruction by thrombus or tumor invasion called?

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Portal Vein Gas

What condition is associated with Ischemic bowel Dz, where air is noted within the intrahepatic portal vein?

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Necreotizing entercolitis

What is intrahepatic portal vein gas in infants due to?

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Liver cysts

What is a fluid-filled space lined by biliary epithelium found in liver called? (anechoic, thined walled, and acoustic enhancement)

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Kidneys (autosomal dominant poly cystic kidney dz)

What should be evaluated if liver cysts are found in someone younger than 50?

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Hemangioma

What most common benign tumor of the liver?

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Cavernous hemangioma

What is the most common benign tumor of the liver?

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Hemangioma

What is made up of multiple vascular channels that appear as a hyperechoic mass with posterior enhancement?

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Focal Nodular Hyperplasia

Benign solid liver mass with central scar, that is a hyper plastic lesion related to an area of congenital vascular malformation? Is more common in women than men.

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Hepatic adenoma

Associated with BCP and gylcogen storaged dz and can cause pain due to tumor hemorrhage. Also has potential for malignant transformation.

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Hepatic Lipoma

What is a rare fatty tumor that is hyperechoic mass with a propagation speed artifact.

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HCC

What is the most common primary malignancy of the liver?

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Gastrointestinal tract

Hyperechoic mets source is?

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Lymphoma

Hypoechoic mets source is?

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Lung

Bull’s eye or Target mets source is?

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Mutinous adenocarcinoma

Calcified mets source is?

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Sarcoma

Cystic metastases source is?

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Hepatoblastoma

What is the third most common intr-abdominal childhood malignancy after adrenal neurolastoma and Wilm’s disease?

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Duct of Wirsung

What is the main pancreatic duct that the CBD drains into called?

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Posterior

How does the CBD travel in reference to the 1 part of the duodenum and pancreatic head?

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>3mm

Gallbladder wall thickness greater than what is considered abnormal?

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Tumefactive sludge

What is organized sludge balls called?

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Hemolysis (RBC breakdown)- sickle cell anemia or spherocytosis

What are some pre-hepatic causes of jaundice (Hemolytic Jaundice)?

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Hepatitis, biliary cirrhosis, Gilbert’s syndrome () , or Crigler-Najjar syndrome()

What are some hepatic causes of jaundice that reduces the livers ability to metabolize bilirubin?

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Choledocholithiasis, Pancreatic Ca, bile duct stricture, biliary atresia, cholangiocarcinoma, Mirizzi syndrome

What are some post-hepatic causes of jaundice ( obstructive jaundice) ?

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Cholesterol, calcium bilirubinate, or calcium carbonate

What can gallstones be made up of?

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True

T/F Does the CBD travel slightly lateral and anterior to the MPV?

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Sphincter of Oddi

What regulates bile flow into the duodenum at the Ampulla of Vater?

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Cholecystokinin

What is released from duodenal mucosa after a fatty meal that stimulates the Gb to contract and sphincter of Oddi to relax?

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Biliary atresia

What is the progressive obliteration of extra & intra hepatic ducts as well as the GB within the first 2 weeks of life called?

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Choledochocele

This forms when a section of CBD has entered the duodenum and enlarges. (ureterocele)

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Courvoisier GB

This type of Gb dz is characterized by an enlarged, palpable Gb resulting from distal obstruction of CBD 2nd to pancreatic head mass?

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Klatskins Tumor

This is a type of cholangiocarcinoma, and adenocarcinoma of the CHD birfurcation.

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Hydrops of Gb

What Gb pathology is also known as a mucocele, which is a round, non inflamed Gb due to cystic duct obstruction that leads to bile reabsorbtion and a Gb filled with anchovy secretions?

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>5cm

What trv diameter measurement of Gb is suggestive of Gb Hydrops?

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Cholesterolosis

What Gb pathology is known to deposit lipids in the Gb walls? Also known as “strawberry Gb”.

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Adenomyomatosis

This causes by plastic changes in Gb wall causing overgrowth of muscosa, thickening of wall, and diverticula.

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RAS- Rokitansky-Aschoff sinuses

What are diverticula within Gb wall that can accumulate stones and sludge called?

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Endoscopic retrograde cholangiopancreatogram-ERCP

What does the test ERCP stand for, which is used to evaluate Gb function?

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Mirizzi Syndrome

What causes extra hepatic biliary obstruction due to an impacted stone in the cystic duct cashiering compression of the CHD called?

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Emphysematous cholecystitis

What pathology is found more commonly in diabetic men, where gas is found In the wall of the Gb,the Gb lumen or biliary tree?

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Empyema of Gb

What is it called when purulent material is found within Gb due to bacteria-containing bile associated with acute cholecystitis?

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Choangitis

What is it called when a bacterial infection is superimposed on an obstruction of the biliary tree?

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Pneumobilia

What is air in the biliary Tract called?

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Choledochal cysts

Congential bile duct anomaly consisting of cystic dilatation of intra and extra hepatic ducts?

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Caroli’s disease

What is a congenital anomaly of the biliary tract that has mulifocal segmental dilatation of INTRAHEPATIC bile ducts?

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Primary sclerosing choleangitis

What is an inflammation and fibrosis of the intrahepatic and extra hepatic bile ducts, which leads to liver failure and transplant

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Primary biliary cirrhosis

What is a chronic and progressive cholestasis due to destruction of the small intrahepatic bile ducts leading to end-stage liver disease?

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Exocrine

What function of the pancreas is to secrete trypsin, lipase, and amylase through the ducal system?

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Endocrine ( non-ductal)

What function of the pancreas is to secrete insulin via the islets of Langerhans?

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Anterior

Head of pancreas is where in relation to the IVC?

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Medial

Head of pancreas is where in relation to the duodenum?

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Anterior and medial

Tail of pancreas is where in relation to the splenic hilum?

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Posterior and lateral

CBD is located where on pancreatic head?

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Anterior and lateral

GDA is located where on pancreatic head?

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Posterior to the pancreatic neck and anterior to the uncinate process

The SMV and SMA are located where in relation to the pancreatic neck? Uncinate process?

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Posterior

Aorta is located where to the body of the pancreas?

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Superior

Celiac axis arises from aorta at what border of the pancreas?

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Inferior

SMA arises from aorta at what border of the pancreas?

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Left gastric artery, splenic artery, and common hepatic artery

What are the branches of the celiac axis?

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Superior border of body and tail

What path does the splenic artery follow in relation to the pancrea?

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Proper hepatic Artery and GDA

What does the common hepatic artery branch into?

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Anterior to MPV and to the left of the CBD

Proper hepatic artery travels where in relation to the portal vein? CBD?

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Phlegmon

What is a spreading inflammatory reaction to an infection which forms a suppurating lesion called?, a spreading inflammatory reaction to infection that can form multiple pus pockets

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Acute- enlarge & hypo / chronic – small & echogenic

What sonographer findings differentiaite acute vs chronic pancreatitis?

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Von Hippel-Lindau syndrome

This is a rare genetic disease that causes rumors or cysts to form in the body, which may be malignnant or benign.

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Multiple Endocrine neoplasia (MEN-1)

This is and inherited endocrine disorder that is categorized into type 1 (Wermer syn) and type 2 (Sipple’s syn), with the most common sites of involvement being: parathyroids, pancreatic islets cells, pituitary gland, adrenal glands, and thyroid.

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Insulinoma

This is the most common islet cell tumor which is usually benign and causes hypoglycemia.

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Gastrinoma

This is the second most common islet cell tumor that causes gastric acid hyper secretion and gastric and duodenal ulcerations

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MRA–Segmental–Interlobar–Arcuate–Interlobular

What is the branching of the renal blood supply starting at the hilum with the MRA?

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Pelvic/Ectopic kidney

What is it called when the kidneys fail to ascend into the abdomen?

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Horseshoe kidneys

What’s the most common fusion anomaly in which the lower poles of the kidneys typically connect across midline anterior of the aorta?

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Crossed fused ectopic kidney

This occurs when the developing kidneys fuse in the pelvis and one kidney ascends to its normal position, carrying the other kidney with it across midline.

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Dromedary Hump

What is a common variant of cortical thickening on the lateral aspect of the left kidney referred to as?

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Junctional parenchymal defect (aka fetal lobulation)

This is a triangular hyperechoic area on the anterior aspect of the upper pole of the right kidney.

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Duplex kidney

This is a duplication of the renal collecting system.

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Posterior Uretheral Valve

This is a common urinary obstruction in the male neonate. this is due to obstruction of the prostatic urethra

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Multicystic dysplastic kidney

What is the most common cause of an abdominal mass in newborns?

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Multicystic dysplastic kidney

This is a non-functioning kidney that consists of non-communicating cysts that is a result of atresia of the uropelvic junction.

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Medullary sponge kidney

Congenital dysplasic cystic dilatation of the medullary pyramids due to tubular ectasia or dysplasia.

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Von Hippel-Lindau Disease

Inherited disease which usually presents in people’s 20s or 30s with serious visual impairment.

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Angiomyolipoma

This is a benign fatty renal tumor that’s hyperechoic and is 80% of the time found in the right kidney.

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Tuberous Sclerosis

This is a multi-system disease that causes seizures, mental retardation, and facial angiofibromas. Patients with this are at an increase incidence for renal cysts and bilateral angiomyolipomas.

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Renal cell carcinoma

This is the most common solid renal mass in the adult that is a hypoechoic, unilateral encapsulated mass. Tumor extension into renal veins and IVC are common.

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Wilm’s Tumor

This is the most common childhood renal tumor with a mean age of diagnosis at 3.5 years.

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Leukemia (35%)

What type of pediatric cancer has the highest incidence?

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Acute pyelonephritis

What is a renal infection that is caused by gram (-) bacilli from intestines called? It causes renal enlargement, hypo parenchyma, and. Absence of sinus echoes.

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Acute focal bacterial nephritis or lobar nephonia

What is it called when acute pyelonephritis is focal causing a focal wedge-shaped hypoechoic area in kidney?

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Emphysematous pyelonephritis

This is a bacterial infection associated with renal ischemia that more commonly affects diabetics and immunocompromised patients.

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Xanthogranulomatous Pyelonephritis

Type of chronic pyelonephritis resulting from chronic infection due to a lone term obstruction. Usually associated with a staghorn calculus.

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Mycetoma (fungal balls)

This is a renal fungal infection that results from hematogenous seeding or ascending from the bladder and forming hyperechoic non-shadowing masses in kidney.

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Pyonephrosis

Purulent material in the collecting system of kidney associated with an infection secondary to renal obstruction. Look for hyperechoic debris in pelvis or fluid-fluid level.

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Changes in serum creatinine which reflects changes in glomerular filtration rate

What is the most accurate method of determining ARF?

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Acute Renal Failure (ARF)

What causes an abrupt decrease in renal filtration marked by an increase in serum creatinine and BUN (azotemia)?

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Acute tubular necrosis

What is the most common cause of medical renal disease?

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Uretrovesical junction

What is the most common area of obstruction by a stone of the kidneys to be found?

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Nephrocalcinosis

Disorder of calcium metabolism (hypercalcemia or hypercalciuria) that results in the formation of calcium stones and deposition of calcium salts internal parenchyma.

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Papillary Necrosis

Ischemia of the medullary pyramids which results in sloughing papilla found in urine.

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Renal sinus lipomatosis

Increased renal sinus fat that replaces the normal renal parenchyma.

Steve Ramsey.PhD,  Calgary- Canada.

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