8.2 TB, Bilharzia, Prostatitis, Intestinal Cystitis, HIV Flashcards
Which organ is the most common site for extra-pulmonary TB
Kidney (Urogenital tract)
Mechanism spread of TB to UT
- hematogenous spread: primary, millary TB, reactivation TB
Regional lymph nodes -> Bacilli -> thoracic duct -> bloodstream -> kidneys, epididymis, prostate ->
(1) kidney - direct spread to collecting system (calyces, renal pelvis, ureters, bladder)
(2) prostate/epipdidymis - spreads contigously to seminal vesicles, vas deferens, testis
What are the two common anatomical changes caused by UGTB?
- urinary collecting system (calcyces, renal pelvis, ureters, bladder)
- renal parenchyma (causing granulomas and total destruction of kidney by primary infection)
What are some of the morphologic features of UGTB in adrenal glands, kidneys, ureters and urinary bladder?
Adrenal glands
- acute adrenalitis (enlargement)
- adrenal calcification (diffuse and focal)
Pelvicalyceal system
- urothelial thickening
- “moth-eaten” calyx
- papillary necrosis
- calyceal blunting
- papilitis
- infundibular stenosis
Renal parenchyma
- pyelonephritis
- cortical abscess rupturing into perinephric space & collecting system
- lobular calcification / putty kidney (auto-nephrectomay)
- miliary TB
- cortical scarring
Ureters
- hiked-up pelvis (Kerr kink)
- stricturing or bending of ureters
- granulation or intravesical septa causing ureterovesical obstruction
Bladder
- thimble bladder
- urethral stricture
Causes of papillary (medullary) necrosis?
Differential Diagnosis
- TB
- DM
- analgesic abuse (aspirin)
- UTI (vesico-ureteric reflux)
- sickle-cell anaemia
What are common pathology caused by UGTB in male genital tract TB (prostate, SV, vas deferens, epididymis, testis)
- Chronic epididymitis (palpable nodules, hardening, scrotal fistula)
- Fibrosis of vas deferens (palpable)
- Prostate involvement = subclinical
What are the endemic areas in SA for Bilharzia?
- Limpopo
- Mpumalanga
- Lower-lying and costal regions if KZN
- Eastern parts of Easten Cape
By what is Bilharzia caused?
Schistosoma Haematobium and it’s eggs
How do you pick up Bilharzia?
- Being in contact with contaminated tropical freshwater sources
- containing Bulinus snail and pollution of human waste
NB Life cycle of Bilharzia
- Human excreting eggs in urine/feces
- freshwater
- eggs hatch and release micracidia
- m penetrate snail tissue
- sporocysts develop in snail
- free swimming cercariae released from snail into water
- penerate skin
- lose tail during penetration -> schistosomulae
- Circulation of human
- Portal blood in liver: mature to adults
- Paired adult worms migrate to :
(1) mesenteric venules of bowel/rectum {eggs shed in faeces}
(2) venous plexus of bladder {eggs shed in urine}
Pathology caused by Bilharzia:
Acute changes
- cercarial dermatitis (“swimmers itch”)
- inflam reaction in bladder & distal ureters (eosinophil & plasma cell infiltrate with viable ova)
Chronic changes
- Fibrosis and calcification in bladder and ureteric walls (“sandy patches”)
Complications of chronic changes in Bilharzia:
Bladder:
- recurrent sec bacterial infec
- small baldder capacity
- bladder calculi
- squamous metaplasia (-> SCC)
Ureters:
- atony (dysfunctional peristalsis)
- vesico-ureteric reflux
- ureteric strictures
- obstructive renal fail due to obstruction
What is Prostatitis and how do we classify it?
- Inflam of prostate gland
Classification:
- Acute bac
- Chronic pac
- Non-bac chronic
Acute bacterial Prostatitis (ABP)
General
Caused by
Symptoms
- uncommon
- makes pt most sick (will require hospitalisation)
- gram - bac (E. coli, Enterobacter)
- urological emergency (acutely ill, localized + systemic sym)
Caused by:
- ascending infec from urethra
- reflux urine into prostate
- direct extension or lymphatic spread from rectum
Sym
- Acute pain
- referred pain to lower back and scrotum
- fever
Chronic bacterial Prostatitis (CBP)
General
Cause
Aetiology
- more common
- recurrent bladder infection
- due to inflam (not organism)
Cause:
- prim voiding dys (anatomical or functional)
- E coli
- resistant to empiric antibiotics: STI’s (Clamydia, Ureaplasma, Trichomonas vaginalis)
- MTB
- HIV
Aetiology
- Unknown
- Reflux urine into prostatic acini (chem induce inflam)
- Stress and anxiety (⬆️ sympath stim -> ⬆️ smooth muscle tone bladder & prostate -> ⬆️ bladder outlet resistance -> urine reflux into prostate)
- Chronic pelvis pain syn
