Bladder

Question 1

This is the congenital defect where there are multiple ureters out of the same kidney

Answer 1

Double and bifid ureters

Question 2

This is the obstriction at the junction between the kidney and ureter caused by abnormal organization of smooth muscle bundles or extreinsic compression by polar renal vessels.

Answer 2

Uteropelvic junction obstruction

Question 3

Uteropelvic junction obstruction can cause what disease in kids?

Answer 3

Hydronephrosis

Question 4

These are saccular outpouchings of the uretheral wall.

Answer 4

Diverticula

Question 5

Uretheral diverticula are normally asymptomatic but can be breeding grounds for what?

Answer 5

bacterial infeciton

Question 6

What is the most common mechanism to cause bladder diverticula?

Answer 6

Persistnat uretheral obstruction like an enlarged prostate

Question 7

This is the developmental failure in the anterior wall of the abdomen and bladder so that the bladder is exposed to teh surgace of the body.

Answer 7

Exstrophy

Question 8

Extrophy of the bladder can predispose you to what form of cancer?

Answer 8

Adenpcarcinoma

Question 9

This is the condition where the bladder and umbilicus are connected

Answer 9

Patent urachus

Question 10

This is the accumulation of lymphocytes in the ureters causing subepithelial elevation and a granular mucosal surface.

Answer 10

Ureteritis follicularis

Question 11

This is when 1-5mm cysts sprinkle the mucosa of the ureters.

Answer 11

Ureteritis cystica

Question 12

When do symptoms typically improve in acute cystitis?

Answer 12

within 2 days after Tx

Question 13

What is the triad of Sx for acute cystitis?

Answer 13

Frequency
Lower abd pain over bladder region
Dysuria

Question 14

How long must u have cystitis to be a “chronic”?

Answer 14

> 2 wks

Question 15

This is the persistent, painful form of chronic cystitis that occurs mainly in women and is characterized by severe suprapubic pain, urinary frequency, urgency, hematuria, and dysuria without evidence of bacterial infection.

Answer 15

Interstitial cystitis

Question 16

What 3 things show up on the bladder mucosa in interstitial cystitis?

Answer 16

fissues, punctate hemorrhages, and Hunner ulcers

Question 17

This is a vesical inflammatory rxn characterized macroscopically by soft, yellow, slightly raised mucosal plaques.

Answer 17

Malacoplakia

Question 18

What do you see on histological exam with malacoplakia?

Answer 18

Large foamy macrophages, with giant cells, and lymphocytes

Question 19

What do you see in the macrophages in malakoplakia?

Answer 19

mineralized Ca deposition in enlarged lysosomes (Michaelis-Gutmann bodies)

Question 20

What causes malacoplakia?

Answer 20

chronic bacterial infection (E. coli or proteus)

Question 21

This is an inflammatory condition resulting from irritation to the bladder mucosa, causing marked submucosa edema (looks a lot like papillary urothelial carcinoma)

Answer 21

Polypoid cystitis

Question 22

What typically causes polypoid cystitis?

Answer 22

Catheters

Question 23

These are mestplastic nests of urothelium (brunn nests) that grow into the lamina propria.

Answer 23

Cystitis glandularis and cystitis cystica

Question 24

What does the bladder epithelium undergo metaplasia to form in cystitis glandularis?

Answer 24

Cuboidal or columnar epithelium

Question 25

This is a variant of cystitis glandularis that includes goblet cells as well as epithelium that resembles intestinal mucosa.

Answer 25

Intestinal or colonic metaplasia

Question 26

This is the metaplastic lesion where the epithelium transforms into cystic spaces filled with clar fluid lined by flattened urothelium.

Answer 26

Cystitis cystica

Question 27

True or False: metaplastic lesions showing extensive intestinal metaplasia have an increased risk of developing adenocarinoma.

Answer 27

FALSE. They do not. except when assocaited with exstrophy... lol

Question 28

What causes squamous metaplasia in the bladder?

Answer 28

Injury

Question 29

Squamous metaplasia should be distinguised from what form of epithelium normally found at the trigone in women?

Answer 29

Glycogenated squamous epithelium

Question 30

These is the tumor shed from renal tubular cells that inplant in sites of injured urothelium.

Answer 30

Nephrogenic adenoma

Question 31

The overlying urothelium of neprhogenic adenomas may be focally replaced by what epithelium, which can assume a papillary growth pattern?

Answer 31

Cuboidal epithelium

Question 32

What are the 2 forms of urothelial/transitional tumors?

Answer 32

1. Non-invasive papillary tumors (most common) | 2. Flat non-invasive urothelial carcinoma (carcinoma in situ)

Question 33

In flat urothelial carcinomas, what is the gross morphology of the area?

Answer 33

Area of mucosal reddening, granularity, or thickening without producing an evident mass.

Question 34

This is the name of the spread of flat urothelial carcinomas where there is scattered malignant cells in an otherwise normal urothelium.

Answer 34

Pagetoid spread

Question 35

This is the type of urothelial cancer wehre there is invasion into muscularis mucosae and spreads.

Answer 35

Invasive urothelial cancer

Question 36

What are the 4 high yield risk factors for urothelial carcinoma?

Answer 36

1. SMOKING 2. Napthylamine 3. Azo-dyes (hairdressers) 4. Long term cyclophosphamide or phenacetin use

Question 37

What is the presentation of urothelial carcinomas?

Answer 37

Painless hematuria

Question 38

In papillary growths of urothelial carcinomas, what is the progression of the disease?

Answer 38

Low grade --> high grade --> invade

Question 39

For flat urotheial carcinomas, what is the progression of the disease?

Answer 39

Start HIGH grade --> invade

Question 40

What mutations are assocaited with flat urothelial carcinomas?

Answer 40

early p53 mutations

Question 41

What must be ruptured in both papillary and flat urothelial carcinomas to become invasive?

Answer 41

The basement membrane

Question 42

Since the bladder doesnt normally have quamous cells, what must occur to have squamous cell carcinoma?

Answer 42

Metaplasia to squamous cells --> dysplasia --> cancer

Question 43

What is the high yield infection that predisposes you to squamous cell carcinomas?

Answer 43

Shistosoma hematobium

Question 44

What type of person may classically present with squamous cell carcinomas from schistosoma hematobium infections?

Answer 44

Middle eastern male

Question 45

What 2 chronic conditions are risk factors for squamous cell carcinomas?

Answer 45

Chronic cystitis | Long-standing nephrolithiasis

Question 46

True or False: it is more common in squamous cell carcinoma for have mixed urothelial carcinomas with areas of squamous carcinoma than just pure squamous cell carcinoma.

Answer 46

True

Question 47

This is the type of cancer from the malignant proliferation of the glands of the bladder.

Answer 47

Adenocarcinoma

Question 48

What are the 3 high yield associations for adenocarcinomas?

Answer 48

1. Urachal remnant 2. Cystitis glandularis 3. Exsotrophy

Question 49

Where is the common location in the bladder for adenocarcinomas from urachal remnants?

Answer 49

Dome of the bladder

Question 50

Urothelial, suqamous, or adenocarcinomas are assocaited with the formation of what other cancer type in the bladder?

Answer 50

Small cell carcinoma

Question 51

What is the most import risk factor for bladder cancer?

Answer 51

Smoking

Question 52

30-60% of bladder cancer have what 2 genetic alterations?

Answer 52

Chromosome 9 monosomy | Deletions of 9p and 9q (as well as deletions of 17p, 13q, 11p and 14q).

Question 53

Deletion of 9p stops the production of which tumor suppresor gene?

Answer 53

p16 (INK4a)

Question 54

Deletion of 17p stops the production of which tumor suppresor gene?

Answer 54

p53

Question 55

After tumor removal, what is common in bladder cancers?

Answer 55

Recurrence

Question 56

What is the diagnostic tool for bladder cancers?

Answer 56

Cystoscopy + biopsy

Question 57

What is the treatment for small, localized, non high grade bladder cancer?

Answer 57

transurethral resection

Question 58

What is the Tx for tumors invading muscularis propria, CIS, or high grade papillary cancer?

Answer 58

Radical cystectomy

Question 59

In males, what typically obstructs the bladder neck?

Answer 59

Prostate

Question 60

In females, what typically obstructs the bladder neck?

Answer 60

Cystocele

Question 61

What happens in the early stages of bladder neck obstruction?

Answer 61

SM hypertrophy and trabeculations in the bladder

Question 62

What happens in the later stages of bladder neck obstruction?

Answer 62

Diverticula

Question 63

What causes markely thinned bladder without trabeculations of the bladder?

Answer 63

Acute obstruction or terminal disease