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CRRAB 2 Week 2 > Bladder Disease > Flashcards

Bladder Disease Flashcards

1
Q

Describe ways men and women differ in terms of bladder anatomy?

A

men - longer urethra, prostate

women - short urethra, no prostate

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2
Q

What’s the bottom part of the bladder called? Upper part?

A 
lower = trigone
upper = dome
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3
Q

WHat are urinary diverticula?

A

outpouchings of the bladder due to increased pressure pushing urine out into weak parts of the wall near where the vessels or ureters leave

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4
Q

What cyst can form in the dome of the bladder?

A

if a urachus remains patent after birth, you can get a urachal cyst

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5
Q

What’s the cancer concern with the a urachal cyst?

A

20-40% will have adenocarcinoma

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6
Q

What happens when there’s failure of development of the anterior abdominal wall?

A

exstrophy of the bladder

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7
Q

What cancer is associated with exstrophy of the bladder?

A

adenocarcinoma again

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8
Q

What type of tissue is an adenocarcinoma made of? Why is this unusual in the bladder?

A

it’s made of glandular mucosa - unusual because the bladder is transitilonal epithelia

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9
Q

Are diverticula of the bladder more often congenital or acquired?

A

acquired

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10
Q

What is a common cause of diverticuli?

A

benign prostatic hypertrophy increases the pressure in the bladder, promoting the formation of diverticula

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11
Q

What happens to the wall of the bladder with benign prostatic hypertrophsy?

A

the wall gets a trabeculated appearance due to pressure-induced hypertrophy

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12
Q

What two things can form in diverticula that will be hard to see on cytoscopy?

A

bladder stones or carcinoma

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13
Q

There are tons of things that can predispose to bladder inflammation. One is a fistula. Where do fistulas often form from?

A

the colon and the rectum

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14
Q

What is a very common cause of a colon-bladder fistula?

A

Crohn’s disease

the inflammation goes right through the wall of the colon into the bladder and the fibrosis that occurs afterwards forms a fistula

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15
Q

What is a cystocele and who is most likely to get them?

A

It’s when the bladder gets pushed down (along with the rectum) by a prolapsing uterus

most common in multi-partum women starting around age 50

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16
Q

What is the symptom triad for cystitis?

A

frequency
pain
dysuria

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17
Q

What is an important systemic effect of cystitis in the elderly population that doesn’t really occur in the young?

A

altered mentation

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18
Q

What are some other infectious causes of cystitic other than e coli, proteus or enterococcus that this guy talked about?

A

fungal: candida, cryptococcus (in immunosuppressed or post ABx)

chlamydia

mycoplasma

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19
Q

What are three causes of non-infectious cystitis?

A

radiation
chemotherapy agents - esp cyclophosphamide
interstitial cystitis (hunner ulcer)

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20
Q

How do acute and chronic cystitic differ pathologically?

A

acute - PMNs with suppurative exudate

chronic - lyphocyte hyperemia, epithelial hyperplasia, fibrosis, may be follicular or eosinophilic

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21
Q

What are the three thgins that can cause hemorrhagic cystitis?

A

radiation
chemo drugs - cyclosphophamide
adenovirus

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22
Q

What is a Hunner Ulcer and who gets them

A

it’s a persistent and very painful full thickness inflammation with fibrosis and fissures

more in women

23
Q

what is the likely cause of a hunner ulcer?

A

probably autoimmune but we’re not sure

24
Q

What is cystitis glandularis?

A

when the inflammation from cystitis induced metaplasic changes from transitional epithelia to glandular mucosa

25
Q

What is malacoplaki? WHat’s it usually in response to?

A

when you get formation of soft yellow raised plaques in the bladder - usually in response to E coli and proteus

26
Q

What cells will you see with malacoplakia? How do they form?

A

Michaelis-Gutman bodies - they’re macrophages that have an abnormality in their lysosomal enzymes so the e coli and proteus they gobble up don’t get broken down and they calcify within the lysosome. it makes the cell look like a bullseye.

27
Q

What is cystitis cystica?

A

Sometimes instead of glandular metaplasia you just see cysts forming in the mucosa

28
Q

What is by far the most common bladder neoplasm?

A

transistional cell carcinoma

others rarely: squamous cell carc, adenocarc, sarcoma, papillomas

29
Q

Who is the most likely person to get a bladder cancer? WHY?

A

male aged 50-80 living in an urban setting

because they’re more likely to smoke! Tobacco is the number 1 contributor to bladder cancer

30
Q

Where in the bladder do you see transitional cell carcinoma?

A

trick question - the whole uroepithelial lining is predisposed in a high risk patient, so they can be anywhere from the renal pelvis down to the urethra

31
Q

Which is better to have: a papillary type or sessile type?

A

papillary! A sessile type is much more likely to infiltrate and metastasize

32
Q

Besides tobacco use, what are some other factors that can contribute to bladder neoplasia?

A

aromatic amines/azo dyes like aniline dye from the rubber industry

chronic shistosomiasis in Africa

long term analgesic use

long term cytoxan exposure

possibly saccharin sweetener

33
Q

WHat are the common symptoms of bladder neoplasia?

A

some will have fequency and dysuria

only 15% will have painless gross hematuria

34
Q

Otherwise unexplained gross hematuria in a patient over 40 is what until proven otherwise?

A

urothelial carcinoma

35
Q

What are some ways to evaluate a hematuria?

A
  1. urinalysis
  2. cytourethroscopy
  3. urinary cytology (beter for high grade carcinoma than low grade)
  4. evaluatoin of upper tracts with IV pyelogram with US or helical CT with urography
36
Q

How do you grade transitional cell carcinoma?

A

Grade 1 - some cytologic and arch. atypia, but closely resemble normal trans. cells

grade 2 - still recognizable as transitional cells, but with mitoses and great loss of polarity

grade 3 - hard to tell they were ever transitional - disarray, loosening, fragmentation, mitoses, nuclear pleomorphism, tumor giant cells

37
Q

How do you stage a bladder cancer?

A 
Ta - papillary in mucosa
TIS - flat in mucosa (worse)
T1 - invades lamina propria
T2a- invades superficial muscle
T2b - invades deep muscle
T3 - invades perivesical fat
T4 - invades adjacent structures - through the bladder completely
38
Q

What does N1, N2 and N3 mean for stagin bladder cancer?

A

Affecting nodes or not?
N1 is less than 2 cm
N2 is 2-5 cm
N3 is over 5 cm

39
Q

What does M1 mean for staging bladder cancer?

A

has distant metastases

40
Q

What is the most important factor in determining prognosis for bladder cancer?

A 
stage
Ta - 5 yr survival 90%
T2 - 80% 5ys
T3- 50-60% 5ys
M1 - less than 10% 5ys
41
Q

What is the treamtnet for a low stage transistional cell carcinoma?

A

transurethral resection

fulguration (cauterize the base)

intravesicular BCG to induce an inflammatory response for 6 weeks

42
Q

What is the treatment of a high stage T2/T3?

A

cystectomy with node dissection

little benefit form post-surgical chemo

43
Q

What is the treatment of a high stage/metastatic in a non-surgical patient?

A

chemotherapy - gemcitabine, cisplatin, methotraxate, vinblast, adriamycin ,cytoxan

44
Q

Is screening reommended for bladder cancer in asymptomatic adults?

A

nope

45
Q

What are the surveillance recommendations after a TURBT with or without BCG?

A

urine cytology and cytoscopy 3 months afterwards

periodic screening thereafter every 3-6 months

46
Q

What is the general prognosis for a squamous cell carcinoma of the bladder and why?

A

70% 1year mortality! Terrible!

because they ofen cover a large area and are already deeply invasive at diagnosis

47
Q

Again, what will predispose a bladder to adenocarcinoma?

A

urachal remnants or glandular metaplasia from chronic inflammation

48
Q

Chronic shistosomiasis predisposes you to what cancer of the bladder? Why?

A

squamous cell - the shisto will penetrate the skin from contaminated water and enter venous circulation. it sets up shop in the portal system and the eggs are deposited in the wall of the bladder. cause a HUGE inflammation that sets up the milieu for squamous cancer down the line.

49
Q

What are some common bacteria that cause urethritis?

A

neiseeria gonorrhea
chlamydia (M>F)
E coli and other enterics

50
Q

What are the symptoms of urethritis?

A

pain, itchiness, frequency

51
Q

What are two benign neoplasia or the urethra?

A

caruncles and papillomas

52
Q

Who gets caruncles? What are they like?

A

females

red painful mass about 102 m in size at the urethral meatus

53
Q

What is a papilloma associated with?

A

HPV

54
Q

What is the most common malignant urethral neoplasia? Who gets it?

A

squamous cell carcinoma

elderly women

CRRAB 2 Week 2 (7 decks)

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