Case 18: haematuria Flashcards
layers of the bladder wall
urothelium
lamina propria
detrusor muscle (muscularis propria)
fatty connective tissue
properties of the urothelium
layer of cells that lines kidneys, ureters, bladder and some of the urethra
urine proof
can cope with being stretched as the bladder fills and then is squashed on emptying by changing shape and spreading cells out or stacking them up
if there is invasion of the lamina propria in bladder cancer which stage is it
T1
non-muscle invasive bladder cancer
if there is invasion of the detrusor muscle in bladder cancer which stage is it
T2
muscle invasive bladder cancer
needs radical treatment
if there is invasion of the fatty connective tissue in bladder cancer which stage is it
T3
treatment of the bladder only is not likely to be curative
which cells make up the bladder urothelium
transitional cells
what is the histology of bladder cancer typically
transitional cell carcinoma
less common types of bladder cancer
squamous cell carcinoma (usually arises from chronic inflammation such as from schistosomiasis parasites which are more common in African countries, bladder stones and long term catheters)
adenocarcinomas
bacteria which most commonly causes UTIs
E coli
how do bacteria get to the urethra
they are usually bacteria in the bowel lumen
these get locally transferred into the urinary tract where they multiply and cause an inflammatory host response
why do women more commonly get UTIs
female urethra is much shorter
allows foe easier access of bacteria to the bladder
how much more common is it for women to get UTIs
20 fold in comparison to men
how does E.coli thrive in the urinary tract
have virulent mechanisms like pili and adhesins which allow for attachment to receptors on the urothelium
they produce toxins and proteases allowing them to absorb nutrients such as iron from the surrounding urothelial cells
this forms a biolfim-like bacterial community to inhibit local immune responses
how does the body defend itself against UTIs
flow of urine involving full emptying of the bladder with each void
mucins in urine which aggregate bacteria to facilitate flushing them out
Tamm-horsfall protein which binds to bacteria and inhibits their attachment to urothelium
the urothelium itself is resistant to bacterial attachment and is covered with a layer of glycosaminoglycan (GAG) to further inhibit this, it also detects when a UPEC has attached to it so it can shed these urothelial cells into the urine
how much urine should and average adult produce per hour
1-2ml/kg/hr
which is oliguria
reduced urine output
defined as below 1mL/kg/hr in infants and less than 0.5mL/mg/hr or less than 500ml in 24hrs in children and adults
causes of oliguria classification
pre-renal
renal
post-renal
pre-renal causes of oliguria
dehydration
blood loss
renal causes of oliguria
infections
toxins
contrast medications
post-renal causes of oliguria
obstruction to the drainage of the kidneys
what are urinary stones most commonly comprised of
calcium oxalate
why do calcium stones form
if there is high blood serum calcium
this leads to higher amount of calcium being filtered by the kidneys into he urine
ironically people with calcium stones have less calcium in their diet
why do oxalate stones form
high dietary intake which the body then excretes in urine
contained in nuts, green vegetables, chocolate, soy and potatoes
how does calcium and oxalate bind
more oxalate is absorbed from the bowl if there is a problem with fatty acid uptake (particularly in the terminal ileum)
if these remain in the bowel they bind calcium, which usually binds strongly to oxalate and so both remain in the bowel to be excreted
when are calcium phosphate stones seen
high blood calcium levels or abnormal urinary pH
can be due to conditions such as renal tubular acidosis (specifically distal)
properties of calcium phosphate stones
very hard and so difficult to breakdown during treatment
when do uric acid stones occur
when there is high levels in the urine
this is caused be high dietary intake
uric acid is in meats, oily fish, beer and surgary drinks and sweets or when cell turnover is high such as when having chemotherapy
can uric acid stones be seen on plain X-Ray
if they are pure with no added calcium no they cannot be seen
what can high uric acid in blood (hyperuricaemia cause)
gout
when would you see struvite (magnesium ammonium phosphate) stones
recurrent UTIs
bacteria react with ammonia in urine to form elements which combine into stones
what are staghorn stones
stones which fill the collecting system and look like stags horns
most commonly struvite (magnesium ammonium phosphate)
