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MIDS 137 > Ch 4 (lower urinary system pathology) > Flashcards

Ch 4 (lower urinary system pathology) Flashcards

1
Q

What 3 things can duplication of the bladder include?

A

-Peritoneal fold (complete or incomplete)
-Septum dividing bladder longitudinally
-TRV band of muscle dividing bladder into 2 unequal cavities

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2
Q

Is complete bladder duplication common?

A

No! Congenital anomalies are very rare

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3
Q

What are 3 complications bladder duplication includes?

A

-Unilateral reflux
-Obstruction
-Infection

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4
Q

Can ureter duplication be incomplete or complete?

A

Either

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5
Q

Can ureter duplication be unilateral or bilateral?

A

Either

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6
Q

What is incomplete ureter duplication?

A

-Bifurcation of ureter at/near renal pelvis that comes together b/w kidney + bladder to enter bladder as 1 ureter
-Image has 2 ureters coming from kidney but only 1 going into bladder

(think incomplete is 1 ureter)

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7
Q

What is complete ureter duplication?

A

-2 separate renal collecting systems + 2 separate ureters
-Ureter from UP kidney inserts into bladder caudad/below the ureter from LP (think it is reversed, UP now is lower than the LP)
-Image has 2 ureters coming from kidney right into the bladder

(think complete is 2 ureters)

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8
Q

What is blind ureter?

A

Image looks like 2 ureters coming out of kidney but only 1 goes into the bladder. The other ureter does not go into the bladder + is “blind”

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9
Q

What is inverted Y ureteral duplication?

A

Image looks like 1 ureter coming from kidney, but 2 ureters go into bladder making a “Y” appearance

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10
Q

Are ureter or bladder duplications more common?

A

Ureter

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11
Q

Is urethra duplication common?

A

Nope (there are numerous variations that exist but none are common)

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12
Q

Is urethra duplication m/c in males or females?

A

Almost exclusively in males!

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13
Q

What is urethra duplication associated with?

A

Duplication of bladder + genitalia

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14
Q

What is bladder diverticula?

A

Outpouching of bladder wall

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15
Q

How is bladder diverticula produced?

A

Produced by mucosal herniation through defects in muscle wall

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16
Q

Cause of diverticula?

A

Congenital or acquired

(usually associated with diseases resulting in bladder outlet obstruction or neurogenic conditions - this causes abnormalities in bladder function with chronically raised intravesical pressure)

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17
Q

Complications of diverticula?

A

-Intradiverticular tumour + stones
-Spontaneous rupture (rare)

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18
Q

SF of diverticula?

A

-Anechoic outpouching
-Thin walls
-Acoustic enhancement
-Connected to bladder via narrow neck
-CD shows bidirectional flow b/w bladder + diverticula

(the diverticula may not empty when voiding + may increase in size)

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19
Q

Would we measure the bladder including the diverticula or w/o it?

A

Depends on location of diverticula

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20
Q

Is urethra diverticula m/c seen in males or females?

A

Females - during transperineal + transvaginal scanning

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21
Q

Complications of urethra diverticula?

A

-Stone formation
-Cancer

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22
Q

SF of normal urethra?

A

Hypoechoic linear structure exiting the base of the bladder + travelling inferior to the symphysis pubis

(in slide image the urethra is b/w the PS + VAG)

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23
Q

SF of urethra diverticula?

A

Simple or complex collections of fluid intimately related to urethra

(image in slide shows an out pouch or urine in the urethra)

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24
Q

What is the m/c bladder outlet obstruction from?

A

Posterior urethral valves (PUV)

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25
What is the m/c cause of urinary obstruction in male infants?
Posterior urethral valves (PUV)
26
Cause of posterior urethral valves?
From development of abnormal valves in the posterior urethra
27
What is posterior urethral valves associated with?
Vesicoureteral reflux
28
What is the "sign" called when posterior urethral valves are seen in fetuses?
The keyhole sign (a dilated urethra)
29
SF of posterior urethral valves?
-Prostatic urethra dilatation + elongation -Bladder wall thickening -Dilated ureters -Hydronephrosis
30
What is bladder exstrophy?
-Abnormal formation of bladder + bony pelvis -Congenital malformation -Bladder protrudes outside abdomen due to abdominal wall defect (bladder is flattened + exposed on the abdominal wall, while the pelvic bones appear widely separated)
31
How are ureteral orfices formed with bladder exstrophy?
Urine spurts onto abdominal wall form them
32
What is bladder exstrophy associated with?
Other congenital anomalies
33
Clinical presentation of bladder exstrophy?
-Widening of iliac crests -Lower abdominal bulge (representing bladder)
34
What will most likely also be seen SF with bladder exstrophy?
-Eversion of bladder through anterior abdominal wall -Hydronephrosis
35
What is an ectopic ureter?
Ureteric insertion in an abnormal position
36
Cause of ectopic ureter?
Embryologic error in development
37
M/c location for an ectopic ureter?
Arises from superior renal pelvis of a duplex kidney + inserts lower and more medially towards the base of bladder (UP kidney to lower area bladder)
38
Does a normal or ectopic ureter take a shorter path from kidney to bladder?
Normal takes shorter path (ectopic takes long path from UP kidney to lower area of bladder)
39
Sonographically, an ectopic ureter may cause what?
Hydroureter
40
What is a ureterocele?
Cyst-like enlargement of the lower end of ureter
41
Cause of a ureterocele?
Congenital or acquired stenosis of distal ureter
42
Complications of a ureterocele?
-Ureteral opening in wall of the sac is stenotic (which results in hydroureter, hydronephrosis + infection proximally) -Ureterocele sac can obstruct bladder outlet or prolapse through urethra
43
What is commonly seen with duplex kidneys or ectopic ureters?
Ureteroceles
44
SF of a ureterocele?
-Round/oval thin walled cystic structure on posterior wall of the distal ureteral orifice -Can change in shape + size depending on intravesical pressure -CD of jets seen in the area (image in slide shows echogenic ring with anechoic fluid inside on the bottom of the bladder)
45
Do ureteroceles commonly change its appearance on u/s?
Yes
46
Should we worry about ureteroceles if we see them?
No, only if pt has symptoms. It is just a cystic area filled with urine.
47
What is the urachus?
An embryonic tract that forms as the bladder begins its descent from the umbilicus into the pelvis in the fetus
48
When does the urachus close?
At birth, but if not than it creates an open channel b/w the bladder + umbilicus
49
Term used for a closed urachus in adults?
Median umbilical ligament
50
What causes a urachus to form in adults + who m/c gets them?
Neoplasms - m/c mucinous adenocarcinoma Men aged 50-60
51
Rank the urachal variants from m/c to l/c?
-Patent urachus/fistula (50%) -Urachal cyst (30%) -Urachal sinus (15%) -Urachal diverticulum (5%)
52
What is a patent urachus/fistula + what does it cause?
-Completely patent/open lumen -Causes urine to drain from umbilicus
53
What is a patent urachus/fistula associated with?
Urethral obstruction
54
What is a urachal cyst?
Both ends close trapping urine in canal
55
CP of urachal cyst?
Palpable mass, fever, dysuria (painful urination)
56
Complications of urachal cyst?
Adenocarcinoma + calculi formation
57
What is a urachal sinus?
Urachus closes at the bladder end but not at the umbilicus end
58
Complication of urachal sinus?
Infection
59
What is urachal diverticulum?
Urachus closes at the umbilicus end but not at the bladder end
60
SF of urachal variants?
-Mass or diverticulum b/w dome of bladder + umbilicus -Can be anechoic or contain echoes
61
What is cystitis?
Inflammation of urinary bladder
62
M/c cause of cystitis?
E.coli
63
Is cystitis m/c in men or women?
Women b/c we have shorter urethra + due to proximity of urethral opening to vagina and anus
64
Where does cystitis m/c arise from?
Ascending, arising from organisms in perineal area
65
RFs of cystitis?
-Urethral obstruction -Rectal or vaginal fistulas -Catheterization -Bladder calculi -Bladder neoplasm -Trauma
66
Symptoms of cystitis?
-Dark/cloudy urine -Blood in urine -Pain in lower tummy -Pain/burning when urinating -Strong urine odor -Need to pee often -Pain during sex -Feeling sick/tired
67
SF of cystitis?
Thickened bladder wall/mucosa or cystic structures along wall
68
Where does bladder calculi m/c come from?
Kidney stones from kidneys
69
RFs of bladder calculi?
-Increase concentration of salts in urine -Infection of urinary tract -Urinary tract obstruction
70
Complications of bladder calculi?
-Obstruction -Inflammation
71
SF of bladder calculi?
-Echogenic foci with shadow -Mobile (turn pt on side to assess this)
72
What is bladder reflux?
When the UVJ valve that prevents regurgitation back into ureter is now incompetent/unable to
73
What would we see on prenatal u/s with bladder reflux?
Hydronephrosis
74
Cause of bladder reflux?
-Abnormal trigone ectopia/placement -PUVs -Paraureteric cyst -Prune belly syndrome -Neurogenic bladder
75
What is bladder reflux associated with?
Contralateral (1 sided) renal abnormalities such as UPJ obstruction + duplex kidney
76
Complications of bladder reflux?
Infection of upper urinary tract
77
SF of bladder reflux?
-Ureteral dilatation when reflux is in progress (must assess in real time) -CD will show urine flowing backwards into dilated ureter
78
Cause of UVJ obstruction?
Congenital: ureterocele, ectopic ureter, ectopic ureterocele Acquired: ureteral reimplantation procedures, infection, stones
79
SF of UVJ obstruction?
-Megaureter -Hydronephrosis -Ectopic ureter (with or w/o ectopic ureterocele)
80
What is a neurogenic bladder?
Loss of voluntary control of voiding due to disturbance in neural pathways
81
Cause of neurogenic bladder?
Many!!! -Neurologic disease -Congenital anomalies -Systemic diseases with neurologic complications -Infection -Trauma -Brain + spinal neoplasms -CNS vascula disease
82
Who m/c gets neurogenic bladder?
Paraplegic pt's (paralyzed lower body)
83
How is the neural system involved with an underactive neurogenic bladder?
When the bladder accumulates urine, it does not send a signal to the neural system to inform the brain they need to urinate
84
How does an overactive neurogenic bladder work?
Release of urine spontaneously + frequently which makes bladder become small
85
Complications of neurogenic bladder?
-Obstruction + narrowing of urethra -Detrusor hypertrophy (detrusor muscle contracts during urination to push urine out of bladder into urethra) -Trabeculations/diverticula -Vesicoureteral reflux -Chronic reflux pyelonephritis -Struvite stones -Bladder debris
86
SF of neurogenic bladder?
-Trabeculated walls -Ureterectasis -Vesicoureteral reflux -Hydronephrosis -Bladder calculi (slide image has lots of debris in bladder)
87
One of the m/c bladder u/s findings is what?
Bladder wall thickening
88
What causes bladder rupture?
Severe blunt trauma (abdominal or pelvic) or Penetrating abdominal + perineal injury
89
What can bladder rupture cause?
Spilling of urine into peritoneum or a urinoma
90
SF of bladder rupture?
-Urinoma (anechoic mass, irregular borders + septa) -Peritoneal spilling of urine (looks like ascites with possible internal echoes) -Hematoma
91
When would a thrombus within the bladder form?
From pathological process or trauma
92
SF of bladder thrombus/blood clot?
-Irregular walls -Adhered to bladder wall -Avascular!!! (bladder tumours will be vascular)
93
What is a bladder flap?
Space b/w bladder + uterus (caused from C section)
94
What causes a bladder flap hematoma?
If hemostasis (stoppage of bleeding) is not obtained after closer of uterine incision, a hematoma can form
95
3 signs of bladder flap hematoma?
-Fever -Mass -Dropping hematocrit (if hematoma is infected the pt will have leukocytosis too)
96
SF of bladder flap hematoma?
-Complex mass with septations, debris + poorly defined borders
97
Difference b/w superficial + subfascial hematomes?
Superficial: anterior to rectus abdominus muscle Subfascial: posterior to rectus abdominus muscle, in the prevesical space ventral to bladder
98
How can we differentiate a bladder flap hematoma from a different kind of hematoma?
Is hard, the history of recent C section will help!
99
Are bladder neoplasms m/c benign or malignant?
Malignant, suspect CA when we see solid mass in bladder (benign ones are rare)
100
Symptoms of benign bladder neoplasms?
-Painless hematuria -Dysuria -Urinary frequency -Urgency
101
SF of benign bladder neoplasms?
Varied appearance, they grow from bladder wall
102
List benign bladder neoplasms?
-Papilloma -Leimyoma -Hemangioma -Neurofibroma -Fibroma -Lipoma (benign ones end in "oma", malignant ones end in "sarcoma")
103
How common is bladder CA?
Males: 4th m/c cancer Females: 8th m/c cancer
104
Is bladder CA treatable?
Yes when it is in a localized stage
105
Who m/c gets bladder CA?
Caucasian men with history of smoking
106
When should we be suspicious of bladder CA?
If we see: -focal wall thickening -mass invading bladder walls or surrounding tissues
107
M/c type of bladder CA?
TCC - transitional cell carcinoma (90%)
108
Where does TCC begin?
In cells that make up inner lining of bladder
109
RFs of TCC?
-Smoking -Analgesic/drug abuse -Industrial carcinogen exposure
110
SF of TCC?
-Irregular VASCULAR echogenic mass -Projects into bladder lumen from fixed location -Polypoid (protruding) or sessile (flat) -Possible shadowing
111
Name 2 other types of bladder CA?
-Adenocarcinoma (2%) -SCC, squamous cell carcinoma (5%)
112
What is most aggressive bladder tumour?
SCC
113
What 2 things is adenocarcinoma associated with?
-Urachal remnants -Bladder exstrophy
114
What 4 things is SCC associated with?
-Chronic inflammatory conditions -Neurogenic bladder -Stones -Bladder schistosomiasis (infection from worms)
115
Bladder metastases are m/c acquired from what?
Direct extension from CA of the cervix, uterus, prostate + rectum
116
SF of bladder metastases?
Similar look on u/s as primary bladder CA

MIDS 137 (14 decks)

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