Exam 2 Lower Urinary Tract Flashcards by Amanda Beach

What parts of the lower urinary tract are lined by transitional epithelium aka urothelium

renal pelvis, ureters, bladder and urethra

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Describe composition or urothelium

flattened umbrella cells with abundant cytoplasm
5-6 layers
sits on top of lamina propria

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bladder cancer is staged based on what

how far it invades the large muscle bundles of detrusor, the muscularis muscle

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what anatomical structures do the ureters pass over as they descend

pelvic brim into pelvis anterior to common iliac or external iliac artery

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What are the 3 narrowings where kidney stones can get stuck

uteropelvic junction, bladder entrance and where cross iliac artery

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what is vesicuuteral reflux

when the slit opening from urethra into bladder does not function properoly and get reflux

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What is cystocele? who is it seen in and what does it cause

uterine prolapse from relaxation of pelvic suport, seen in middle aged women and elderly
doesn’t empty during micturition

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what can an enlarged prostate do to the bladder

compress it and cause urinary tract obstruction

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What occurs to patients with double or bifid ureters

asymptomatic. no problems. usually unilateral

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What is the most common cause of congenital hydronephrosis in kids

uteropelvic junction obstruction

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what is the population seen with ureteropelvic junction obstruction

boys, infants and children

adults- females and usually unilateral

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What causes ureteropelvic juntion obstruction

abnormal organization of smooth mm bundles at the UPJ, excess stromal depositions of collagen between bundles

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What is a diverticula

piuchlike evagination of bladder wall

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what is the most common cause of bladder diverticula

persitent urethral obstruction

usually seen with prostates

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What causes congenital diverticula of bladder wall

focal failure of development of the normal musculature or some urinary tract obstruction during fetal development

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what is the clinical significance of diverticulae

sites of urinary stasis, propensity for infection and formation of bladder caliculi
predispose to vesicoureteral reflux if impinge on ureter

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What is the morphology of ureteritis

accumulation of lymphocytes, germinal centers in subepithelial region
sligh elevations in mucosa and fine granular mucosal surface( ureteritis follicularis)
mucosa sprinkled with cysts lined by flattened epithelium (ureteritis cystica)

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What are fibroepithelial polylps

mesenchymal benign tumors on ureters,
usually in children
loose vascularized CT mass under mucosa

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What is sclerosing retroperitoneal fibrosis

uncommon cause of uteteral narrowing or obstruction due to fibrous proliferative inflammatory process

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What are intrinsic causes of ureteral obstruction

caliculi, strictures, tumors, blood clots and neurogenic

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What is bladder exstrophy

developmental failure in anterior wall of abdomen and bladder
projects directly though a large defect to body surface or lies as unopened sac

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What is the demographic distribution for exstophy of the bladder

M=F and W»B

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Patients with exstrophy have an increased risk for what

adenocarcinoma in bladder remnant

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What is Px for exstrophy

after surgery good

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When is VUR(vesicoureteral reflux) Dx

infancy/childhood | 1/3 children with recurrent UTI have VUR

When does VUR become a problem

stasis leads to infection that involves ureter and kidney

4y/o comes in with abdominal pain and fever. CT shows heterogenous mass in midline anterior to bladder what could it be

infected urachal remanat/cyst

What is antecedent bacterial acute cystitis

infection of blader that spread to kidneys | Ecolo. proteus, klebsiella, enterobacter, staph saprophyticus

what bacteria is highger on Ddx if female with acute cystitis is from middle east

schistosomiasis

What are predisposing factors to acute cystitis

bladder stones, urinary obstruction, DM, catheters, immune deficient, trauma during sex

What are classic symptoms and signs of cystitis

frequency, dysuria, pelvic/abdominal pain | low grade fever, turbid urine or occasionally hematuria

patients on cytotoxic anti timor drugs can have what type of cystitis

hemorrhagic

what amount of bacteria strongly indicates infection in symptomatic young women with pyuria

>1000 organisms/mL

What amount of bacteria indicates UTI in men and asymptomatic women

>10 to the 4 | 100,000

Does pregnancy change bacterial levels in urine cultures

yes. need higher amount to Dx

If a patient is on antimicrobial Therapy how does that affect culture

false negative

what are the common coliforms found in urine

E coli, proteus, klebsiella, enterobacter

What is the morphology of acute cystitis

non specific acute inflammation, hperemia of mucosa | WBC in urine

Adenovirus infection can lead to waht type cystitis

hemorrhagic

how does chronic cystitis differ from acute

nature of inflammatory cell infiltrate and clinical sequelae

What is a hunner ulcer? signs/symptoms?

interstitial cystitis chornic persistend painful form of cystitis 30-40 y/o females intermittent suprapubic pain, urinary frequency, urgency, hematuria and dysuria with negative cultures

what do you see microscopically in interstitial cystitis

varied pattern, mast cells, lymphocytes

bladder shows soft yello slightly raised mucosal plaques involving bladder. 3-4 cm in diamter foamy macrophagesm multinuclear giant cells and lymphocytes michaelis gutmann bodies

malacoplakia

What is a common cause of malacoplakia

E coli, proteus

what is population of those affected by malacoplakia

F>>M middle aged

what is the most common cause of polylpod cystitis

indwelling catheters

DEscribe pathogenesis of cystitis cystica and glandularis

metaplasia of urothelium from iritants, urothelium proliferates into buds which grow into CT into lamina propria and then differentiate either into cystic deposits or intestinal columnar mucin-secreting glands (goblet cells)

What are signs of cystitis cystica and cystitis glandularis

chronic irritation, frequency, dysuria, urgency and hematuria

How is follicular cystitis characterized

aggregation of lymphocytes into lymphoid follicles in mucosa underly wall

how does eosinophilic cystitis manifest

infiltration by submucosal eosinophils, typically also represents nonspecific subacure inflammation rarely systemic allergic reaction, auto immune, parasite infection or sequal to chemo/radiation

What are the benign non epithelial tumors of bladder

leiomyoma, lipoma, fibroma, neurofibroma, other

what are the malignant non-epithelial tumors of bladder

rhabdomyosarcoma(kids) leiomyosarcoma(adults) lymphoma other

what is the malignant mesenchymal tumor that is more common in children, though rare

rhabdomyosarcoma | avg 4 y/o

What is population that leiomyosarcomas affect though rare

adults 60 y/o M:F 2:1 | post chemo

descirbe population affected by primary malignant lymphomas in bladder

adults 65 y/o M:F 1:6 most with chronic cystitis on-Hodgkin lymphoma diffuse large B cell and MALT

What is the Px for primary malignant lymphoma of bladder

radioselective good prognosis

>90% tumors in urinary bladder are what type

urothelial tumors: exophytic papilloma, inverted papilloma, papillary urotehlial neoplasms, low and high grade papillary urothelial cancers carcinoma in situ CIS

What is the least common tumor of urinary bladder

sarcoma

What are the squamous cell carcinomas seen in bladder

mixed carcinoma adenocarcinoma, small cell

What is the population of urothelial carcinomas

white males | industrial and urban> non industrial and rural

What are risk factors for urothelial carcinomas

``` cigarette smoking 3-7x industrial exposure to arylamines schistosome hematobium long term use analgesics long term cyclophosphamide radiation ```

What genetic factors are common in urothelial carcinomas

chr 9 monosomy or deletions seen in superficial and non-invasice chr 17p deletions, invasive and CIS

noninvasive papillary tumors arise from what

papillary urothelial hyperplasia

epidemiology of urothelial carcionma

73 y/o avg painless hematuria sometimes: frequency, urgency and dysuria

At intial Dx of urothelial carcinoma what could be found

mutliple tumors

What is Tx for noninvasive urothelial carcinomas

``` transurethral resection TUR and surveillance Intravesical therapy (chemo of BCG) ```

What is Tx for invasive urothelial carcinomas

segmental cystectomy radical cystectomy with urinary diversion immunotheraphy and photodynamic therapy

What is grade I and II and III urothelial flat neoplasia

I is thickening II atypical hyperplasia III CIS

A bump in the trigone covered by normal mucosa(grossly) in a younger male could be what

inverted papilloma

papillary urothelial neoplasia of low malignant potnetial accounts for what percent of papillary tumors

15-20%

most common form of papillary tumors is what

papillary carcinoma low grade

What are the histo layers of bladder wall

urothelium, lamina propria, musclaris propria and adventitia

What is the major prognostic value in bladder cancer

muscle invasion, depth

What stages of bladder cancer only have 50% 5 yr survival rates

T2-T4

Squamous cell carcinoma of bladder is assoc with what bacteria

schistosomiasis, S hematobium | middle east

What is Reiter syndrome

clinical triad of arthritis, conjunctivits and urethritis