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Year2 Renal > Exam 2 Lower Urinary Tract > Flashcards

Exam 2 Lower Urinary Tract Flashcards

1
Q

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

A

renal pelvis, ureters, bladder and urethra

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2
Q

Describe composition or urothelium

A

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

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3
Q

bladder cancer is staged based on what

A

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

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4
Q

what anatomical structures do the ureters pass over as they descend

A

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

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5
Q

What are the 3 narrowings where kidney stones can get stuck

A

uteropelvic junction, bladder entrance and where cross iliac artery

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6
Q

what is vesicuuteral reflux

A

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

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7
Q

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

A

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

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8
Q

what can an enlarged prostate do to the bladder

A

compress it and cause urinary tract obstruction

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9
Q

What occurs to patients with double or bifid ureters

A

asymptomatic. no problems. usually unilateral

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10
Q

What is the most common cause of congenital hydronephrosis in kids

A

uteropelvic junction obstruction

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11
Q

what is the population seen with ureteropelvic junction obstruction

A

boys, infants and children

adults- females and usually unilateral

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12
Q

What causes ureteropelvic juntion obstruction

A

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

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13
Q

What is a diverticula

A

piuchlike evagination of bladder wall

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14
Q

what is the most common cause of bladder diverticula

A

persitent urethral obstruction

usually seen with prostates

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15
Q

What causes congenital diverticula of bladder wall

A

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

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16
Q

what is the clinical significance of diverticulae

A

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

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17
Q

What is the morphology of ureteritis

A

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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18
Q

What are fibroepithelial polylps

A

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

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19
Q

What is sclerosing retroperitoneal fibrosis

A

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

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20
Q

What are intrinsic causes of ureteral obstruction

A

caliculi, strictures, tumors, blood clots and neurogenic

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21
Q

What is bladder exstrophy

A

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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22
Q

What is the demographic distribution for exstophy of the bladder

A

M=F and W»B

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23
Q

Patients with exstrophy have an increased risk for what

A

adenocarcinoma in bladder remnant

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24
Q

What is Px for exstrophy

A

after surgery good

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25
Q

When is VUR(vesicoureteral reflux) Dx

A

infancy/childhood

1/3 children with recurrent UTI have VUR

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26
Q

When does VUR become a problem

A

stasis leads to infection that involves ureter and kidney

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27
Q

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

A

infected urachal remanat/cyst

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28
Q

What is antecedent bacterial acute cystitis

A

infection of blader that spread to kidneys

Ecolo. proteus, klebsiella, enterobacter, staph saprophyticus

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29
Q

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

A

schistosomiasis

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30
Q

What are predisposing factors to acute cystitis

A

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

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31
Q

What are classic symptoms and signs of cystitis

A

frequency, dysuria, pelvic/abdominal pain

low grade fever, turbid urine or occasionally hematuria

32
Q

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

A

hemorrhagic

33
Q

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

A

> 1000 organisms/mL

34
Q

What amount of bacteria indicates UTI in men and asymptomatic women

A

> 10 to the 4

100,000

35
Q

Does pregnancy change bacterial levels in urine cultures

A

yes. need higher amount to Dx

36
Q

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

A

false negative

37
Q

what are the common coliforms found in urine

A

E coli, proteus, klebsiella, enterobacter

38
Q

What is the morphology of acute cystitis

A

non specific acute inflammation, hperemia of mucosa

WBC in urine

39
Q

Adenovirus infection can lead to waht type cystitis

A

hemorrhagic

40
Q

how does chronic cystitis differ from acute

A

nature of inflammatory cell infiltrate and clinical sequelae

41
Q

What is a hunner ulcer? signs/symptoms?

A

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

42
Q

what do you see microscopically in interstitial cystitis

A

varied pattern, mast cells, lymphocytes

43
Q

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

A

malacoplakia

44
Q

What is a common cause of malacoplakia

A

E coli, proteus

45
Q

what is population of those affected by malacoplakia

A

F»M middle aged

46
Q

what is the most common cause of polylpod cystitis

A

indwelling catheters

47
Q

DEscribe pathogenesis of cystitis cystica and glandularis

A

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)

48
Q

What are signs of cystitis cystica and cystitis glandularis

A

chronic irritation, frequency, dysuria, urgency and hematuria

49
Q

How is follicular cystitis characterized

A

aggregation of lymphocytes into lymphoid follicles in mucosa underly wall

50
Q

how does eosinophilic cystitis manifest

A

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

51
Q

What are the benign non epithelial tumors of bladder

A

leiomyoma, lipoma, fibroma, neurofibroma, other

52
Q

what are the malignant non-epithelial tumors of bladder

A

rhabdomyosarcoma(kids)
leiomyosarcoma(adults)
lymphoma
other

53
Q

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

A

rhabdomyosarcoma

avg 4 y/o

54
Q

What is population that leiomyosarcomas affect though rare

A

adults 60 y/o M:F 2:1

post chemo

55
Q

descirbe population affected by primary malignant lymphomas in bladder

A

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

56
Q

What is the Px for primary malignant lymphoma of bladder

A

radioselective good prognosis

57
Q

> 90% tumors in urinary bladder are what type

A

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

58
Q

What is the least common tumor of urinary bladder

A

sarcoma

59
Q

What are the squamous cell carcinomas seen in bladder

A

mixed carcinoma adenocarcinoma, small cell

60
Q

What is the population of urothelial carcinomas

A

white males

industrial and urban> non industrial and rural

61
Q

What are risk factors for urothelial carcinomas

A 
cigarette smoking 3-7x
industrial exposure to arylamines
schistosome hematobium
long term use analgesics
long term cyclophosphamide
radiation
62
Q

What genetic factors are common in urothelial carcinomas

A

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

63
Q

noninvasive papillary tumors arise from what

A

papillary urothelial hyperplasia

64
Q

epidemiology of urothelial carcionma

A

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

65
Q

At intial Dx of urothelial carcinoma what could be found

A

mutliple tumors

66
Q

What is Tx for noninvasive urothelial carcinomas

A 
transurethral resection TUR and surveillance
Intravesical therapy (chemo of BCG)
67
Q

What is Tx for invasive urothelial carcinomas

A

segmental cystectomy
radical cystectomy with urinary diversion
immunotheraphy and photodynamic therapy

68
Q

What is grade I and II and III urothelial flat neoplasia

A

I is thickening
II atypical hyperplasia
III CIS

69
Q

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

A

inverted papilloma

70
Q

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

A

15-20%

71
Q

most common form of papillary tumors is what

A

papillary carcinoma low grade

72
Q

What are the histo layers of bladder wall

A

urothelium, lamina propria, musclaris propria and adventitia

73
Q

What is the major prognostic value in bladder cancer

A

muscle invasion, depth

74
Q

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

A

T2-T4

75
Q

Squamous cell carcinoma of bladder is assoc with what bacteria

A

schistosomiasis, S hematobium

middle east

76
Q

What is Reiter syndrome

A

clinical triad of arthritis, conjunctivits and urethritis

Year2 Renal (20 decks)

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