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Pathophysiology > Genitourinary (GU) > Flashcards

Genitourinary (GU) Flashcards

1
Q

What is acute pyelonephritis (bacterial tubulointerstitial nephritis)?

A

A common suppurative inflammation of the kidney and the renal pelvis.

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2
Q

What is the epidemiology of acute pyelonephritis?

A

Stems commonly from urinary tract infections of lower tract (cystitis, prostatitis, urethritis).

More in females.

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3
Q

What is the pathogenesis of acute pyelonephritis?

A

1) Gram-negative bacilli
* E. coli*
- proteus, Klebsiella, enterobacter, pseudomonas

2) migration of pathogen from lower urinary tract in ascending infection or hematogenous infection

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4
Q

What are the morphological changes and clinical features of acute pyelonephritis?

A

Morphology:

  • discrete, yellow raised abscesses on surfaces of kidneys
  • intratubular damage and obstruction from WBC casts

Clinical features:

  • CVA pain
  • dysuria, frequency, urgency, pyuria
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5
Q

Define chronic pyelonephritis and its two forms.

A
  • interstitial inflammation and scarring of renal parenchyma

1) chronic obstructive
- recurrent infections on obstructive lesions
- bilateral (congenital anomalies to urethra) or unilateral (calculi in ureter)

2) chronic reflux-associated
- most common cause from superimposition of a UTI (vesicoureteral reflux and intrarenal reflux)

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6
Q

What is the underlying defect of hereditary cystic disease of the kidney?

A

Defect in the cilia-centrosome complex of tubular epithelial cells interfering with fluid absorption, resulting in cyst formation.

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7
Q

What is the pathogenesis of adult polycystic kidney disease (APKD)?

A

Mutation of PKD1 (85%) causes defects in mechanosensing of ciliary tubular cells in kidneys leading to calcium influx and lack of polarity –> cysts formation.

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8
Q

What is the morphology and clinical features of adult polycystic kidney disease (APKD)?

A

Morphology:

  • kidney reach enormous size
  • fluid-filled cysts anywhere in kidney but mostly Bowman’s capsule
  • expanding cysts lead to ischemic atrophy

Clinical feature:

  • asymptomatic until renal failure sets
  • hematuria, HTN, polyuria, proteinuria
  • renal failure mainly in PKD1 mutations; HTN enhance progression
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9
Q

What is urolithiasis?

A

Calculus formation in any level of the urinary collecting system.

Occurs mainly in men.

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10
Q

What is the pathogenesis of urolithiasis? Define the three common types of stones.

A

Pathogenesis:
- increased urinary concentration of the stone’s material that exceeds their solubility in urine.

  1. 80% calcium oxalate/phosphate
  2. 10% magnesium ammonium phosphate
  3. 6-9% uric acid/cystine
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11
Q

Define hydronephrosis.

A

Dilation of renal pelvis and calyces with parenchymal atrophy caused by obstruction of urine outflow.

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12
Q

What are the causes of hydronephrosis?

A

Congenital:

  • atresia (narrowing) of urethra
  • valve formation in ureter/urethra
  • aberrant renal artery compressing ureter

Acquired:
- foreign bodies, lesions, inflammation, neurogenic, pregnancy

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13
Q

What is the pathogenesis of hydronephrosis?

A

Filtration continues despite blockage, causing high pressure in renal pelvis. Dilation and compression of renal vasculature ensues leading to atrophy. Arterial insufficiency and venous stasis results.

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14
Q

What is the clinical findings of hydronephrosis?

A

Anuria - complete bilateral obstruction
Polyuria - incomplete bilateral obstruction
Bladder distention

*Unilateral hydronephrosis is silent due to other normal kidney.

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15
Q

What is the epidemiology and risk factors of renal cell carcinoma?

A

Epidemiology:

  • Age 60-70
  • Men:Women (2:1)

Risk Factors:

  • Smokers
  • Hypertension
  • Obesity
  • Cadmium exposure
  • Polycystic disease
  • Genetic factors
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16
Q

What is the clinical course of renal cell carcinoma?

A

Triad of RCC:

  1. painless hematuria
  2. palpable mass
  3. dull flank pain

Also, fever, polycythemia.

17
Q

What are Wilms tumor?

A
  • Nephroblastoma
  • Most common renal cancer in children (2-5 y/o)
  • autosomal dominant
  • HTN, abdominal mass/swelling
18
Q

Define:

1) hypospadias
2) epispadias
3) hydrocele

A

1) Urethra opening is on the ventral aspect of the penis along the shaft (more common)
2) Urethra opening on the dorsal aspect of penis (less common)
3) Accumulation of serous fluids within tunica vaginalis from infection, tumors or idiopathic (cause scrotal swelling)

19
Q

Describe the following for penile cancer:

1) risk factors
2) most common type
3) clinical presentation

A

1) Risk factor
- HPV
- poor hygiene, smoking, uncircumcised

2) Common type
- squamous cell carcinoma

2) Clinical presentation:
- solitary plaque on shaft of penis (in situ)
- gray, crusted, papular lesions –> ulcerative infiltrative lesions

20
Q

Define cryptorchidism and describe the risks thereof.

A

Incomplete descent of the testis from the abdomen to scrotum.

Risks of cryptorchidism:

  • tubular atrophy and sterility
  • 3-5x increased risk for testicular cancer
21
Q

What is the epidemiology and risk factors of testicular neoplasms?

A

Epidemiology

  • 6 per 100,000 males
  • 15-35 y/o

Risk factors:

  • cryptorchidism
  • family hx
  • Caucasian > African-American
  • Intersex syndromes
  • cancer in other teste
22
Q

What is the clinical features of testicular germ cell neoplasm and risk of malignancy?

A

Clinical features:

  • painless, non-translucent testicular mass
  • seminomas = confined in testis
  • nonseminomatous - likely to metastasize

Malignancy risks:
Almost all malignant

23
Q

What is the prostate? Distinguish between hyperplasia and carcinoma based on prostatic anatomical location.

A

Exocrine gland that produces seminal fluid that nourishes sperm

Hyperplasia (transitional zone)

Carcinomas (peripheral zone)

24
Q

What is benign prostatic hyperplasia (BPH) and its anatomical origin?

A

Proliferation of stromal and glandular elements leading to prostatic enlargement.

Origin: periurethral transition zone

25
Q

What are the common clinical sequelae of benign prostatic hyperplasia (BPH)?

A
  • lower tract obstruction
  • urinary hesitancy
  • urgency, frequency, nocturia
  • residual urine in bladder
26
Q

Identify the major hormonal stimulus of benign prostatic hyperplasia (BPH).

A
  • Dihydrotestosterone (DHT)

- Testosterone (via alpha reductase)

27
Q

What is the pathogenesis of prostate cancer with respect to epidemiology and risk factors?

A
  1. Androgens
    - support cellular matrix for cancer growth
  2. Hereditary
    - first degree relative increases risks
    - African-American and Scandinavians
  3. Environment
    - dietary components can increase risks
  4. Acquired genetic aberrations
    - TMPRSS2-ETS fusion genes found in 40-60%
28
Q

What is the risk factors and epidemiology of bladder cancer (urothelial carcinoma)?

A

Risk factors:

  • smoking
  • naphthylamine, azo dyes, cyclophosphamide or phenacetin use

Epidemiology:
- older adults

29
Q

What is the most common presenting sign or symptom of bladder cancer (urothelial carcinoma)?

A

Painless hematuria.

Pathophysiology (9 decks)

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