KEY wk 7 lec 2

Question 1

superomeidal aspect of kidney has _____ gland for endocrine function

Answer 1

suprarenal

Question 2

retroperitoneal structures for urination

Answer 2

superior urinary organs (kidneys and ureters), their vessels, and the suprarenal glands

Question 3

____ fat surrounds the kidneys and extends to renal sinuse

Answer 3

perinephric

Question 4

entrance to kidney

Answer 4

renal hilum–> renal sinus

Question 5

where do renal arteries lie at

Answer 5

L1-L2 vertebrae

Question 6

segmental arteries all come from which branch

Answer 6

anterior branch

Segmental arteries are distributed to the renal segments as follows
The superior (apical) segment is supplied by the superior (apical) segmental artery
The anterosuperior and antero-inferior segments are supplied by the anterosuperior segmental and antero-inferior segmental arteries
The inferior segment is supplied by the inferior segmental artery.
ALL These arteries originate from the anterior branch of the renal artery.

The posterior segmental artery, which originates from a continuation of the posterior branch of the renal artery, supplies the posterior segment of the kidney.

Question 7

renal veins drain into

Answer 7

IVC

Question 8

atomic nerves of the kidneys and ureters

Answer 8

-kidneys: abdominopelvic splanchnic nerves –> renal nerve plexus

ureter: from renal, abdominal aortic, and superior hypogastric plexuses

visceral afferents for pain T11-L2

ureteric pain from ipsilateral lower quadrant of anterior abdomen wall

Question 9

nerves of the bladder

Answer 9

sympathetic from inferior thoracic and upper lumbar spinal cord to vesicle plexus via hypogastric plexus

PNS from pelvic splanchnic nerves and the inferior hypogastric plexus

Question 10

PNS fibers in bladder

Answer 10

motor to the detrusor muscle and inhibitory to the internal urethral sphincter of the male bladder.

(this is how men pee; stretching causes bladder to contract then sphincter to relax) (SNS can cause internal sphincter to contract)

Question 11

prevent release of urine via which sphincters

which for voluntary and involuntary urine

Answer 11

internal and external urethral sphincters

The internal urethral sphincter controls involuntary urine flow from the bladder to the urethra

the external urethral sphincter controls voluntary urine flow from the bladder to the urethra.

–> in males the internal one is also to prevent semen flow into bladder when ejactulate

Question 12

male urethra

Answer 12

prostatic plexus

hypogastric plexus

Question 13

prostate nerves

Answer 13

T12–L2 (or L3) spinal cord segments.

splanchnic nerves and the hypogastric and pelvic plexuses

inferior hypogastric/pelvic plexuses.

Question 14

nerves for female urethra

Answer 14

vesical (nerve) plexus and the pudendal nerve. .

pelvic splanchnic nerves, but the termination receives somatic afferents from the pudendal nerve.

Question 15

micturition (urination) goal

Answer 15

low pressure bladder filling with periodic voluntary bladder emptying (voluntary switch btwn storage and voiding)

Question 16

bladder filling

which nerves

Answer 16

sympathetic (hypogastric nerve) and somatic (pudendal nerve)

contract internal smooth and external striated urethral sphincters, respectively

Question 17

sympathetic mediated inhibition of what muscle allows the bladder to accommodate increasing volumes at low intravesical pressures

Answer 17

detrusor muscle

Question 18

what center is released from tonic inhibitory control or higher cortical and subcortical centers of the brain when time to void/pee

which other system turns on causing the contraction and relaxation of what muscles

Answer 18

pontine micturition center

The parasympathetic system then switches “on,” stimulating a detrusor contraction and relaxation of the pelvic floor and external and internal urethral sphincters

Question 19

which brain areas to switch between storage and voiding phases of micturition

Answer 19

periaqueductal gray (PAG)

Frontal, Midcingulate, and Subcortical areas of the brain all contribute as separate levels of control over the PAG and regulation of the LUT (lower urinary tract)

Question 20

slide 26

Question 21

umbrella cells are where and for what function

what is their shape and for what function

Answer 21

in urinary bladder for impermeability of bladder wall; resistant to urine

folds/plaques/ridges for expansion and contraction of bladder during filling and emptying (increase surface area)

Question 22

apical membrane of umbrella cells so impermeable to leak urine

Answer 22

hexagonally arranged Uroplakin plaques

tight junctions

Question 23

channels in umbrella cells to reabsorb water from urine during dehydration

Answer 23

aquaporin water channels

Question 24

what protein does umbrella cells keep making for the plaque to maintain integrity in apical membrane and ensure barrier function

Answer 24

continuously synthesize and turnover uroplakins, the major protein components of the urothelial plaques.

Question 25

role of umbrella cells

Answer 25

maintain bladder integrity prevent leakage of urine and protect the underlying tissues from the potentially harmful substances present in urine.

Question 26

vesicoureteric what is the junction and its function

Answer 26

junction where ureter enters the bladder AKA ureterovesical junction preventing the backflow of urine from the bladder into the ureter

Question 27

vesicoureteric reflux

Answer 27

urine flows back from bladder into ureters and possible kidney vesicoureteric junction/ valve isn't working so urine goes back up during bladder filling or voiding

Question 28

flow of urine

Answer 28

kidneys --> ureter --> bladder

Question 29

grades of vesicoureteral reflux

Answer 29

grade I (mildest) to grade V (most severe), with grade V involving the reflux of urine all the way up to the kidneys.

Question 30

urinary tract infection includes

Answer 30

asymptomatic bacteriuria (ASB), cystitis, prostatitis, and pyelonephritis.

Question 31

asymptomatic bacteriuria and urinary tract infection include what is the differnece

Answer 31

bacteria in urinary tract, w white blood cells and inflammatory cytokines in urine ASB has no sx and doesnt require treatment UTI is more sx and needs antimicrobials

Question 32

most common way to get UTI

Answer 32

bacteria ascend from urethra to bladder (if get bacteria in bladder i.e. sex, it wont always cause sx infection)

Question 33

asymptomatic bacteriuria

Answer 33

bacteriuria detected incidentally when do urine screening no sx

Question 34

uncomplicated vs complicated cystitis

Answer 34

uncomplicated: bladder infection in healthy person -sx: dysuria, urinary frequency, urgency, nocturne, hestistency, suprapubic discomfort complicated: back or flank pain means involves upper urinary tract, fever means involved kidney, prostate, bloodstream. this in in pt with risk factors i.e. pregnant, diabetes...

Question 35

pyeloneprhtis (kinden infection) mild vs severe

Answer 35

mild: low grade fever, with or w/o low back or costovertebral angle pain severe: high fever, rigours, N/V, flank or loin pain

Question 36

main distringuishing feature btwn cystitis and pyelonephrtitis

Answer 36

fever fever of pyelonephritis typically exhibits a high spiking “picket-fence” pattern and resolves over 72 h of therapy.

Question 37

signs of pyelonephritis

Answer 37

increase serum creatine papillary necrosis

Question 38

emphysematous pyelonephritis who does it occur in

Answer 38

gas in renal and perinephritc tissues in diabetic people

Question 39

Xanthogranulomatous Pyelonephritis cause

Answer 39

chronic urinary obstruction (often by staghorn calculi), together with chronic infection, leads to suppurative destruction of renal tissue lipid laden macrophages, yellow, intraparenchymal abscess

Question 40

urosepsis

Answer 40

bacteria in urinary tract, from bladder or kidneys, enters bloodstream and causes sepsis (systemic) low BP, fever, chills, rapid HR and breathing, confusion, decreased urine IV antibiotics, stabilize vitals, manage organ dysfunction

Question 41

normal vaginal microbiomes

Answer 41

lactobacillus species L. crispatus, L. gasseri, L. jensenii, and L. iners

Question 42

environment in vaginal

Answer 42

acidic via lactic acid production (from lactobacilli) also make antimicrobials: hydrogen peroxide and bacteriocin-like substances

Question 43

normal vaginal microbiota

Answer 43

dominance of Lactobacillus species and a stable acidic pH, which helps to maintain the vaginal ecosystem and protect against infections.

Question 44

UTI risk factors

Answer 44

obstruction i.e. renal stone, urethral stricture short urethra length bladder catheterization

Question 45

microorganism causing UTI

Answer 45

E. coli 75% klebsiella 15% proteus 5%

Question 46

15% of cystitis cases in young, sexually active women from

Answer 46

s. saprophyticus

Question 47

nosocomial infections of UTI (hospital)

Answer 47

Enterobacter, Pseudomonas, enterococci, Candida, S. epidermidis, and Corynebacterium.

Question 48

e coli. causing UTI have what virulence factors

Answer 48

adhesins --> P. fimbriae (interact with receptor on renal epithelial cells) ;; can cause pyelonephritis --> type 1 pilus (fimbria) (bind uropethial cells in bladder via mannose) ;; for bladder infection operons; respond to envo; turn on and off flagella

Question 49

what does P fimbriae from e coli bind to

Answer 49

blood group antigen P, which contains a D-galactose-D-galactose residue

Question 50

what do type 1 pilus fimbriae on e coli bind

Answer 50

mannose on the luminal surface of bladder uroepithelial cells.

Question 51

impact of type 1 pilus (fimbria) on e coli

Answer 51

This increased ability to adhere to the epithelial cells of the urethra in addition to increased resistance to serum cidal activity and hemolysin production makes them very invasive

Question 52

what on e coli respond to envo to turn on or off flagella

Answer 52

operons The expression of flagella and other surface molecules allows bacteria to alternate between migrating up the urethra and ureters and adhering to epithelial cells in the urinary tract.

Question 53

proteus bacteria need to synthesize what for optimal growth

Answer 53

guanine, arginine, and glutamine

Question 54

proteus mirabilis produces what that causes pyeloneprhtitis and how does it do so

Answer 54

make ureases which generate ammonium and raise urine pH >7 alkaline urine= bacterial growth and renal stones

Question 55

what does proteus bacteria make

Answer 55

ureases IgA proteases hemolysin operons (turn on and off flagella) endotoxin

Question 56

what does endotoxin in proteus bacteria do to cause pyelonephritis

Answer 56

decreasing ureteral peristalsis, slowing the downward flow of urine and enhancing the ability of gram-negative bacteria to ascend into the kidneys.

Question 57

klebsiella bacteria causing nosocomial UTIs via what factors they have

Answer 57

bladder or kidney via fimbriae and adhesins form biofilms to protect against host immune response and antibiotics virulence factors: polysaccharides, LPS, toxins, siderophores antibiotic resistnat

Question 58

enterococci causing UTI via what

Answer 58

indwelling catheterization instrumentation or anatomic abnormalities of the genitourinary tract

Question 59

enterococci and s. epidermis virulence

Answer 59

biofilms virulence factors: surface proteins, adhesins, toxins, and enzymes.

Question 60

interstitial cystitis

Answer 60

chronic bladder pain (and outside i.e. pelvis, abs, genitals) and inflammation lower urinary tract symptoms

Question 61

causes of interstitial cystitis

Answer 61

Infection and the urinary microbiota (dysbiosis; no specific microbe) Autoimmunity Inflammation Urothelial dysfunction

Question 62

autoimmune and interstitial cyctitis

Answer 62

anti-urothelial antibodies inflammatory infiltrate: lymphoplasmacytic infiltrates, stromal edema and fibrosis, urothelial denudation, and detrusor mastocytosis.

Question 63

inflammation in interstitial cystitis

Answer 63

Hunner lesions—discrete inflammatory lesions

Question 64

interstitial cystitis and ureothelial dysfunction

Answer 64

urothelrium (stratified epithelium in the bladder) urothelium has GAGs and tight junctions and umbrella cells for robust barrier defects in barrier then could cause bladder pain syndrome

Question 65

sx of interstitial cystitis

Answer 65

men and female pain In bladder associated w urinary storage urinary frequency + urgency

Question 66

complications of interstitial cystitis

Answer 66

mental health and quality of life, suicide associated with fibromyalgia, RA, peripheral neuropathy

Question 67

most common tumor for bladder cancer

Answer 67

urothelial malignant neoplasms/ urotwhelial carcinomas

Question 68

most common site for tumor in urinary tract

Answer 68

bladder

Question 69

risk factors for bladder cancer

Answer 69

Cigarette smoking and exposure to industrial dyes or solvents Cigarette smoking (fourfold increased risk) Industrial exposure to azo dyes Infection with S. haematobium (in endemic regions) Drugs, such as cyclophosphamide and analgesics Radiation therapy (following cervical, prostate, or rectal cancer)

Question 70

3 papillomas (bengign epethial tumor) in bladder cancer

Answer 70

1. urothelial papilloma (classic exophytic and inverted) 2. exophytic papilloma: papillary fronds in transitional epithelium (grows outward to epithelial surface) 3. inverted papillomas: nodular mucosal lesions in trigone area (grows inward into underlying epithelium)

Question 71

urothelial carcinoma in situ

Answer 71

callular atypia: loss of nuclear polarity, nuclear irregularity, enlargement, hyperchromatism, and prominent nucleoli. The basement membrane is intact, and there is no invasion into underlying stroma.

Question 72

where does papillary cancer occur most often

Answer 72

lateral or posterior bladder walls

Question 73

Papillary urothelial neoplasms of low malignant potential

Answer 73

larger than papillomas but lack cytologic and architectural atypia that is seen in low grade carcinomas

Question 74

Low-grade papillary urothelial carcinoma: vs high grade

Answer 74

Low-grade papillary urothelial carcinoma: Low-grade tumors have fronds lined by neoplastic urothelial epithelium with minimal architectural and cytologic atypia . The cells are moderately hyperchromatic with little nuclear pleomorphism and low mitotic activity. Papillae are long and delicate. Invasion of the lamina propria or the deep muscularis propria occurs in 10%. High-grade papillary urothelial carcinoma: These tumors show significant nuclear hyperchromasia and pleomorphism. The epithelium is disorganized with mitoses in all layers. Approximately 80% of all high-grade tumors invade the lamina propria and, less often, the muscularis propria, or through the entire thickness of the bladder wall. Regional lymph nodes contain metastatic tumor in half of patients with these invasive tumors.

Question 75

invasie urothelial caricnoma

Answer 75

highly malignant from papillary lesion or flat carcinomas in situ

Question 76

tumor extension and subsequent recurrence of bladder cancer increases with

Answer 76

Increased tumor size High stage High grade Presence of multiple tumors Vascular or lymphatic invasion Urothelial dysplasia (including carcinoma in situ) at other sites in the bladder

Question 77

sx of bladder cancer

Answer 77

hematuria dysuria cystoscopy shows tumor

Question 78

bladder cancer stages via most common metastases?

Answer 78

tumor node metastasis (TNM) system In order of decreasing frequency, metastases involve the regional and periaortic lymph nodes, liver, lung, and bone.