Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

RENAL II, Test 2 > Lower Urinary Tract > Flashcards

Lower Urinary Tract Flashcards

1
Q

cystocele

A

bladder protrudes into the vagina and creates a pouch that fails to empty readily with micturition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

ureteropelvic junction obstruction

A

): most common cause of hydronephrosis in infants and children,
o more common in women and is bilateral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

diverticula

A

saccular outpouching of the ureteral wall
o leads to recurrent infections, due to sites of urinary stasis
o may predispose to VUR if it impinges ureter
o commonly due to persistent urethral obstruction
o Congenital form: due to focal failure of development of normal musculature during fetal development
o Acquired form: most often seen w/ prostatic enlargement producing obstruction to urine flow and thickening of bladder wall
o rarely carcinomas may arise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

exstrophy of bladder

A

o a developmental failure in anterior wall of abdomen and bladder
o exposed mucosa may undergo metaplasia and is subject to infections that can spread to upper GU tract
o increased risk of adenocarcinoma arising from bladder remnant
o amenable to surgery w/ long-term survival rate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

VUR

A

• Vesicouteral reflux:
o ureter enters bladder at unusual angle the valve does not work properly resulting in retrograde urine flow back into ureter and kidney

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

patent urachus/urachal cyst

A

• Patent Urachus/Urachal cyst:
o fistulus urinary tract connects the bladder w/ the umbilicus
o carcinomas or glandular tumors may arise from such cysts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

ureteritis

A

inflammation, typically not assoc. w/ infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

pyelonephritis

A

kidney infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

hydronephrosis

A

water in kidney

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

hydroureter

A

ureteral dilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

fibroepithelial polyp

A

• fibroepithelial polyp: tumor-like lesion that presents as small mass projecting into the lumen, often in children

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

urothelial carcinoma

A

primary malignant tumors of ureter – resembles those in renal pelvis, calyces and bladder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

sclerosing retroperitoneal fibrosis

A

o common cause of ureteral narrowing/obstruction

o fibrotic proliferative inflamm. process encasing retroperitoneal structures and causing hydronephrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

cystitis

A

= bladder inflammation

Organisms causing cystitis:
• E. coli, Proteus, Klebsiella, Enterobacter (Staph and Saprophyticus are less likely)
• women more likely to develop
• Candida albicans seen in IC patients
• Schistomiasis – rare in US but seen in Egypt - assoc. w/ squamous cell carinoma of bladder

cystitis is often before pyelonephritis

Predisposing factors: 
•	bladder calculi
•	urinary obstruction
•	DM
•	instrumentation
•	IC

Morphology:
• see hyperemia of mucosa, sometimes exudate present

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

clinical triad of cystitis

A
  • frequency
  • lower abdominal pain (over bladder, suprapubic region)
  • dysuria (pain with urination)
  • also see low-grade fever, turbid urine, occasional hematuria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

hemorrhagic cystitis

A
  • pt. receiving cytotoxic anti-tumor drugs such as cyclophosphamides often develop this
  • adenovirus has been shown to cause it as well
17
Q

interstitial cystitis

A

chronic pelvic pain syndrome
• occurs most freq. in women, ages 30-40 years
• intermittent severe suprapubic pain, urinary frequency, urgency, hematuria, dysuria
• often followed by late stage ulceration
• Mast cells characteristically seen, along w/ inflammation and fibrosis of bladder wall and fissures

18
Q

malakoplakia

A
  • chronic inflamm. rxn that appears to stem from acquired defects in phagocyte function
  • E. coli or Proteus species
  • more common in IC patients
  • more common in females that are middle aged
  • lesions are 3-4 cm soft, yellow, mucosal plaques made of foamy macrophages stuffed with bacterial debris
  • foamy macrophages have Michaelis-Gutmann bodies – suggesting defective function
19
Q

polyploid cystitis

A
  • inflamm. condition resulting from irritation to bladder mucosa
  • indwelling catheters most common cause
  • has been misdiagnosed as papillary carcinoma
20
Q

cystitis cystica and cystitis glandularis

A
  • Cystitis Cystica (CC) and Cystitis Glandularis (CG) are common chronic reactive/inflammatory disorders which occur in the setting of chronic irritation
  • Metaplasia of the urothelium is incited by irritants such as infection, calculi, outlet obstruction, or even tumor
  • The urothelium proliferates into buds (nests of von Brunn) which grow down into the connective tissue beneath the epithelium into the lamina propria.
  • The buds then differentiate into cystic deposits of CC or into intestinal columnar mucin-secreting glands (goblet cells) resulting in CG.
  • The histologic features of both CC and CG are usually present, rather than either in its pure form
  • CC and CG can occur at any age, and there is a reported prevalence of 2.4% of children associated with UTIs.
  • A slight male predominance is reported
  • Symptoms include those of chronic irritation, such as frequency, dysuria, urgency, and hematuria.
21
Q

squamous metaplasia

A
  • occurs in response to injury

* urothelium replaced by nonkeratinizing squamous epithelium, which is more durable

22
Q

Nephrogenic Adenoma:

A

• results from implantation of shed renal tubular cells at sites of injured urotehlium

23
Q

urothelial tumors

A

“Transitional Cell Carcinoma”
• 90% of bladder cancers
• two distinct precursor lesions to invasive urothelial carcinoma: noninvasive papillary tumors and flat noninvasive urothelial carcinoma (CIS)
• CIS = Carcinoma in Situ – describes lesions w/ features of malignancy but are confined to the epithelium, showing no evidence of BM invasion
• ½ of individuals w/ bladder cancer, have tumor invasion of bladder wall at time of presentation
• invasion of detrusor muscle (muscularis propria) = decreased survival rate

24
Q

pathogenesis of urothelial tumors

A
  • more common in men, developed nations, urban areas
  • patients b/w 50-80 years
  • cigarette smoking is most important influence
  • industrial exposure to aryl amines, Schisosoma haematobium, long-term use of analgesics, cyclophosphamide (IM suppressive agent), irradiation
  • p53 mutation = bad sign
  • high grade invasive tumors: see loss-of-fn. mutation of TP53 and Rb tumor suppressor genes
  • low-grade noninvasive tumors: see HRAS oncogene mutation
  • low-grade papillary tumors: FGFR3 and RAS mutations
25
Q

clinical features of transitional cell carcinoma?

A
  • painless hematuria: most common manifestation
  • frequency, urgency, dysuria, pyelonephritis, hydronephrosis may all occur as well
  • high rate of recurrence after tumor excision
  • Papillomas, papillary urothelial neoplasms of low malignant potential and low-grade papillary urothelial cancer yield 98% survival rate
  • high grade leads to death in 25% of cases
  • primary CIS is less likely to invade than when it is assoc. w/ infiltrating urothelial cancer
  • squamous cell and adenocarcinoma are assoc. w/ worse prognosis than urothelial carcinoma, yet stage for stage they are the same
26
Q

tx of transitional cell carcinoma?

A

• clinical investigation via cystoscopy and urine cytology
• Majority: have transurethral resection and surveillance, followed by chemo
• Miniroty: have segmental cystectomy (invasive) and immunotherapy
o radical cystectomy reserved for tumor invading muscularis propria, CIS or high grade cancer, VIS extending into prostatic urethra and ducts

27
Q

papillomas

A 
Papillomas: better							
•	1% of bladder tumors
•	seen in younger patients
•	small, delicate structures attached via a stalk = “exophytic papillomas” 
•	no atypia/dysplasia
•	small and extends from surface
•	low/moderate recurrence rate
•	“inverted papilloma” 
o	occurs in younger males
o	typically a raised “bump” in the trigone covered by grossly normal mucosa
28
Q

papillary urothelial neoplasms of low malignant potential

A 
(PUNLMP) better
•	similar to papillomas but have thicker urothelium 
•	larger than papillomas 
•	moderate recurrence rate
•	minimal cellular atypia
29
Q

low-grade papillary urothelial carcinoma

A

less than 10% invade – ok
• 45% of papillary tumors
• cells are evenly spaced (maintain polarity and cohesive)
• mild degree of nuclear atypia, infrequent mitotic figures seen

30
Q

high-grade papillary urothelial carcinoma

A

over 80% are invasive - BAD
• 30% of papillary tumors
• non-cohesive cells with large hyperchromatic nuclei
• highly anaplastic, atypical mitotic figures, loss of polarity
• high recurrence rate

31
Q

carcinoma in situ (CIS)

A

INVASIVE
• flat urothelial carcinoma
• cytologically malignant cells w/ flat urothelium
• lack cohesiveness, resulting in shedding of malignant cells into urine
• CIs usually appears as area of mucosal reddening, granularity, or thickening w/out evident intraluminal mass
• if untreated 50-70% of CIS progress to invasive cancer

32
Q

invasive urothelial cancer

A

INVASIVE

- may be assoc. w/ papillary urothelial carcinoma (usually high grade), or with flat urothelial carcinoma (CIS)

33
Q

staging in bladder cancer

A
  • high recurrence following treatment
    ** muscle invasion invasion i.e., depth of muscle invasion is the major prognostic issue to be established
    T2-T4 50% 5-Year disease-specific survival
34
Q

squamous cell carcinoma

A
  • more freq. in countries where urinary schistosomiasis is endemic
  • assoc. w/ chronic bladder irritation and infection
35
Q

Mixed urothelial carcinomas w/ areas of squamous carcinoma:

A
  • more frequent than pure squamous cell

* invasive, fungating tumors that are infiltrative an ulcerative

36
Q

primary malignant lymphoma

A
  • adults, age 65 y/o, very rare, more common in females
  • usually non-hodgkin lymphoma
  • radiosensitve, thus good prognosis
37
Q

leiomyoma

A

benign smooth mm. mesenchymal tumor

38
Q

sarcomas in bladder

A

uncommon in bladder

most common in infancy/childhood is rhabdomyosarcoma
o malignant mesenchymal tumor typically in children,
o rare, average age is 4 y/o

leiomyosarcoma:
o malignant mesenchymal tumor
o adults, 60 y/o, rare, more common in males
o seen in post chemo/radiation

RENAL II, Test 2 (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions