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D&T 3 Test 3 > Lower Urinary Tract > Flashcards

Lower Urinary Tract Flashcards

1
Q

name 3 locations for ureter narrowing

A
  1. ureteropelvic junction ( renal pelvis meets proximal ureter)
  2. crossing at external/common iliac artery
  3. ureters enter bladder
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2
Q

what is a cause of ureter obstruction

A

hydronephrosis

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3
Q

what site and and in who is ureter obstruction common in

A

left side

boys

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4
Q

What are 3 congenital anomalies of ureters

A
  1. double ureters
  2. ureteropelvic junction obstruction
  3. Diverticula
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5
Q

what is diverticula

A

saccular outpouching of ureteral wall

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6
Q

What are 2 types of inflammation that can occur to the ureters

A

acute

chronic

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7
Q

What are 3 types of chronic inflammation of the ureter

A
  1. ureteritis cystica
  2. ureteritis follicularis
  3. ureteritis glandularis
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8
Q

what is ureteritis cystica

A

fine cysts in mucosa composed of dilated Brunn nests

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9
Q

what is ureteritis follicularis

A

fine granular mucosa due to lymphoid follicles

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10
Q

What is ureteritis glandularis

A

intestinal metaplasia

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11
Q

What are benign Ureter tumors

A

Fibroepithelial polyps

Leiomyomas

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12
Q

What are malignant ureter tumors

A

majority urothelial (transitional cells) carcinoma

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13
Q

What is the number one cause of urothelial carcinoma

A

smoking

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14
Q

Urothelial carcinoma is associated with what other syndrome

A

HNPCC

hereditary nonpolyposis colorectal cancer syndrome

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15
Q

What are 3 things that can cause sclerosing retroperitoneal fibrosis

A
  1. drugs ( ergot derivatives)
  2. adjacent inflammatory conditions ( Crohn’s)
  3. malignancy ( lymphomas)
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16
Q

Sclerosing retroperitoneal fibrosis is associated what problems in other parts of the body

A

mediastinal fibrosis
sclerosing cholangitis
Riedel fibrosing thyroiditis

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17
Q

Sclerosing retroperitoneal fibrosis is associated with what disease

A

IgG4

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18
Q

Micro what is seen in Sclerosing retroperitoneal fibrosis

A

lymphocytes
germinal centers
plasma cells
eosinophils

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19
Q

treatment for Sclerosing retroperitoneal fibrosis

A

surgical

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20
Q

What are 4 congenital anomalies of bladder

A
  1. diverticula
  2. exstrophy
  3. vesicoureteral reflux
  4. urachus/urachal remnant
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21
Q

What is diverticula

A

congenital ( can also be acquired) invagination of bladder wall

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22
Q

what is exstrophy

A

development failure of anterior wall of abdomen and bladder

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23
Q

What is urachus/urachal remnant

A
  • comes out of dome of bladder

- connects fetal bladder with allantois

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24
Q

What is the clinical triad for cystitis ( bladder inflammation)

A
  1. urination frequency
  2. suprapubic pain
  3. dysuria
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25
Q

What is dysuria

A

pain/burning sensation

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26
Q

What are common agents for bladder inflammation

A

E. coli, Proteus, Klebseilla, Enterobacter

Schistosomiasis

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27
Q

what is clinical presentation for interstitial cystitis ? another name?

A

painful/persistent chronic cystitis

Chronic pelvic pain syndrome

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28
Q

What happens to the bladder in interstitial cystitis

A

fibrosis of all layers of bladder wall

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29
Q

What immune response occurs in interstitial cystitis late phase

A 
classic 
ulcerative phase ( hunner ulcers) 
chronic mucosal ulcers
30
Q

What immune response occurs in interstitial cystitis early phase

A

(nonclassic/nonulcerative)

submucosal hemorrhage

31
Q

What is Malacoplakia

A

inflammatory reaction

  • slightly raised mucosal plaque
  • defect in phagocytosis of bacterial products
32
Q

what is micro found in Malacoplakia

A

large foamy macrophages
multinucleated giant cells
lymphocytes
Michaelis- Gutmann bodies

33
Q

What are Michaelis-Gutmann bodies

A

laminated mineralized concentrations ( Ca in lysosomes)

34
Q

Malacoplakia is associated with what bacteria

A

E. coli

Proteus

35
Q

Name 3 metaplastic lesions

A
  1. Brunn nests
  2. Cystitis cystica
  3. cystisis glandularis
36
Q

what are brunn nests

A

urothelium grows into lamina propia

37
Q

What is cystic spaced lined by in cystitis cystica

A

urothelium

38
Q

what epithelium is seen in cystitis glandularis

A

cuboidal/columnar/ goblet cells

39
Q

Name 2 metaplastic lesions

A
  1. squamous metaplasia

2. nephrogenic metaplasia

40
Q

when does squamous metaplasia occur

A

response to injury

41
Q

What happens in nephrogenic metaplasia

A

change to cuboidal epithelium

tubular proliferation of lamina propia

42
Q

For bladder tumors, what is a gain of function mutation? What does it activate? what is it seen in?

A

FGFR3

  • activates tyrosine kinase
  • low grade urothelial carcinoma
43
Q

For bladder tumors, what is a loss of function mutation? Who usually gets it?

A

TP53 and RB

- high grade urothelial carcinoma

44
Q

For bladder tumors, what is an activating mutation and where is loss of genetic material?

A

HRAS

Chr 9

45
Q

What is a benign bladder tumor

A

urothelial tumors

46
Q

What is a borderline bladder tumor

A

Papillary urothelial neoplasms of low malignant potential

47
Q

What are malignant bladder tumors

A

Papillary urothelial carcinoma

Carcinoma in situ

48
Q

what is the histo for bladder tumor papilloma? who usually gets it?

A

papillae in core
normal urothelium

youngsters

49
Q

Where does inverted papilloma occur in histo

A

in lamina propia

50
Q

PUNLMP hiso?

A
  1. thicker urothelium
  2. diffuse nuclear enlargement
  3. mitotic figures rare
51
Q

histo for low-grade papillary urothelial carcinoma

A
  1. orderly
  2. evenly spaced
  3. minimal atypia
  4. some mitotic figures
52
Q

hist for high-grade papillary urothelial carcinoma

A
  1. architectural disarray and loss of polarity
  2. anaplasia
  3. mitotic figures
53
Q

histo for carcinoma in situ

A
  1. cytologically malignant cells within flat urothelium

2. no invasion of basement membrane

54
Q

What is the pathological staging scale

A

T1 - lamina propia
T2- muscularis propia
T3 - pervescial fat
T4 - adjacent structures

55
Q

histo for squamous cell carcinoma

A

keritization

pink cells

56
Q

50 year old moves from Egypt to US. Presents with large bladder mass

A

Squamous cell carcinoma: schistosoma

57
Q

Botyroid rhabdomyosarcoma has what origin

A

muscle origin

58
Q

histo for botyroid rhabdomyosarcoma

A

cambium layer

deeper hypocellular and myxiod stroma

59
Q

who does botyroid rhabdomyosarcoma occur in

A

infancy or childhood

60
Q

botyroid rhabdomyosarcoma gross apperance

A

grape-like

61
Q

histo for leiomyosarcoma

A

fascicles of malignant spindle cells

62
Q

What is morphology of early bladder obstruction

A

some thickening of bladder wall

normal mucosa

63
Q

What is morphology of late bladder obstruction

A

individual muscle bundles enlarge

trabeculation of bladder wall ( hypertrophy muscles)

64
Q

how can prostatic hypertrophy impact bladder

A

hypertrophy and trabeculation of bladder

65
Q

What are common agents for urethra inflammation

A

Gonococcal

non-gonococcal ( e. coli, chlamydia, mycoplasma)

66
Q

Urethra problems can cause what syndrome

A

Reiter syndrome

67
Q

triad of reiter syndrome

A
  1. arthritis
  2. conjunctivitis
  3. urethritis
68
Q

What is urethral caruncle

A

small, red, painful mass in external urethral meatus of female

69
Q

proximal malignant tumors of urethra have what orgin

A

urothelial

70
Q

distal malignant tumors of urethra have what origin

A

squamous cell origin

D&T 3 Test 3 (7 decks)

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