Lower Urinary Tract Path (Handorf)

Question 1

What are the layers of the wall of the ureter?

Answer 1

mucosa, muscualris, and adventitia

Question 2

what propels the urine through the ureter?

Answer 2

peristaltic contractions

Question 3

aquired strictures in the ureter are due to ..

Answer 3

chronic inflammation or sclerosing retroperitoneal fibrosis

Question 4

what are the most common tumors in the ureter

Answer 4

mets

Question 5

what are the most common benign primary tumors of the ureter?

Answer 5

fibroepithelial polyps and leiomyomas

Question 6

what is the most common type of malignant tumor of the ureter?

Answer 6

transitional cell carcinoma

Question 7

intrinsic or extrinsic cause of ureter obstruction:

neurogenic causes

Answer 7

intrinsic (interruption of neuronal pathways)

Question 8

what is a the major/serious complication of chronic ureter obstruction?

Answer 8

hydronephrosis (which can lead to renal failure)

**due to distention of renal pelvis and increased pressure on the kidney parenchyma

Question 9

What are causes of periureteral inflammation

Answer 9

salpingitis, diverticulitis, peritonitis, sclerosing retroperitoneal fibrosis

Question 10

a fibrous proliferative inflammatory process thet encases retroperitoneal structures and causes compression of the ureter

Answer 10

sclerosing retroperitoneal fibrosis

Question 11

what are the causes of sclerosing retroperitoneal fibrosis

Answer 11

unknown (70%)
drugs
chron’s dz
malignancy (lymphoma and urinary tract carcinoma)

Question 12

ectopic endometrium is…

Answer 12

endometriosis

Question 13

is the endometrial tissue in endometriosis functional?

Answer 13

yes

Question 14

how can endometriosis lead to ureter obstruction?

Answer 14

hormones –> proliferation –> bleeding –> scarring –> compression of uretrer

Question 15

what are 2 outcomes of chronic ureteritis

Answer 15

ureteritis folliculitis and ureteritis cystica

Question 16

gross difference between ureteritis folliculitis and ureteritis cystica

Answer 16

ureteritis folliculitis = fine granularity on mucosal surface

ureteritis cystica = cysts on mucosal surface

Question 17

produced by the accumulation of lymphocytes in the subepithelial region of the ureter in response to chronic inflammation

Answer 17

ureteritis folliculitis

Question 18

male infant with hydronephrosis on the left side

Answer 18

uteropelvic junction obstruction

Question 19

what is the pathophys of uteropelvic junction obstruction

Answer 19

abnormal organization and/or excess STROMAL deposition of COLLAGEN between smooth muscle bundles

Question 20

saccular outpouchings of ureteral wall

Answer 20

diverticula

Question 21

etiology of diverticula

Answer 21

congenital or due to increased pressure secondary to obstruction

Question 22

what is the complication most assc with diverticula?

Answer 22

pockets of stasis = infection

Question 23

congenital anomalies of the ureter

Answer 23

double/bifricated ureters, uteropelvic junction obstruction

Question 24

describe the changes that occur in the bladder with chronic obstruction

Answer 24

increased pressure → hypertrophy → trabeculation → crypts form → diverticula → pyelonephritis or hydronephrosis

Question 25

congenital cause of bladder diverticuIi

Answer 25

focal muscular defect

Question 26

most common aquired cause of bladder diverticuIi

Answer 26

urethral obstruction

Question 27

developmental defect of the closure of the anterior wall of the abdomen and the bladder

Answer 27

exstrophy | *i.e. the bladder communicates with the exterior of the body

Question 28

vestigial structure that located between the apex of the bladder and the umbilicus and connected the bladder to the allantois

Answer 28

urachus

Question 29

result of a totally patent urachus

Answer 29

fistulous urinary tract

Question 30

result of a urachus with only the center obliterated

Answer 30

diverticulum (infections)

Question 31

result of a urachus with only the center persists

Answer 31

urachal cyst --> adenocarcinoma

Question 32

describe the pathogenesis of a cystocele

Answer 32

relaxation of the pelvic support (usually old age/trauma from childbirth) → uterine prolapse → bladder floor pulled downward into vagina = cystocele

Question 33

congenital cause of vesicoureteral reflux

Answer 33

defect in the intravesical portion of the ureter such that there is no longer an oblique connection **without the oblique connection the bladder musculature cannot act like a sphincter

Question 34

how does vesicoureteral reflux present?

Answer 34

baby with lots of UTIs, pylonephrosis, or hydronephrosis

Question 35

orgs that commonly cause cystitis

Answer 35

E coli, proteus, klebsiella, enterobacter | **presents like a UTI

Question 36

seen in exudate of acute cystitis

Answer 36

neutrophils | *these predominate

Question 37

seen in the exudate of chronic cystitis

Answer 37

lymphocytes, plasma cells, macrophages | *these predominate

Question 38

non-infectious cuases of cystitis

Answer 38

radiation, chemo, trauma

Question 39

lymphoid follicles are formed in the bladder mucosa in ...

Answer 39

follicular cystitis (a form of chronic cystitis)

Question 40

foamy macropahges (PAS +) and michaelis-gutmann bodies

Answer 40

malakoplakia

Question 41

what is the etiology/pathogenesis of malakoplakia

Answer 41

defective host response to bacterial infection

Question 42

middle aged woman | suprapubic pain, uirnary frequency, urgency, and hematuria, without evidence of bacterial infection

Answer 42

interstitial cystitis

Question 43

related to cystitis cystica and is due to chronic inflammation of the bladder

Answer 43

cystitis glandularis

Question 44

90% of bladder tumors originate from

Answer 44

urothelium (transitional epithelium)

Question 45

inflammation and fibrosis of all layers of the bladder wall +/- localized mucosal ulcers (Hunner ulcers)

Answer 45

interstitial cystitis

Question 46

may predispose people to adenocarcinom

Answer 46

cystitis glandularis exstrophy urachal remnant

Question 47

morphologic patterns of urothelial bladder tumors

Answer 47

papillary and flat

Question 48

what areas of the bladder do most cancers arise? consequence of this?

Answer 48

lateral and posterior walls at the base --> commonly causes ureteral obstruction

Question 49

risk factors for bladder carcinomas

Answer 49

``` aniline dyes smoking cylophosphamide phenacetin schistosomiasis ```

Question 50

presenting symptoms of bladder carcinoma

Answer 50

painless hematuria | +/- frequency, urgency and dysruia

Question 51

where do bladder carcinomas invade?

Answer 51

bladder wall, prostate, seminal vesicles, ureters, retroperitoneum, **may produce fistuals to the vagina or rectum

Question 52

where do bladder carcinomas metastasize to?

Answer 52

regional LN, liver, lungs, bone marrow | *heme spread

Question 53

what tends to happen to urothelial tumors after they are removed?

Answer 53

new ones develop and these are typically at a higher grade

Question 54

in general, the higher the grade of the urothelial tumor, the

Answer 54

higher the chance of reoccurance

Question 55

assc with schistosomiasis and chronic irriation (i.e. calculi)

Answer 55

squamous cell carcinoma of the bladder

Question 56

where to squamous cell carcinomas of the bladder tend to airse?

Answer 56

trigone

Question 57

what morphology do squamous cell carcinomas of the bladder commonly have

Answer 57

fungating and invasive

Question 58

focal glandualr changes with mucin production

Answer 58

adenocarcimona

Question 59

adenocarcimona common morphology

Answer 59

solitary and deeply invasive (may ulcerate in center)

Question 60

non-smoker, egyption immigrant with bladder cancer most likely has

Answer 60

squamous cell carcinomas of the bladder

Question 61

benign bladder neoplasms

Answer 61

leiomyoma hemangioma granular cell tumor neurofibroma

Question 62

schistosoma hematobium

Answer 62

squamous cell carcinomas of the bladder

Question 63

malignant mesenchymal bladder neoplasms

Answer 63

rhabdomyosarcoma leiomyosarcoma **sarcomas

Question 64

grape like projections into lumen of bladder in an infant or child

Answer 64

embryonal rhabdomyosarcoma (sarcoma botryoides)

Question 65

arthritis + conjunctivitis + urethritis

Answer 65

reiter syndrome

Question 66

structure of the urethra is due to ... and causes...

Answer 66

due to chronic urethritis and can cause outflow obstruction

Question 67

small, red, painful, friable mass about the external urethral meatus in a female pt

Answer 67

urethral caruncle

Question 68

histo of urethral caruncle

Answer 68

leukocytes + fibrous CT (vascularized)

Question 69

tumor at the external meatus of the urethra and has a viral origin

Answer 69

papilloma

Question 70

____ carcinomas occur in the urethra (typically at the external meatus)

Answer 70

squamous cell