LUT- URETERS- CONGENITALANOMALIES/ INFLAMMATION/ TUMORS Flashcards
Congenital anomalies of the ureters are found in about 2% or 3% of all autopsies.
Although
most have little clinical significance, certain anomalies may contribute to obstruction to the flow
of urine and thus cause clinical disease.
Anomalies of the ureterovesical junction that potentiate
reflux are discussed with pyelonephritis in Chapter 20 .
Ureter Congenital Anomalies
- Dobule and bifid ureters
- uretopelvic junction obstruction
- Diverticula
Double and bifid ureters .
____________ are almost invariably associated either with totally distinct double renal pelves or with the anomalous development of a large kidney having a
partially bifid pelvis terminating in separate ureters.
Double ureter
________________, a congenital disorder, results in hydronephrosis.
It usually presents in infants or children, much more commonly in boys.
However, it is bilateral in
20% of cases and may be associated with other congenital anomalies
Ureteropelvic junction (UPJ) obstruction
. It is the most common
cause of hydronephrosis in infants and children.
In adults, UPJ obstruction is more common in
women and is most often unilateral. The condition has been ascribed to abnormal organization
of smooth muscle bundles at the UPJ, to excess stromal deposition of collagen between smooth
muscle bundles, or rarely to congenitally extrinsic compression by polar renal vessels.
There is
agenesis of the kidney on the opposite side in a significant number of cases, probably resulting
from obstructive lesions in utero.
UPJ
__________________ are uncommon lesions that are usually
asymptomaticandare found on imaging studies.
They appear as congenital or acquired
defects and are of importance as pockets of stasis and s
. Dilation
(hydroureter), elongation, and tortuosity of the ureters may occur as congenital anomalies or as
acquired defects.
Diverticula, saccular outpouchings of the ureteral wall,
Ureteritis, though associated with inflammation, is typically not associated with infection and is of
little clinical consequence.
Ureteritis,
Morphology. The accumulation or aggregation of lymphocytes forming germinal centers in
the subepithelial region may cause slight elevations of the mucosa and produce a fine
granular mucosal surface_____________
** (ureteritis follicularis).**
At other times the mucosa may become
sprinkled with fine cysts varying in diameter from 1 to 5 mm lined by** flattened urothelium**
____________________
(ureteritis cystica)
TUMORS AND TUMOR-LIKE LESIONS
Primary tumors of the ureter are rare.
- *Small benign tumors** of the ureter are generally of
- *____________**
mesenchymal origin.
_____________-is a tumor-like lesion that grossly presents as a small
mass projecting into the lumen, often in children.
The lesion occurs more commonly in the
ureters but may also appear in the bladder, renal pelves, and urethra.
Fibroepithelial polyp
Fibroepithelial polyp is composed
of a__________________mass lying beneath the mucosa.
loose, vascularized connective tissue
Primary malignant tumors of the ureter resemble those arising in the _____________
The majority are urothelial carcinomas ( Fig. 21-2 ). They are found most frequently
during the sixth and seventh decades of life and cause obstruction of the ureteral lumen.
They
are sometimes multiple and commonly occur concurrently with similar neoplasms in the bladder
or renal pelvis
renal pelvis, calyces, and
bladder.
A great variety of pathologic lesions may obstruct the ureters and give rise to hydroureter, hydronephrosis, and sometimes pyelonephritis ( Chapter 20 )
- hydroureter,
- hydronephrosis,
- and sometimes pyelonephritis (
. It is not the ureteral dilation that
is of significance in these cases, but theconsequent involvement of the kidneys.
The more
important causes, divided into those of intrinsic or extrinsic origin, are listed in Table 21-1 .
________________ typically results from proximal causes,
Unilateral obstruction
whereas ______________arises
from distal causes, such as nodular hyperplasia of the prostate. Only sclerosing retroperitoneal
fibrosis is discussed further.
bilateral obstruction
Major Causes of Ureteral Obstruction
Type of
Obstruction Cause
- INTRINSIC
- EXTRINSIC
INTRINSIC TYPE OF OBSTRUCTION
- CAlculi
- Strictures
- Tumors
- Blood clots
- Neurogenic
EXTRINSIC
- Pregnancy
- Periureteral Inflammation
- Endometriosis
- Tumors
- Of renal origin, rarely more than 5 mm in diameter
- Larger renal stones cannot enter ureters
- Impact at loci of ureteral narrowing—ureteropelvic junction, where ureters cross iliac vessels, and where they enter bladder—and cause excruciating “renal colic”
Calculi
Which part among of the ureteral narrowing cause excruciating “ renal coli”
UPJ
Congenital or acquired (inflammations)
Strictures
Transitional cell carcinomas arising in ureters
Rarely, benign tumors or fibroepithelial polyps
Tumors
Congenital or acquired (inflammations)
Strictures
Massive hematuria from renal calculi, tumors, or papillary necrosis
Blood Clots
_____________ Interruption of the neural pathways to the bladder
Neurogenic
________________- Physiologic relaxation of smooth muscle or pressure on ureters at pelvic brim from
enlarging fundus
Pregnancy
Salpingitis, diverticulitis, peritonitis, sclerosing retroperitoneal fibrosis
Periureteral
inflammation
Cancers of the rectum, bladder, prostate, ovaries, uterus, cervix; lymphomas,
sarcomas
Tumors
This refers to an uncommon cause of ureteral narrowing or obstruction characterized by a
fibrous proliferative inflammatoryprocessencasing the retroperitoneal structures and causing
hydronephrosis. [1]
The disorder occurs in middle to late age.
Sclerosing Retroperitoneal Fibrosis.
In some cases , what are the specific causes of Sclerosing Retorperitoneal Fibrosis?
In some cases specific causes
can be identified, such as:
- drugs (ergot derivatives, β-adrenergic blockers),
- adjacent inflammatory conditions (vasculitis, diverticulitis, Crohn disease),
- or malignant disease (lymphomas, urinary tract carcinomas).
How many percent is Sclerosing Retroperintoneal Fibrosis__________ of cases have no obvious cause and are
considered primary or idiopathic (Ormond disease).
NOTE : Several cases have been reported with
similar fibrotic changes in other sites (such as mediastinal fibrosis, sclerosing cholangitis, and
Riedel fibrosing thyroiditis), suggesting that the disorder is systemic in distribution but
preferentially involves the retroperitoneum. Thus, an autoimmune reaction, sometimes triggered
by drugs, has been proposed as the immediate cause of the systemic disease
70%
