LUT- URINARY BLADDER- CONGENITAL ANOMALIES/ INFLAMMATION

Question 1

CONGENITAL ANOMALIES OF THE URINARY BLADDER

Answer 1

1. DIVERTICULA
2. EXSTROPHY

Question 2

Diseases of the bladder, particularly inflammation (cystitis), constitute an important source of
clinical signs and symptoms.

Usually, however, these disorders are more disabling than lethal.
Cystitis is particularly common in** ______________**

Tumors of the bladder are
an important source of both morbidity and mortality.

Answer 2

young women of reproductive age.

Question 3

A bladder or vesical diverticulum consists of a pouchlike evagination of the bladder wall.
Diverticula may arise as congenital defects but more commonly are acquired lesions caused by
______________

Answer 3

persistent urethral obstruction.

Question 4

The congenital form of Urinary bladder diverticula may be due to a focal_____________________ during fetal development.

Answer 4

failure of development of the normal musculature or
to some urinary tract obstruction

Question 5

Acquired diverticula are most often
seen with ________________, producing obstruction to urine
outflow and marked muscle thickening of the bladder wall. The increased intravesical pressure
causes outpouching of the bladder wall and the formation of diverticula.

They are frequently
multiple and have narrow necks located between the interweaving hypertrophied muscle
bundles. In both the congenital and the acquired forms, the diverticulum usually consists of a
round to ovoid, saclike pouch that varies from less than 1 cm to 5 to 10 cm in diameter.

Answer 5

prostatic enlargement (hyperplasia or neoplasia)

Question 6

Although most diverticula are small and asymptomatic, they may be clinically significant, since

Answer 6

• they constitute sites of urinary stasis and predispose to infection and the formation of bladder
  calculi.
• They may also predispose to vesicoureteral reflux as a result of impingement on the
• *urete**r
• . Rarely, carcinomas may arise in bladder diverticuli.

Question 7

When invasive cancers arise in diverticula, they tend to be more advanced in stage as a result of the________________

Answer 7

** thin or absent muscle wall
of a diverticulum.**

Question 8

Exstrophy of the bladder is a developmental failure in the ___________________ so that the bladder either communicates directly through a large defect with the
surface of the body or lies as an opened sac ( Fig. 21-3 ).

The exposed bladder mucosa may
undergo colonic glandular metaplasia and is subject to infections that often spread to upper
levels of the urinary system.

Patients have an increased risk of adenocarcinoma arising in the bladder remnant. [2] These lesions are amenable to surgical correction, and long-term survival
is possible.

Answer 8

anterior wall of the abdomen and the
bladder,

Question 9

Miscellaneous Anomalies.
___________ is the most common and serious anomaly.

As a major contributor to renal
infection and scarring, it was discussed earlier, in Chapter 20 , in the consideration of pyelonephritis.

Answer 9

Vesicoureteral reflux

Question 10

Abnormal connections between the **bladder and the vagina, rectum, or uterus **may create________________
Rarely, the urachus (the canal that connects the fetal bladder with the allantois) may remain patent in part or in whole. When totally patent, a fistulous urinary tract is created that connects
the bladder with the umbilicus.

Answer 10

congenital vesicouterine fistulas.

Question 11

At times, only the central region of the urachus persists, giving
rise to ____________-, lined by either urothelium or metaplastic glandular epithelium.
Carcinomas, mostly glandular tumors, may arise from such cysts (see “Neoplasms”).

These
account for only a minority of all bladder cancers (0.1% to 0.3%) but 20% to 40% of bladder
adenocarcinomas.

Answer 11

urachal cysts

Question 12

The pathogenesis of cystitis and the common bacterial etiologic agents are discussed in
Chapter 20 in the consideration of urinary tract infections. As emphasized earlier, bacterial
pyelonephritis is frequently preceded by i_________________

Answer 12

nfection of the urinary bladder, with retrograde spread of microorganisms into the kidneys and their collecting systems.

Question 13

The common etiologic agents
of cystitis are the coliforms: _____________, _____________,____________ and ___________

Answer 13

• : Escherichia coli, followed by
• Proteus,
• Klebsiella,
• and Enterobacter.

Question 14

Women are more likely to develop cystitis as a result of their ____________.

Answer 14

shorter urethras

Question 15

__________________ is almost always a sequel to renal tuberculosis.

Answer 15

Tuberculous
cystitis

Question 16

_________________ and, much less often,
cryptococcal agents cause cystitis, particularly in immunosuppressed patients or those
receiving long-term antibiotics

Answer 16

Candida albicans

Question 17

________________is rare in the
United States but is **common in certain Middle Eastern countries, notably Egypt. **

Answer 17

. Schistosomiasis (Schistosoma haematobium)

Question 18

Viruses (e.g.,
adenovirus), Chlamydia, and Mycoplasma may also cause cystitis.

Question 19

Predisposing factors in cystitis include
________________

Answer 19

• bladder calculi,
• urinary obstruction,
• diabetes mellitus,
• instrumentation,
• and immune deficiency.

Question 20

Finally, irradiation of the bladder region gives rise to ________________

Answer 20

radiation cystitis.

Question 21

Morphology.

Most cases of cystitis take the form of__________________

Answer 21

nonspecific acute or chronic
inflammation of the bladder.

Question 22

What is the gross appearance of cystitis, there is________________

Answer 22

hyperemia of the mucosa,
sometimes associated with exudate.

Question 23

Patients receiving cytotoxic antitumor drugs, such as
____________- may develop hemorrhagic cystitis. [3]

Answer 23

cyclophosphamide,

Question 24

______________ also
causes a hemorrhagic cystitis.

Answer 24

Adenovirus infection

Question 25

• *Persistence of the infection leads to chronic cystitis,** which differs from the acute form only
• *in the character of the_____________________**

Answer 25

** inflammatory infiltrate.**

Question 26

_________________, characterized by the
aggregation of lymphocytes into lymphoid follicles within the bladder mucosa and underlying
wall, is not necessarily associated with infection.

Answer 26

Follicular cystitis

Question 27

_____________, manifested by
infiltration with submucosal eosinophils, typically also represents nonspecific subacute
inflammation, although rarely it is a manifestation of a systemic allergic disorder.

Answer 27

Eosinophilic cystitis

Question 28

The
ubiquitous presence of mild chronic inflammation in the bladder unaccompanied by clinical
symptoms should not be given the diagnosis of chronic cystitis

Answer 28

so dapat may clinical symptoms ;)

Question 29

What are the two that causes hemorrhagic cystitis?

Answer 29

1. Adenovirus
2. cyclophosphomide drug

Question 30

Special Forms of Cystitis

Several variants of cystitis are distinctive by their morphologic appearance or causation.

Answer 30

1. Interstitial Cystitis (Chronic Pelvic Pain Syndrome)
2. Malacoplakia.
3. Polypoid Cystitis.

Question 31

This is a persistent, painful form of chronic cystitis occurring most frequently in women. [4]

Answer 31

Interstitial Cystitis (Chronic Pelvic Pain Syndrome).

Question 32

What is the clinical characteristic of interstitial cystitis?

Answer 32

It is
characterized clinically by:

• intermittent,
• often severe suprapubic pain,
• urinary frequency,
• urgency,
• hematuria
• and dysuria without evidence of bacterial infection, and cystoscopic findings of fissures and punctate hemorrhages (glomerulations) in the bladder mucosa after luminal distention.
• Some but not all patients show morphologic features of chronic mucosal ulcers

Question 33

In the Interstitial Cystitis (Chronic Pelvic Pain Syndrome) some but not all patients show morphologic features of_______________; this is termed the late (classic, ulcerative) phase.

Answer 33

chronic mucosal ulcers(Hunner ulcers)

Question 34

What is the characteristic in the late phase of Intertstitial Cystitis ( Chronic Pelvic Pain Syndrome)

Answer 34

mast cells are
characteristic of this disease, there is no uniformity in the literature about their specificity and
diagnostic utility.

Late in the disease, transmural fibrosis may ensue, leading to a contracted
bladder.

The major role of biopsy is not to specifically diagnose the disease as much as it is to
rule out carcinoma in situ, which may mimic interstitial cystitis clinically. Its etiology is unknown,
its evaluation and diagnosis remain controversial, and its treatment is largely empiric.

Question 35

This designation refers to a peculiar pattern of vesical inflammatory reaction characterized macroscopically by soft, yellow, slightly raised mucosal plaques 3 to 4 cm in diameter ( Fig. 21-
4 ), and histologically by infiltration with large, foamy macrophages mixed with occasional
multinucleate giant cells and interspersed lymphocytes. [6]

The macrophages have an
abundant granular cytoplasm due to phagosomes stuffed with particulate and membranous
debris of bacterial origin.

Answer 35

Malacoplakia.

Question 36

In addition to the Malacoplakia, laminated mineralized concretions resulting from
deposition of calcium in enlarged lysosomes, known as ______________, are typically
present within the macrophages ( Fig. 21-5 ).

Similar lesions have been described in the colon,
lungs, bones, kidneys, prostate, and epididymis.

Answer 36

Michaelis-Gutmann bodies

Question 37

Malacoplakia is clearly related to chronic bacterial infection, mostly by ____________or occasionally
Proteus species.

It occurs with increased frequency in immunosuppressed transplant recipients.

Answer 37

**E. coli **

Question 38

In malacoplakia the** unusual-appearing macrophages** and giant phagosomes _______________, such that phagosomes become overloaded with
undigested bacterial products.

Answer 38

point to defects in phagocytic or
degradative function of macrophages

Question 39

Polypoid cystitis is an inflammatory condition resulting from ____________ [7,] [8]

Answer 39

irritation to the bladder
mucosa.

Question 40

What is the most common culprit in Polyploid Cystitis?

Answer 40

indwelling catheters are the most commonly cited culprits, any
injurious agent may give rise to this lesion.

The urothelium is thrown into broad bulbous
polypoid projections as a result of marked submucosal edema.

Question 41

Polypoid cystitis may be
confused with __________ both clinically and histologically.

Answer 41

papillary urothelial carcinoma