Male Pathophys 3 Flashcards by Michael Castellarin

Cell types from the bottom up in a urinary bladder?

Basal cells, intermediate cells, umbrella cells

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Three layers of the wall of the ureter are?

Mucosa, muscularis, adventitia

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Remember that the ureter is not a passive structure. Peristaltic contraction of its muscle layer propels the urine

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The two most common primary tumors of the ureter are?

fibroepithelial polyps and leiomyomas

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Really there are two sorts of ways that the ureter may stop operating properly

1) Physically blocked

2) Some sort of neurogenic cause that prevents peristalsis from occuring

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Sclerosing retroperitoneal fibrosis

Fibrous proliferative inflammatory process, encasing the retroperitoneal structures including the URETER and causing COMPRESION OF THE URETER. Rare disease, middle to late age. Can be related to drugs like ergot derivatives, beta blockers, and diseases like Crohns

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Endometriosis

Presence of endometrial tissue outside of the uterus. Most commonly found on organs adjacent to the uterus (fallopian tubes, ovaries, etc..) The interesting thing about endometriosis is that it is responsive to hormones and therefore is characterized by cyclic bleeding and menstrual related pain

Regarding the ureters, you can get cyclical hydronephrosis if the endometriosis is compressing the ureters somehow

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Ureteritis cystica

Only develops with longstanding ureteritis.
The accumulation of lymphocytes in the subepithelial layer may produce a fine granularity of the mucosa- ureteritis follicularis
Ureter can develop cysts filled with clear yellow fluid- ureteritis cystica

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Chronic obstruction of the bladder results in hypertrophy of its muscle. Trabeculation of the bladder wall develops.

Diverticulum may form and why is this problematic?

May lead to infection

Eventually this process affects kidneys

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Exstrophy?

Developmental defect of closure of the anterior wall of the abdomen and bladder so that the bladder communicates with the exterior of the body as a large defect or as an open sac.
Its often related with other GU abnormalities and may lead to increased incidence of malignancy

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Urachus

danger of adenocarcinoma

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Cystocele

Protrusion of the bladder into the vagina creating a pouch. It’s caused by uterine prolapse which pushes the bladder down.

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Ureter enters the bladder normally at an acute angle. This is great design, because when the bladder fills up it shuts of the ureters so that urine can’t flow back up into the kidney.

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Malakoplakia

KNOW IT…Inflammatory disorder
Malakoplakia
Soft yellow 3-4 cm mucosal plaques composed of closely packed, large, foamy macrophages with occasional giant cells and interspersed lymphocytes.
Macrophages contain PAS + granules filled with bacterial debris.
Michaelis-Gutmann bodies: laminated mineralized concretions within and between macrophages.
Most likely represents a defective host response to bacterial infection, usually from gram-negative bacilli (E. coli, Proteus, etc.)

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Strictures of the ureter can be acquired or congenital. Examples of acquired strictures are:

chronic inflammations and/or sclerosing retroperitoneal fibrosis

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What is salpingitis

inflammation of the fallopian tube

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Diverticulitis

inflammation of the intestinal diverticulum and surrounding tissues

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What is peritonitis

inflammation of the peritoneum

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Ureteropelvic junction obstruction

Usually in boys, usually on the left, abnormal organization or excess stromal collagen between smooth muscle bundles. Leads to hydronephrosis

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Diverticuli in the bladder

Either congenital ( caused by focal muscular defect) or acquired (following persistent urethral obstruction
- Urinary stasis can develop within these outpouches and you end up with infectionWhat

What the hell is a urachus

It’s a structure that exists in the embryo in order to connect the bladder to the allantois. Rarely, it may remain patent in a newborn baby. If it is totally patent (open) then you have a connection between the bladder and the umbilicus. If only the central region of the urachus persists, it causes a urachal cyst predispose to bladder adenocarcinoma (20-40% of adenocarcinomas)

Ureters enter the bladder at what kind of angle?

Acute. pRevents backflow when the bladder fills

Cystitis?

bladder infection

Acute cystitis urinalysis will show

tons of neutrophils

Chronic cystitis urinalysis will show

lymphocytes, plasma cells, macrophages etc...

Hemorrhagic cystitis

cystitis with a hemorrhagic component

most common cause of hemorrhagic cystitis

bacterial cystitis ALTHOUGH...it often follows radiation and chemo

Interstitial cystitis also called

Hunner Ulcer

WHat is a Hunner ulcer

persistent chronic cystitis, causes intermittent suprapubic pain, urinary frequency, dysuria, etc... THere is usually NO evidence of bacterial infection Thought to be autoimmune Bladder will show inflammation and fibrosis of all layers of the bladder wall, some pts will have localized mucosal ulcers

Cystitis glandularis may predispose to

Adenocarcinoma of the bladder

Bladder tumors are most commonly of what origin?

Epithelial orgin and most epithelial tumors are of UROTHELIAL (transitional) cell type

Urothelial tumors represent about what percentage of all bladder tumors?

90%

There are two morphologic patterns of urothelial bladder tumors and they are:

Papillary and Flat

The majority of bladder cancers are high grade lesions

Most bladder cancers arise from what part of the bladder

Lateral or posterior walls at the bladder base

Partial or complete ureteral obstruction commonly occurs with bladder cancer

Squamous cell carcinoma of the bladder accounts for what percentage of bladder cancers?

Squamous cell carcinoma of the bladder is a result of infestation by

Schistosoma hematobium...lives predominantly in the Nile River Delta (Egyptian immigrant).. "non-smoker egyptian immigrant with bladder cancer"

Adenocarcinom of the bladder develops as a result of what 3 things

- cystitis glandularis - exystrophy - urachal remnant only 2% of bladder cancers Generally very deeply invasive

Benign bladder tumors are ....

rare

What is the most common benign tumor of the bladder

leiomyoma

Embryonal Rhabdomyosarcoma

infants and childrem for the most part. If you see a large grape-like projection into the lumen....yeah, its embryonal rhabdomyosarcoma.

Urethitis is divided into what two categories

gonococcal and non-gonococcal

Non-gonococcal urethritis can be caused by what?

E. Coli, Chlamydia, Mycoplasma

Reiter syndrome

Arthritis, conjunctivitis, urethritis | Reiter's triad

Remember that stricture of the urethra due to chronic urethritis can cause urinary outflow obstruction with subsequent involvement of the urinary bladder, ureters, and kidney

Urethral caruncle

inflammatory lesion presenting as a small mass at the external urethral meatus

Papillomas

Occur usually on the external urethral meatus

Carcinoma of the urethra

rare. more often in women of advanced age