Male Pathophys 3 Flashcards
Cell types from the bottom up in a urinary bladder?
Basal cells, intermediate cells, umbrella cells
Three layers of the wall of the ureter are?
Mucosa, muscularis, adventitia
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
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
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
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
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
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
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
Urachus
danger of adenocarcinoma
Cystocele
Protrusion of the bladder into the vagina creating a pouch. It’s caused by uterine prolapse which pushes the bladder down.
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.)
Strictures of the ureter can be acquired or congenital. Examples of acquired strictures are:
chronic inflammations and/or sclerosing retroperitoneal fibrosis
What is salpingitis
inflammation of the fallopian tube
Diverticulitis
inflammation of the intestinal diverticulum and surrounding tissues
What is peritonitis
inflammation of the peritoneum
Ureteropelvic junction obstruction
Usually in boys, usually on the left, abnormal organization or excess stromal collagen between smooth muscle bundles. Leads to hydronephrosis
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
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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
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Squamous cell carcinoma of the bladder accounts for what percentage of bladder cancers?
5%
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
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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
