Midterm Flashcards
Urolithiasis refers to __ formation at ___ level of the collecting urine system
calculus
any
Urolithiasis develops mostly in ___. __% of the population has this. Pathogenesis is associated with ___ of the urine.
Males
10
supersaturation
What are most kidney stones made up of?
Pure Calcium Oxalate or combination with calcium phosphate (75% are made up of these)
If urine stone blocks __ __, it causes accumulation of fluid because fluid cannot ___. This increases ___ pressure leading to __ __ of the tissue.
major calyx
compress
hydrostatic
pressure atrophy
10-15% of stones in the urinary tract are made up of __ and __. What is the official name?
magnesium
monophosphate
Triple Stones or Struvites
Alkaline urine is more susceptible to bacteria like __ __ and other __ __ __, which are a normal part of gut flora and may cause a ___ and can convert urea into substance that create alkaline environment. Urine sometimes becomes alkaline with ___.
Proteus Vulgaris
Gram - Rods
UTI
vegetarians
6-23% of stones are __ __ salts. These stones are radio___ and will sometimes have inclusion of __ within the stones and appear __ on the xray
Uric Acid
lucent
calcium
patchy
0.5-4% of stones are ___, an amino acid. The stones are radio___
Cystine
opaque
What are some predisposing factors to stone formation?
Urinary Obstruction
Epithelial Injury
Changes in urine
Quick weight loss
What are possible causes of urinary obstruction?
Enlarged prostate
Pregnancy
Diverticuli
Enlarged Prostate: There are __ lobes to the prostate. Central lobe can compress the __ and cause obstruction. Peripheral lobe has low access to the urethra, __ must grow here to be symptomatic.
2
urethra
tumors
Enlarged Prostate: Benign Prostatic Hypertrophy/ Hyperplasia: Located in the __ lobes. A smaller amount of fluid causes urination, so there is __ urination. Because the urethra is narrowed, there may be ___, increased __ pressure, and inguinal ___. There is also difficulty __ urination.
central frequent dribbling abdominal hernias initiating (hesitancy)
Enlarged Prostate: 70-80% of __ __ begins in the peripheral lobes, and is usually caught __.
Prostatic Carcinoma
late
Pregnancy: The fetus can be in a position that compresses the __. This increases __ pressure as the fluid builds up in the __ and may lead to atrophy of the ___. The capsule around the kidney is very sensitive to pain from the __ of the kidneys.
ureter
hydrostatic
kidney
parenchyme
Pregnancy: Fetus may also compress veins leading to ___ veins or may compress the __ __ causing __ __.
varicose
bile duct
gall stones
DIvertuculi can also cause ___
compression/ obstruction
Epithelial Injury: Epithelial cells can slough off and form a ___. Vit __ and Vit __ deficency cause a reduction in the life span of epithelial cells so they slough off more often.
nidus
A
B6
Changes in urine: What may cause changes in urine that lead to predisposition to stone formation?
Dehydration
Hypercalcuria
Hyperphosphoturia
Oxaluria
Quick Weight loss: __ usually surrounds and cushions the kidney. With weight loss, the kidneys ___ which can causes compression of the ___ and lead to ___
Fat
distend
ureters
pyelonephritis
What are some complications of kidney stones?
Staghorn Calculus
Hydronephrosis
Ureteral Colic (Renal Colic)
Staghorn Calculus: 99% are made up of __ __ __. and 1% are made from __. These are large stones formed in a __ environment. Leads to dramatic loss of kidney __ and __ __.
Magnesium Ammonium Phosphate (triple stones) Cystine Alkaline function urine flow
Staghorn Calculus: Urine will accumulate in the kidney causing (3). Parenchyme becomes __ due to increased __ __.
distention hydronephrosis atrophy thin hydrostatic pressure
Hydronephrosis- distention of the kidney __ with accompanying __ of the kidney __ due to __ of urine outflow.
pelvis
atrophy
peranchyma
obstruction
Hydronephrosis: Once complete obstruction occurs, complete __ of the kidney will occur and death occurs within __ weeks. What is the MCC of hydronephrosis?
atrophy
3
Kidney Stones
Renal Colic: Full __ of the ureter by a stone. __ of the __ muscle walls of the ureter lodge. Extremely painful. Where does pain radiate to?
obstruction
Spasm
smooth
-Pain from kidney will radiate down the flank to the groin, ending in the ipsilateral genitalia.
Renal Colic: Stone injures the wall causing __. There would be a very positive __ __. What does treatment include?
hematuria
murphy’s punch
-Tx includes pain relievers and muscle relaxers to allow stone movement. If too large, may need to remove surgically
Bladder stones are more common in __ over __ years old. How are they removed?
males
60
-Instrument is inserted into the urethra to remove the stones. Ouch.
-No anesthesia is used bc Dr. could tear urethra near the __.
Acute Cystitis: What are some causes?
E. Coli- #1 cause Other Gram - Bacteria STDs- Gonorrhea and Chlamydia Yeast Infection Some Cytostatics used to Tx cancer and Autoimmune disorders may cause hemorrhagic cystitis
Yeast Infection: Candida Albicans AKA ___. Common condition in USA because of overuse of ___.
Molina
antibiotics
What are some predisposing factors to Acute Cystitis?
Exposure of female pelvis to cold temperatures Catheter Stones Pouches in bladder Obstruction Foreign bodies in bladder
Acute Cystitis is inflammation of the __ __. Usually occurs in __. Usually caused by an infection from the __ __ __
urinary bladder
females
normal gut flora
Exposure of female pelvis to cold: Ovaries are very sensitive to the cold. __ decreases blood flow and there is a decrease in the function of ___, and an increase in ___. The healing process forms __ __ that will __ and __ the lumen of fallopian tubes leading to tubal pregnancy or infection.
Vsoconstriction enzymes infection connective tissues shorten narrow
What are the 3 major symptoms of Acute Cystitis?
Dysuria
Increased Frequency
Lower abdominal or subrapubic pain
- Must have all 3 to be acute cystitis. If one is missing, may be pelvic subluxation.
- Hematuria may or may not be present with AC
Acute cystitis is treated with __. Improvement should occur within __ day(s). If there is no improvement within __ days, it is not cystitis. If antibiotics are not take for at least 7 days, this could lead to __ __, which reduces bladder __ and is incurable.
Antibiotics 1 3 chronic cystitis capacity
What are the 4 types of prostate inflammation pathologies?
Acute Bacterial Prostatitis
Chronic Bacterial Prostatitis
Chronic Abacterial Prostatitis
Granulomatous Prostatitis
Acute bacterial prostatitis is caused by ___, usually (3), or other gram - rod bacteria. This is due to intraprostatic __ of urine and may follow __ manipulation of the uerthra of prostate.
UTI Staphylococcus E Coli Enterococcus reflux surgical
- Catherization, cytoscopy, etc. may cause
- Extremely boggy prostate
Chronic Bacterial Prostatitis: Difficult to diagnose. Diagnosis is dependent on ___ and Hx of infections. What are some symptoms?
Cultures Insidious LBP Dysuria Perineal/ suprapubic discomfort *Antibiotic not effective
Chronic Abacterial Prostatitis: MCC of Prostatitis. No history of recurrent ___. __ are present in the urine, but __ are not.
infection
Leukocytes
Bacteria
Granulomatous Prostatitis is a __ procedure in the US, instill __ for superficial bladder cancer. There is also a __ type which occurs in immunocompromised patients. The relatively common non specific type is a reaction to secretions form a ruptured __ __
common
bacillus
fungal
prostatic duct
What is benign Nodular Enlargement AKA?
Nodular Hyperplasia
Nodular Hyperplasia: Extremely common in men over __. __% of men by the age of 40. __% of men by the age of 60. __% of the men by the age of 70. __% of men with hyperplasia have symptoms.
50 20 70 90 50
Nodular Hyperplasia: Involves hyperplasia of the __ and __ cells forming a large and discrete nodule that compresses the ___ zone which narrows or obstructs the urethral canal.
stroma
epithelial
periurethral
Nodular Hyperplasia: Etoliology?
Prostate synthesizes dihydrotestosterone from circulating testosterone which controls the prostate’s growth
What are the symptoms of Nodular Hyperplasia?
Difficulty urinating Retention of urine (Bladder hypertrophy, distention, cystitis, renal infection) Frequency Nocturia Dribbling Dysuria
Nodular Hyperplasia: Treatment?
Surgically by transurethral resection, alpha blockers, reduced fluid at bedtime, reduced alcohol and caffeine, and phytochemicals.
Adenocarcinoma of prostate: Most common form of cancer in men, 2nd leading cause of cancer deaths. Typically affects men over 50, uncommon in __ men, more common in US __ males. Etiology is unknown. A common genetic alteration is hypermethylation of ____.
Asian
Black
Glutathione S-transferase gene promoter (GSTP1)
Adenocarcinoma of the prostate is __ during rectal exam. due to typical __ location on the __ zone. Will feel gritty and firm. Spreads locally or through __ or __. May involve __ __ and the base of the __.
palpable posterior peripheral bloodstream lymph seminal vesicle bladder
How does gleason grading of prostate cancer work?
5 grades based on glandular differentiation and pattern
Grade 1- well defined tumor
Grade 5- No glandular differentiation
Primary and secondary patterns added together
5-7 is treatable
8-10 is not treatable
What is PSA and what is it used for?
Prostetic Specimen antigen
Product of epithelium and is organ specific, not cancer specific. Useful fro Tx response.
What is treatment of Adenosarcoma of prostate?
Radical Prostatectomy
What are the neural, endocrine, and local stimulators of HCl?
Pernicious Anemia means ___Neural- Vagus N. (Parasympathetic)
Endocrine- Gastrin8ik
Local- Histamine
*Histamine is found in mast cells, eating spicy food will cause degranulation of mast cells.
Pernicious Anemia: Blood cells are ___ and have a __ membrane that prevents them from bending to get out of the ___. Neutrophils and other WBCs are ___ with more than __ nuclei. There is CNS damage of the __ columns of the spinal cord. With __ __ deficient anemia the CNS is spared.
large rigid capillaries hypersegmented 5 Posterior Folic Acid
Zygomen cells AKA
Chief Cells
Chief Cells produce ___ which is inactive. This is activated by __ to __. The zygomen cells would be damaged if they produced activated pepsin.
pepsinogen
HCL
Pepsin
G Cells are located in the __ area and produce __, the __ stimulator.
antropyloric
gastrin
endocrine
Ghronic Gastritis: Chronic __ inflammatory changes of the stomach wall that eventually result in mucosal __ and __.
mucosa
atrophy
metaplasia
Chronic Gastritis: Caused by __ __. __% of americans have this in their stomach and __% of russians and puerto ricans do. This produces __ that are toxins or enzymes that are harmful, causing atrophy of the mucosa. The stomach epithelial cells may transform into ___ epithelial cells
Helicobactor Pylori 50 80 metabolites intestinal
Chronic Gastritis: Metaplasia predisposes to intestinal type ___
carcinoma
Autoimmune gastritis is more common in __ countries. The __ cells are selectively damaged. This leads to __ deficiency because less __ __ is produced. They will have __acidity and __ anemia.
scandenavian parietal B12 intrinsic factor hypo megaloblastic
What are the 2 types of stomach cancer that make up 95% of all stomach cancers?
Intestinal Type Adenocarcinoma
Diffuse stomach carcinoma
Stomach cancer is most common in the __ __.
lesser curvature
Horner’s Syndrome is defined as ___ of the ___ lymph nodes called __ nodes, due to either __ or __ cancer.
lymphadenopathy supraclavicular Virchow's stomach lung
Stomach cancer, or cancer of the GI tract metastasizes to the liver via the __ __ __
hepatic portal (venous) system
Diffuse Stomach Carcinoma- more common than __ type adenocarcinoma. Involves entire __ wall. Has a __ latent period before metastisizes and often comes to medical attention late. Risk factors are undefined and __ __ and __ __ are usually absent.
Intestinal stomach short H. Pylori chronic gastritis
Diffuse Stomach Carcinoma: Is a schirrous cancer made of mostly ___. The stomach shrinks because of the __ __. It is sometimes called __ __ stomach or __ __ because the stomach is rigid and can’t distend.
stroma
connective tissue
leather bottle
linutus plastica
Intestinal Type Adenocarcinoma- Less malignant than diffuse type carcinoma. It has a __ latent period. It also has predisposing factors. Tumor projects into the __ of the stomach. What are predisposing factors?
long lumen Infection with H. Pylori Diet (nitrites/ smoked food, salty, pickled food, lack of F&V) Parietal Gastrectomy Gastric Adenomas (40% cancerous at time of Dx, 30% with adjacent cancer at Dx Barrett Esophagus Family Hx
Benign stomach polyps are malignant __% of the time. Colinic polyps become cancerous __% of the time.
4
40
Krukenberg Tumor- Stomach cancer that spreads through the __ cavity to the __
abdominal
ovaries
Epigastric Pain less than 30 minutes after a meal indicates __ __
stomach cancer
Epigastric pain 30 min to 1 hour after eating indicates __ __ __
stomach peptic ulcer
Epigastric pain 1 to 3 hours after eating indicates __ __ __
Duodenal peptic ulcer
