Non-neoplastic Bladder Diseases Flashcards
Acute and chronic cystits
Infection of the bladder most commonly (98%) caused by an ascending UTI.
- 2% is hematogenous
- if untreated leads to an ascending pyelonephritis and uretitis
Most common organisms via ascending infections
- E. Coli
- Proteus
- Enterobacter
- klebsiella
- *PEeCK species**
Most common organisms via hematogenous spread
- staph sapho (females only)
- e. Coli (#1 in both sexes)
Labs/diagnosis:
- (+) nitrates
- (+) leukocyte esterase
- (+) culture
- **if (-) culture with pyuria = chlamydia or gonorrhea species
very rare occasions (usually only immunocompromised = tuberculous species and yeast
**most common in women since they have shorter urethras
Tuberculous cystitis always leads to what?
Renal tuberculosis
TB infections are very common in HIV/AIDS patients as well.
What species cause cystitis only in immunocompromised patients?
Candida albicans
- any yeast really**
What is the most known protozoan to causes acute and chronic cystitis?
Schistosoma haematobium
- most commonly in Egypt and super rare in US
What are the most common causes of hemorrhagic cystitis?
Cytotoxic anti tumor medications (cyclophosphamide is #1)
Radiation therapy
Chronic infections with adenovirus
What is the triad of symptoms in cystitis?
1) urinary frequency (More common than normal but varies with time limit)
2) lower abdominal pain (localized over the bladder region or in the suprapubic region)
3) dysuria (pain or burning with urination)
Most common Causes of urinary stasis
Prostatic enlargement
Cystocele Of the bladder
Renal Caliculi
Tumors
Interstitial cystitis
Chronic pelvic pain syndrome
Most commonly occurs in women
- *characterized by:
- intermittent severe suprapubic pain
- urinary frequency
- urgency
- hematuria
- dysuria
On exam the bladder has fissures and punctate hemorrhages in the bladder mucosa
- late phase = shows hunner ulcers (chronic mucosal ulcers)
On histology = shows inflammation with large amounts of mast cells present
*has unknown etiology and its treatment is largely empiric antibiotics/ empiric conservative care
Malakoplakia
Distinctive chronic inflammatory reaction that causes acquired defects in phagocyte function and shape
- caused primarily by chronic E. Coli and Proteus species
- phagocytes get really dark nuclei appearance with white surrounding and abundant granular cytoplasm. Called a michaelis-Gutmann body (looks like a googlie eye)
Higher chance of this occurs in immunosuppresed patients
Occurs in colon, lungs, bones, kidneys, prostate and bladder
On gross appearance shows raised 3-4 cm white plaques around the structure that is affected
What are michaelis-gutmann bodies?
Enlarged lysosomes stuffed with deposition of calcium seen in
- will look blue if stained with Von kossa’s stain
Polyposis cystitis
Inflammatory lesion resulting from irritation of the bladder mucosa
- very common in patients who have repeated catheterization or prolonged catheterization
**Often gets confused with papillary urothelial carcinoma
Cystitis glandularis and cystitis cystica
Both are common lesions of the urinary bladder which generate nests of urothelium called “Brunn nests” into the lamina propria
The urothelium cells in these nests undergo metaplasia and either turn into:
1) cuboidal columnar-like cells = glandularis
2) flat cells with cystic spaces = cystica
Squamous metaplasia of the bladder
Urothelium in the bladder is replaced by nonkertinizing squamous epithelium
- usually in response to repetitive injuries
Nephrogenic adenoma
Unusual lesion that results from implantation of shed renal tubular cells at sites of injured urothelium
- often assumes a papillary/glandular growth pattern
Usually small lesions, but can be large (larger = more likely to be cancerous)
