Pathology Flashcards
1
Q
what is agenesis
A
absence of one or both kidneys
2
Q
what is the name given to small kidneys but normal development
A
hypoplasia
3
Q
what is a ‘horseshoe’ kidney
A
fusion of the kidneys at either ple
4
Q
what is duplex system
A
two kidneys (one on top of the other) on one or both sides of your body
5
Q
what is a very common cystic disease of the kidney
A
simple cysts
can be multiple and large
usually clear fluid filled
often incidental finding
6
Q
what conditions is simple cysts often secondary to
A
native kidneys in long term dialysis
7
Q
what are the two subtypes of genetic polycystic disease
A
infantile type (ARPKD) adult polycystic disease (ADPKD)
8
Q
features of infantile polycystic disease
A
rare
causes terminal renal failure
less severe cases can survive for some months
9
Q
why is infantile polycystic disease terminal
A
perinatal - not suitable for renal transplant or dialysis
10
Q
what are pathological features of infantile polycystic disease
A
Uniform bilateral renal enlargement.
Elongated cysts – dilatation of medullary collecting ducts.
11
Q
what type of genetic inheritance is infantile polycystic disease
A
autosomal recessive
12
Q
what is infantile polycystic disease associated with
A
congenital hepatic fibrosis
13
Q
how is infantile polycystic disease diagnosed
A
prenatal ultrasound
14
Q
what congenital cystic disease is more common
A
Adult Polycystic Disease
15
Q
what type of inheritance is Adult Polycystic Disease
A
autosomal dominant
16
Q
what are the two possible chromosomes that can be affect to cause Adult Polycystic Disease
A
Chromosome 16
Chromosome 4
17
Q
what chromosome defect is 90% of the cases of Adult Polycystic Disease
A
Chromosome 16 defect
18
Q
typical presentation of adult polycystic disease
A
middle adult life abdominal mass haematuria hypertension chronic renal failure renal stone
19
Q
pathology of Adult Polycystic Disease
A
massive bilateral renal enlargement
multiple cysts of varying size arising in any part of nephron
20
Q
what is seen in 1/3rd of patients with Adult Polycystic Disease
A
cysts in liver, pancreas, lung but with no functional effect
21
Q
what is Adult Polycystic Disease associated with
A
Berry aneurysms in Circle of Willis
22
Q
what does Berry aneurysms predisposed patients to
A
subarachnoid haemorrhage.
23
Q
what other haemorrhage are patients with adult polycystic disease are at risk at and why
A
intra-cerebral haemorrhage
due to hypertension
24
Q
most common benign renal tumour and its features
A
fibroma
Medullary origin, white nodules. No clinical consequence.
25
typical features of a benign renal adenoma
yellowish nodules
26
what is an Angiomyolipoma
benign renal tumour
mixture of fat, muscle and blood vessels
can be multiple and bilateral so can affect renal function
27
what are angiomyolipoma associated with
tuberous sclerosis
28
what is a JGCT and what can they cause
tumour of the cells that make renin
| secondary hypertension >> due to over production of renin
29
what is the commonest renal tumour of childhood
Wilms' Nephroblastoma
30
what is the pathology of a Wilms tumour
undifferentiated mesodermal tumour of the intermediate cell mass
31
Sx of Wilms' tumour
fever
flank pain
abdo mass
32
where are Urothelial Carcinomas found
in renal pelvis and calcyes
33
what is the commonest renal tumour of adulthood
Renal Cell Carcinoma
34
what is a Renal Cell Carcinoma also known as
Clear Cell Ca,
hypernephroma
Grawitz tumour
35
what does a RCC arise from
renal tubular epithelium
36
typical presentation of RCC
55-60 y/o
| M > F
37
Sx of RCC
Abdominal mass
haematuria
flank pain
weight loss, malaise
38
what do RCC often cause
polycythaemia - increased concentration of haemoglobin in the blood, either through reduction of plasma volume or increase in red cell numbers
39
why does RCC cause polycythaemia
erythropoietic stimulating substance
40
what other disorder can RCC cause
hypercalcaemia
41
pathology of RCC
Large, well circumscribed mass centred on cortex.
Yellow - due to tumour being rich in glycogen and lipid
Renal vein extension common
Can extend into vena cava
42
where does RCC tend to spread
via blood
| lung, bone
43
where can a Transitional Cell Carcinoma arise
bladder, ureter or renal pelvis
44
how common are TCC's
are 90% of bladder tumours
45
Risk factors for TCCs
Smoking
schistosomiasis (parasitic infection caught in tropical countries)
Dye and Rubber industry occupation
46
Sx of TCCs
```
Painless Haematuria - v common
Frequency
Urgency
Dysuria
Urinary tract obstruction
```
47
Ix of TCC
Cystoscopy w/ biopsy - diagnostic
| CT urogram - 2nd line
48
pathology of TCC
75% occur in region of trigone
Papillary or solid.
Papillae have thicker lining than normal urothelium.
49
main tumour seen on the penis and prognosis
squamous carcinoma arising from the skin
only 5% become invasive
50
what is Bowen disease of the penis called and what does it indicate
Erythroplasia of Queyrat.
pre-malignancy
51
histology of squamous carcinoma in the penis
full thickness dysplasia of epidermis
52
aetiology of penis tumours
uncircumcised men
poor hygiene
HPV infection
53
what was a common tumour in chimney sweeps
SCC of scrotum
54
Benign Nodular Hyperplasia of Prostate (BNH) is an uncommon and always troublesome disease - true or false
false
75% of men over 70 have it
only 5% have significant symptoms
55
what causes BNH
Irregular proliferation of both glandular and stromal prostatic tissue.
56
how can BNH obstruct the bladder sphincter mechanism
by physical obstruction
or
physiological interference
57
where does BNH often affect physiological interference in the bladder
peri-urethral glands at internal urethral meatus.
| where internal opening are
58
what is prostatism (symptoms of bladder obstruction)
difficulty in starting micturition (i.e. starting to pee)
poor stream
overflow incontinence
59
what is complication of BNH
chronic urinary retention
bladder hypertrophy
diverticulum formation in bladder wall
If untreated > hydroureter, hydronephrosis, infection
60
Mx of BNH
Surgery - transurethral resection
| Drugs - alpha blockers, 5 alpha reductase inhibitors
61
is BNH pre-malignant
No
62
Ix for BNH
Midstream urine sample
Ultrasound
Rule out Cancer - PSA, transrectal USS +/- biopsy
63
prostate cancer is linked with BNH - true or false
false
there is no link
however they can before occur in the same gland
64
where does prostate cancer most often arise
peripheral ducts and glands
| particularly posterior lobe
65
when does prostate cancer become symptomatic
when it reaches the peri-urethral zone in later stages
66
where does prostate cancer often spread to
local - bladder, rectum
lymphatic - sacral, iliac, para-aortic
blood - bone, lungs, liver
67
what is the relationship of prostate cancer and bone spread
makes new bone
very dense
mets termed osteosclerotic
should always x-ray w/ prostate cancer
68
Ix of prostate cancer
1st - Rectal Examination + PSA levels (increased levels but not all prostate cancers do)
2nd - transrectal US and biopsy
3rd - x-ray and bone scan
69
what can greatly increase the risk of getting testicular cancer
undescended testicles
70
features of testicular cancer
commonest solid organ malignancy in males aged 15-44
| only 1% cancer deaths
71
what does testicular cancer present w/ and what can it be associated with
painless testicular enlargement
associated with hydrocele, gynaecomastia, general effects of malignant disease.
72
classifications of testicular tumours
Germ cell tumours (90% of tumours)
| Others (10%) - primary lymphoma, metastatic leukaemia
73
what are the types of germ cell tumours
Seminoma, Teratoma, mixed.
74
what do patients with Leygid cell tumours present with
gynaecomastia
75
what is the commonest GCT
seminoma
76
pathology of seminoma
Solid, homogenous, pale macroscopic appearance – “potato” tumour.
Large, clear tumour cells with variable stromal lymphocytic infiltrate.
77
tumour markers of seminoma
PLAP - placental alkaline phosphatase
78
Tx for seminoma
very Radiosensitivity
| sensitive to radiotherapy and chemotherapy
79
what is the second commonest GCT
teratoma - tumour of all 3 cell lines
80
tumour markers of teratoma
AFP - seen in teratomas with yolk sac elements
| bhCG - seen in highly malignant teratomas containing trophoblastic tissue
81
what is the classifications of teratoma
Differentiated Teratoma (TD) - benign
Malignant Teratoma Intermediate (MTI).
Malignant Teratoma Undifferentiated (MTU).
Malignant Teratoma Trophoblastic (MTT).
82
3rd commonest GCT
Mixed seminoma/teratoma
83
features of glomerulonephritis
non-infective
immunological mechanisms
usually diffuse, can be focal
84
definition of Pyelonephritis
Bacterial infection of renal pelvis, calyces, tubules and interstitium.
85
features of Pyelonephritis
acute or chronic
pathy distribution
commoner in females
86
what organisms are common to cause Pyelonephritis
E. Coli - most common
Pseudomonas - seen in immunocompromised
87
pathogenesis of Pyelonephritis
can be due to septicaemia, post-surgery - blood borne
ascending infection from distal urinary tract, cystitis often present (infection in the bladder) - more common pathogenesis
88
risk factors for pyelonephritis
Age
Female - shorter, wider urethra
Pregnancy; can cause Ureteric dilatation
Instrumentation/Surgery
Urinary Tract obstruction e.g. calculus, stricture, prostatic pathology
Vesico-ureteric reflux (VUR)
Diabetes
89
symptoms of Chronic pyelonephritis
often no previous Hx of UTI
Vague symptoms
Hypertension and/or uraemia
Large volume of urine
90
what would renal imaging of Chronic pyelonephritis show
coarse cortical scarring
| distortion of calyces
91
how can TB be spread to the urinary tracy
causes pyelonephritis via haematogenous spread from lung
92
Sx of TB pyelonephritis
```
Vague symptoms
Weight loss
Fever esp at night
Loin pain
Dysuria - pain on passing urine
Sterile pyuria - pus in the urine, but in the initial stage of culture does not grow anything
```
93
what is the typical form of necrosis seen in TB
Caseous foci
| - slow growth with progressive renal destruction
94
What stained is used to diagnose TB
Zeehl-Neilsen
95
what is cystitis
inflammation of the bladder normally caused by an infection
96
what bacteria commonly cause cystitis
E. Coli. - most common
Klebsiella, Proteus, Pseudomonas.
97
what can chronic cystitis cause
ureteritis
| cystitis cystica
98
what is Ureteritis and Cystitis Cystica
multiple small fluid filled cysts projecting into lumen
99
what can cause urethral obstruction
stricture
posterior urethral valves
prostatic disease
100
consequences of prolonged bladder outlet obstruction
hypertrophy of detrusor muscle
diverticulum formation.
101
what is hydronephrosis
water in the kidney -
| happens to kidney that is exposed to prolonged urinary obstruction
102
what happens is hydronephrosis
Dilatation of pelvicalyceal system with parenchymal atrophy
103
when is hydronephrosis bilateral
urethral obstruction
neurogenic disturbance
VUR
bilateral ureteric obstruction e.g. advanced carcinoma of cervix
104
when is hydronephrosis unilateral
calculi
neoplasms
pelvi-ureteric obstruction
strictures
105
what happens when hydronephrosis is sudden and quick
urine production quickly ceases > little pelvicalyceal dilatation
106
what happens when hydronephrosis is gradual and partial
dilatation
107
what happens when hydronephrosis is severe
Marked cortical thinning, atrophy and fibrosis.
Secondary infection often follows
108
what is infection of a hydronephrotic kidney called
Pyonephrosis
