Pathology Flashcards
ESRD =
end stage renal disease
end stage of CKD
++_+__ in diet should be restricted in those with ESRD
potassium
phosphate
salt
fluids
physical effects of ESRD (7)
dehydration nausea depression anorexia malnutrition osteopenia anaemia
anuria =
kidneys are no longer producing urine
IS NOT retention
causes sterile pyuria
Tuberculous pyelonephritis
4 orgs that cause cystitis
E. coli
pseudomonas
proteus
klebsiella
schistosomiasis predisposes ptnt to ___
squamous cell carcinoma
hydronephrosis =
dilatation of the renal pelvis and calyces with parenchymal atrophy
5 types of incontinence
urge stress urethral overflow mixed
compliance of the bladder =
its ability to keep its P unchanged despite volume and afferent stimulation
___ assesses P in bladder and abdomen
the difference between the two Ps = ___ P
urodynamics
detrusor
high detrusor P on urodynamics while voiding indicates
obstruction
CNS centres involved in micturition reflex =
pons
S2 + 3 in spinal cord
sympathetic for the bladder filling phase is from ___
hypogastric nerve (T10-L2)
voiding phase of bladder is controlled by _____ nerves ie.
parasympathetic
plevic S2-4
the ___ nerve controls the external sphincter in voluntary voiding
pudendal
s+s of overflow incontinence
palpable bladder
insensible incontinence
nocturia
renal impairment (due to increased renal pelvis P)
involuntary leakage immediately preceded by/accompanied by urgency =
urge incontinence
s+s of urge incontinence
daytime freq
enuresis
small vol
urgency
detrusor overactivity can cause ____
is diagnosed by ___
urge incontinence
urodynamics
afferent overstimulation can cause urge incontinence
examples of these causes =
bladder stones
tumours
urine leaks during increased intra-abdominal pressure without detrusor contraction =
stress incontinence
Rx for overflow incontinence
treat obstruction
catheterise
rehabilitate bladder
teach intermittent self-catheterisation
Rx for urge incontinence
avoid caffeine and alcohol lose wt pelvic floor exercises botox antimuscarinics/beta3 adrenergics enterocystoplasty
Rx for stress incontinence
lose wt stop smoking pelvic floor exercises duloxetine (not v effective) colposuspension/taping
ectopic ureter opens into where?
diagnosed by ___
urethra below external urethral sphincter
CT/MRI
caused by prolonged obstructed labour - more often sen in developing countries
vesico-vaginal fistula
a bladder diary is kept for how long?
3 days
FVC = __
it records the volume voided and time of micturition over 24hrs
frequency volume chart
if have decreased kidney function in utero =>
oligohydramnios => flattened compressed face
infantile polycystic kidney disease =
gross kidney features =
ARPKD
uniform bilateral renal enlargement
elongated cysts
reniform shape maintained - no gross distortion
ARPKD is ass with congenital __
hepatic fibrosis
adult polycystic kidney disease =
90% - 1 = chromosome __ mutation
2 = chromosome __
ADPKD
16
4
ADPKD gross features of the kidneys
massive bilateral renal enlargement
distortion of reniform shape
In ADPKD cysts can also be present in ++_ but usually no ___ effect
lungs, liver and pancreas
no functional effect
ADPKD is ass with __+__
Berry aneurysms in circle of Willis
Subarachnoid haemorrhages
4 benign renal tumours
fibroma
adenoma
angiomyolipoma
JGCT
__ is produced by a JGCT => ___
renin
2ndry hbp
adenoma of kidney gross appearance
yellow nodules <2cm
cortical
fibroma of kidney gross appearance
medullary origin
white nodules
angiomyolipoma is ass with which condition?
tuberous sclerosis
commonest intra abdominal tumour in kids =
Wilms tumour/ nephroblastoma
3 other names for renal cell carcinoma
clear cell carcinoma
hypernephroma
Grawitz tumour
renal cell carcinoma arises from
renal tubular epithelium
age and F:M for renal cell carcinoma
55-60yo
M2:1F
paraneoplastic syndromes caused by renal cell carcinoma
polycythaemia (Epo stimulating substance)
hypercalcaemia
gross apearance of renal cell carcinoma
large, well circumscribed mass centred on cortex
yellow with solid, cystic, necrotic and haemorrhagic areas
if a renal cell carcinoma invades this, which it commonly does, it is a bad prognosis
renal vein
grading system for renal cell carcinoma
Fuhrman
transitional cell carcinoma can occur anywhere from __ to ___
renal pelvis to urethra
75% of TCCs occur in __ area
trigone
risks for transitional cell carcinoma
aniline dyes rubber benzidine analgesia schistosomiasis smoking
transitional cell carcinoma are __/__
papillary or solid
grading for TCCs =
pTa (no invasion)
pT1 (stromal invasion)
pT2 (muscle invasion)
TCC spreads to ++_
obturator lymph nodes
liver
lungs
causes of bladder adenocarcinomas
extroversion (congenital = post wall left open)
urachal remnants
long standing cystitis cystica
risk factors for urinary tract squamous cell carcinomas
schistosomiasis
calculi
commonest malig bladder ca in kids and teens
embryonal rhabdomyosarcoma
2 squamous carcinoma in situ of the penis =
both = full thickness dysplasia of __
Bowen’s disease
Erythroplasia of Queyrat
epidermis
carcinogen that causes SCC of scrotum =
from chimney sweeps
hormonal cause of BPH
androgen decreased : oestrogen
prostatism sympts
retention
hesitancy
overflow incontinence
poor stream
drug Rx for BPH
alpha blockers
5 alpha reductase inhibitors
incidence peak for prostate carcinoma =
arises esp in __ lobe
60-80yo
posterior
spread of prostate cancer =
local - urethra, capsule, seminal vesicle, bladder, rectum
lymph - sacral, iliac and para-aortic nodes
blood - bone, lung and liver
Ix for prostate cancer =
PR, US
xray and bone scans
PSA
TUR biopsy
Rx for prostatic cancer
antiandrogens - oestrogens and cyproterone
radio (bone mets)
radical prostatectomy
painless testicular enlargement can be due to __
testicular tumours
germ cell tumours of the testicles
seminoma
teratoma
mixed
___ cell cancer is most ass wwith gynaecomastia of all the testicular cancers
Leydig ( a stromal cancer)
age of seminoma ptnts
gross appearance =
cells =
30-50yo - v rare before puberty
potato
large clear cells with variable stromal lymphatic infiltrate
marker for seminoma
PLAP
seminoma are very sensitive to __ and cure rate =
radiotherapy
95%
spread of seminomas
para aortic nodes
lungs
liver
age peak for teratomas =
different types =
20-30yo - can occur in kids differentiated malignant teratoma intermediate malig undifferentiated malig trophoblastic
markers for teratomas =
betaHCG - trophoblastic parts - most malig
AFP - yollk sac parts
2 types of non-visible haematuria
symptomatic/asymptomatic
microscopic haematuria is sig if
> = 3 RBCs per high power field on microscopic evaluation of urinary sediment from 2 out of 3 urinalysis specimens
why is BPH more likely to cause haematuria than prostate cancer?
it is central
after trauma can get ___ haematuria due to ateriovenous communications
deferred (2-3wks)
why do long distance runners get haematuria?
vasoconstriction of renal vessels (nephron hypoxia) and of efferent glomerular arteriole ( increase filtration P)
loin pain haematuria syndrome =
loin pain, dysuria, vomiting and low grade fever wo UTI - ass with disease of renal peripheral arteries
decompression haematuria occurs when
empty bladder too quickly after retention
timing of haematuria :
if is initial =
total =
terminal =
urethral
bladder/kidneys/ureters
prostate/bladder neck
vermiform clots in urine suggest ___ cause
upper UT
refer all ptnts with visible haematuria/sympt microscopic/asympt micro +>=4o yo to
urology
precipitators of acute urinary retention
Sx. catheterisation
anaesthetics
sympathomimetric/anticholinergic drugs
Rx for acute urinary retention =
catheterise
then give uroselective alpha blocker (alfuzosin/tamsulosin) before TWOC (trial wo catheter)
after Rx for urinary retention may get
post obstructive diuresis -
due to solute diuresis and defect in concentrating ability of the kidneys
watch if >200ml/hr - resolves in 24-48hrs
Rx for acute loin pain due to calculi
NSAID +/- opiate
alpha blocker for small stones
if calculi not passed in __ likely to need intervention
1 month
indications to treat renal stones early =
Rx =
unrelieved pain
pyrexia
nausea and vom persistently
high grade obstruction
ureteric stent/fragmentation/removal
percutaneous nephrostomy for infected hydronephrosis
in frank haematuria if have clot retention Rx =
3 way irrigating haematuria catheter
Ix for frank haematuria =
CT urogram and cytoscopy
spermatic cord torsion is most common at which age
usually occurs __
puberty
spontaneously eg woken from sleep
examination findings in spermatic cord torsion =
testes high in scrotum
transverse lie
abscence of cremasteric reflex
Rx for spermatic cord torsion =
rapid 2/3 point fixation with fine non-absorbale sutures
must fix contralateral side - otherwise = bell clapper deformity
signs of torsion of appendix testes =
Rx =
local tenderness at upper pole
blue dot sign
testes mobile and cremasteric reflex present
resolve spontaneously
examination findings for epididymitis
cremasteric reflex present
pyuria
doppler = swollen epididymis with increased bloodflow
Rx for epididymitis
analgesia and scrotal support
ofloxacin 400mg/day for 14 days
Rx for paraphimosis
iced glove
granular sugar
manual compression with distal traction
dorsal slit
priapism =
> 4hrs erection, often painful and not ass with sexual arousal
causes of priapism
sickle cell erectile dysfunction injections - papaverine trauma neurological idiopathic
basis of ischaemic type (low flow/veno-occlusive) priapism
vascular stasis and decreased venous outflow
corpus cavernosa rigid and tender
painful penis
basis of non-ischaemic/arterial/high flow priapism
traumatic disruption of penile vasc => blood into corpora => fistula formation between cavernous arteries and lacunar spaces => blood bypasses normal helicine arteriolar bed
aspirate of corpus cavernosum in low flow priapism =
dark blood, low O2 and high CO2
aspirate of corpus cavernosum in high flow priapism =
normal arterial blood
Ix for priapism
aspirate corpus cavernosum
colour duplex US
Rx for non-ischaemic priapism
may spont resolve if watch
selective arterial embolisation with non permanent materials
Rx for ischaemic priapism
aspirate +/- saline irrigation
inject alpha agonist (phenylephrine)
may => Sx shunt
form of nec fasc around M genitalia
Fourniers gangrene
s+s of Fourniers gangrene
marked pain, fever, sepsis, swelling and crepitus of scrotum, dark purple areas
Ix for Fourniers gangrene
plain XR/US = gas in tissues
Rx for Founriers gangrene
Abx and surgical debridement
emphysematous pyelonephritis =
acute necrotising parenchymal and perianal infection due to gas forming uropathogens esp E coli
emphysematous pyelonephritis usually occurs in __ and is ass with +++
diabetics
ureteric obstruction, fever, vom, flank pain
Ix for emphysematous pyelonephritis =
palin abdo XR (KUB) = gas
CT defines extent
Rx for emphysematous pyelonephritis =
nephrectomy
perinephric abscess is usually due to ___
Ix =
Rx =
rupture of an acute cortical abscess into perinephric space / from haem. seeding
CT
Abx and drain
Ix for renal trauma with haematuria/penetrating/shock
contrast CT
Rx for kidney trauma =
angiography/embolisation (98% Rx of blunt trauma)
Sx
Ix for bladder trauma =
CT cystography
post urethral injusry is often ass with
pubic rami #
___ is most vulnerable part of urethra to trauma as is fixed at __+__
bulbomembranous junction
urogenital diaphragm and puboprostatic ligaments
s+s of urethral trauma
blood at meatus cant urinate palpable bladder high riding prostate butterfly perineal haematoma
Ix for urethral trauma =
retrograde urogram
Rx for urethra trauma
suprapubic catheter
delayed reconstruction >= 3 months later
in kidneys: petechial haemorrhages, arteriolosclerosis and hyalinosis suggests:
hypertension
in malignant hypertension ____ is seen in the kidneys
fibrinoid necrosis
lesions on the kidney seen in diabetes mellitus
Kimmelstiel-Wilson
form of inherited kidney disease ass with Berry aneurysms and subarachnoid haemorrhages
ADPKD
dilatation of the renal pelvis and calyces
hydronephrosis
renal cell carcinoma is derived from which tissue
renal tubular epithelium
the being present increases the likelihood of renal cell carcinoma metastasising
renal vein invasion
3/4 of bladder cancers are found in this area
trigone
used to treat superficial bladder cancers
mitomycin
the hormonal predisposers to BPH and prostate ca
BPH = oestrogen increased compared to testosterone Ca= androgen driven
eGFR is not used in AKI because
Cr is changing rapidly
and Cr lags behind GFR
Cr and urea tend to rise together but a disproportionate rise in urea can be because of __
high protein meal (eg. gut bleed)
hypercatabolic state
dehydration
NSAIDs have a worse effect on the kidneys if the ptnt is ___
dehydrated
