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Renal > Pathology II > Flashcards

Pathology II Flashcards

1
Q

Where is urothelium present?

A

Not just bladder = ureters and collecting system of kidney, significant portion of the urethra

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2
Q

What does the distribution of urothelium mean?

A

Any pathology that affects the bladder urothelium can affect any other part of the body that has urothelium

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3
Q

How common is cystitis in the bladder?

A

Very common and rarely biopsied

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4
Q

What are the important variants of cystitis?

A

Parasites and mycotic infection, aseptic, reactive to catheters

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5
Q

What parasite is implicated in cystitis?

A

Schistosomiasis = mainly schistosomiasis haematobium, swims up the urethra, difficult to get rid of eggs

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6
Q

How does schistosomiasis infection cause cancer?

A

Persistent inflammation causes squamous metaplasia

Squamous metaplasia leads to eventual squamous cell carcinoma

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7
Q

What are some features of cystitis causes by catheters?

A

Persistent inflammation, scarring, metaplasia and squamous cell carcinoma, problematic if paraplegic

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8
Q

What is the old name for aseptic cystitis?

A

Interstitial cystitis

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9
Q

What occurs in aseptic cystitis?

A

Persistent symptoms of dysuria
Persistently negative cultures and urinalysis
Variable pathology = some inflammation, congestion, mast cells

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10
Q

What is cystitis cystica?

A

Descriptive term = infolding of bladder mucosa into cysts

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11
Q

How do diverticulae affect the bladder?

A

Not uncommon = stagnant urine, infection, stones and cancer can occur

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12
Q

How does bladder obstruction occur?

A

Prostatism = bladder muscle works hard and becomes trabeculated, eventual persistent back pressure

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13
Q

What occurs in urinary tract obstruction?

A

Back pressure = any obstruction (e.g stone, tumour)
Collecting system continues to dilate amd renal parenchyma becomes atrophic
Hydronephrosis occurs

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14
Q

Why can urinary tract obstruction affect the kidneys?

A

It is the last point in the tract

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15
Q

What is the aetiology of urothelial neoplasm?

A

Relatively common = middle aged and elderly patients, no sex predilection

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16
Q

What is urothelial neoplasm associated with?

A

Highly associated with smoking

Linked to beta-naphthyline = dye industry

17
Q

What are some features of transitional cell carcinomas?

A

Often papillary (finger like projections) but may be CIS (flat), more concentrated in bladder but whole tract is at risk

18
Q

What do adenocarcinomas occur on a background of?

A

Metaplasia = difficult to distinguish from colon cancer that has invaded through

19
Q

What is the urachus?

A

Formed from the allantois

20
Q

What are some features of the allantois?

A

Spans from dome of bladder to the umbilicus, usually involutes, may remain patent in some parts

21
Q

Where does urachal adenocarcinoma affect?

A

Isolated to dome of the bladder

22
Q

How can squamous cell carcinomas occur in the bladder when squamous epithelium doesn’t occur there normally?

A

Due to persistent inflammation = metaplastic epithelium is unstable and has increased risk of cancer

23
Q

What is the function of the prostate?

A

Prostatic fluid and fluid from seminal vesicles, some contractile function during ejaculation

24
Q

What can happen if the prostate gets bigger?

A

Due to hormonal influence = can obstruct urine flow if it occurs in the central or transitional zones

25
Q

Where does hyperplasia of the prostate affect?

A

Mainly the central zone of the prostate = treated by trans urethral resection

26
Q

How common is prostate cancer?

A

30% at age 50
70% at age 70
90% at age 90

27
Q

What are some features of prostate cancer?

A

Most are low grade and slow growing so only followed up even when diagnosed
Occurs in periphery of gland usually

28
Q

What are the risk factors for prostate cancer?

A

Cadmium batteries, less hormonal link that in benign prostatic hyperplasia, cause not clear

29
Q

What is the grading system used for prostate cancer?

A

Gleason grading

30
Q

How is Gleason grading performed?

A

Combination of two numbers = worst grade and predominant grade, each out of 5
Lowest is usually 3+3 (6), highest is 5+5 (10)

31
Q

How is prostate cancer diagnosed?

A

Biopsy =transanal/rectal core biopsy

Don’t want to sample periurethrally due to peripheral location

32
Q

What is PSA?

A

Prostate specific antigen = glycoprotein enzyme (kalkrein 3),

33
Q

What is the normal function of PSA?

A

Liquifies semen in ejaculate and allows sperm to swim

34
Q

Why is PSA not a great marker for prostate cancer?

A

Lacks sensitivity and specificity = raised by PR exam, riding a bike, by having a large prostate and in prostatitis

35
Q

Why is PSA not produced by the worst cancers?

A

High grade dysplasia means that the cells of the prostate are no longer normal and can’t produce PSA

Renal (36 decks)

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