Pathology Lecture 1

Question 1

pyelonephritis definition

Answer 1

infection of the renal pelvis ,calyces, tubules and intersititium

Question 2

pyelonephritis can be

Answer 2

acute or chronic

Question 3

pyelonephritis is a type of

Answer 3

upper urinary tract infection

Question 4

acute pyelonephritis is most often caused by an

Answer 4

ascending infection from bacteria that has colonised the urethra and the bladder

Question 5

most common pathogen causing pyelonephritis

Answer 5

E.coli

Question 6

other pathogens causing pyelonephritis

Answer 6

pseudomonas and strep faecalis

Question 7

risk factors for pyelonephritis

Answer 7

• female sex
• sexual intercourse
• indwelling catheters
• diabetes mellitus
• urinary tract obstruction: calculus, strictures and neoplasms
• vesico- ureteral reflux

Question 8

vesico-urethral reflux is caused by

Answer 8

failure of the vesicle-ureteric orifice (which is the one way valve which allows urine to flow from the ureter into the bladder but stops urine flowing from the bladder back into the urethra)

Question 9

causes of VUR

Answer 9

primary congenital defect or a bladder outlet obstruction

Question 10

pyelonephritis can also occur due to

Answer 10

haematogenous spread but this is more rare and is a consequence of bacteraemia from sepsis or infective endocarditis

Question 11

acute pyelonephritis is usually

Answer 11

unilateral, bacteria adhere to the renal epithelium of the tubules which triggers an inflammatory response
chemokines attract neutrophils to the renal intersitium ( typically the glomeruli and the vessels of the kidney are spared) as neutrophils die-off they pass through the urinary tract to be excreted in the urine

Question 12

in acute pyelonephritis urinalysis shows

Answer 12

increased white cell count and white cell casts

Question 13

presentation of acute pyelonephritis

Answer 13

fever, nausea, vomiting, flank pain at the cost-vertebral angle

Question 14

costo-vertebral angle is the

Answer 14

acute angle formed on either side of the human back between the twelfth rib and vertebral column

Question 15

treatment of acute pyelonephritis

Answer 15

antibioticsand fluids

Question 16

chronic pyelonephritis

Answer 16

recurrent episodes of acute pyelonephritis causes the kidneys to become visibly scarred at which point it is called chronic pyelonephritis

Question 17

acute and chronic pyelonephritis are type of

Answer 17

upper urinary tract infections

Question 18

most common risk factor for recurrent acute pyelonephritis and therefore acute pyelonephritis is

Answer 18

vesico-ureteral reflux

Question 19

VUR can be

Answer 19

caused by a primariy congenital defected or caused by a bladder outlet obstruction

Question 20

a bladder outlet obstruction causes

Answer 20

increased pressure within the bladder and causes urinary stasis making bacterial adherence easier

Question 21

bilateral obstruction affects

Answer 21

both kidneys and is caused by blockage of the urethra

Question 22

causes of blockage of the urethra

Answer 22

• posterior urethral valve
• benign prostatic hyperplasia
• cervical carcinoma

Question 23

recurrent episodes of acute pyelonephritis causes

Answer 23

the renal intersitium to undergo fibrosis and scarring and causes atrophy of the renal tubules

Question 24

the changes in chronic pyelonephritis generally affect

Answer 24

the superior and inferior poles of the kidneys

Question 25

on imaging

Answer 25

ie a CT urogram the renal calyxes become flattened

Question 26

on histology

Answer 26

some tubules may be dilated and filled with colloid

Question 27

tuberculous pyelonephritis

Answer 27

haematogenonus spread from the lung caused by mycobacterium tuberculosis

Question 28

presentation of tuberculous pyelonephritis is

Answer 28

vague with symptoms of weight loss, fever, loin pain, dysuria, sterile pyuria

Question 29

sterile pyuria

Answer 29

elevated numbers of white cell in the urine which appeared sterile using standard future techniques

Question 30

what is seen in tuberculous pyelonephritis

Answer 30

caseous foci which is slow growth with progressive renal destruction which spreads to ureters, bladder and other viscera

Question 31

what type of granuloma is seen in tuberculous pyeloneprhtis

Answer 31

caseous granulomatous inflammation which is ziehl nelson stain positive

Question 32

cystitis

Answer 32

acute inflammation of the bladder but can become necrotising is associated with a bladder outlet obstruction

Question 33

common organisms seen in cystitis

Answer 33

E.coli, Klebsiella, proteus, pseudomonas

Question 34

cystitis cystica is also known as

Answer 34

urethritis cystica

Question 35

urethritis cystica is a

Answer 35

benign condition of the ureters representing multiple small submucosal cysts

Question 36

urethritis cystica is common in who

Answer 36

diabetics with recurrent UTIs

Question 37

schistosomiasis

Answer 37

parasitic disease caused by flukes (trematodes) of the genus shistosoma

Question 38

schistosomiasis is most common where

Answer 38

in tropical countries

Question 39

what is the type of schistosomiasis which causes urinary schistosomiasis

Answer 39

s. hematobium

Question 40

schistosomiasis predisposes to what

Answer 40

urothelial malignancy particularly squamous carcinoma

Question 41

urinary tract obstruction is usually a

Answer 41

urethral obstruction which is confined to males and causes include strictures, posterior urethral valves, prostatic disease

Question 42

prolonged bladder outlet obstruction causes

Answer 42

hypertrophy of the detrusor muscle leading to the formation of diverticulum

Question 43

hydronephrotsis literally means

Answer 43

water in the kidney

Question 44

hydronephrosis causes

Answer 44

urinary tract obstruction and reflux

Question 45

bilateral hydronephrosis caused by

Answer 45

• urethral obstruction, neurogenic disturbance, VUR, bilateral ureteric obstruction (e.g advanced carcinoma of the cervix)

Question 46

unilateral hydronephrosis caused by

Answer 46

calculi, neoplasms, pelvics-ureteric obstruction, strictures

Question 47

presentation of hydronephrosis

Answer 47

• if sudden and there is a complete obstruction urein production will cease and there is little pelicalyceal dilation
• if gradual and there is a partial obstruction urine production will continue but there will be pelvicalyceal dilation

Question 48

if hydronephrosis is severe

Answer 48

there will be marked cortical thinning, atrophy and fibrosis and secondary infection often follows urinary stasis (pyonephrosis)