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Systemic Pathology I > Pathology of the Renal System: Lower Urinary Tract > Flashcards

Pathology of the Renal System: Lower Urinary Tract Flashcards

1
Q

What structures make up the lower urinary system?

A
  • PAIRED URETERS
  • URINARY BLADDER
  • URETHRA
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2
Q

Most diseases of the LUT are associated with?

A
  • Obstruction and Infection ( can occur at the same time)
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3
Q

What are males more predisposed to when it comes to the urinary system? Why is this?

A

Males are more prone to obstruction due to urethral anatomy ( long and has sharp turns) Urethra narrows

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4
Q

What are females more predisposed to when it comes to the urinary system? Why is this?

A

Females are more prone to infection this is due to its proximity to the external environment and proximity to the rectum.

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5
Q

What are the most prominent locations in the male anatomy where urinary obstruction can occur?

A
  • Sigmoid Flexure
  • Urethral Process
  • Os penis
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6
Q

What is the most important ureteral anomoly?

A

Extopic ureter

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7
Q

What is an ectopic ureter?

A

Rather than terminating at the trigone of the bladder, it terminates at the urethra or vagina

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8
Q

How are ectopic ureters usually diagnosed?

A

Incidental Finding

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9
Q

What does a ectopic ureter predispose the patient to?

A

-> predisposes them to ascending infection and compression of ureter. This causes an obstruction of the ureter, distention of the renal pelvis, hydronephrosis and UTI-pyelonephritis from the ascending infection.

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10
Q

What is seen in this image?

A
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11
Q

What is urolithiasis?

A

Presence of calculi (uroliths or stones) in the urinary passages

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12
Q

What is the most important urinary pathology?

A

Urolithiasis

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13
Q

What is calculi made of ?

A

Calculi are aggregates of precipitated urinary solutes, urinary proteins and
proteinaceous debris

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14
Q

Are all cases of urolithiasis related to stones?

A

No it could be from stones or a plug( urethral debris)

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15
Q

What is calculi?

A
  • Calculi: minerals predominate, round/spherical hard structures
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16
Q

What are urethral plugs?

A
  • Urethral plugs: masses of sandy sludge with a much higher organic component
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17
Q

Will calculi have a higher organic component or would urethral plugs?

A

Urethral plugs

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18
Q

What causes urolith formation?

A

Cystitis-> desquamation of epithelium. This sloughed off epithelium is what starts urolith formation.

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19
Q

What are the causes of urolithiasis?

A
  • Defective meabolism of substance (i.e dalmations and urate stones)
  • Metabolic diseases (i.e hyperparathyroid/ hypercalecemia)
  • High levels of a substance in the diet (sillicic acid in native pastures -> ruminants)
  • Infection
  • other factors: pH, decreased water intake, urine supersaturation, foreign body (suture, grass awn, catheter)
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20
Q

What are examples of urolith formation due to defective substance metabolism?

A
  • Uric Acid in Dalmations -> urate calculi
  • Cystine ( defective proximal tubular resorption from GF)
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21
Q

How do cystine stones occur?

A
  • defective proximal tubular resorption from GF causes high levels of cystine in the bladder which causese calculi formation and sedimentation.
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22
Q

What are examples of metabolic diseases that cause urolithiasis?

A

Metabolic diseases
- Hyperpathyroidism, hypercalcemia: Calcium oxalate
- Severe liver disease(liver fibrosis)/portosystemic shunts: Ammonium biurate calculi (ammonia not metabolized by liver thus ending up in the urinary bladder and forming stones)

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23
Q

What are examples of high levels of substances in diets that cause urolithiasis?

A
  • High levels of a substance in the diet
  • Silicic acid in native pastures, ruminants - Mineral imbalance (calcium, phosphorus, magnesium)

If you have a ruminant (cattle or small ruminants) with urolithiasis then check for diet imbalance.

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24
Q

What is the typical crystals/ stones that form due to infection? What are the animals that are usually affected by this?

A

Struvite
Dogs ++++++
and Cats

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25
Q

What other factors can affect predisposition to stone formation?

A

Certain factors are more or less important: urinary pH, reduced water intake, urine supersaturation, foreign body (suture, grass awn, catheter)

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26
Q

If you have a bull with urolithiasis, within the urinary bladder what is most likely your cause?

A
  • High level of a substance
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27
Q

Which dog would be more predisposed to urolithiasis?
a.) Intact female
b.) Spayed female
c.) Intact male
d.) Neutered male

A

d.) Neutered male

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28
Q

Staph and proteus secrete _____ to induce supersaturation?

A

(Ureases from Staph/Proteus induce
supersaturation)

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29
Q

Which animal is more likely to be affected by urolithiasis?
a.) horses
b.) cats
c.) pigs
d.) sheep

A

b.) cats

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30
Q

What breeds of dogs are predisposed to urolithiasis?

A

Predisposed breeds in dogs: Dachshunds, Dalmations, Cocker
spaniels, Basset Hounds, Poodles, Schnauzers, and small terriers

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31
Q

Where can calcili form in the urinary system?
a.) urethra
b.) renal pelvis
c.) ureter
d.) bladder
e.) all of the above

A

e.) all of the above
Can form anywhere from the renal pelvis to the urethra

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32
Q

Where is the most common site of lodgement of urethral calculi in cattle?

A

Cattle: at the ischial arch and at the proximal end of the sigmoid flexure

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33
Q

Where is the most common site of lodgement of urethral calculi in rams?

A

Rams: at the urethral process (vermiform appendage)

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34
Q

Where is the most common site of lodgement of urethral calculi in dogs?

A

Dogs: at proximal to the base of the os penis

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35
Q

Where is the most common site of lodgement of urethral calculi in cats?

A

Cats: along the entire length of the urethra

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36
Q

What occurs to the tissue at the site of calculi lodgement? What can this cause?

A

At the site in which calculi lodge, there is local pressure necrosis, ulceration of the mucosa, and acute hemorrhagic urethritis/cystitis
Causes: Hematuria and dysuria (straining to urinate)

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37
Q

What can be a risk factor/ result during medical intervention of a urinary obstruction in the urethra ? Why does this occur?

A

Urethral tear
- Damage to mucosa makes it more friable.

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38
Q

What is seen in this image?

A

Nephrolith ( goat)

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39
Q

What is seen in this image?

A

uroliths in bladder of dog

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40
Q

What is seen in this image? What is indicated by the teal, aqua, and sage circles?

A

Teal: Hemorrhage
Aqua: Calculi, sludge/ sand, and uroliths
Sage: Hydronephrosis

41
Q

What is seen in this image? What is indicated by the teal, aqua, and sage circles?

A

Teal: Hematuria
Sage: Hemorrhage and ulceration
Aqua: Calculi

42
Q

What is the most common crystals in dogs? What is the cause?

A

Struvite most common in dogs. This is due to infection/ bacteria

43
Q

What do stones cause on the mucosa of the bladder?

A

Causes direct damage to epithelium resulting in ulceration and hemorrhage.

44
Q

What is seen in this image? What is indicated by the teal, aqua, and sage circles?

A

Sage Line: Ulceration
Aqua: Uroliths
Teal: Hemorrhage

45
Q

What is seen in this image? What is indicated by the teal, aqua, and sage circles/ lines? What is the likely stone composition if this is a dalmation?

A

most likely urate calculi due to dalmations defect in uric acid metabolism.
Aqua: urate calculi
Sage: Hemorrhage ( likely more apparent underneath stones)
Teal: Cystitis / ulceration

46
Q

What is seen in this image? What is indicated by the sage and aqua circles?

A

Necrosis of the urethral process
Aqua: calculi in the vermiform appendage/ urethral process of a small ruminant
Sage: Gangrenous Necrosis

47
Q

What is a common complication of cows with a urethral obstruction?

A

Rupture of the urethra with accumulation of urine in the subcutis

48
Q

What is seen in this image?

A
49
Q

What is seen in this image? What is indicated by the light blue, aqua, purple and seage circles?

A

This is a goat with a urethral obstruction
Purple: areas of inflammation -> neutrophils -> indicating a suppurative pyelonephritis ascending infection
Sage: distended ureter (hydroureter)
Aqua: pyelonephritis ( exudate present in renal pelvis)
Light blue: Hydronephrosis

50
Q

What is seen in this image? What is a likely consequence related to the urinary system for animals with this condition?

A

This is a portosystemic shunt. you can see the hepatic portal vein ( circled in teal) and the new vessels created to help bypass the liver.
The condition that they are at risk for is developing ammonium biurate crystals.

51
Q

What is the pathogenesis for ammonium biurate crystal formation for pathients with acquired portosystemic shunts?

A

Quick N dirty: Liver fibrosis -> compression of portal vein -> portal hypertenison -> shunt formed to bypass liver -> shunt connects portal vein to vensa cava to bypass liver -> NH3+ in blood not metabolized (from here there are two consequences) -> NH3 + crosses bbb and causes hepatic encephalopathy, and NH3+ in urine casue ammonium biurate stones.

52
Q

What are the normal antibacterial properties of the bladder?

A
  • Repeated voiding
  • Protective urothelial mucus coating
  • Mucosal IgA
  • High urea and organic acids
53
Q

What are the risk factors for infection within the bladder?

A
  • Stagnation of urine (obstruction of urinary flow).
  • Incomplete voiding (spinal cord lesions)
  • Urothelial trauma
54
Q

What animal and species is more prone to bacterial cystitis?

A

Females -> due to closeness of vagina to the rectum/ outside environment

55
Q

What are the causes of cystitis?

A
  1. Bacterial (♀ - ↑cystitis)
  2. Chemicals (cyclophosphamide)
  3. Urolithiasis
  4. Trauma
56
Q

What is the most common bacteria that causes cystitis?

A
57
Q

What are specifc renal pathogens of cattle, pigs, and horses?

A
58
Q

What is a chemical cause of cystitis in horses fed hay?

A
59
Q

What is the likely cause of the cystitis in this hay fed horse whose bladder is shown below?

A
60
Q

What chemotherapy agent has a common side effect of causing hemorrhagic ulcerative cystitis?

A

Cyclophosphamide

61
Q

What is the cause of feline lower urinary tract disease?

A
  • Multifactorial condition
  • Multiple causes:
  • Feline idiopathic (interstitial) cystitis
  • Infection
  • Uroliths/urethral obstruction
62
Q

What is seen in this image? What is the cause of these lesions ? ( hint Cat)

A
63
Q

What is the risk factors for feline lower urinary tract disease?

A

Risk factors:
* Middle-aged and neutered cats
* Over-weight and cats which take little exercise
* Cats with little or no access outside
* Cats that eat a dry diet
* Multiple animal households
* STRESS

64
Q

What is the number one cause of feline cystitis? What is it caused by?

A

Struvites caused by idiopathic cystitis.

65
Q

What are the 2 types of chronic cystitis?

A
  • Follicular: Disseminated submucosal lymphoid nodules
  • Polypoid: Polyps composed of connective tissue mixed with mononuclear cells
66
Q

What is the kind of chronic cystitis seen in this image?

A

follicular

67
Q

What is the kind of chronic cystitis seen in this image?

A

Raised from fiberous connective tissue/ Make sure to distinguish polyp vs. mass

68
Q

What is seen in this image?

A

Emphysematous cystitis

69
Q

What is emphysematous cystitis? What is it associated with?

A
70
Q

What are the neoplasms of the urinary bladder?

A
71
Q

What is the most common neoplasia of the urinary tract?

A

Transitional cell carcinoma

72
Q

Where is transitional cell carcinoma typically found in the urinary bladder

A

Most common is urinary bladder neck and trigone.

73
Q

What animals are transitional cell carcinomas more common in?

A

Dogs.

74
Q

What tumors can be seen in cattle with chronic bracken fern poisoning?

A

Transitional cell carcinomas, hemangiomas,
hemangiosarcomas
Can see multiple at the same time.

75
Q

What breed of dog has a predisposition for transitional cell carcinoma? What is it linked to?

A

Scottish terriers ( any terriers really) linked to lawn pesticides

76
Q

What percent of these tumors have already metastasized by the time of clinical diagnosis?

A

40% of these tumors have metastasized by the time of clinical diagnosis

77
Q

Where do transitional cell carcinomas metastasize to?

A

Lymph nodes, lung and bone

78
Q

What are the classifications of TCC? Which has the worst prognosis/ why? Which has the best?

A

1) Papillary and non-infiltrating - no invasion of the stroma ( Better prognosis)
2) Papillary and infiltrating (most common)
- Rupture of basement membrane leads to invasion of blood vessels and mets.
3) Non-papillary and non-infiltrating (carcinoma in- situ)
- Malignant only in the mucosa. Not infiltrating the sub mucosa.
4) Non-papillary and infiltrating – most common to metastasize (not as good prognosis)

79
Q

What classification of TCC is being indicated in this image?

A

Papillary and non-infiltrating

80
Q

What classification of TCC is being indicated in this image?

A

Invasive papillary Carcinoma

81
Q

What classification of TCC is being indicated in this image?

A

Flat non invasive carcinoma

82
Q

What classification of TCC is being indicated in this image?

A

Flat invasive carcinoma

83
Q

What is seen in this image? What is being indicated by the teal circles?

A
84
Q

What is seen in this image?

A
85
Q

What is seen in this image? What kind is it?

A

Transitional cell carcinoma - papillary

86
Q

What is seen in this image? What is the distribution?

A
87
Q

What is the mechanism for the tumor formation from bracken fern posioning?

A
88
Q

What virus is involved in tumor formation for bracken fern posioning?

A

Bovine papilloma virus - 2

89
Q

What is the toxic principle of bracken fern posioning?

A

Toxic principle: Ptaquiloside (carcinogenic and immunosuppressive)

90
Q

What is the most common clinical sign of bracken fern posioning?

A

Hematuria

91
Q

What is seen in this image?

A
92
Q

What is seen in this image?

A
93
Q

What is seen in this image?

A
94
Q

What is a botryoid rhabdomyosarcoma? What animals do you usually see them in?

A
95
Q

What breed are botryoid rhabdomyosarcomas overrepresented in?

A

St. Benard

96
Q

Where does a botryoid rhabdomyosarcoma arise from? what is its origin cells?

A

Arise at the trigone or bladder neck from embryonic
myoblasts

97
Q

What can you see clinically with patients with botryoid rhabdomyosarcoma??????????????????

A

Clinically cause obstruction (In one case - hypertrophic
osteopathy in a dog)

98
Q

What is seen in this image? (Hint: young dog)

A

Botryoid Rhabdomyosarcoma

99
Q

What is seen in this image? (Hint: young dog)

A

Botryoid Rhabdomyosarcoma

Systemic Pathology I (23 decks)

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