pathology of the urinary tract Flashcards
describe renal function impairment/ failure? 3
- Decreased ability of the kidney to excrete nitrogenous waste and regulation of water and electrolytes
- Acute renal function impairment
- Chronic kidney disease (CKD)- stages 1-4 based on the GFR
what are the parameters to assess renal function? 6
- Urea
- Creatinine
- Na+
- K+
- Cl-
- Estimated glomerular filtration rate (eGFR)
which two excretory compounds are raised in renal failure?
- creatine
- urea
what test will be abnormal when assessing full blood count in chronic renal failure and why?
Low haemoglobin due to lack of erythropoietin resulting in normocytic normochromic anaemia
what are the causes of acute renal failure? 3
- Hypovolaemic shock due to blood loss, burns, heavy bleeding relate to pregnancy, vomiting and diarrhoea
- Drugs= gentamycin
- Congestive cardiac failure
what are the causes of chronic renal failure?7
- Several types of glomerulonephritis
- Chronic use of some drugs such as aspirin
- Chronic pyelonephritis
- Hypertension
- Diabetes mellitus
- Autoimmune diseases (systemic lupus, erythematosus)
- Obstruction of the urinary tract
in some cases the glomeruli are scarred and there is associated chronic inflammation
describe chronic urinary tract obstruction? 5
- Calculi or stones
- Stricture in the ureter
- Stricture in the urethra
- Benign prostatic hyperplasia
- Cancer of the bladder or prostate
describe renal cell cancer? 6
- Patients may present with haematuria
- Or as an incidental finding
- Patient may have a loin discomfort
- Affects patients in the 60-70 age group
- More males than females
- Large renal cell cancer has a yellow and pale variegated appearance
what does urothelium line? 3
describe it? 3
- Bladder
- Ureters
- Pelvi- calyceal system
Consists of four cells or more
Acts as a barrier and prevents back diffusion of urine
Different form squamous epithelium as the cells is more cuboidal than flat
what are the symptoms of cystitis? 6
- Dysuria= pain when passing urine
- Haematuria= blood in the urine
- Frequency= passing urine at short intervals
- -urgency to pass urine
- Urge incontinence
- Fever and lower abdominal pain
describe bladder cancer?
investigations? 5
- Patients may present with frank haematuria or microscopic haematuria (urine dipstick)
- Investigations:
- US
- Cystoscopy and biopsy or resection cancer
- MRI to assess local spread and lymph node status
- CT scan- for staging to look for metastasis to other organs
- Histology: transitional cell carcinoma/ urothelial carcinoma
how can bladder cancer be removed?
trans-urethral resection= transurethral resection of bladder tumours (TRUBT)
what would patients with advanced bladder cancer receive?
neo-adjuvant chemotherapy prior to surgery
describe benign prostatic hyperplasia? 9
- Cause unknown- may be related to androgens
- Affects over 50% of men over 60 years
- Symptoms due to urethral obstruction
- Frequency in micturition
- Nocturia
- Poor stream
- Difficult in starting and stopping stream. (prostatism)
- Urinary tract infections
- Bladder outlet obstruction leads to hydronephrosis
describe prostatic cancer? 3
- Most common cancer in men
- Patient may present with urinary symptoms
- Or raised prostatic specific antigen (PSA) usually requesting by GP
is there a screening programme for prostatic cancer?
no
what are the screening programmes for cancer in the UK? 3
- bowel
- breast
- cervical
what are the types of specimen from the prostate?
- Needle core biopsies for diagnosis of Ca prostate in patients with raised PSA; biopsies taken per rectum under US guidance
- Transurethral resection of prostate (prostate chips) for treatment of benign prostatic hyperplasia (BPH) or palliation in Ca prostate if patient presents with obstructive symptoms
- Radical prostatectomy for early prostatic cancer
what are the investigations for prostatic cancer? 5
- PSA raised in prostatic cancer and other conditions such as inflammation of the prostate
- MRI to identify the cancer and assess for local spread
- Needle core biopsy with transrectal US scan
- CT scan to seek for distant metastasis
- Bone scan because prostate cancer spreads to the bones
what other cancers spread to the bones? 4
- breast
- kidney
- lung
- thyroid
what are the complications of radical prostatectomy? 6
- Bleeding
- UTI
- Urinary incontinence
- Erectile dysfunction (impotence)
- Narrowing of the urethra or bladder neck
- Formation of cysts containing lymph
what are the possible complications of vertebral bone metastasis? 2
- tumours can weaken the bone causing them to fracture- pain, spinal instability
- Spinal cord compression with resultant lower limb paralysis, urinary and faecal incontinence
