Renal, Genitourinary, and Breast Pathology Flashcards
1
Q
kidney is _____ of body weight
A
0.4%
2
Q
what are kidney functions
A
- filters 25% of blood through glomeruli
- excretes nitrogenous waste products of metabolism- cleans the blood- turns 1.5L into urine
- regulates body water and electrolytes
- maintains appropriate acid-base balance
- endocrine organ- secretes hormones
3
Q
what hormones does kidney excrete and what does it control
A
- renin - blood pressure
- erythropoietin- proliferative effect on bone marrow to make RBCs
4
Q
what are the morphologic components of the nephron
A
- glomeruli
- convoluted tubules
- collecting ducts
5
Q
what does the juxtagomerular complex do
A
controls BP
6
Q
where are the juxtaglomerular cells located
A
in the afferent arteriole
7
Q
what is in the juxtaglomerular complex
A
- juxtaglomerular cells
- macula densa
8
Q
where is the macula densa located and what does it do
A
- in wall of DCT
- sensor for sodium
9
Q
describe azotemia
A
- elevation of blood urea nitrogen and creatinine levels
- usually related to reduced glomerular filtration rate
- associated with many primary renal disorders
- may also be associated with extra renal disroders
10
Q
what is pre-renal azotemia
A
hypoperfusion of the kidneys decreases GFR in the absence of parenchymal damage
11
Q
what is post renal azotemia
A
urine flow obstructed below the level of the kidney
12
Q
what is uremia
A
progression of azotemia to produce clinical manifestations and systemic biochemical abnormalities
- failure of renal excretory function
- metabolic and endocrine alterations
13
Q
what organs are secondarily involved in uremia
A
- uremic gastroenteritis
- peripheral neuropathy
- uremic fibrinous pericarditis
- uremic stomatitis
14
Q
what are the clinical manifestations of renal diseases
A
- nephrotic syndrome
- nephritic syndrome
- acute renal failure
- chronic renal failure
- urinary tract infections
- nephrolithiasis
- urinary tract obstruction
- renal tumors
15
Q
describe nephrotic syndrome
A
- glomerular syndrome
- heavy proteinuria
- hypoalbuminemia
- severe edema
- hyperlipidemia
- lipiduria
16
Q
describe nephritic syndrome
A
- glomerular syndrome
- acute onset of grossly- visible hematuria
- mild to moderate proteinuria
- azotemia
- edema
- hypertension
- classic presentation of acute post streptococcal glomerulonephritis
17
Q
describe acute renal failure and what might it result from
A
oliguria or anuria with recent onset of azotemia
- may result from glomerular injury or acute tubular necrosis
18
Q
describe urinary tract infections
A
- bacteriuria and pyuria - symptomatic or asymptomatic- kidney (pyelonephritis) or bladder (cystits)
19
Q
what are nephrolithiasis and what are they caused by
A
- kidney stones
- colic
- hematuria
20
Q
describe what causes nephrotic syndrome
A
a non specific disorder in which the kidneys are damaged, causing them to leak large amounts of protein from the blood into the urine
21
Q
describe what causes nephritis syndrome
A
a non specific disorder in which the kidneys are damaged causing them to leak protein and red blood cells from the blood into the urine
22
Q
what is glomerulonephritis and what is it treated with
A
- an immune mediated disease of the renal glomeruli
- treated with steroids
23
Q
what is pyelonephritis and what is it treated with
A
- an infection of the kidney ( not the glomerulus) usually caused by bacteria and of retrograde origin
- treated with antibiotics
24
Q
describe post streptococcal glomerulonephritis
A
- acute onset of nephritic syndrome in 9-14 days following streptococcal infection
- type III immune injury ( immune complex mediated inflammation)
25
what are the pathways of renal infection in pyelonephritis and which is mroe common
- hematogenous dissemination
- ascending infection- more comon
26
how is pyelonephritis spread and what is the tx
- fecal bacteria from perineal area
- bactrim
27
pyelonephritis is ____ common than glomerulonephritis
more
28
what are the symptoms of kidney stones
- may cause obstruction
- pain
- ascending infection
- hematuria
- pyuria
- lithotripsy
- may be associated with hypercalcemia
29
how are kidney stones treated
extracorporeal shock wave lithotripsy (ESWL)
30
describe the renin- angiotensin- aldosterone axis
- blood pressure drop detected by JG cells
- secretes renin
- converts to angiotensin I
- ACE converts to ANG II
- ANGII does vasoconstriction and increases aldosterone which increased Na+ retention and increases BP
31
what are the organs involved in end organ damage in complications of HTN
- cardiovascular system
- peripheral vascular system
- renal system
- central nervous system
- visual system
32
how is the CVS affected in end organ damage in HTN
- accelerated coronary atherosclerosis
- increased myocardial oxygen demand
- ventricular remodeling
- heart failure
- increased risk for arrythmias
33
how is the peripheral vascular system affected in end organ damage in HTN
- atherosclerosis
- aortic dissection
-abdominal aortic aneurysm
- peripheral vascular disease
34
how is the renal system affected in end organ damage in HTN
- hypertensive nephrosclerosis
- end stage renal disease
35
how is the CNS affected in end stage organ disease with HTN
- hemorrhagic CVA
- thromboembolic CVA
36
how is the visual system affected in end organ damage in HTN
- retinal infarction
- hypertensive retinopathy
- blindness
37
what is arteriosclerosis
- affects arterioles
- thickened walls reduce lumen diameter causing ischemic injury
38
what are the types of arteriosclerosis and what diseases are each associated with
- hyaline arteriosclerosis: benign hypertension, diabetes mellitus
- hyperplastic arteriosclerosis: malignant hypertension
39
what is the inheritance pattern for adult polycystic renal disease
autosomal dominant
40
what is a cause of renal cell carcinoma
cystic changes associated with renal dialysis
41
describe renal cell carcinoma
- arises from renal tubular epithelium
- often silent
- may grow into renal vein
42
is metastasis to kidney a normal site
no
43
describe Wilm's tumor, who it affects, symptoms, histopathology and survival
- nephroblastoma
- children under 5 years
- abdominal mass
- chronic low grade fever
- histopathology of several cell types, some of which resemble abortive glomeruli and others that resemble skeletal muscle
- better than 90% 5 year survival
44
describe urothelial carcinoma and causes
- arises from the urinary tract lining epithelium
- bladder most common site
- painless hematuria
- cigarette smoking, industrial solvents (beta- napththlyamine), chronic cystitis, schistosomiasis, drugs (cyclosphamide)
45
the clinical significance of urothelial carcinoma depends on:
histologic grade, differentiation and depth of invasion
46
what are the three major diseases of the prostate
- prostatits
- benign prostatic hyperplasia
- adenocarcinoma of prostate
47
what is the normal serum level of prostate specific antigen(PSA)
< 4ng/ml
48
what are the physiologic functions of PSA
- liquefy semen, allowing sperm to swim freely
- dissolution of cervical mucous cap
49
increased levels of PSA may suggest:
the presence of prostate cancer
50
PSA is elevated in:
prostatitis
51
what is prostatitis
acute bacterial disease treated with antibiotics
52
describe nodular (benign) prostatic hyperplasia- BPH
- obstruction to flow
- urinary frequency
- ascending infections
- rule-out neoplasia
- pharmacologic treatment
- surgical treatment (TURP)
53
describe adenocarcinoma of prostate
- 70% of men develop prostate cancer by 70-80 years of age
- digital prostate examination
- biopsy - multiple cores
- wide variation in clinical behavior
- gleason grading
54
what is cryptorchidism
undescended testes
55
what is seminoma
germ cell tumor- malignant
56
what are infections of the tested
- TB
- mumps
- syphilis
- gonorrhea
57
describe cryptorchidism
- absence of one or both testes in the scrotum
- failure of testis to descend from an abdominal position through the inguinal canal into the scrotum
- infertility
- increased risk for neoplasia
- orchiopexy
58
describe seminoma
- most common germ cell tumor of testis
- young adults: 15-34 years
- surgery plus radiation therapy and chemotherapy
- one of the most treatable and curable cancers
- over 95% long term survival in early stages
59
what are the complications of mumps
- orchitis
- oophoritis
- mastitis
- meningitis
- thyroiditis
- pancreatitis
- sterility
- hearing loss
60
when are complications common in the course of mumps
in older individuals
61
what are hypospadias
- developmental defect of the urethra in the male
- abnormally placed urethral meatus
- urethral meatus open on the glans penis most commonly
62
what is phimosis
- foreskin cannot be fully retracted from the head of the penis
63
what is priapism
- erect penis or clitoris does not return to its flaccid state despite the absence of both physical and psychological stimulation within four hours
- medical emergency
64
what is priapism caused by
- hematologic diseases: sickle cell disease, leukemia
- trauma
65
what is uterine leiomyoma
- benign smooth muscle neoplasm
- fibroids
- may cause irregular bleeding (metrorrhagia) or painful intercourse (dyspareunia)
66
what are the proliferative lesions of the endometrium
-endometrial hyperplasia
- polyps
67
what is associated with proliferative lesions of the endometrium
- glandular epithelium
- bleeding
68
what are the two major diseases of the endometrium
- endometriosis
- adenocarcinoma
69
describe endometriosis
- endometrial tissue outside the uterine cavity
- ectopic endometrial tissue influenced by hormonal chnages
- recurring pelvic pain
- symptoms depend on the site involved and worsen with the menstrual cycle
70
what are the risk factors for endometrial carcinoma
- age: most common in 55-65 age group
- obesity- greater synthesis of estrogen in body fat
- infertility- women who are nulliparoud are at increased risk
71
describe cervical squamous cell carcinoma
- exfoliative cytologic screening for early detection - papanicolau smear
- squamo- columnar junction
- high risk HPV subtypes- 16,18
- vaccination
72
what are the types of cervical intraepithelial neoplasia
- Grades I, II, and III
- LSIL- low grade squamous intraepithelial lesion
- HSIL- high grade squamous intraepithelial lesion
73
what is a teratoma
- a tumor containing tissues from all three germ layers
- arise in gonadal tissues
- most commonly seen in the ovary
- dermoid cyst of the ovary - a benign cystic teratoma
74
describe gonorhhea
- neisseria gonorrhea
- "mother natures brith control"
- pelvic inflammatory disease
- tubal scarring
- ectopic pregnancy
75
what microbe causes acute epididymitis
- neisseria gonorrhea
76
what are in breasts
- glandular epithelium
- ducts
- lobules
- interstitial tissue
- lymphatics
77
what is gynecomastia
- enlargement of male breast may occur in response to estrogen
- hyperestrinism in male
- bilateral - rule out hormonal
- unilateral- rule out tumor
78
what are the causes of hyperestrinism in male
- cirrhosis of liver- inability to metabolize estrogens
- klinefeller syndrome
- estrogen- secreting tumors
- estrogen therapy
79
describe fibroadenoma
- most common benign neoplasm of breast
- discrete usually solitary, moveable nodule
- young women
80
what are the types of malignant neoplasms of the breast/breast cancer
- lobules- lobular carcinoma
- ducts- ductal carcinom
81
describe lobular carcinoma
- lobular carcinoma in situ
- invasive lobular carcinoma
82
describe ductal carcinoma
- ductal carcinoma- in situ
- invasive ductal carcinoma
83
what is the pathogenesis of breast cancer
- genetic changes
- hormonal influences
- environmental variables
84
what are the well established risk factors for breast cancer
- age: uncommon less than 30 years old
- genetic and family history
- menstrual history- early periods less than 12 years old or late menopasue greater than 55 years old
- length of reproductive life
- nulliparous- having children in protective
- geographic variation
85
what genes are associated with breast cancer
- p53
- BRCA 1/2 genes
86
what are other risk factors of breast cancer
- exogenous estrogens- postmenopausal hormone replacement therapy
- oral contraceptives- newer formulations of balanced,low doses of estrogen and progesterone are safe
- ionizing radiation during breast development
87
what are less established risk factors associted with breast cancer
- alcohol consumption
- high fat diet
- obesity
- cigarette smoking
88
what are the genetic changes associated with breast cancer
- familial syndromes
- HER2/NEU proto oncogene
- amplification of RAS and MYC- proto-oncogenes
- mutations of Rb and p53 - tumor suppressors
- estrogen receptor positivity
-progesterone receptor positivity
89
what are the familial syndromes associated in breast cancer
- Li- Fraumeni syndrome- p53
- cowden syndrome- PTEN
- ataxia- telangiectasia- DNA repair genes
- BRCA1/2
90
describe the associated of HER2/NEU with breast cancer and how is it treated
- epidermal growth factor receptor
- amplified in 30% of breast cancers
- overexpression associated with poor prognosis
- therapeutic intervention- herceptin
91
what therapeutic intervention is used with estrogen receptor positivity
tamoxifen
92
what is increased exposure to estrogen caused by
-long duration of reproductive life
- nulliparity- having children in protective
- late age at birth of first child
93
how does obesity affect breast cancer risk
- adipose tissue produces small amounts of estrogen
- after menopauseobesity increases breast cancer risk by increasing level of estrogen
- the more fat the higher the estrogen level
- premenopausal obesity does not increase breast cancer risk
94
what is the affect of age on breast cancer risk
- there is a change in the structure of breast lobule at pregnancy with first child
- late age at birth of first child increases breast cancer risk
- with late age of birth of first child, type 1 and type 2 breast lobules persist longer and are more sensitive to carcinogens
- during 3rd trimester lobules mature into type 3 lobules
- type 4 lobules are formed after childbirth and produce milk
- type 3 and type 4 are resistant to carcinogens
95
what are the locations and prevalcne of breast cancer
- upper outer quadrant- 50%
- central portion - 20%
- lower outer quadrant- 10%
- upper inner quadrant - 10%
- lower inner quadrant - 10 %
96
what are the classifications of breast cancers
- non invasive
- invasive
97
describe noninvasive breast cancers
- have not penetrated the basement membrane
- ductal carcinoma in situ (DCIS, intraductal carcinoma)
- lobular carcinoma in situ (LCIS)
98
describe invasive breast carcinoma
- have penetrated the basement membrane (infiltrating)
- invasive ductal carcinoma- most common- scirrhous carcinoma
- invasive lobular carcinoma
99
describe ductal carcinoma in situ
- precursor lesion to invasive carcinoma
- when invasive carcinoma develops in a woman with a previuous diagnosis of DCIS usually in same breast
- good long term prognosis
100
what are the treatments for ductal carcinoma in situ
- surgery and radiation
- tamoxifen- antiestrogenic if estrogen receptor- blocks estrogen receptor
- aromatase inhibitors- post menopausal women - blocks estrogen formation
101
describe paget's disease of the nipple
- clinical variant of DCIS
- extension of DCIS up to the lactiferous ducts and into the contiugous skin of the nipple
- crustating exudate over the nipple and areolar skin
- underlying invasive carcinoma in 50%
102
describe lobular carcinoma in situ
- one third of women with LCIS develop invasive carcinoma
- the invasive carcinoma may arise in either breast
- LCIS is a marker of increased ridk for developing breast cancer in either breast
- bilateral prophylactic mastectomy may be performed
103
describe invasive ductal carcinomas
- most breast carcinomas (70-80%)
- term used for all carcinomas that cannot be sub- classified into a specific type
- does not imply that the tumor specificity arises from the duct system
- carcinoma of no special type or not otherwise specified are synonyms for invasive ductal carcinoma
104
what are the clinical features common to invasive carcinomas
- fixation secondary to adherence to pectoral muscles or deep fascia of chest wall
- adherence to overlying skin with retraction or dimpling of the skin or nipple
- lymphatic involvement may cause localized lymphedema with the skin thickened around exaggerated hair follicles- peau d'orange
105
what is the TNM staging of breast cancer
- stage 1: tumor less than 2cm, without nodal involvement, no metastases
- stage 2: tumor <5cm with <3 nodes and no distant metastases
- stage 3: many categories any cancer infiltration into skin and chest wall, with nodes, without disseminated metastases
- stage 4: any cancer with disseminated metastates
106
what are prognostic factors for breast cancer
- size of primary carcinoma
- lymph node involvement and number of nodes
- distant metastases
- histologic grade
- histologic type
- estrogen or progesterone receptor expression - tamoxifen
- proliferative rate
- aneuploidy
- HER2/NEU overexpression- herceptin
107
what are the five year survival rates by stage of breast cancer
- DCIS or LCIS- 92%
- stage 1: 87%
- stage 2: 75%
- stage 3: 46%
- stage 4: 13%
- for all stages combine 10 year surivial is 50%
