renal, penis, balls, female reproductive Flashcards
kidney functions
Structure: filter %
Excretes what waste?
Regulates?
Maintains what balance?
Endocrine?
Structurally complex - 0.4% of body weight, but filters 25% of blood through glomeruli
Excretes nitrogenous waste products of metabolism - cleans the blood – turns 1.5 L into urine
Regulates body water and electrolytes
Maintains appropriate acid-base balance
Endocrine organ – secretes hormones
Renin – blood pressure
Erythropoietin – proliferative effect on bone marrow to make RBCs
components of the nephron
Glomeruli
Convoluted tubules
Collecting ducts
JGA controls? how/components?
BP
Juxtaglomerular cells in wall of afferent arteriole: Sensor for blood pressure
Macula densa in wall of distal convoluted tubule: Sensor for sodium
Azotemia – Laboratory Findings
Elevation of blood urea nitrogen and creatinine levels
azotemia usually related to what?
Usually related to reduced glomerular filtration rate (GFR)
azotemia can be associated with what disorders?
Associated with many primary renal disorders or May also be associated with extra-renal disorders
pre and post renal azotemia
Pre-renal azotemia – hypoperfusion of the kidneys decreases GFR in the absence of parenchymal damage
Post-renal azotemia – urine flow obstructed below the level of the kidney
both lead to azometia
Uremia – Clinical Findings
Progression of azotemia to produce clinical manifestations and systemic
biochemical abnormalities
causes of uremia
failure of excretion or metabolic/endocrine alterations
gastric? nn? pericadium? skin?
uremia secondary involvment of organ systems
Uremic gastroenteritis
Peripheral neuropathy
Uremic fibrinous pericarditis
Uremic stomatitis
possible clinical manifestations of renal dx
nephritic
nephrotic
acute failure
chronic failure
UTI
nephrolithsatsis
UT obstructiuon
renal tumors
signs?
nephrotic syndrome
Glomerular syndrome
A non-specific disorder in which the kidneys are damaged, causing them to leak large amounts of protein from the blood into the urine.
Heavy proteinuria
Hypoalbuminemia
Severe edema
Hyperlipidemia
Lipiduria
nephritic syndrome
onset?
signs?
Glomerular syndrome
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.
Acute onset
Grossly-visible hematuria
Mild-to-moderate proteinuria
Azotemia
Edema
Hypertension
Glomerulonephritis
tx?
an immune mediated disease of the renal glomeruli
Treated with steroids
Pyelonephritis
Treated with?
an infection of the kidney (not the glomerulus) usually caused by bacteria and of retrograde origin
Treated with antibiotics
Post-Streptococcal Glomerulonephritis
(Postinfectious Glomerulonephtitis)
onset?
Type of immune injury
Acute onset of nephritic syndrome in 9-14 days following
Streptococcal infection
Type III immune injury (Immune complex-mediated inflammation)
Pyelonephritis paths of infection
Hematogenous dissemination – least common
Ascending infection – most common
Fecal bacteria from perineal area
tx?
how to test for polynephritis
Culture and sensitivity – Bactrim tx
Pyelonephritis is much ______ common than glomerulonephritis
Pyelonephritis is much more common than glomerulonephritis
Kidney Stones (Nephrolithiasis)
Urolithiasis
common? may cause?
Common
May cause obstruction
signs of nephrolithstasis
tx?
Pain
Hematuria
Pyuria (pus in urine)
Lithotripsy= sound waves to break up stones
those with kdney stones are prone to?
ascending infections
nephrolithstasis may be associated with?
May be associated with hypercalcemia (for example,
hyperparathyroidism, metastatic skeletal disease, multiple myeloma
tx of kidney stones
Extracorporeal Shock
Wave Lithotripsy (ESWL)= break up to smaller pieces
Staghorn Calculus
large calculus deposit in the kidney
forms of nephrosclerosis
benign and malignant, both often due to hyperBP
malignant nephrosclerosis
CM junction is obstrucuted
simple renal cyst
common, benign
can be single or many
genetic dx of polycystic kidneys
Autosomal Dominant
Polycystic Renal Disease
where are the dialysis tubes
dialysis vessel complication
Dialysis Shunt - Arterio-Venous Fistula possible
both tubes in the vv
what changes can occur at kidneys due to dialysis
cystic changes
what can result from cystic chnages of the kidneys with dialysis
renal cell carcinoma
how can. this be done potentially
End Stage Renal Disease long term tx
End Stage Renal Disease - Transplant
can simply add adiitonal kidney-do not remove other two
what is a comoplication of trnasplant for renal failure
rejection, tx with immunosupressants
Renal Cell Carcinoma
Arises from?
Often present how?
May grow into?
Arises from renal tubular epithelium
Often silent, non-specific S/S
May grow into renal vein
infarcts and renal cell Ca
can lead to infarct such as adrenal gland
is metastisis common at kidney
no, but possible
Wilm’s Tumor
(Nephroblastoma)
demo
presentation
sign
survival rate?
Children under 5 years
Abdominal mass
Chronic low-grade fever
high survival rate (95%)
Wilm’s Tumor
(Nephroblastoma) histo
Histopathology consists of several cell
types, some of which resemble abortive
glomeruli and others that resemble skeletal muscle
Urothelial Carcinoma
Arises from?
most common site?
sign?
Arises from the urinary tract lining epithelium (transitional epithelium)
Bladder most common site
Painless hematuria
urothelial carcinoma risk factors
Cigarette smoking, industrial solvents
(beta-naphthlylamine), chronic cystitis,
schistosomiasis, drugs (cyclophosphamide)
Urothelial Carcinoma Clinical significance depends on:
histologic grade, differentiation and depth of invasion
where else can urothelial Ca occur?
Renal Calyces
kidney
Prostate – Three Major Diseases
Prostatitis
Benign prostatic hyperplasia
Adenocarcinoma of prostate
Prostate-Specific Antigen - PSA
WNL ?
Increased levels may suggest?
Elevated in?
Velocity of change?
Protein present in the serum at low levels (nl: < 4 ng/mL)
Increased levels may suggest the presence of prostate cancer
Elevated in prostatitis
Velocity of change significant
PSA physio functions
Liquefy semen, allowing sperm to swim freely
Dissolution of cervical mucous cap
Prostatitis
tx?
Acute bacterial disease treated with antibiotics
Nodular (Benign)
Prostatic Hyperplasia - BPH can lead to?
Obstruction to flow
Urinary frequency
Ascending infections
with BPH what should be ruled out
neoplasia
tx BPH
Pharmacologic treatment
Surgical treatment (TURP)
Adenocarcinoma of Prostate common?
70% of men develop prostate cancer by 70-80 years of age
clnical behavior?
diagnosis of prostate adeno-Ca
Digital rectal prostate examination
Biopsy – multiple cores
Wide variation in clinical behavior
grading of prostate cancer scale name
Gleason grading
Metastatic Prostatic
Adenocarcinoma can go to?
the spine
what lesion can be seen on xray with metastic prostate adeno-Ca
Osteoblastic Lesion
Testes dx’s
Cryptorchidism
Seminoma
Infections
Cryptorchidism
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 (“undescended” testes)
Cryptorchidism can lead to
Infertility
Increased risk for neoplasia
Cryptorchidism tx
orchiopexy
Seminoma
common?
demo?
tx?
treatable and curable?
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
Infectious Parotitis
(Mumps) and testes
Complications rare in the young and more common in older individuals
Orchitis can occur
Hypospadias
Developmental defect of the urethra in the male
Abnormally placed urethral meatus
Urethral meatus opens on the glans penis most commonly (first degree hypospadias)
Peyronie’s Disease
fibrous cord in the penis causing curve
Phimosis
Foreskin cannot be fully retracted from the head of the penis
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
Hematologic diseases are predesposition: Sickle cell disease and Leukemia
Trauma
Erythroplasia of Querat
decreased thickness of tissue at head causing ulceration (immature keratinocytes)
can SCCa occur at penis
yes
Uterine Leiomyoma
B/M? tissue?
May cause?
Benign smooth muscle neoplasm= “Fibroids”
May cause irregular bleeding (metrorrhagia) or Painful intercourse (dyspareunia)
what can these cause?
Proliferative Lesions of the endometrium
Endometrial Hyperplasia and Polyps
Glandular epithelium
Bleeding
Two Major Diseases of the Endometrium
Endometriosis
Adenocarcinoma
Endometriosis
what/where?
influenced by?
sign?
Symptoms depend on? worsen with?
Endometrial tissue outside the uterine cavity
Ectopic endometrial tissue influenced by hormonal changes
Recurring pelvic pain
Symptoms depend on the site involved and worsen with
the menstrual cycle
endometriosis can cause what at ovaries
ovarian adhesions and choclate cysts
Risk Factors for
Endometrial Carcinoma
Age – most common in the 55 to 65 age group
Obesity – greater synthesis of estrogen in body fat
Infertility – women who are nulliparous are at increased risk of endometrial carcinoma
Cervical
Squamous Cell Carcinoma detection
Exfoliative cytologic screening for early detection
(Papanicolau smear)
where does cervical SCCa occur?
Squamo-columnar junction
HPV and cervical cancer
High risk HPV sub-types – 16, 18
can cervical cancer be prevented
yes HPV vax
Sequence of Events That
May Follow HPV Infection
premalignant lesion of cervical cancer
Cervical Intraepithelial Neoplasia -
Grades I, II, III
LSIL (low-grade squamous intraepithelial lesion)
HSIL (high-grade squamous intraepithelial lesion)
depends on level of epithelial invasion
Teratoma
contains?
Generally arise in?
Most commonly seen in?
app? – B/M? – may contain?
A tumor containing tissues from all three germ layers (Most tumors are derived from one cell layer)
Generally arise in gonadal tissues
Most commonly seen in the ovary
“Dermoid cyst” of the ovary – a benign cystic teratoma – may
contain a variety of tissues including hair, teeth, bone, cartillage,
thyroid, etc.
ectopic pregnancy
fertilized egg embeds in the tube
potetnial for rupture and massive internal bleeding, must be removed
pelvic inflam dx
usually inflammatory mass occrung in F tract that can obscure ovary/tubes
Gonorrhea and PID
microbe?
can lead to?
Neisseria gonorrhea
“Mother nature’s birth control”
causes Pelvic inflammatory disease
can lead to Tubal scarring and Ectopic pregnancy (infertility)
Neisseria Gonorrhea in males may cause?
Acute Epididymitis –
Neisseria Gonorrheae in females can form?
Tubo-Ovarian Abscess
Accessory Nipples
many forms
Breast components?
Glandular epithelium
Ducts
Lobules
Interstitial tissue
Lymphatics
Lymphatic Drainage of Breast
mainly to axillary LN
Physiologic Hyperplasia of Female Breast /
Breast Development
based on hormone levels, increased at puberty/preg and lactation
Fibrocystic Changes of the breast
often occur at breasts and do present as masses but are benign, most common finding at breasts
Gynecomastia
causes?
if bi/unilateral?
Enlargement of male breast may occur in response to estrogen
Hyperestrinism in male
Cirrhosis of liver – inability to metabolize estrogens
Klinefelter syndrome
Estrogen-secreting tumors
Estrogen therapy
Bilateral – rule-out hormonal
Unilateral – rule out tumor
Fibroadenoma
common? B/M?
present as?
demo?
Most common benign neoplasm of breast
Discrete, usually solitary, moveable nodule
Young women (third decade)
forms of malignant breast cancer
Lobules - lobular carcinoma
* Lobular carcinoma-in-situ
* Invasive lobular carcinoma
Ducts - ductal carcinoma
* Ductal carcinoma-in-situ
* Invasive ductal carcinoma
Pathogenesis of Breast Cancer
Genetic?
Hormonal?
Environmental?
Genetic changes
Hormonal influences
Environmental variables
Risk Factors in Breast Cancer
Well-established risk factors
Age?
Genetics/genes?
Menstrual history?
Length of?
Nulliparous?
Geographic?
Age – uncommon < 30 y
Genetics and family history - p53, BRCA1/2 genes
Menstrual history – early menarche (<12y), late menopause (>55y)
Length of reproductive life
Nulliparous – having children is protective
Geographic variation
other risk factors of breast cancer
Exogenous?
contrceptives?
Ionizing radiation?
Exogenous estrogens -postmenopausal hormone replacement therapy
Oral contraceptives – newer formulations of balanced, low doses of estrogen and progestin safe
Ionizing radiation during breast development
Less well-established risk factors of breast cancer
Alcohol consumption
High fat diet
Obesity
Cigarette smoking
what is mutated?
Familial syndromes and breast cancer
Li-Fraumeni Syndrome –germ-line mutations in p53
Cowden Syndrome –germ-line mutations in PTEN
Ataxia-telangiectasia gene – DNA repair genes
BRCA1/BRCA2 – germ-line
mutations
HER2/NEU proto-oncogene
normal function?
Amplified in?
Overexpression associated with?
Therapeutic intervention?
Epidermal growth factor
receptor
Amplified in 30% of breast
cancers
Overexpression associated with poor
prognosis
Therapeutic intervention –Herceptin (trastuzumab)
amplifications of what genes can lead to breast cancer
Amplification of RAS and MYC
(proto-oncogenes)
mutations to what genes can lead to breast cancer
Mutations of Rb and p53 (tumor suppressor genes)
Estrogen receptor positivity indicates what tx?
Therapeutic intervention -
Tamoxifen
Hormonal Changes – Risk Factors for breast cancer
Increased exposure to estrogen
Long duration of reproductive life (More estrogen)
Nulliparity – having children is protective
Late age at birth of first child
estrogen effect on breast tissue
Estrogen exposure has a proliferative effect on breast tissue.
Proliferative breast disease found on biopsy indicates an exposure
to increased levels of estrogen. An increased risk of breast cancer
is found in women who have proliferative breast disease
The more estrogen the breasts are exposed to over a lifetime, the ____ risk of cancer? when are these levels higher
The more estrogen the breasts are exposed to over a lifetime, the
higher the risk of breast cancer. During each monthly menstrual cycle, the breasts are exposed to increased estrogen levels, especially at the time of ovulation.
early age of menses and late menopause effect for breast cancer?
Both early age at the start of menstrual cycles (menarche) and
late menopause increase breast cancer risk through increased exposure to estrogen during more menstrual cycles.
Late age for menarche and early age for menopause and breast cancer risk?
ate age for menarche and early age for menopause decrease
breast cancer risk through fewer menstrual cycles.
Birth control pills and hormone replacement therapy _______
breast cancer risk
why?
Birth control pills and hormone replacement therapy increase
breast cancer risk through increased exposure to estrogen.
Removal of both ovaries before natural menopause ______
breast cancer risk
why?
Removal of both ovaries before natural menopause decreases breast cancer risk by decreasing levels of estrogen.
how can OH cause breast cancer?
Alcohol consumption. The more alcohol consumed, the more impaired the liver becomes in its ability to metabolize estrogen. Therefore, alcohol consumption increases breast cancer.
pre and post menopause
obesity and breast cancer
dipose tissue produces small amounts of estrogen. After menopause, obesity increases breast cancer risk by increasing the level of estrogen. The more fat, the higher the estrogen level. Premenopausal obesity does not increase breast cancer risk. Before menopause, obesity causes hormonal changes which decrease estrogen production by the ovaries and can even
result in infertility.
age at birth of first child and breast cancer
There is a change in structure of breast
lobule at pregnancy. Late age at birth of first child increases breast cancer risk. With late age at birth of first child, type 1 and type 2 breast lobules persist longer. They are more sensitive to carcinogens. Therefore, risk increases. During the 3rd trimester of pregnancy (after 32 weeks), the breast lobules mature into Type 3
lobules. Type 4 lobules are formed after childbirth and produce milk. Both Type 3 and Type 4 lobules are resistant to carcinogens.
main breast cancer location
upper outer quadrant
Classification of Breast
Cancers (Abridged)
Noninvasive – have not penetrated the basement membrane
Ductal carcinoma in situ (DCIS, intraductal carcinoma)
Lobular carcinoma in situ (LCIS)
Invasive – have penetrated the basement membrane (infiltrating)
Invasive ductal carcinoma – most common (scirrhous carcinoma)
Invasive lobular carcinoma
precursor to? if it progresses where will it form?
Ductal Carcinoma in Situ
Precursor lesion to invasive carcinoma
When invasive carcinoma develops in a woman with a previous diagnosis of DCIS, it is usually in the same breast.
if estrogen receptor +? post-menopause?
ductal Ca in situ tx
surgery and radiation
Tamoxifen – antiestrogenic if estrogen receptor + (blocks estrogen receptor)
Aromatase inhibitors – post-menopausal women (blocks estrogen formation)
Paget’s Disease of Nipple
variant of? how?
app?
Underlying invasive carcinoma?
Clinical variant of DCIS
Extension of DCIS up to the lactiferous ducts and into the contiguous skin of the nipple
Crusting exudate over the nipple and areolar skin
Underlying invasive carcinoma in 50%
Lobular Carcinoma in Situ
proportion developing invasive
carcinoma?
The invasive carcinoma may arise in?
LCIS is a marker of?
prophylactic mastectomy?
One-third of women with LCIS develop invasive carcinoma
The invasive carcinoma may arise in either breast
LCIS is a marker of increased risk for developing breast
cancer in either breast
Bilateral prophylactic mastectomy may be performed
Invasive Ductal Carcinoma
% breast carcinomas
Term used for? does not imply?
synonyms for invasive ductal carcinoma?
Invasive Ductal Carcinoma
Most breast carcinomas (70-80%)
Term used for all carcinomas that cannot be sub-classified into a specific type (not discussed)
Does not imply that the tumor specifically arises from the duct system
Carcinoma of “no special type” or “not otherwise specified” (NOS) are synonyms for invasive ductal carcinoma
Invasive Ductal Carcinoma
has what response?
IDC has a Scirrhous Response (hardening/induration, dense stroma)
invasive ductal Ca invades what tissue of the breast?
adipose
Clinical Features Common to
all Invasive Carcinomas
Fixation?
Adherence?
Lymphatic involvement may cause?
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 – orange
peel appearance)
TNM Staging of Breast Cancer
satges 1-4
stage 1 breast cancer
umor <2 cm, without nodal involvement, no
metastases
stage 2 breast cancer
tumor <5 cm with <3 nodes and no distant metastases (or more than 5 cm without nodes)
stage 3 breast cancer
many categories, any cancer infiltration into skin and chest wall, with nodes, without disseminated metastases
stage 4 breast cancer
any cancer with disseminated metastases
Prognostic Factors of breast cancer
Size of?
Lymph node?
Distant?
Histologic?
Estrogen or progesterone receptor? tx?
Proliferative?
Aneuploidy?
HER2/NEU? tx?
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
