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CRRAB II- Week 2 > Tworney- Bladder Disease > Flashcards

Tworney- Bladder Disease Flashcards

1
Q

What are diverticular?

A

d/t bladder outlet obstruction (stasis, infection, calculi)

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2
Q

What is a patent urachus/urachal cyst?

A

persistent allantoic duct located in the dome of the bladder if the allantoic duct doesn’t close

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3
Q

What does vesicoureteral reflux cause?

A

pyelonephritis

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4
Q

What is exstrophy?

A

failure of closure of anterior abdominal wall–ureters drain into air, malformed genitals

chronic infections, adenocarcinoma

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5
Q

What causes trabeculated muscular hypertrophy 99% of the time?

A

BPH

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6
Q

What conditions predispose to bladder inflammation/infx?

A 
extrophy
urethral obstruction
fistula- GI or uterus
catheter
cystocele- prolapse from pregnancy
calculi
neoplasm
trauma
diabetes
pyelonephritis
pregnancy
neurogenic (never empty fully)
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7
Q

What is a cystocele?

A

Prolapsed bladder

MCC= pregnancy, also age

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8
Q

What is the triad for cystitis?

A

frequency
pain
dysuria

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9
Q

What are systemic signs of cystitis?

A

fever
chills
malaise
mentation changes (elderly)

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10
Q

What are the MCC of fistula from rectum into bladder?

A

Chron’s disease–> deep ulcerations in colon> extend through wall of colon> into bladder

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11
Q

What are infectious causes of cystitis?

A

Bacterial- e. coli, proteus, enterococcus

fungal- candida, cryptococcus, immunosuppressed, chronic abx use

Younger/sexually active: chlamydia, mycoplasma

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12
Q

What are non infectious causes of cystitis?

A 
radiation
chemo agents (cyclophosphamide)
interstitial cystitis (hunner ulcer)
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13
Q

What is seen histologically w/ acute cystitis?

A

PMN’s hyperemia
suppurative exudate

NEUTROPHILS and pus

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14
Q

What is seen histologically w/ chronic cystitis

A

Lymphocytes

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15
Q

What causes hemorrhagic cystitis?

A

radiation/chemo

adenovirus

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16
Q

What causes interstitial cystitis? What is it?

A

Autoimmune? May be associated w/ SLE

F>M

Persistent and painful
full thickness inflammation and fibrosis
culture negative

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17
Q

What is malacoplakia?

A

see soft raised yellow plaques in surface of mucosa

histologically see lymphocytes, foamy macrophages

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18
Q

What goes with malacoplakia?

A

michaelis gutman bodies

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19
Q

What causes malacoplakia?

A

e coli
proteus

Kidney, prostate, lungs, colon

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20
Q

What makes up the majority of bladder cancers in the US?

A

*Transitional cell carcinoma

Sq cell
adeno
sarcoma

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21
Q

What is the incidence of TCC?

A

90% w/ incidence rising

4-10% of all cancers

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22
Q

What is the typical demo fro bladder cancer?

A

50-80
M:F 3:1
Urban> rural

*smoking

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23
Q

How is TCC a “field effect” cancer?

A

You’ll usually see multiple cancers in multiple locations. Anywhere there is urothelium–you predispose entire lining to cancer.

**bladder cancer pts often have more than one tumor

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24
Q

What is the most common TCC?

A

Villous tumor

25
Q

What are the most serious TCC?

A

Sessile infiltrating carcinoma–> progress to metasteses

26
Q

What is urine cytology a good screening test for?

A

High grade tumors

27
Q

What architecture do you normally see w/ bladder cancer?

A

Papillary projections

28
Q

What is the primary cause of bladder cancer?

A

tobacco use (50-80% of all cancers)

29
Q

What are other causes of bladder cancer?

A

Aromatic amines/azo dye (aniline dye)–> no longer used

Chronic schistosomiasis- S. haemotobium

Long term analgesic use–> no longer used

Long term cytoxan exposure (breast cancer and AI diseases)

saccharin–sweetener that in high doses causes bladder cancer

30
Q

What are the clinical fxs of bladder cancer?

A

gross hematuria–large amts of blood in urine

frequency/dysuria

31
Q

Unexplained gross hematuria in patient greater than 40 is assumed to be what until proven otherwise?

A

Bladder cancer

32
Q

If you have a UA that shows blood on the dibstick and micro-casts, rbc?

A

glomerular bleeding (KIDNEY)

33
Q

What if you see blood on the dipstick but no casts micro?

A

RBC cytoplasm substance but no intact red cells is a sign of HEMOLYSIS

34
Q

What happens if you see dipstick blood and RBCs?

A

Could be cancer, sign of something below the kidney. Then to a cystoourethroscopy to find out what’s going on.

35
Q

What is urine cytology best for?

A

high grade 90% sensitivity

36
Q

How do you evaluate upper tracts?

A

IVP or helical CT

37
Q

How do you determine prognosis w/ bladder cancer?

A

By stage

38
Q

What stage has a long term survival?

A

Ta (limited to muscoa)

39
Q

Why are TIS more serious?

A

higher grade and more likely to form invasive mass

40
Q

When does a tumor get a T2 grade?

A

invades muscle layer

41
Q

When does a tumor get a T3 grade?

A

invades perivesical fat

42
Q

When does a tumor get a T4 grade?

A

adjacent strctures

43
Q

When does a tumor get a M1 grade?

A

distan metatstases

44
Q

When does a tumor get a N1-3 grade?

A

dependent on size

3 is >5 cm

45
Q

What does pt age tell you with bladder cancer?

A

low grade in young pts but are at risk longer

46
Q

How does tumor cell DNA content relate to prognosis of bladder cancer?

A

polyploid/aneuploid content is an adverse factor

aneuploidy correlates w/ higher grade/higher stage

47
Q

What is common tx for low stage?

A

TURBT
fulguration
Intravesicular BCG–weekly for 6 wks

48
Q

What is tx for high stage T2/T3?

A

cystectomy w/ node dissection

little benefit form post-surgical chemoa

49
Q

What is treatment for T2, T3 or metastatic?

A
  1. Chemo

2. Radiation (not a strong role)

50
Q

Should you screen for bladder cancer?

A

no

51
Q

What is surveillance like for bladder cancer?

A

Recommend urine cytology and cystoscopy 3 months after TURBT with or without BCG

Periodic screening thereafter 3-6 month intervals

52
Q

Where do you see sq cell carcinoma?

A

east coast of africa

schistosoma–org comes out of snail, penetrates skin, gets in venous circulation and sets up in portal circulation, where the parasites deposit egss in wall of bladder

53
Q

What are the two types of urethral infections?

A

gonococcal

nongonococcal

54
Q

What causes gonococcal? What are the sxs?

A

Neisseria gonorrhea

One of earliest manifestations

Pain, itch, frequency

need to get to right away–can be destructive

55
Q

What causes non-gonococcal? sxs?

A

E. coli + other enterics
Chlamydia M>F

Pain, itch, frequency

56
Q

What is a benign caruncle?

A

Females
Red painful mass
1-2cm
At urethral meatus

57
Q

What are benign papillomas?

A

At meatus

HPV related

58
Q

What causes malignant urethral neoplasms?

A

sq cell carcinioma

in elderly women

CRRAB II- Week 2 (9 decks)

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