Tworney- Bladder Disease Flashcards
What are diverticular?
d/t bladder outlet obstruction (stasis, infection, calculi)
What is a patent urachus/urachal cyst?
persistent allantoic duct located in the dome of the bladder if the allantoic duct doesn’t close
What does vesicoureteral reflux cause?
pyelonephritis
What is exstrophy?
failure of closure of anterior abdominal wall–ureters drain into air, malformed genitals
chronic infections, adenocarcinoma
What causes trabeculated muscular hypertrophy 99% of the time?
BPH
What conditions predispose to bladder inflammation/infx?
extrophy urethral obstruction fistula- GI or uterus catheter cystocele- prolapse from pregnancy calculi neoplasm trauma diabetes pyelonephritis pregnancy neurogenic (never empty fully)
What is a cystocele?
Prolapsed bladder
MCC= pregnancy, also age
What is the triad for cystitis?
frequency
pain
dysuria
What are systemic signs of cystitis?
fever
chills
malaise
mentation changes (elderly)
What are the MCC of fistula from rectum into bladder?
Chron’s disease–> deep ulcerations in colon> extend through wall of colon> into bladder
What are infectious causes of cystitis?
Bacterial- e. coli, proteus, enterococcus
fungal- candida, cryptococcus, immunosuppressed, chronic abx use
Younger/sexually active: chlamydia, mycoplasma
What are non infectious causes of cystitis?
radiation chemo agents (cyclophosphamide) interstitial cystitis (hunner ulcer)
What is seen histologically w/ acute cystitis?
PMN’s hyperemia
suppurative exudate
NEUTROPHILS and pus
What is seen histologically w/ chronic cystitis
Lymphocytes
What causes hemorrhagic cystitis?
radiation/chemo
adenovirus
What causes interstitial cystitis? What is it?
Autoimmune? May be associated w/ SLE
F>M
Persistent and painful
full thickness inflammation and fibrosis
culture negative
What is malacoplakia?
see soft raised yellow plaques in surface of mucosa
histologically see lymphocytes, foamy macrophages
What goes with malacoplakia?
michaelis gutman bodies
What causes malacoplakia?
e coli
proteus
Kidney, prostate, lungs, colon
What makes up the majority of bladder cancers in the US?
*Transitional cell carcinoma
Sq cell
adeno
sarcoma
What is the incidence of TCC?
90% w/ incidence rising
4-10% of all cancers
What is the typical demo fro bladder cancer?
50-80
M:F 3:1
Urban> rural
*smoking
How is TCC a “field effect” cancer?
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
What is the most common TCC?
Villous tumor
What are the most serious TCC?
Sessile infiltrating carcinoma–> progress to metasteses
What is urine cytology a good screening test for?
High grade tumors
What architecture do you normally see w/ bladder cancer?
Papillary projections
What is the primary cause of bladder cancer?
tobacco use (50-80% of all cancers)
What are other causes of bladder cancer?
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
What are the clinical fxs of bladder cancer?
gross hematuria–large amts of blood in urine
frequency/dysuria
Unexplained gross hematuria in patient greater than 40 is assumed to be what until proven otherwise?
Bladder cancer
If you have a UA that shows blood on the dibstick and micro-casts, rbc?
glomerular bleeding (KIDNEY)
What if you see blood on the dipstick but no casts micro?
RBC cytoplasm substance but no intact red cells is a sign of HEMOLYSIS
What happens if you see dipstick blood and RBCs?
Could be cancer, sign of something below the kidney. Then to a cystoourethroscopy to find out what’s going on.
What is urine cytology best for?
high grade 90% sensitivity
How do you evaluate upper tracts?
IVP or helical CT
How do you determine prognosis w/ bladder cancer?
By stage
What stage has a long term survival?
Ta (limited to muscoa)
Why are TIS more serious?
higher grade and more likely to form invasive mass
When does a tumor get a T2 grade?
invades muscle layer
When does a tumor get a T3 grade?
invades perivesical fat
When does a tumor get a T4 grade?
adjacent strctures
When does a tumor get a M1 grade?
distan metatstases
When does a tumor get a N1-3 grade?
dependent on size
3 is >5 cm
What does pt age tell you with bladder cancer?
low grade in young pts but are at risk longer
How does tumor cell DNA content relate to prognosis of bladder cancer?
polyploid/aneuploid content is an adverse factor
aneuploidy correlates w/ higher grade/higher stage
What is common tx for low stage?
TURBT
fulguration
Intravesicular BCG–weekly for 6 wks
What is tx for high stage T2/T3?
cystectomy w/ node dissection
little benefit form post-surgical chemoa
What is treatment for T2, T3 or metastatic?
- Chemo
2. Radiation (not a strong role)
Should you screen for bladder cancer?
no
What is surveillance like for bladder cancer?
Recommend urine cytology and cystoscopy 3 months after TURBT with or without BCG
Periodic screening thereafter 3-6 month intervals
Where do you see sq cell carcinoma?
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
What are the two types of urethral infections?
gonococcal
nongonococcal
What causes gonococcal? What are the sxs?
Neisseria gonorrhea
One of earliest manifestations
Pain, itch, frequency
need to get to right away–can be destructive
What causes non-gonococcal? sxs?
E. coli + other enterics
Chlamydia M>F
Pain, itch, frequency
What is a benign caruncle?
Females
Red painful mass
1-2cm
At urethral meatus
What are benign papillomas?
At meatus
HPV related
What causes malignant urethral neoplasms?
sq cell carcinioma
in elderly women
