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DT3-Exam 3 > Urinary Tract/ Bladder Disease-- Melissa* > Flashcards

Urinary Tract/ Bladder Disease-- Melissa* Flashcards

1
Q

What type of tissue lines the lower URT (ureters, bladder, urethra)?

A

urothelial epithelium (Transitional epithelium)

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2
Q

List three sites of normal anatomical ureter narrowing:

A
  1. Ureteropelvic junction (infant obstruction common)
  2. Crossing at external/common iliac aa.
  3. Ureter/bladder junction (enter in oblique fashion)
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3
Q

Common finding associated with double ureter:

A

-Associated with duplication of renal pelvis

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4
Q

Population that gets urteopelvic junction obstruction?
Which side is this normally on?
What can it cause?

A
  • # 1 Male children

- Lt&raquo_space;> Rt–>Hydronephrosis

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5
Q

What is a ureteral diverticulum?

A

Saccular outpouching of ureteral wall

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6
Q

Describe what is seen with acute ureter inflammation. How does this occur?

A

UTI

Neutrophillic infiltrate; acute inflammatory changes

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7
Q

What are the 4 types of chronic ureter inflammation?

A 
Uretritis  Cystica
Uretritis Folliculitis
Uretritis Glandularis
Intestinal Metaplasia 
**All will have lymphs, fibrosis, and typical chronic inflammatory changes**
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8
Q

Uretritis Cystica:

Definition and defying histo feature?

A
  • Cysts deep in mucosa

- BRUNN NESTS (mucosal invaginations ) with small central clearing (1-5mm cysts)

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9
Q

Uretritis Folliculitis:

Definition and histo features?

A

-Bumps on ureter surface full of lymph tissue

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10
Q

Uretritis Glandularis:

What happens here?

A

-Ureteral tissue replaces with glandular tissue

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11
Q

Intestinal Metaplasia:

What happens here?

A

-Uroepithelium–> goblet cells

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12
Q

Two Benign tumors of the bladder?

A

Leiomyoma and polyps

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13
Q 
What do we call malignancy of the bladder? 
#1 risk? With what genetic disorder might these tumors be associated?
A

Uroepithelial Ca.

  • # 1 risk = SMOKING (also occupational exposure, analgesic nephropathy)
  • Asstd with Hereditary Nonpolyposis colorectal cancer
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14
Q

Genetic mutation associated with HNPCC

A

HNPCC DNA mismatch repair gene mutation

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15
Q

Two general types of ureter obstructive lesions:

A

Can be intrinsic—calculi, strictures, tumor etc. or extrinsic—preggos, inflammation, endometriosis, etc

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16
Q

Two obstructive diseases of the ureter:

A
  • Sclerosing Retroperitoneal Fibrosis

- Hydronephrosis (secondary to ureteropelvic junction obstruction)

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17
Q

Sclerosing Retroperitoneal Fibrosis:
Population + #1 cause?
By what is this disease mediated?
How is it treated?

A
  • Generally idiopathic syndrome of middle to late age
  • IgG4 mediated ureter fusion to retroperitoneum
  • requires surgical correction
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18
Q

Three potential causes of sclerosing retroperitoneal fibrosis?

Three potential comorbidities with sclerosing retroperitoneal fibrosis?

A
  • Potential causes: ergot derivatives, inflammatory syndromes (Chrons), malignancy (lymphoma)
  • Possible comorbidities: mediastinal fibrosis, Sclerosing cholangitis, Riedel Fibrosing thyroiditis
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19
Q

Sclerosing Retroperitoneal Fibrosis:

Histo features

A

-Micro: Chronic inflammatory changes; EOS; +/-fat necrosis; +/-granulomas

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20
Q

Hydronephrosis:

What is it, who gets it, and where does it most commonly occur?

A
  • Common complication secondary to uretopelvic junction obstruction in males
  • Typically on left side (20% bilateral)
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21
Q

What is a bladder diverticula? Why is it dangerous?

A
  • Congenital&raquo_space;> Acquired invagination of bladder wall

- Possible site for tumorigenesis

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22
Q

Exstrophy of the bladder: what is it?

A
  • Developmental failure of anterior abdominal and bladder wall
  • Bladder extrudes lower abdominal wall
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23
Q

Vesicoureteral Reflux causes…

A

Causes chronic UTI

24
Q

What is a Urachal remnant**?
What did the structure do developmentally?
Why is it important?

A
  • Urachus/Urachal remnant at dome of bladder (structure connected fetal bladder w/ allantois in utero)
  • May be mistaken for tumor/ provide site for tumorigenesis
25
Q

Micro histology of uracheal remnant:

A

Glandular & uroepithelial tissue (should be just uroepithelial!)

26
Q

Clinical triad associated with cystitis:

A

Clinical Triad:

  1. ^ Frequency urination (~15min)
  2. Suprapubic Pain
  3. Dysuria (pain and burning with urination)
27
Q

Hemorrhagic Cystitis: three things associated?

A

Associated with radiation, chemo, and viral infection

28
Q

What is the most common cause of bacterial cystitis?

What are some fungi, parasites, and viruses that can also cause cystitis?

A

Bacterial–>#1: E.coli (Also: Proteus, Klebsiella, Enterobacter, mycoplasma, chlamydia); RARELY TB
Fungal–> Candida albicans
Schistosomiasis–>Middle east; SE Africa
Viral–> Adenovirus

29
Q

Schistosomiasis related cystitis is common in which groups of people?

A

Middle east; SE Africa

30
Q

Follicular Cystitis is…

A

Inflammation of lymphoid follicles in the bladder

31
Q

Eosinophilic Cystitis is…

A

Allergic reaction; non specific (EOS = red, bi-lobar!)

32
Q

Interstitial Cystitis***

  • What is it and how is it mediated
  • Describe gross changes to bladder wall
  • Describe progression
A
  • Painful persistent chronic cystitis likely immune mediated
  • Fibrosis of ALL bladder wall layers

Progression:
Submucosal Hemorrhaging –>Classic chronic mucosal ulcers (Hunner’s Ulcers)

33
Q

Malacoplakia: What are the most common causes? Describe progression of the disease:

A 
#1: E.coli + Proteus  
Immunocomp. w/ defective phagocytosis--> chronic infection --> (3-4cm) raised mucosal plaque
s
34
Q

Histo features of Malacoplakia

A

Chronic inflammatory cells; large foamy macs
Michaelis-Gutmann bodies (Laminated mineralized concretions– ^^ Ca)

(M)acs and (M)ineralized (M)ichaelis bodies in (M)alackoplakia

35
Q

4 types of metaplasia of the bladder:

A
  • Brunn Cysts; Cystitis Cystica
  • Cystitis Glandular
  • Squamous Metaplasia
  • Nephrogenic Metaplasia/ Adenoma
36
Q

What are Brunn Cysts of the bladder?

A

Urothelium invaginates into lamina propria

37
Q

What is cystitis cystic of the bladder?

A

Cyst lined with urothelium (has central clearing)

*Basically brun cysts with CENTRAL CLEARING

38
Q

What is cystitis glandularis of the bladder?

What do the cysts contain (3)

A

Stems from GLAND–> Contains cuboidal, columnar, goblet cell epi

39
Q

Nephrogenic Metaplasia/ Adenoma*** of the bladder: what is this and how does it look on histo?

A
  • Remember this is a BENIGN response to injury

- Histo:tubular cells of kidney replace uroepi tissue.

40
Q

Two benign tumors of the bladder?

A

Papilloma; PUNLMP (borderline lesion)

41
Q

Who gets papillomas of the bladder?
How big are they?
That are the two types?

A
  • Younger patients; ~1cm

- Two Types: Inverted (located in lamina propia) or Exophytic

42
Q

PUNLMP (Papillary Urothelial Neoplasms of low malignant potential):
What are these? How do they differ from papilloma? Describe the histo feature>

A
  • BOARDERLINE LESION
  • Thicker urothelium
  • HISTO: Nuclear enlargement; rarely have mitosis
43
Q

Low grade uroepithelial ca of the bladder: Histo

A
  • Orderly tumor

- Micro: some polarity evident, minimal atypia/ mitoses

44
Q

High grade uroepithelial ca of the bladder: Histo

A
  • DISORDERLY tumor

- Disarray, NO POLARITY, ^ ANAPLASIA,^Mitosis

45
Q

Squamous Cell Ca of the bladder: What organism can cause this? Describe the histo.

A

-SCHISTOSOMA; will see several eggs in Urothelium
-Micro: Keratin (pink); intercellular bridging
(common to ALL squamous cell tumors)

46
Q

Small cell ca of the bladder: 3 stains and histo description:

A
  • Stain: CD56/57 +; Synaptophysin+; Chromogranin +

- Micro: Small blue cells like in lung!

47
Q

Botyroid Rhabdomyosarcoma:

Who gets this? Describe the macro and micro histo:

A
  • Infancy/Childhood tumor of smooth muscle origin
  • Macro: Looks like grapes!
  • Micro: Dark staining CAMBIUM layer; deeper hypocellular/myxiod stroma
48
Q

Leiomyosarcoma of the bladder: describe the histo

A

fascicles of malignant spindle cells; mitoses and atypica evicent

49
Q

Describe the T1-T4 staging of malignant bladder tumors:

A

T1: Lamina P.
T2: Muscularis P. (surgery candidates)
T3: Perivisceral Fat
T4: Adjacent structures

50
Q

Describe the early and late changes associated with chronic bladder obstruction:

A

BPH/Neurogenic bladder/Etc.–>
Early thickening of muscular bladder wall–>
Later muscle hypertrophy and trabeculation

51
Q

What is the most common organism causing urethritis?
What are three other bacteria that can cause this?
Which what syndrome might this be associated?

A
  • Typically Gonococcal
  • Possibly E.coli, Chlamydia, Mycoplasma
  • May be associated with REITER’s SYNDROME (HLA B27)
52
Q

Which genetic polymorphism is associated with reiter’s syndrome?
What is the clinical triad of this disease?

A

REITER’s SYNDROME (HLA B27):
Arthritis, conjunctivitis, urethritis
Cant see cant pee cant climb a tree

53
Q

What is a urethral carbuncle? Describe the histology:

A
  • BENIGN Small, red painful granulation tissue (inflammatory) tumor on urethral meatus of elderly females
  • Micro: Vascular, fibroblasts, leukocytes
  • cut it off.
54
Q

What is a urethral papilloma

A

-Benign mucosal proliferations

55
Q

Where are urethral condylomas located?

A

-More common in distal urethra

56
Q

How common are urethral malicnangies? Describe the tissue of origin for urethral malignancies based on where they arise:

A

Rare!!!
Proximal–> Urothelial origin
Distal–> Squamous cell origin

DT3-Exam 3 (9 decks)

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