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xB10W2 > URINARY TRACT PATHOLOGY > Flashcards

URINARY TRACT PATHOLOGY Flashcards

1
Q

whats the function of the urethra?

A

ejecting urine and semen

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2
Q

describe the 2 urethral sphincters

A

involuntary internal urethral sphincter made of smooth muscle
voluntary external urethral sphincter made of skeletal muscle

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3
Q

outline the difference in length of male and female urethras?

A

males - 15-20cm

women - 4cm

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4
Q

what are the 2 pathologies of the urethra?

A

urethritis and urethral stricture

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5
Q

what is urethritis?

A

inflammation of urethra

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6
Q

what are the symptoms of urethritis?

A

burning sensation whilst urinating
itching or burning near opening of penis/urethra
presence of blood in semen or urine
discharge from penis / abnormal discharge from the vagina
more frequent urge to urinate
discomfort when urinating

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7
Q

what are the 2 types of urethritis?

A

gonococcal and non-gonococcal

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8
Q

what is gonococcal urethritis?

A

sexually transmitted urethritis caused by gonorrhoea

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9
Q

what is non-gonococcal urethritis?

A

urethritis caused by pathogens other than gonorrhoea e.g. chlamydia

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10
Q

what is a urethral stricture?

A

scarring that narrows the urethra

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11
Q

what causes urethral strictures?

A

injury, urethritis, placement of catheters/instruments into urethra

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12
Q

whats the function of the prostate?

A

to produce fluid that nourishes and transports sperm. the fluid contains citric acid, zinc and enzymes include prostate specific antigen

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13
Q

what does prostate specific antigen do?

A

dissolution of the seminal fluid coagulum (making it more fluid) and plays an important role in fertility

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14
Q

where is the prostate located?

A

just below the bladder and in front of the rectum.

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15
Q

outline the lobes of the prostate?

A

anterior, median, right and left lateral, posterior

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16
Q

what are the 3 zones of the prostate?

A

central zone, peripheral zone and transitional zone

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17
Q

what enters the prostate in the transitional zone?

A

the urethra

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18
Q

what does the central zone surround in the prostate?

A

the ejaculatory ducts

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19
Q

what is the largest zone of the prostate?

A

the peripheral zone

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20
Q

which zone of the prostate enlarged during benign prostatic hyperplasia?

A

transitional zone

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21
Q

what zone of the prostate enlarges in prostate cancer?

A

the peripheral zone

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22
Q

what is benign prostatic hyperplasia?

A

enlargement of the prostate gland as a result of abnormal glandular cell proliferation under the influence of testosterone

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23
Q

what percentage of men over 80 have BPH?

A

90%

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24
Q

what are some complications of BPH?

A

LUTS, urinary retention, UTI, bladder stones and bladder fauilure

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25
Q

what are risk factors for prostate cancer?

A

> 65, afrocaribbean>white>asian, family history, obesity, hereditary breast and ovarian cancer syndrome,

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26
Q

what genes can account for some hereditary prostate cancer types?

A

BRCA1 BRCA2 and HOXB13

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27
Q

what types of prostate cancer are there and whats the most prevalent type

A

acinar adenocarcinoma and ductal adenocarcinoma - most prevalent types
transitional cell carcinoma
squamous cell carcinoma
small cell prostate cancer

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28
Q

how does prostatic cancer mostly spread?

A

through lymphatic system and bones

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29
Q

what is Gleason’s score?

A

a grading system for prostate cancer

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30
Q

outline gleasons pattern?

A

gleasons pattern 1 - most well-differentiated tumour pattern, smallest, closely packed glands
to gleasons pattern 5- poorly differentiated tumour pattern

31
Q

how is a gleason’s score calculated?

A

based on how cells look under a microscope, with the first half of the score based on the dominant cell morphology, and the second half based on the non-dominant cell pattern with the highest grade. These two numbers are then combined to produce a total score for the cancer. total score will be between 2 and 10

32
Q

when can PSA be abnormally high?

A

in UTI, prostatitis, BPH, prolonged bike rides, recent ejaculation

33
Q

what 3 things classify prostate cancer in a risk category?

A

TNM stage, PSA, gleason score

34
Q

what is the trigone of the bladder?

A

a triangular area on the posterior surface of the bladder that contains the ureteric openings and the bladder neck.

35
Q

whats the function of the bladder?

A

urine storage and secretion

36
Q

outline the histology of the bladder?

A

transitional epithelium, lamina propria, submucosa, detrusor muscle

37
Q

why is it important that the bladder is impermeable?

A

so that it can act as a storage unit

38
Q

how does the structure of the bladder prevent reflux?

A

The ureters normally enter the bladder at a diagonal angle and have a special one-way valve system that prevents urine from flowing back up the ureters in the direction of the kidneys.

39
Q

why is bladder cancer declining in prevalence?

A

due to better knowledge and reduction in risk factors such as smoking

40
Q

what type of bladder cancer is most common?

A

transitional cell carcinomas

41
Q

what is non-muscle invasive bladder cancer?

A

cancer found in the tissue that lines the inner surface of the bladder- does not affect the detrusor muscle

42
Q

is non-muscle or muscle invasive bladder cancer more prevalent?

A

non-muscle invasive - 75%

43
Q

what is the 5 year survival rate for non-invasive muscle cancer?

A

80%

44
Q

what is the 5 year survival rate for muscle invasive bladder cancer?

A

60%

45
Q

what stage is muscle invasive bladder cancer?

A

stage T2 and above

46
Q

what is muscle invasive bladder cancer?

A

cancer that spreads into the detrusor muscle of the bladder.

47
Q

whats the most common cause of UTIs?

A

E.coli

48
Q

what are the risk factors of UTIs?

A

increased age, being female, urinary tract abnormalities, blockages in the urinary tract, suppressed immune system, catheter use, recent urinary procedures

49
Q

how does the urinary tract defend against UTIs?

A

prevention of adherance by antegrade flow of urine rinsing pathogens away, glucoamines forming a protective layer on the luminal surface and Tamm-Horsfall protein
epithelial exfoliation as surface cells shed, releasing attached pathogens
innate and active antibody response

50
Q

what are Tamm-Horsfall proteins?

A

proteins secreted by the loop of henle that act as anti-adhesive substances by binding to fimbriae of bacteria

51
Q

how long is the ureter?

A

25cm

52
Q

what are the 3 sites of narrowing in the ureter?

A

uteropelvic junction
cross over of common iliac arteries
uterovesical junction
(these are sites where stones usually get stuck)

53
Q

what is uterovesicle junction?

A

urine flows retrogradely back up to the bladder, ureters and kidneys e.g. due to balve mechansms in pladder not working (primary) and blockage at the bladder outlet causing pressure to build up in ureters and overcoming normal valve reflux (secondary)

54
Q

whats the peak age of for urinary tract stones?

A

20-50

55
Q

what are some risk factors for urinary tract stones?

A

Diet, excess body weight, some medical conditions, and certain supplements and medications, crohns disease, PUJO, UTIs

56
Q

what do urinary tract stones consist of?

A

calcium oxalate

57
Q

how do urinary tract stones form?

A

supersaturation of urine or due to calcium/oxalate metabolism disorders

58
Q

whats the function of testicles?

A

making sperm and producing tostesterone

59
Q

why are testicles located outside the body?

A

to allow for cooler tempertures for sperm production

60
Q

outline the movement of sperm flow from the testicles?

A

testicles -> seminiferous tubules -> epididymis -> vas deferens

61
Q

whats the 10 year survival rate of testicular cancer?

A

> 90%

62
Q

what are risk factors for testicular cancer?

A

An undescended testicle. Family history of testicular cancer. HIV infection. white caucasuan

63
Q

what are the 2 main types of testicular cancer?

A

seminoma and nonseminomatous germ cell tumors

64
Q

what is testicular torsion?

A

when a testicle rotates, twisting the spermatic cord that brings blood to the scrotum.

65
Q

what is extravaginal torsion?

A

twist of the spermatic cord is taking place outside the sack of tunica vaginalis in the scrotum.

66
Q

what is intravaginal torsion?

A

the testicle rotates on the spermatic cord within the tunica vaginalis

67
Q

at what age is testicular torsion most common?

A

between 12-18

68
Q

how does testicular torsion present?

A

severe acute unilateral scrotal pain, nausea, and vomiting.

69
Q

what happens if testicular torsion is left untreated for 24 hours?

A

it can lead to a dead, non-viable testicle which may need to be removed- may affect fertility down the line.

70
Q

what are the most common signs of upper UTI

A

dysuria, increased urinary frequency and urgency, urine that is strong smelling, cloudy or contains blood, and persistent lower abdominal pain, loin pain and fever.

71
Q

what are common symptoms of lower UTI?

A

dysuria, increased urinary frequency and urgency, urine that is strong smelling, cloudy or contains blood, and persistent lower abdominal pain.

72
Q

what are upper UTIs called?

A

pyelonephritis

73
Q

why are NSAIDs and ACEi contraindicated for kidney disease?

A

NSAIDs cause vasoconstriction of afferent arterioles and ACEi cause vasodilation of efferent arterioles so used together reduces blood flow to the nephrons, reducing GFR

74
Q

what are the 2 main causes of death in dialysis patients?

A

CVD, infections

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