Urinary Tract Pathology Flashcards
1
Q
- which structures make up the upper urinary tract?
- which structures make up the lower urinary tract?
- Name 7 general pathologies that can affect the urinary tract
A
- kidney, renal pelvis and ureter
- bladder, prostate, urethra and genitalia
- congenital, infection, inflammation, stones, cancer, trauma, neurological
2
Q
- Name 4 congenital pathologies
2. what is Weigert Mayer rule? What problems does it cause?
A
1. horseshoe kindye absent kidney renal duplucation duplex ureters 2. if there is a duplex ureter, the ureter from the upper pole moeiry will always insert into the bladder more inferiorly and medially
3
Q
Define the following congenital abnormalities:
- bladder exstrophy
- vesicoureteric reflux
- patent urachus
- posterior urethral valves
- epispadias/hypospadias
- phimosis
A
- bladder and cloaca haven’t fused properly, resulting in a bladder that is inside out and open in the abdomen
- reflux of urine up the ureters if the bladder has not developed properly
- small communication between dome of bladder and umbilical cord
- valve structure in the urethra which requires high pressure to urinate against - causes retention and renal failure
- congenital abnormalities of penis formation; a cord like structure causes a bend in the penis and the external meatus does not open in the glans
- inability to retract foreskin
4
Q
- What is benign prostatic hyperplasia?
- define hyperplasia
- name 6 symptoms of BPH. What type of symptoms are these?
- Describe the pathophysiology of BPH.
A
- benign enlargement of the prostate, involving hyperplasia of the prostatic stroma and epithelial cells in the transition zone
- increase in cell number
- OBSTRUCTIVE VOIDING SYMPTOMS
- frequency
- urgency
- nocturia
- weak stream
- intermittent stream
- terminal dribbling - 5-alpha reductase in the stromal cells coverts testosterone to DHT, which is much more potent than testosterone. 5-HT promotes the proliferation of stromal cells (autocrine) and epithelial cells (paracrine)
5
Q
- what are strictures?
- what is urolithiasis?
- what are the risk factors of urolithiasis?
- describe the pathophysiology of urolithiasis
- what is a staghorn calculus?
A
- narrowing of the lumen due to inflammation, scarring and fibrosis
- stones affecting the urinary tract
- male, dehydration, dietary components and genetic factors
- supersaturation of the urine > nucleation > aggregation
- stone like structure that fills the renal pelvis
6
Q
- what is an ascending uti?
- what is a haematogenous uti?
- what is urethritis?
- what is cystitis?
- what is pyelonephritis?
A
- UTI acquired via ascent from the urethra up the tract
- UTI acquired from the blood stream to the kidney
- infection of the urethra
- infection of the bladder
- infection of the kidney
7
Q
- what does UTI in children usually mean?
2. which two population have a high incidence of UTI?
A
- congenital abnormality
- women of reproductive age (honeymoon cystitis and pregnancy)
older men (related to BPH)
8
Q
- Which bacteria is the commonest cause of UTI?
- name another bacteria which is a common cause of UTI
- which viruses are associated with haemorrhagic cystitis in immunocompromised individuals?
- what type of infections are BK and JC viruses associated with
- mame a parasite that can cause UTI
A
- E. coli
- Staphylopcoccus saprophyticus (gram positive bacteria found in the normal flora of the female GI tract and perineum)
- adenoviruses
- infection and graft failure in patients following kidney transplants
- schistosomal haematobium
9
Q
name 5 host defences to UTI
A
- urine flow and micturition - flush out bacteria
- urine chemistry - osmolarity, pH, organic acids
- secreted factors - IgA and lactoferrin
- mucosal factors (which makes the tract slippery)
10
Q
Describe the two virulence factors of uropathogenic E. coli (UPEC)
A
- type 1 fimbriae - bind to mannose on host cells
2. Type P fimbriae - adhere to urinary tract cells, and prevent immune cells phagocytosing the bacterium.
11
Q
Name 6 risk factors for UTI, and why they increase the risk
A
- Female - shorter urethra; closer to perineum
- anatomic abnormality - urinary reflux, stagnant urine, residual urine
- Functional abnormality/neurlogical disorders - incomplete emptying; requirement for catheterisation
- catheterisation - bypasses host defences; acts as foreign body; biofilm formation
- pregnancy - dilated ureters; incomplete bladder emptying; gestational glycosuria
- foreign body - mucosal damage
- urinary tract surgery - mucosal damage; directly intorduces bacteria; post operative infection; frequent catheterisation
12
Q
- describe symptoms of cystitis/urethritis (5)
2. describe symptoms of pyelonephritis (5)
A
1. frequency
dysuria
urgency
mild suprapubic discomfort
low grade fever/no fever
2. symptoms of cystitis
loin pain
fever
rigor
renal angle tenderness
13
Q
- what is examined in a dipstick test?
- what is the NPV and PPV of dipstick analysis?
- What does urine microscopy examine?
A
- protein, blood, leucocyte esterase and nitrites
- high NPV but poorer LPV
- white cells, epithelial cells (suggests contamination), red cells
14
Q
- What is urethral syndrome?
2. Name 4 explanations for urethral syndrome?
A
- negative urine cultures, despite symptoms of cystitis
- low counts of bacteria
fastidious bacteria that do not grow on routine culture media
non-imfective inflammation
sexually transmitted pathogens
15
Q
Name the 4 antibiotics used to treat UTI, when they should be used, and when they can’t be used
A
- TRIMETHOPRIM - first line; cheap; active against most uropathogens associated with uncomplicated UTI. Can’t be used for pyelonephritis
- NITROFURANTOIN - achieves high urine concentrations; can’t be used against upper tract infections as it does not achieve effective concentrations in the kidney
- AMOXICILLIN - shouldn;t be used empirically due to high rates of resistance
- CIPROFLOXACIN - last resort antibiotic used to treat complicated UTI/pyelonephritis
