urogenital Flashcards
what is urolithiasis and its primary cause?
formation of a calculus or calculi (stones) within the urinary tract
- due to stasis
- supersaturation of urine with crystalline material (calcium salt)
secondary causes of urolithiasis?
- UTI
- catheter or foreign body in the bladder
- vit A deficiency producing squamous metaplasia of upper urinary tract mucosa
- low urinary PH predisposes to formation of uric acid stones
types of renal calculi
- calcium containing stones
- triple stones
- urate stones
effects of calculi
- urinary stasis (can be the cause of stones or caused by stones)
- ulceration (scratches the lining)
- bleeding
- infection (bacteria may be hiding in stone surface)
- pain
- fistula formation (stone can erode through organ)
what is acute tubular necrosis?
tubular epithelial cell death -> reduction/loss of tubular function
what is acute tubular necrosis?
tubular epithelial cell death -> reduction/loss of tubular function
what are the causes of acute tubular necrosis?
Ischaemic causes:
- shock
- haemorrhage
- major surgery
- severe burns
- dehydration
Toxic causes:
- endogenous products: myoglobin, haemoglobin
- drugs
- heavy metals
- organic solvents
tubular epithelial cells in ATN show varying degrees of:
- swelling
- vacuolation
- flattening
- sloughing
- necrosis
what acute interstitial nephritis mainly caused by?
allergic reaction to drugs
what is acute pyelonephritis?
infection of the kidney, usually bacterial infection
bacteria may derive from (in acute pyelonephritis)?
-> ascending spread from bladder
predisposing factors include:
- lower urinary tract obstruction
- vesicoureteric reflux
- diabetes
- pregnancy
-> haematogenous spread (bacteraemia)
chronic pyelonephritis may be due to:
-> vesicoereteric REFLUX
-> OBSTRUCTION
what appearance does the kidney have in chronic pyelonephritis
flea-bitten appearance, cortex has collapsed
what mimics renal cell carcinoma?
xanthogranulomatous pyelonephritis
what differentiates xanthogranulomatous pyelonephritis from renal cell carcinoma?
presence of foam cells in xanthogranulomatous pyelonephritis
what are the complications of acute pyelonephritis?
- septic shock
- acute renal failure
- pyonephrosis
- perinephric abscess
what is hydronephrosis?
dilatation of renal pelvis and calyces filled with fluid with progressive kidney enlargement and parenchymal atrophy, eventually renal cortex is thinned out due to obstruction of urine outflow
microscopic changes in hydronephrosis
- tubules and bowman’s spaces are dilated
- tubular epithelium flattens
eventually - tubular atrophy with fibrosis
- glomeruli disappears
what is pyonephrosis
infected hydronephrosis with pus in the dilated calyces and pelvis
what is pyoureter
hydroureter infected and contains pus
what are the triad clinical features of renal cell carcinoma?
painless haematuria
mass in flank
fever
gross features of clear cell renal cell carcinoma?
- unilateral, solitary, CIRCUMSCRIBED appearance
- yellowish cut surface with variegated appearance due to necrosis and haemorrhage
- possible invasion of renal vein
- may metastasise
microscopic features of clear cell renal cell carcinoma?
- polygonal cells with clear cytoplasm
- delicate branching vasculature
- invasion of renal vein
what is urothelial carcinoma of the kidney? (can affect ureter and bladder)
- may be non-invasive papillary urothelial carcinoma or invasive carcinoma
- involves the areas of the kidney lined by urothelium
- pts are at very high risk of recurrent tumours anywhere in the urothelial tract
what is angiomyolipoma?
- benign tumour of the kidney that can become very big
- combination of fat cells, blood vessels and myoid spindle cells
- may be sporadic or associated with tuberous sclerosis
gross and microscopic appearances of angiomyolipoma
GROSS
- unencapsulated
- yellow (fatty) areas
MICROSCOPIC
- mixture of myoid spindle cells, adipocytes and blood vessels
- myoid cells show immunostaining for HMB-45
how does benign prostate hyperplasia come about?
- in the prostate, type 2 5alpha-reductase in the stromal cells converts testosterone to dihydrotestosterone (DHT)
- DHT binds to androgen receptors in the epithelial and stromal cells and induces the production of growth factors that increase the growth of these cells
- causes hyperplasia of the epithelial and stromal cells
where does benign prostate hyperplasia occur?
transitional zone -> compression of prostatic urethra -> partial obstruction (lower UTI obstruction)
complications of benign prostate hyperplasia
- bladder hypertrophy
- bladder distension and hypotonic
- bladder diverticulum
- UTI
- urolithiasis
- hydronephrosis and hydroureter
- chronic kidney disease
what is the most common type of prostatic carcinoma?
acinar adenocarcinoma
condyloma acuminatum is a benign tumour of the penis on coronal sulcus, inner surface of prepuce, what HPV type is it associated with?
HPV type 6 and 11
squamous cell carcinoma of the penis is associated with HPV types?
HPV type 16 and 18
testicular tumours are mainly
germ cell tumours
predisposing factors of testicular tumours
- crytorchidism (undescended testicle into scrotum)
- genetic factors
- testicular dysgenesis (abnormal organ development)