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CP > Urological Pathology > Flashcards

Urological Pathology Flashcards

1
Q

Renal cell carcinoma

A

Cancer of the kidney that arises from the renal tubular epithelium

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2
Q

Epidemiology of renal cell carcinoma

A

Age >60
Male
PMH of obesity, smoking, NSAID use, ESRF and on dialysis
Family history (especially Von Hippel-Lindau)

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3
Q

Paraneoplastic syndromes

A

Signs and syndromes not related to local effects of the primary or metastatic tumours (e.g. proteins/hormones secreted by tumour cells or immune cross-reactivity)

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4
Q

Local primary tumour effects of RCC

A

Haematuria

(sometimes) Abdominal pain

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5
Q

Paraneoplastic syndromes of RCC

A

Common in RCC!
Cachexia
Hypertension (from renin)
Polycythemia (from erythropoietin)

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6
Q

Wilms’ tumour

A

Aka nephroblastoma
Cancer of the kidney that arises from nephroblasts
Occurs in children under 5
5-10% a/w genetic syndromes (Beckwith-Weidemann, WAGR, Denys-Drash)
90% unilateral

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7
Q

Complications of macroglossia

A

Dysphagia
Airway obstruction
Speech problems

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8
Q

Clinical features of Wilms’ tumour

A

+++ abdominal distension especially if bilateral
Haematuria
Mets are rare
Paraneoplastic syndromes are rare

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9
Q

Urolithiasis

A 
Renal stones
Classed by composition of stone
70% calcium
5% urate
1% cysteine
15% struvite (magnesium ammonium phosphate)
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10
Q

Aetiology of calcium urolithiasis

A

Hypercalcaemia

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11
Q

Aetiology of urate urolithiasis

A

Gout, malignancy (high cell turnover)

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12
Q

Aetiology of cysteine urolithiasis

A

Congenital cystinuria

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13
Q

Aetiology of struvite urolithiasis

A

UTI with urease production
Urease converts urea to ammonia
Ammonia causes pH rise
Precipitation of magnesium, ammonium and phosphate salts

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14
Q

Clinical features of urolithiasis

A

Pain
If in ureter - ‘loin to groin pain’ (renal colic)
If in bladder - lower abdominal pain
If in urethra - dysuria
N.B. X-ray does not eliminate stone possibility due to radiotransparency of irate stones

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15
Q

Complications of urolithiasis

A

Obstruction = hydronephrosis +/- hydroureter = renal impairment
Urinary stasis = infection
Local trauma = squamous metaplasia = SCC risk

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16
Q

Vesicoureteral reflux (VUR)

A

When urine flows backwards from the bladder to ureter

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17
Q

Epidemiology of VUR

A

Affects 10% of population
Young people, especially age < 2
Those with a family history of VUR

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18
Q

Aetiology of VUR

A

Congenital abnormality of vesicouretic junction - fails to close when bladder wall contracts

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19
Q

Clinical features of VUR

A

Usually asymptomatic

Most children grow out of it

20
Q

Complications of VUR

A

Stasis = UTI

Back pressure and ascending infection = renal damage

21
Q

Urothelial carcinoma

A

Aka transitional cell carcinoma
Cancer arising from urothelium
Accounts for >90% of bladder cancer

22
Q

Epidemiology for urothelial carcinoma

A

Adults aged >60
Male
Smokers
Exposure to certain industrial chemicals (dye, rubber)
Family history
Treatment for previous cancer (pelvic radiotherapy, cyclophosphamide)

23
Q

Clinical features of urothelial carcinoma

A 
Haematuria
Frequency, urgency, dysuria
Urinary obstruction
Can get lung, bone and liver mets
Paraneoplastic syndromes are rare
50% 5 year survival but improving due to radical surgery
24
Q

Neurogenic bladder

A

Inability to properly empty the bladder due to neurological damage
Spastic: if damage to brain or spinal cord
Flaccid: if damage to peripheral nerves

25
Q

Epidemiology of neurogenic bladder

A

All genders and ages - depends on cause

26
Q

Aetiology of neurogenic bladder

A

UMN/spastic neurogenic bladder: stroke, MS, spinal injury

LMN/flaccid neurogenic bladder: pregnancy, diabetes, alcohol (B12 deficiency)

27
Q

Clinical features of neurogenic bladder

A

Symptoms related to lack of control of bladder emptying e.g. urinary retention, abdominal distention, incontinence, urge, frequency

28
Q

Complications of neurogenic bladder

A

Stasis - UTI
Stasis - Urinary stones
Inability to empty bladder - bladder distention, hydroureter, hydronephrosis, renal function impairment, oedema etc.

29
Q

Benign prostatic hyperplasia

A

Increased number of both stromal and glandular cells in the prostate
Known by patients as enlarged prostate

30
Q

Epidemiology of benign prostatic hyperplasia

A 
Old men (20% by age 40, 70% by age 60)
Obesity, diabetes, FH
31
Q

Clinical features of benign prostatic hyperplasia

A 
LUTS (lower urinary tract symptoms)
Hesitancy or urgency
Poor/intermittent stream
Straining
Prolonged micturition
Incomplete bladder emptying
Frequency
Incontinence
Nocturia
32
Q

Prostatic adenocarcinoma

A

Cancer of the glandular epithelium in the prostate

33
Q

Epidemiology of prostatic adenocarcinoma

A

Old men
Black men
Family history (including BRCA1/2)
Pesticide exposure

34
Q

Clinical features of prostatic adenocarcinoma

A

Lower urinary tract symptoms

Can metastasise to bone

35
Q

Cryptorchidism

A 
Undescended testis (testis is not in scrotum)
Types based on site of testis
36
Q

Epidemiology of cryptorchidism

A

In 3% of full term babies
Much more common in premature babies
More common with Down’s syndrome or Kleinefelter syndrome (XXY male)

37
Q

Aetiology of cryptorchidism

A

Multifactorial

Often no cause identified

38
Q

Pathogenesis of cryptorchidism

A

Embryological failure of descent
7 weeks - testes begin to form
10-15 weeks - trans abdominal descent
25-35 weeks - inguinoscrotal descent

39
Q

Clinical features of cryptorchidism

A 
Empty scrotum (10% bilateral)
May resolve spontaneously
40
Q

Complications of cryptorchidism

A

Infertility
Hernias
Testicular cancer risk
Testicular torsion

41
Q

Seminoma

A

Malignant neoplasm of the testis arising from germ cells in the seminiferous tubules
Most common type of testicular cancer

42
Q

Epidemiology of seminoma

A

Young men (25-45)
Family history
Cryptorchidism (EVEN IF IT WAS SURGICALLY CORRECTED OR ONLY AFFECTED OTHER TESTIS)

43
Q

Clinical features of seminoma

A

Testicular lump, swelling, pain
Can give lung mets and LN mets
Can cause gynecomastia
95% 5 year survival

44
Q

Presentation of urinary tract obstruction

A

Symptoms of causative factor (many possibilities) plus…
If complete obstruction - anuria, pain
If partial obstruction - often asymptomatic

45
Q

Complications of urinary tract obstruction

A

Irreversible renal impairment or secondary VUR (due to back pressure)
Infection or calculi formation due to urinary stasis

CP (19 decks)

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