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16 Cards in this Set
- Front
- Back
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what layers is in the bladder?
what's special about bladder? |
urothelium (epithelium) lamina propria smooth muscle = detrusor serosa
has to be able to fill up and void has to have permeability barrier since urine has weird crap in it |
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what are the structures on the urothelium?
what do they do?
what isn't so great about it? |
uroplakins
contribute to permeability barrier and stabilize cell membrane when stretch/fold
this is where the mannose is where type 1 pili E. coli attach to it to avoid being flushed out
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Which layer tends to get cancer? |
the urothelium = urethelial carcinoma = transitional cell carcinoma
includes prostatic urethra- renal papilla to proximal urethra |
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pt comes in and says 'i haz hematuria'
what do you do to workup pt? |
if not gross, do microscopic UA eval to find out how much hematuria there is. If there is 3 RBC or more/HPF then do work up.
Do a CT urogram (non-contrast first: stones, large renal masses; contrast: urothelium, subtle renal masses)
If nothing found, do a cystoscopy |
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If pt is allergic to contrast and you're working up hematuria, what do you do? |
If allergic, CT scan w/o contrast; MRI and can use Gb contrast; US: to see kidney.
Cystoscopy with retrograde pyelograms (contrast put in ureters from below: doesn't trigger allergy) to see urothelium
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In what cases would you skip the cystoscopy after a clear CT when working up hematuria? |
if microscopic hematuria only pt under 35 no bladder sx no tobacco or chemical exposure |
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what is another option to look for urethelial cancer if pt high risk? |
urine cytology |
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flank pain palpable mass hematuria |
classic triad for kidney cancer |
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kidney cancer causes what paraneoplastic syndromes? |
hypercalcemia: tumor puts out PTH-like peptides, osteolytic bone mets an issue
HTN: tumor making renin or compresses renal vessels
polycythemia: tumor +/- hypoxic adjacent tissue makes EPO
Stauffer syndrome: liver dysfunction from inflam cytokines (not liver mets) |
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+/- pain hematuria acute onset: pain while voiding urgency frequent urination
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bladder cancer
that it doesn't have pain with hematuria is a huge red flag. Any bladder sx esp if acutely onset is also a flag. |
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if you suspect bladder cancer, what do you do to dx? |
cystoscopy of bladder
see upper tracts with retrograde pyelogram, ureteroscopy
urine cytology to find carcinoma cells shed in urine. Dx if +, but false negatives are many. |
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what's the tx for kidney and bladder cancer? |
surgery. take it out before it spreads
you can use chemotherapy and that might help person feel better or prolong life, but that will NOT cure
kidney: partial or complete nephrectomy bladder: transurethral resection. Recurrence happens a lot, so may have to remove bladder |
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what's the kinds of cancer kidney gets? |
renal cell carcinoma***. Subtypes: clear cell*** (80%) papillary (15%) others
urothelial (pelvis or calyces)
rare: sarcoma, lymphoma, met |
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what is tx for renal cell carcinoma? |
cytotoxic chemotherapy does not work, has no role
EXCEPT clear cell type which angiogenesis is used as target. Solid tumors need VEGF and new blood vessels, so block. (figured from trisomy 21 pts) |
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what is VHL mutation and disease? |
von-Hippel Lindau
VHL is gene of a tumor suppressor. VHL dz is AD. Only 1 copy of VHL left, once hit, cancer happens. So multiple tumors in VHL dz. Including clear cell renal carcinoma
During hypoxia, cells make hypoxia-inducible factor (HIF), once normal O2, VHL degrades HIF. If no VHL, HIF persists -> angiogenic, GF esp VEGF |
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For urothelial cancer, what kinds of drugs are used? |
in bladder: bacillus Clamette-Guerin, mitomycin C
systemic to get met's: Cis-platinum plus: gemcitabine or paclitaxel or docetaxel |
