Patho Final 3

Front 1

Benign prostatic hypertrophy

Back 1

– prostate gland becomes enlarged

Front 2

Urinary tract infections

Back 2

• incidence
o Common
o Risk factors
• Instrumentation and catherization
• Impaired bladder emptying (elderly, immobility)
• Outflow obstruction
• DM – glucose in urine
• Female sex - shorter urethra
• Sexual activity
• Pathology
o Gi bacteria (e.coli 80%)
o Usually ascending (from bottom to top)
o Can affect Upper and lower tracts
• Sx
o Frequency, urgency, dysuria (pain with urination), nocturia, incontinence (leaking of urine), enuresis (bed wetting)
o Cloudy, blood or foul smelling urine in more severe cases
o Pain (pelvic pain, between urination)
o Fever, chills and malaise with upper tract involvement
• Prevention
o Hydration
o Sexual hygiene
• Urinating after sex
o Wipe front to back
o Prophylactic antibiotics in those with strong predisposition
• Dx
o Hx and urinalysis
• Bacterial gram stain and culture
• Leukocyte count
• Usually no WBCs in the urine
o U/s, Ct or renal scan if suspect obstruction
• If the patient is not typical patient

Front 3

Pyelonephritis

Back 3

• Pathology
o Acute or chronic
o Severe infection of kidney parenchyma and tubules
o Associated with ascending uti
• Esp. with ureteral reflux
• Ureter – detrusor muscle in bladder contracts, flap is supposed to prevent urine from going back up into ureter
• Presents similar to UTI but with fever, chills, malaise, leukocytosis
• Tx with antibiotics
• Can lead to severe renal injury, failure and death if untreated

Front 4

Renal Neoplasms

Back 4

• Renal cell CA
o Most common adult renal neoplasm
o Risks
• Males 2:1
• 60-70 yo
• von hippel-lindau
• familial disorder
• genetic
• predisposes you to a number of different types of tumors
• smoking
• obesity
• environmental
• people who have no fruits/vegis
• red meat
• solvents.asbestos
o Sx
• Usually silent early – develops at the upper part of the kidney, doesn’t block flow from kidney
• Later:
• Hematuria
o Blood in urine
• Pain
• Palpable mass
• Weight loss, anemia, mets
• Ectopic hormone production
• Hypertension
• Erythrocytosis
• Mets to lungs, brain and bone
o Dx
• Imaging
• US, MRI, CT
• Biopsy
o Tx
• Radical nephrectomy with node dissection
o Prognosis
• 35% mortality
• poor prognosis if invades capsule of kidney or spreads to nodes or distant mets
• small, incidentally found tumors have good prognosis

Front 5

Wilms’ Tumor

Back 5

• Pathology
o Nephroblastoma
• Most common malignant neoplasm in children (1st 7 years)
o Hereditary predisposition
• Presents with large abdominal mass, pain, hematuria, hypertension, fever and NV
• Tx – surgical resection with chemo
• Better prognosis with younger age

Front 6

Renal cystic disease

Back 6

• Types
o Polycystic kidney disease
• Later in life
o Medullary sponge kidney
o Aquired cystic disease
o Single or multiple cysts (most common)
• Polycystic kidney dz
o 2 forms: hereditary, autosomal recessive in children and autosomal dominant in adults
o Sx: pain, hematuria, fever, hypertension, palpable kidneys
o Tx: supportive with anti-HTN, low protein diet
o Leads to renal failure

Front 7

Renal calculi (nephrolithiasis)

Back 7

– KIDNEY STONE
• Etiology/path
o 80-90% calcium
o also, uric acid, cystine, etc.
o increased blood levels and urinary excretion of principle component(calcium)
• Risk factors
o Men 4:1, 30-40 yo
o Dehydration – produce less urine, urine is more concentrated
• Summer months
• Decreased fluid intake
o Excess intake of calcium, oxalate and pruiness
o Obesity in women
o Sleeping only on one side
• Sx
o Renal colic
• Pain that comes and goes in a regular pattern
o Pain radiation
• Flank pain, pelvic pain, testicular, penial pain
o Nv
o Urinary urgency and frequency
o Hematuria – irritate wall of ureter… etc.
• Obstruction
o Common sites
• Ureteropelvic junction
• Iliac vessels
• Uretovessical junction
• Where the ureter passes into the wall of the urinary bladder
o Dx
• 90% radiopaque – calcium stones
• CT,UX, IVP (dye with xray), UA (urine analysis), and Cx (culture)
o Tx
• Smaller stones pass spontaneously
• Pain meds
• Antibiotics

Front 8

Chronic renal failure

Back 8

• Etiology and risk factors
o DM and poorly controlled hypertension
o Others
• Urinary tract obstruction, infection, hereditary, glomerulonephritis, SLE, NSAIDs (toxic to the kidneys at high levels)
• Pathology
o Progressive loss of nephrons leads initially to renal insufficiency and then to failure and end stage renal disease (ESRD)
o Depends on underlying cause
• Glomerular filtration rate
o 20-35% of normal
• insufficiency
• azotemia, anemia, hypertension
o <20-25% of normal
• failure
• edema, metabolic acidosis, hypercalcemia
• neuro, GI and CV complications
o > 90% function lost
• ESRD (End stage renal disease)
• Uremia (high levels of uria in the blood), widespread systemic disease
• Survival dependant on dialysis or transplant
o Markers for renal failure
• Cr (found in the urine)
• BUN?
• CM
o General – gradual progression
• NV
• Anorexia
• Fatigue
• Hypertension
• Itching
• Oliguria?
• Edema, feet and face
• Slowed thinkin

Front 9

Bladder Cancer

Back 9

• Incidence
o 4th leading cancer in men and 7th leading cause of cancer death in US
• Risks
o Males, older age, smoking, chronic infection (catheters), stones or previous tumors, exposure to carcinogens
• Patho
o Transitional cell carcinoma, most common
o Squamous cell and adenocarcinoma
• Less common
• Sx
o Hematuria – microscopic or gross
o Frequency
o Urgency
o Dysuria – pain with urination
• Dx
o Usually not early
• Open space, can grow before sx’s
o Transurethral resection or biopsy
o If invades through the wall of the bladder to the muscle, work up for mets (CT, bone scan, chest film, etc)
• Prevention
o 50% in men due to smoking
o others to industrial or agricultural carcinogens
• Tx
o Bacilli calmette-guerin (BCG)
• TB vaccine
• Not approved by FDA, not recommended in US
• Not very good at preventing TB
• Positive TB skin test
• Injected into the bladder, causes inflammation in bladder, forces your own immune system to get rid of the tumor

Front 10

Urinary incontinence

Back 10

• Common and often under-diagnosed
• Types
o 1. Functional
• Normal urine control but cant reach toilet due to immobility (muscle or joint dysfunction, etc)
o 2. Stress incontinence
• During activities that increase intra-abdominal pressure
• Cough, lifting, laughing
• Risks – weakness/damage to pelvic floor mm
• Aging, childbirth, pelvic surgery
o 3. Urge incontinence (neurogenic bladder)
• Sudden, unexpected urge to urinate and uncontrolled loss of urine
• Due to reduced bladder capacity or detrusor instability
• CVA, MS, DM, spinal cord injury, demetia, alzheimer’s
o 4. Overflow incontinence (neurogenic bladder)
• when reflex to urinate is gone – no urge to urinate
• constant leaking from full bladder, but unable to empty
• hypotonic detrusor (weak)
• drugs may have that effect
• fecal impaction – pressure on back of bladder
• dm – peripheral nerve injury
• lower spinal cord injury or pelvic nerve injury
• MS
• Obstruction
o Benign p