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58 Cards in this Set
- Front
- Back
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What are the 2 common sequelae of obstructive uropathy with stagnation?
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Increased risk of infection
Increases risk of calculi |
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hydronephrosis and obstruction can lead to what?
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loss of renal function
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what is the term used to describe dilation of the renal pelvis and calyces associated with progressive atrophy of the kidney due to obstruction to the outflow of urine
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Hydronephrosis
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pts with pain and abnormal stream of urine are probably having what kind of uropathy
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obstructive
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pt presents with poluria, nocturia and ability to concentrate urine..what type of obstructive uropathy do they have?
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bilateral partial
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pt presents with oliguria, anuria what type of obstructive uropathy do they have?
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Bilateral complete obstruction
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renal colic and obstruction; hematuria =
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Smaller stones
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remain in kidney → hematuria; hydronephrosis
what type of stone |
large stones
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what are the 4 types of stones? most common?
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Calcium (oxalate and/or phosphate) - ~ 70%
Struvite (“triple stones”): magnesium ammonium phosphate Uric acid Cystine |
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does a pt have to have high serum Ca to have high urinary Ca?
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nope
can still have stones |
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what causes staghorn stones?
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Magnesium ammonium phosphate
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how do Magnesium ammonium phosphate stones show up
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Urea → ammonia (increase urine pH)
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what are the 2 stones that occur when the pH is low?
high? |
low: cystine, UA
high: magnesium ammonium phosphate |
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what is the urachus? if it remains patent
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a tube that goes from the apex of the bladder up to the umbilicus
can lead to an adenocarcinoma |
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what is the trigone?
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triangular region located at base of bladder
Between ureteral orifices superolaterally and the urethral orifice inferiorly |
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what kind of epithelium lines the mucosa of the bladder
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transitional epithelium (urothelium)
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if a child has a mass on the bladder is it more likely epithelial or mesenchymal?
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mesenchymal
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out-pouchings of visceral organ (bladder in this case) consisting of all layers of the wall of the organ =
is it benign or maligant |
Diverticula
benign |
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what is the main problem with a bladder diverticula?
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it can set up a place for stone formation and infection
seen congenitally in kids |
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how does a diverticula present?
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urinary obstruction
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Anterior bladder wall and abdominal wall are absent
Exposes bladder mucosa to external environment = |
Exstrophy
Increased risk of cystitis and carcinoma (adenocarcinoma) |
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vestigial remnant of the connection of bladder apex to the allantois (located at umbilicus) =
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Urachus
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communicating duct between umbilicus and urinary bladder → infection..what is this?
how do you fix it? |
Patent urachus
May close spontaneously; typically requires surgical closure |
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what is the most common urachal anomaly?
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urachal cyst
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pt has fever, malaise and inflammation of the bladder...what do they have
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chronic cystitis
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most common bacterial infection seen in cystitis?
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E. coli
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common non-bacterial cause of cystitis? (not paracytic)
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FUNGAL: Candidia
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Middle east/ north africa (Egypt) =
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Schistosomiasis
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Schistosomiasis causes
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cystitis
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a kid comes in with severe hematuria, conjuctivitis, and CROUP. what was the likely etiological agent?
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adenovirus
he has hemorrhagic cystitis |
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Pt has prostatic cancer and needs to be treated with cyclophosphamide and now is peeing blood..what does he have
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cystitis
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this problem may result in in transmural fibrosis with dysfunctional bladder
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interstitial cystitis
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May mimic in situ urothelial carcinoma in the bladder
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interstitial cystitis
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Macroscopic bladder finding of soft, tan/yellow slightly elevated mucosal plaques
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Malacoplakia
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Microscopic bladder finding of large, foamy macrophages mixed with multinucleated giant cells and lymphocytes
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Malacoplakia
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what 2 things can be a cause of Malacoplakia?
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E. coli
Immunosuppressed transplant pts (aka chronic bacterial infections) |
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the large macrophages with granular PAS-positive cytoplasm and several dense, round Michaelis-Gutmann bodies =
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Malacoplakia
(remember that amyloid was PAS negative!) |
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alteration of the epithelium from its typical mature form to a different type of epithelium (usually mature as well) =
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Metaplasia
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pt is a smoker, they are having bladder problems, you look at some of the cells obtained from biopsy and expect to see transitional epithelium, but instead see columnar or squamous... what is going on?
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metaplasia
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vast majority of all cancers of the bladder are going to be? (cell type)
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epithelial (transitional)
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3 classifications of urinary neoplasm
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Benign, premalignant, and malignant
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Benign urinary bladder tumor is normally what?
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urothelial papilloma
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if you have a metaplasia that turns to columnar cells what is it protecting against
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they are glandular, so protection against chemical environment
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if you have a metaplasia that turns to epithelial cells what is it protecting against
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protection against physical (and possible chemical) environmental stressors
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what are the 2 types of premalignant neoplasm?
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papillary: has some additional features that make it more prone to be growing/invading-->papillary urothelial neoplasm of low malignant potential (PUNLMP)
Flat: carcinoma in situ--> Tends to be multifocal and greater tendency to progress to more aggressive malignant neoplasm |
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Tends to be multifocal and greater tendency to progress to more aggressive malignant neoplasm
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Flat: urothelial carcinoma in situ (CIS)
premalignant neoplasm |
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what is the difference between an non-invasive papillary urothelial carcinoma and pre-malignant tumors? (seeing as they both don't invade, how is one cancer and the other not?)
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Has to do with histological grade
higher the grade cells, the more likely to invade |
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Papillary architecture is apparent, and fibrovascular cores (arrows) are lined by cells (often > 7 cell layers thick) with increased nuclear size and overall mildly disorganized pattern =
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Low-grade papillary urothelial carcinoma.
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Papillary architecture is maintained, but the cells are less organized and show more prominent nuclei, variably prominent nucleoli, and readily apparent mitotic figures =
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High-grade papillary urothelial carcinoma.
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schistosomiasis can lead to what bladder cancer?
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Squamous cell carcinoma
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number one modification to stop kidney cancer?
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Cig smoking
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a 67 year old Asian man comes in and is found to have bladder cancer. He is a non-smoker and is found to work as a dry cleaner... what is the likely cause for his cancer?
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Arylamine chemicals
(2-naphthylamine) |
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pt presents with painless hematuria and may not even know that they have it. these are clinical presentations of what?
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urinary bladder cancer
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Tumor size
Stage Grade Multifocality Presence of CIS in surrounding mucosa these are risks of? |
recurrence of bladder cancer
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what is important for the prognosis of urinary bladder cancer?
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Histologic grade and stage at diagnosis
Importance of early detection and resection |
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tx for small localized papillary tumor?
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Transurethral resection of bladder tumor (TURBT)
Close follow-up surveillance : urine cytology, cystoscopy |
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tx for CIS, high-grade papillary TCC, multifocal disease, history of rapid recurrence
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Topical immunotherapy/chemotherapy
Intravesical installation of bacillus Calmette-Guerin (BCG)* Local inflammatory reaction destroys tumor |
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tx for Tumor invading muscularis propria; tumor refractory to BCG; metastatic tumor
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Cystectomy (remove whole bladder)
Possibly systemic chemotherapy |
