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42 Cards in this Set

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describe the length, location, and vulnerability of the ureters.
30cm long, retroperitoneal, close to the uterine arteries and vulnerable to damage during GYN surgery
name the term that describes when urine backs up into the ureters caused by a defect in the vesicoureters.
vesicoureteral reflux
name the 3 normal anatomic sites of narrowing of the ureters that are a common place for renal stones to impact.
1)ureteropelvic junction; 2)pelvic brim (iliac vessels); 3)entrance to the bladder
besides calculi, Name some other reasons for occulsion of the ureters.
tumors, strictures, blood clots; EXTRINSIC: tumors, pregnancy, sclerosing retroperitonitis; endometriosis
Define hydroureter.
dilation of the ureter caused by a distal obstruction. may lead to infection -> hydronephrosis -> and ultimately renal failure
name the term that means a developmental failure of anterior abdominal wall and is commonly associated with what other congenital anomalies?
exstrophy of the bladder; associated with epispadias, bilateral inguinal hernias, bifid clitoris, and vaginal stenosis
name the 3 acquired structural disorders of the bladder.
1) cystocele (prolapse); 2) Diverticula (b/c of stones, infection, perforation, cancer); 3) fistula formation (associated with malignancy, radiation, trauma; includes: vesiculo-uterine, rectal, enteric, and vaginal)
name the term for inflammed bladder and describe the symptoms.
cystitis causes increased frequency, lower abdominal pain and dysuria
What are the predisposing conditions that cause cystitis?
coitus, prostatic hyperplasia, diabetes, stones, diverticula, tumors, pregnancy, neuronal disorders, caths and surgery, radiation
Name some common organisms that cause cystitis.
Gram negative: E.coli, Proteus, Klebsiella; TB; Schistosomiasis (esp. in egypt); candida albicans, aspergilliosisi, coccidioides immitis; IMMUNOCOMPROMISED: polyoma, adenovirus, HSV2, Herpes zoster, and CMV virus
Besides the common acute cystitis, name other types.
chronic, granulomatous, tuberculous, BCG-induced, Post-surgical, Malakoplakia, Treatment induced (radiation, BCG, Cytoxan); Interstitial, Eosinophilic
Granulomatous cystitis has several etiologies. name some.
TB, syphilis, coccidiomycosis, histoplasmosis, schistosoma, malakoplakia, xanthoma (cholesterol), vasculitis, and idiopathic
name this common type of bladder dz that is secondary to a generalized spread from pulmonary infection.
Tuberculous cystitis - scarring, obstruction, and fistulas - see caseating granulomas and fibrosis on micro
Bacillus Calmette-Guerin (BCG) is used for what?
to treat superficial bladder carcinoma; it may cause cystitis and cause dysuria, frequency, fever, etc
_______ is a treatable inflammatory reaction to bacteria, mycobacteria, or fungi that may occur in immunocompromised patients.
Malakoplakia: Usually occurring in the urinary tract, it has also been reported in the lungs.
The inflammation in Malakoplakia is characterized by enlarged, granular macrophages, scattered PMNs, and characteristic concentrically lamellated, calcified structures called ___________.
Michaelis-Gutman bodies - defective phagosomes that can't degrade bacteria
This flatworm is generally found in SW Asia, Africa, esp. Egypt and causes granulomatous inflammation and fibrosis of the lamina propria.
schistosomiasis - ID of the eggs is diagnostic
How long does it take to get acute, subacute, and chronic treatment induced cystits?
acute - 1st 6months; subacute: 6months-2yrs; chronic: 2-5yrs
________ (the generic name for Cytoxan, Neosar) is a nitrogen mustard alkylating agent, used to treat various types of cancer and some autoimmune disorders.
cyclophosphamide - causes hemorrhagic cystitis
When is the diagnosis of interstitial cystitis given?
clinical basis on symptoms after r/o of all other known causes. Associated with RA, SLE, or automimmune thyroiditis; ANA is + in 50% of cases
This inflammatory process is seen mainly in women and kids often with allergic disorders associated with peripheral eosinophilia.
Eosinophilic Cystitis -
Name the principal characteristics of carcinoma of the bladder.
Usually papillary; often multicentric; initially superficial; assoc. with bleeding and infection;
How would you visualize bladder carcinoma?
cystoscopy
____ is the most frequent malignant tumor of the urinary tract and 84% occur on the ___ and ___ walls of this organ.
Bladder Carcinoma; posterior and lateral walls (40% occur in the trigone)
This disease is most common in what age group?
50-80yrs old; Men 3:1
even though Transitional Cell Carcinoma (subtypes: papillary and invasive) of the bladder is more common, these factors cause squamous cell carcinoma of the bladder.
chronic bladder infections, calculous dz, and schistosoma
Name some causes of (95% of cases) of Transitional Cell Carcinoma of the bladder.
aniline dyes, smoking, cyclophosphamide, analgesic abuse
What is the most common finding and the first sign in 75% of bladder cancer?
gross hematuria (bladder irritability with frequency and dysuria are in later stages)
Extra: name the different types of bladder cancer and list in order of most common.
Transitional Cell Carcinoma (95%- usually papillary) -> Squamous Cell Carcinoma -> Adenocarcinoma (urachal remnant and exstrophy) -> Sarcoma botryoides (embryonal rhabdomyosarcoma)
What diagnostic procedures are used to detect bladder CA?
urinalysis, excretory urography, cystoscopy, cytology, DNA Analysis
What is the most important factor in predicting the ultimate prognosis of bladder CA?
depth of invasion into the bladder wall - forms the basis of staging bladder CA
Most low-grade bladder CAs are usually papillary and not invasive. what does this mean?
they are confined to the superficial mucosa and do well (those that invade (high-grade) the lamina propria have a worse prognosis and require aggressive treatment)
This lesion represents the majority of bladder tumors and have a 98% 10yr survival rate.
Papillary CA (low grade)
There are 3 types of Papillary Bladder Neoplasms. Name them.
Papilloma Urothelial/Low Malignant Potential; Papillary urothelial Ca (low grade); Papillary Urothelial (high grade)
THis bladder lesion is often widespread, and one step from invasion. Diffuse topical tx or cystectomy is often required.
Flat urothelial/CIS
This cancer is associated with chronic irritation - stones, schistosoma. What is the survival rate of this CA?
Squamous Cell Ca - 70% are dead in one year
____ ___ and ____ are usually used for diagnosis and therapy of superifical lesions with a slow recurrence rate and control of bleeding in poor operative risks or advanced cases.
Endoscopic resection and fulguration
What is fulguration?
removal or destruction of diseased tissue using a controlled electric current. Also called electrocoagulation or electrocauterization
___ or ___ is used for large superficial tumors or multiple lesions and control of bleeding.
Open loop resection and fulguration
_________ is used for removing single large lesions at the dome of the bladder and the lateral wall.
segmental bladder resection
what is a urinary diversion? and name the common forms.
You do not need to have a bladder in order to live but it is critical to maintain an uninterrupted flow of urine from the body. accomplished with a urinary diversion procedure including: Illeal Loop (uretero-ilieal-cutaneous); Rectal Bladder (uretero-rectal with colostomy fecal diversion; Uretero-cutaneous
There is a ___% chance of a high grade lesion recurring.
80-90%