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34 Cards in this Set
- Front
- Back
- 3rd side (hint)
UG embryology
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bladder derived from UG sinus (meso & endoderm)
urachus connects fetal bladder to umbilicus |
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Ureter Developmental Abnormalities
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Rare 2-3%
bifid ureter w/ or w/o double pelvis ureteropelvic junction obstruction (L side in males or pregnant females) congenital hyroureter or megaureter |
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Urinary bladder abnormalities
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Diverticula (acquired or congenital)
exstrophy (--> chronic inflammation --> adenocarcinoma) veisoureteral reflux congenital fistulae persistent urachus |
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urinary bladder w/ diverticulum (congenital or acquired)
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extrophy of bladder
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--> chronic infections --> adenocarcinoma
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normal urothelium (5-7 cell layers thick)
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UTI
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lower tract infections are ascending (Mycobacterium tuberculosis is the exception)
Bacterial - coliforms (e. coli, proteus, klebsiella, enterobacter, chlamydia, mycoplasm) fungal - candida, cryptococcus virus - adenovirus, BK parasites - s. haematobium, t. vaginalis |
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Polyoma or BK virus infection
"frosted glass" nuclear inclusions w/ clumped native chromatin |
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schistosomiasis
note granulomas |
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schistosomiasis
note granulomas |
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UT inflammation
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acute - frequency, abd pain, dysuria, PMN infiltrate, mucosal hyperemia, exudative or ulcerative
chronic - lymphoplasmacytic w/ fibrosis, follicular and eosinophilic variants acute or chronic cystitis may cause pyelonephritis |
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acute cystitis w/ exudate
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Interstitial cystitis
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chronic inflammation and fibrosis of all layers of the bladder wall, more common in women, associated w/ autoimmune dz
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Malacoplakia
mucosal plaques containing foamy macrophages Michaelis-Gutmann bodies |
associated w/ immunocomp pts, e.coli, defects in phagosome activity
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Cystitis glandularis
nests of downward growing urothelium, may become cystic, intestinal metaplasia may occur |
incr risk of adenocarcinoma
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Cystisis cystica
nests of downward gorwing urothelium, may become cystic, extensive metaplasia |
incr risk adenocarcinoma
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intestinal metaplasia
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incr risk of adenocarcinoma w/ metaplasia
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chemotherapy effect
enlarged cells, degenerative changes (cytoplasm fraying and nuclear smudging), crystals |
hemorrhagic cystitis associated w/ cyclophosphamide, radiation, adenovirus, causes gross hematuria
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UT neoplasms
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high M&M, 50k pts/yr
95% are urothelial (location % dependent on surface area) risk factors - tobacco, arylamines, chronic irritation, phenacetin, cyclophosphamide Chromosome 9 alterations - low grade, noninvasive (tumor suppressor gene) Chromosome 17 - p53, invasive lesions Chromosome 13 - Rb gene, invasive Chromosome 14 - flat and invasive |
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benign papilloma
papillary growth pattern, thin epithelium, orderly growth |
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urothelial neoplasm of low malignant potential
papillary architecture and foacl thickening of epithelium w/ areas of maturation |
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low grade urothelial carcinoma
complex branching architecture, epithelial thickening and crowding |
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low grade urothelial carcinoma
crosded group of hyperchromatic cells clumped cells in urine = cancer |
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urothelial carcinoma of the renal pelvis
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don't be fooled! its still the renal pelvis --> still urothelial
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low grade urothelial carcinoma
papillae are beginning to fuse |
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low grade papillary urothelial carcinoma
epithelial thickness, lack of maturation, mitosis off bm |
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high grade urothelial carcinoma
pleomorphism, discohesion at edges, necrosis |
papillary, nodular, both
80% show invasion of muscularis, anaplasia, cellular discohesion, squamous or glandular differentiation ulceration may be present |
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high grade papillary urothelial carcinoma
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papillary, nodular, both
80% show invasion of muscularis, anaplasia, cellular discohesion, squamous or glandular differentiation ulceration may be present |
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urothelial carcinoma in situ
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urothelial carcinoma in situ
if you understand why or can see a basement membrane please enlighten me |
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urothelial carcinoma
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presents: PAINLESS hematuria, pyelonephritis or hyronephrosis (depending on location)
high rate of recurrence papillomas and low grade have 98% 10 yr survival high grade cancers have 40% 10 yr survival pure squamous cell is poor prognosis |
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obstructive lesions
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sclerosing retroperitoneal fibrosis - idiopathic, late/middle age
congenital narrowing, inflammatory stricture, fibrosis, contracture, compression, neurogenic |
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urethral inflammation
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gonococcal v. nongonococcal
associated w/ ascending cystitis |
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urethral neoplasms
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caruncle - inflammatory pseudotumor in older women (bleeds)
papillomas - viral, at meatus carcinoma - rare, older women, squamous near meatus, aggressive |
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