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YEAR 2 S2 PATHOLOGY > UTI I and II > Flashcards

UTI I and II Flashcards

1
Q

what are the most common diseases of the urinary tract

A

1) Benign prostatic hyperplasia (BPH) in men
2) Urinary tract infection (UTI) in women
3) Urinary incontinence

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2
Q

which symptoms suggest urinary tract disease

A
  • Frequency of micturition
  • Dysuria (pain on urination)
  • Haematuria
  • Urinary retention
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3
Q

describe UTI

A
  • common
  • Incidence 50,000/million/year
  • Accounts for 1-2% patients in primary care
  • more common in women
  • major form of UTI is CYSTITIS
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4
Q

what is cystitis

A
  • Inflammation of the bladder; common in UTI
  • More common in women
  • Acute or chronic
  • Mainly caused by infection; pathogens:
    • Most common: E. Coli and Proteus
    • Others (Candida albicans, Cryptococcus, Schistosoma, Mycobacterium tuberculosis)
  • Sterile cystitis
    • Radiation
    • Drugs
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5
Q

how does cystitis present

A
  • classic symptoms
    1) urgency
    2) frequence
    3) dysuria
    4) lower abdominal pain and tenderness
    COMPLICATION: pyelonephritis (inflammation of the kidney)
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6
Q

what is the pathology of cystitis

A
  • Non-specific acute or chronic inflammation
    Acute cystitis: mucosa becomes hyperaemic, often producing an exudate
    Chronic cystitis: –results from recurrent or persistent infection of the bladder. –Chronic infection leads to fibrous thickening & scarring; bladder wall less distensible
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7
Q

how is cystitis diagnosed an treated

A

Diagnosis: Urine bacterial count; microscopy, WBCs, Treatment−3-5 day course of antibiotics
−High fluid intake, (cranberry juice)

Recurrent infection: investigation

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8
Q

describe bladder tumours

A

Metaplasia: urothelium (transitional cell lining) of the bladder can undergo metaplastic changes

  • Squamous metaplasia
  • Intestinal or glandular metaplasia
  • Nephrogenic metaplasia

Benign tumours of the bladder- rare, 2-3% of epithelial tumours

Transitional cell carcinomas: −common malignant tumours arising from transitional cell epithelium−account for 90%+ of bladder epithelial cell tumours

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9
Q

what are transitional cell carcinomas

A
  • Uncommon under 50 yrs old; more commonly affect males (4 males: 1 female)
  • Notoriously silent tumours: 50% incurable at diagnosis
  • The most common presentation is painless haematuria
  • Often accompanied by symptoms of UTI (dysuria, frequency and urgency)
  • Symptoms of local invasion: ureteric obstruction
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10
Q

what are the risk factors for transitional cell carcinoma

A
  • smoking
  • Exposure to acrylamine chemicals in industry (naphthylamine, benzidine)
  • drugs (analgesic abuse, immunosupressive agent like cyclophosphamide)
  • radiation
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11
Q

what is the pathology of transitional cell carcinoma

A 
- Two main types of transitional cell tumour:
Papillary tumour (70%)
Sessile (flat) tumour
  • In situ or invasive
  • Graded to I-III according to cytological atypia
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12
Q

what are the 4 patterns of urothelial carcinoma

A

1) papilloma
2) invasive papilloma carcinoma
3) flat non invasive carcinoma
4) flat invasive carcinoma

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13
Q

what are the clinical features of transitional carcinoma

A
  • painless haematuria
  • symptoms of UTI:
    • dysuria
    • frequency
    • urgency
  • symptoms of local invasion
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14
Q

how is transitional carcinoma diagnosed and treated

A

Diagnosis:
Urine cytological examination:- malignant cells
Cystoscopy for pathology

Treatment:According to the stage and histological grade
Tumour resection using diathermy
Radiotherapy
Cystectomy

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15
Q

what is the prognosis for transitional carcinoma

A

Five year survival 80% if bladder wall not involved

5% if local invasion on presentation

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16
Q

what is incontinence

A

Defined as involuntary loss of urine
Common in the elderly, 25% of women and 15% of man over 65
Socially distressing

17
Q

what is urge incontinence

A

Due to detrusor overactivity with leakage of urine(the bladder is perceived to be full)−As isolated event−Secondary to local factors (bladder infection, stones) or central factors (stroke, dementia, Parkinson’s disease)

18
Q

what is stress incontinence

A

Occurs when intra-abdominal pressure is increased (cough, sneeze)−Weak pelvic floor or urethral sphincter−Common in women after childbirth

19
Q

what is overflow incontincnce

A

Leakage of urine from a full distended bladderCommonly in men with prostatic obstruction
Following spinal cord injury
In women with cystocoeles or after gynaecological surgery

20
Q

what is functional incontinence

A

assage of urine owing to inability to get to a toilet because of disability (stroke, trauma, unavailability of toilet facilities or dementia)

21
Q

how is incontinence treated

A

Urge incontinence

  • Bladder training
  • Antimuscarinics
  • Treatment of underlying causes(UTI, bladder stones, tumours)

Stress incontinence
- pelvic floor exercises

Overflow
- removal of obstruction

Functional incontinence
- Improve facilities, regular urinary voiding, absorbent padding

22
Q

what is the prostate

what is the structure

A
  • A gland that surrounds the bladder neck and proximal urethra
  • slowly grows with age
  • diseases are common > age 50
  • 4 zones: (central, peripheral, transitional, periurethral)
  • common prostate diseases:
    • Benign prostatic hyperplasia
    • Prostate cancer
    • Prostatitis - an infection, usually caused by bacteria
23
Q

describe benign prostatic hyperplasia (BPH)

A
  • non neoplastic enlargement
  • common >60 years
  • only 10% are symptomatic
  • Prostate enlarged with nodule formation
  • Histology:
    • Fibromuscular & glandular hyperplasia
24
Q

what are other clinical features of BPH

A
  • Urinary retention
  • Cystitis
  • Bladder hypertrophy
  • Hydronephrosis, pyelonephritis
25
Q

what are the symptoms of BPH

A
  • Hesitancy in initiation of micturition
  • A poor stream
  • Dribbling postmicturition
  • Frequency and nocturia
26
Q

what is the examination for BPH

investigation?

A
  • digital Rectal examination for the enlarged prostate (will feel firm, smooth and rubbery)
  • if ENLARGED PALPABLE BLADDER then ABDOMINAL EXAMINATION
27
Q

what is the pathology of BPH

A
  • Nodular hyperplasia
  • fibromuscular( stroma- smooth muscle and fibrous tissue)
  • glandular
28
Q

how is BPH treated

A

MEDICAL:
- alpha-blockers (relax smooth muscle at the bladder neck)
- antiandrogens (prevent testosterone conversion)
SURGICAL:
- transurethral resection (TURP)
- new treatment - PROSTATE ARTERY EMBOLISATION

29
Q

what is the pathogenesis of BPH

A

The cause is unknown, but might be related to levels of male sex hormone (testosterone)

hyperplasia (lateral and median lobes) –> compression of urethra –> bladder outflow obstruction

30
Q

wha are the clinical features and symptoms of BPH

A
  • Hesitancy in initiation ofmicturition
  • A poor stream
  • Dribbling postmicturition
  • Frequency and nocturia
    other clinical fetaures:
  • Urinary retention
  • Cystitis (bladder inflammation)
  • Bladder hypertrophy
  • Hydronephrosis (kidney swells due to urine failing to properly drain from the kidney to the bladder), pyelonephritis (inflammtion of kidney)
31
Q

describe the incidence of prostate cancer
who doe sit affect
cause

A
  • Very common, the second most common cancer in men (after lung) accounting for 1/4 of all cancers in men
  • A disease of elderly men, occurring in 1 in 10 men >70yrs, rare < 55yrs
  • The cause is unknown, but there is a link between androgenic hormones and tumour growth
32
Q

what is the aetiology of prostate cancer

A
  • unknown, but the hormonal changes that occur with increasing age may be involved
  • Age-dependent hormonal changes; androgens & hypersensitivity of androgen receptor
  • Family history (there is a strong hereditary component)
  • Associated with BPH but no proof of causal releationship
33
Q

what is the pathology of prostate cancer

A
  • HISTOLOGY:Adenocarcinoma
  • Mostly in peripheral zone, classically posterior location - this is palpable on examination
  • Grading – Gleason (Grade 1-5 depending on glandular differentiation and architectural patterns) classification
  • SPREAD:
  • local: bladder floor, pelvis, other adjacent structures
  • distant metastases: (bone, esp. spine, pelvis, femur, ribs; liver & lungs)
34
Q

what are the symptoms/ presentation of prostate cancer

A
  • Symptoms of lower urinary tract obstruction
  • Hard craggy prostate on rectal examination
  • Metastatic disease in the bone; pain
  • Asymptomatic carcinoma, found in autopsies
35
Q

how is prostate cancer diagnosed

A
  • Transrectal ultrasound: size & staging
  • Prostatic biopsy:histological diagnosis & Gleason scoring
    • Prostate-specific antigen (PSA) high levels detected via blood test - metastases
    • EN2 protein excreted by ONLY CANCER prostate cells is a recent discovery (more specific/sensitive to cancer than PSA)
  • further testing: MRI- detailed structure if significant chance of spreading; recent advance: mpMRI (multi parametric MRI) . non invasive
36
Q

how is prostate cancer treated

A
  • surgery (radical prostatectomy)
  • hormone manipulation - LHRH analogues; orchidectomy
  • radiotherapy
  • prognosis is dependent on stage
37
Q

what are histological patterns typically seen in Gleason pattern 3

A
  • abundant amphophilic cytoplasm

- enlarged nuclei with prominent nucleoli

YEAR 2 S2 PATHOLOGY (22 decks)

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