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MIDS 137 > Ch 4 (lower urinary system pathology) > Flashcards

Ch 4 (lower urinary system pathology) Flashcards

1
Q

What 3 things can duplication of the bladder include?

A

-Peritoneal fold (complete or incomplete)
-Septum dividing bladder longitudinally
-TRV band of muscle dividing bladder into 2 unequal cavities

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2
Q

Is complete bladder duplication common?

A

No! Congenital anomalies are very rare

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3
Q

What are 3 complications bladder duplication includes?

A

-Unilateral reflux
-Obstruction
-Infection

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4
Q

Can ureter duplication be incomplete or complete?

A

Either

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5
Q

Can ureter duplication be unilateral or bilateral?

A

Either

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6
Q

What is incomplete ureter duplication?

A

-Bifurcation of ureter at/near renal pelvis that comes together b/w kidney + bladder to enter bladder as 1 ureter
-Image has 2 ureters coming from kidney but only 1 going into bladder

(think incomplete is 1 ureter)

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7
Q

What is complete ureter duplication?

A

-2 separate renal collecting systems + 2 separate ureters
-Ureter from UP kidney inserts into bladder caudad/below the ureter from LP (think it is reversed, UP now is lower than the LP)
-Image has 2 ureters coming from kidney right into the bladder

(think complete is 2 ureters)

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8
Q

What is blind ureter?

A

Image looks like 2 ureters coming out of kidney but only 1 goes into the bladder. The other ureter does not go into the bladder + is “blind”

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9
Q

What is inverted Y ureteral duplication?

A

Image looks like 1 ureter coming from kidney, but 2 ureters go into bladder making a “Y” appearance

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10
Q

Are ureter or bladder duplications more common?

A

Ureter

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11
Q

Is urethra duplication common?

A

Nope (there are numerous variations that exist but none are common)

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12
Q

Is urethra duplication m/c in males or females?

A

Almost exclusively in males!

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13
Q

What is urethra duplication associated with?

A

Duplication of bladder + genitalia

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14
Q

What is bladder diverticula?

A

Outpouching of bladder wall

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15
Q

How is bladder diverticula produced?

A

Produced by mucosal herniation through defects in muscle wall

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16
Q

Cause of diverticula?

A

Congenital or acquired

(usually associated with diseases resulting in bladder outlet obstruction or neurogenic conditions - this causes abnormalities in bladder function with chronically raised intravesical pressure)

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17
Q

Complications of diverticula?

A

-Intradiverticular tumour + stones
-Spontaneous rupture (rare)

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18
Q

SF of diverticula?

A

-Anechoic outpouching
-Thin walls
-Acoustic enhancement
-Connected to bladder via narrow neck
-CD shows bidirectional flow b/w bladder + diverticula

(the diverticula may not empty when voiding + may increase in size)

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19
Q

Would we measure the bladder including the diverticula or w/o it?

A

Depends on location of diverticula

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20
Q

Is urethra diverticula m/c seen in males or females?

A

Females - during transperineal + transvaginal scanning

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21
Q

Complications of urethra diverticula?

A

-Stone formation
-Cancer

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22
Q

SF of normal urethra?

A

Hypoechoic linear structure exiting the base of the bladder + travelling inferior to the symphysis pubis

(in slide image the urethra is b/w the PS + VAG)

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23
Q

SF of urethra diverticula?

A

Simple or complex collections of fluid intimately related to urethra

(image in slide shows an out pouch or urine in the urethra)

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24
Q

What is the m/c bladder outlet obstruction from?

A

Posterior urethral valves (PUV)

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25
Q

What is the m/c cause of urinary obstruction in male infants?

A

Posterior urethral valves (PUV)

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26
Q

Cause of posterior urethral valves?

A

From development of abnormal valves in the posterior urethra

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27
Q

What is posterior urethral valves associated with?

A

Vesicoureteral reflux

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28
Q

What is the “sign” called when posterior urethral valves are seen in fetuses?

A

The keyhole sign (a dilated urethra)

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29
Q

SF of posterior urethral valves?

A

-Prostatic urethra dilatation + elongation
-Bladder wall thickening
-Dilated ureters
-Hydronephrosis

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30
Q

What is bladder exstrophy?

A

-Abnormal formation of bladder + bony pelvis
-Congenital malformation
-Bladder protrudes outside abdomen due to abdominal wall defect

(bladder is flattened + exposed on the abdominal wall, while the pelvic bones appear widely separated)

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31
Q

How are ureteral orfices formed with bladder exstrophy?

A

Urine spurts onto abdominal wall form them

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32
Q

What is bladder exstrophy associated with?

A

Other congenital anomalies

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33
Q

Clinical presentation of bladder exstrophy?

A

-Widening of iliac crests
-Lower abdominal bulge (representing bladder)

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34
Q

What will most likely also be seen SF with bladder exstrophy?

A

-Eversion of bladder through anterior abdominal wall
-Hydronephrosis

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35
Q

What is an ectopic ureter?

A

Ureteric insertion in an abnormal position

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36
Q

Cause of ectopic ureter?

A

Embryologic error in development

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37
Q

M/c location for an ectopic ureter?

A

Arises from superior renal pelvis of a duplex kidney + inserts lower and more medially towards the base of bladder

(UP kidney to lower area bladder)

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38
Q

Does a normal or ectopic ureter take a shorter path from kidney to bladder?

A

Normal takes shorter path

(ectopic takes long path from UP kidney to lower area of bladder)

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39
Q

Sonographically, an ectopic ureter may cause what?

A

Hydroureter

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40
Q

What is a ureterocele?

A

Cyst-like enlargement of the lower end of ureter

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41
Q

Cause of a ureterocele?

A

Congenital or acquired stenosis of distal ureter

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42
Q

Complications of a ureterocele?

A

-Ureteral opening in wall of the sac is stenotic (which results in hydroureter, hydronephrosis + infection proximally)

-Ureterocele sac can obstruct bladder outlet or prolapse through urethra

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43
Q

What is commonly seen with duplex kidneys or ectopic ureters?

A

Ureteroceles

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44
Q

SF of a ureterocele?

A

-Round/oval thin walled cystic structure on posterior wall of the distal ureteral orifice
-Can change in shape + size depending on intravesical pressure
-CD of jets seen in the area

(image in slide shows echogenic ring with anechoic fluid inside on the bottom of the bladder)

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45
Q

Do ureteroceles commonly change its appearance on u/s?

A

Yes

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46
Q

Should we worry about ureteroceles if we see them?

A

No, only if pt has symptoms. It is just a cystic area filled with urine.

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47
Q

What is the urachus?

A

An embryonic tract that forms as the bladder begins its descent from the umbilicus into the pelvis in the fetus

48
Q

When does the urachus close?

A

At birth, but if not than it creates an open channel b/w the bladder + umbilicus

49
Q

Term used for a closed urachus in adults?

A

Median umbilical ligament

50
Q

What causes a urachus to form in adults + who m/c gets them?

A

Neoplasms - m/c mucinous adenocarcinoma

Men aged 50-60

51
Q

Rank the urachal variants from m/c to l/c?

A

-Patent urachus/fistula (50%)
-Urachal cyst (30%)
-Urachal sinus (15%)
-Urachal diverticulum (5%)

52
Q

What is a patent urachus/fistula + what does it cause?

A

-Completely patent/open lumen
-Causes urine to drain from umbilicus

53
Q

What is a patent urachus/fistula associated with?

A

Urethral obstruction

54
Q

What is a urachal cyst?

A

Both ends close trapping urine in canal

55
Q

CP of urachal cyst?

A

Palpable mass, fever, dysuria (painful urination)

56
Q

Complications of urachal cyst?

A

Adenocarcinoma + calculi formation

57
Q

What is a urachal sinus?

A

Urachus closes at the bladder end but not at the umbilicus end

58
Q

Complication of urachal sinus?

A

Infection

59
Q

What is urachal diverticulum?

A

Urachus closes at the umbilicus end but not at the bladder end

60
Q

SF of urachal variants?

A

-Mass or diverticulum b/w dome of bladder + umbilicus
-Can be anechoic or contain echoes

61
Q

What is cystitis?

A

Inflammation of urinary bladder

62
Q

M/c cause of cystitis?

A

E.coli

63
Q

Is cystitis m/c in men or women?

A

Women b/c we have shorter urethra + due to proximity of urethral opening to vagina and anus

64
Q

Where does cystitis m/c arise from?

A

Ascending, arising from organisms in perineal area

65
Q

RFs of cystitis?

A

-Urethral obstruction
-Rectal or vaginal fistulas
-Catheterization
-Bladder calculi
-Bladder neoplasm
-Trauma

66
Q

Symptoms of cystitis?

A

-Dark/cloudy urine
-Blood in urine
-Pain in lower tummy
-Pain/burning when urinating
-Strong urine odor
-Need to pee often
-Pain during sex
-Feeling sick/tired

67
Q

SF of cystitis?

A

Thickened bladder wall/mucosa or cystic structures along wall

68
Q

Where does bladder calculi m/c come from?

A

Kidney stones from kidneys

69
Q

RFs of bladder calculi?

A

-Increase concentration of salts in urine
-Infection of urinary tract
-Urinary tract obstruction

70
Q

Complications of bladder calculi?

A

-Obstruction
-Inflammation

71
Q

SF of bladder calculi?

A

-Echogenic foci with shadow
-Mobile (turn pt on side to assess this)

72
Q

What is bladder reflux?

A

When the UVJ valve that prevents regurgitation back into ureter is now incompetent/unable to

73
Q

What would we see on prenatal u/s with bladder reflux?

A

Hydronephrosis

74
Q

Cause of bladder reflux?

A

-Abnormal trigone ectopia/placement
-PUVs
-Paraureteric cyst
-Prune belly syndrome
-Neurogenic bladder

75
Q

What is bladder reflux associated with?

A

Contralateral (1 sided) renal abnormalities such as UPJ obstruction + duplex kidney

76
Q

Complications of bladder reflux?

A

Infection of upper urinary tract

77
Q

SF of bladder reflux?

A

-Ureteral dilatation when reflux is in progress (must assess in real time)
-CD will show urine flowing backwards into dilated ureter

78
Q

Cause of UVJ obstruction?

A

Congenital: ureterocele, ectopic ureter, ectopic ureterocele

Acquired: ureteral reimplantation procedures, infection, stones

79
Q

SF of UVJ obstruction?

A

-Megaureter
-Hydronephrosis
-Ectopic ureter (with or w/o ectopic ureterocele)

80
Q

What is a neurogenic bladder?

A

Loss of voluntary control of voiding due to disturbance in neural pathways

81
Q

Cause of neurogenic bladder?

A

Many!!!
-Neurologic disease
-Congenital anomalies
-Systemic diseases with neurologic complications
-Infection
-Trauma
-Brain + spinal neoplasms
-CNS vascula disease

82
Q

Who m/c gets neurogenic bladder?

A

Paraplegic pt’s (paralyzed lower body)

83
Q

How is the neural system involved with an underactive neurogenic bladder?

A

When the bladder accumulates urine, it does not send a signal to the neural system to inform the brain they need to urinate

84
Q

How does an overactive neurogenic bladder work?

A

Release of urine spontaneously + frequently which makes bladder become small

85
Q

Complications of neurogenic bladder?

A

-Obstruction + narrowing of urethra
-Detrusor hypertrophy (detrusor muscle contracts during urination to push urine out of bladder into urethra)
-Trabeculations/diverticula
-Vesicoureteral reflux
-Chronic reflux pyelonephritis
-Struvite stones
-Bladder debris

86
Q

SF of neurogenic bladder?

A

-Trabeculated walls
-Ureterectasis
-Vesicoureteral reflux
-Hydronephrosis
-Bladder calculi

(slide image has lots of debris in bladder)

87
Q

One of the m/c bladder u/s findings is what?

A

Bladder wall thickening

88
Q

What causes bladder rupture?

A

Severe blunt trauma (abdominal or pelvic)
or
Penetrating abdominal + perineal injury

89
Q

What can bladder rupture cause?

A

Spilling of urine into peritoneum or a urinoma

90
Q

SF of bladder rupture?

A

-Urinoma (anechoic mass, irregular borders + septa)
-Peritoneal spilling of urine (looks like ascites with possible internal echoes)
-Hematoma

91
Q

When would a thrombus within the bladder form?

A

From pathological process or trauma

92
Q

SF of bladder thrombus/blood clot?

A

-Irregular walls
-Adhered to bladder wall
-Avascular!!!

(bladder tumours will be vascular)

93
Q

What is a bladder flap?

A

Space b/w bladder + uterus

(caused from C section)

94
Q

What causes a bladder flap hematoma?

A

If hemostasis (stoppage of bleeding) is not obtained after closer of uterine incision, a hematoma can form

95
Q

3 signs of bladder flap hematoma?

A

-Fever
-Mass
-Dropping hematocrit

(if hematoma is infected the pt will have leukocytosis too)

96
Q

SF of bladder flap hematoma?

A

-Complex mass with septations, debris + poorly defined borders

97
Q

Difference b/w superficial + subfascial hematomes?

A

Superficial: anterior to rectus abdominus muscle

Subfascial: posterior to rectus abdominus muscle, in the prevesical space ventral to bladder

98
Q

How can we differentiate a bladder flap hematoma from a different kind of hematoma?

A

Is hard, the history of recent C section will help!

99
Q

Are bladder neoplasms m/c benign or malignant?

A

Malignant, suspect CA when we see solid mass in bladder

(benign ones are rare)

100
Q

Symptoms of benign bladder neoplasms?

A

-Painless hematuria
-Dysuria
-Urinary frequency
-Urgency

101
Q

SF of benign bladder neoplasms?

A

Varied appearance, they grow from bladder wall

102
Q

List benign bladder neoplasms?

A

-Papilloma
-Leimyoma
-Hemangioma
-Neurofibroma
-Fibroma
-Lipoma

(benign ones end in “oma”, malignant ones end in “sarcoma”)

103
Q

How common is bladder CA?

A

Males: 4th m/c cancer
Females: 8th m/c cancer

104
Q

Is bladder CA treatable?

A

Yes when it is in a localized stage

105
Q

Who m/c gets bladder CA?

A

Caucasian men with history of smoking

106
Q

When should we be suspicious of bladder CA?

A

If we see:
-focal wall thickening
-mass invading bladder walls or surrounding tissues

107
Q

M/c type of bladder CA?

A

TCC - transitional cell carcinoma (90%)

108
Q

Where does TCC begin?

A

In cells that make up inner lining of bladder

109
Q

RFs of TCC?

A

-Smoking
-Analgesic/drug abuse
-Industrial carcinogen exposure

110
Q

SF of TCC?

A

-Irregular VASCULAR echogenic mass
-Projects into bladder lumen from fixed location
-Polypoid (protruding) or sessile (flat)
-Possible shadowing

111
Q

Name 2 other types of bladder CA?

A

-Adenocarcinoma (2%)
-SCC, squamous cell carcinoma (5%)

112
Q

What is most aggressive bladder tumour?

A

SCC

113
Q

What 2 things is adenocarcinoma associated with?

A

-Urachal remnants
-Bladder exstrophy

114
Q

What 4 things is SCC associated with?

A

-Chronic inflammatory conditions
-Neurogenic bladder
-Stones
-Bladder schistosomiasis (infection from worms)

115
Q

Bladder metastases are m/c acquired from what?

A

Direct extension from CA of the cervix, uterus, prostate + rectum

116
Q

SF of bladder metastases?

A

Similar look on u/s as primary bladder CA

MIDS 137 (14 decks)

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