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P&T Block 5 Renal > L60 > Flashcards

Flashcards in L60 Deck (30)
1

What is a diverticuli + associated complications?

Outpouching of bladder wall
Complications:
1. Urinary statis -> infection + stones
2. Reflux
3. Malignancy

2

Describe congenital vs acquired diverticuli

Congenital: didn't develop normal muscle in bladder wall, *single*
vs
Acquired: obstruction (prostate enlargement) -> muscle thickening, *multiple*

3

What is exstrophy? Complications + surg

Fail to develop ant wall abdomen
Bladder connects to exterior
Complications: infection (duh), adenocarcinoma
Treat: surg

4

What is vesi-cou-reteral reflux? Congenital vs acquired causes

Reflux of urine from bladder into ureters
Congenital: shorten the part of the ureter in the bladder (doesn't compress when you pee)
vs
Acquired: bladder atony aka no bladder tone to create urine directionality (spinal cord injury)

5

Complication of vesicoureteral reflux

Pyelo - duh
Renal scarring

6

3 structural abnormalities of the ureter

Double
Bifid
Ureteropelvic jxn (where ureter connects to the kidney) obstruction - congenital, *most common cause hydronephrosis in kids

7

What is cystitis? Common causes

Bladder infection
Bacteria: EColi, enterobacteria
Fungal: IC pts
Schistosoma haematobium
Anti-cancer drugs/radiation

8

Gross vs microscopic appearance of cystitis

Red bladder
Micro: inflam cells in bladder epithelium
Acute = neutrophils
Chronic = lymphocytes + plasma cells, maybe cysts of these cells

9

What type of disease is interstitial cystitis? M vs W. Treat?

Chronic cystitis
Freq pee, nocturia, urgency, pubic pain or pressure relieved by peeing
W > M
Difficult to treat

10

Histo for interstitial cystitis

Edema in submucosa
Maybe punctate hemorrhages
Hunner's ulcer (classic)

11

What is malacoplakia?

Mass lesion in bladder or kidney: raised yellow plaques
Due to chronic infection - EColi maybe proteus
Aka common in IC pts

12

Malacoplakia histo

Foamy macrophages (lipid inside)
Michaelis Gutmann bodies = Ca phosphate inclusions

13

What is polypoid cystitis?

Inflam lesion of bladder due to irritation (indwelling catheter)
Don't confuse for urothelial carcinoma

14

Polypoid cystitis histo

Broad, edema polypoid projections
Vs urothelial neoplasm = narrow

15

Urothelial cancer:
M vs W
Name top risk factors

M > W
SMOKING!!!!
Aniline dyes
Chronic irritation: chronic cystitis, diverticula, parasites
Analgesic abuse

16

How does urothelial carcinoma recur?

Original resected tumor doesn't come back
The entire urothelium has increased chance of cancer
Different tumor, new location

17

What are the types of flat urothelial neoplasms lesions you might see?

Flat lesions are either benign (low grade) or carcinoma in situ (high grade + confined to mucosa)
If goes past mucosa = invasive carcinoma

18

What are the types of papillary urothelial neoplasms?

Papilloma = no chance recur, *young pts*
PUNLMP
Papillary carcinoma, low or high grade

19

Histo of papillary urothelial cancers

Thin papillae (vs polypoid cystits)
W/ fibrovasc cores

20

What is a PUNLMP? Histo

Papillary urothelial neoplasm of low malignant potential
- Thick epithelium w/o atypia
- No invasion
- Potential to recur

21

Histo of low grade papillary urothelial carcinoma

Uniform nuclei
Scattered mitoses
Recur commonly but rarely invade

22

Histo high grade papillary urothelial carcinoma

Many mitoses
Disordered cells
Dyscohesive cells
Invade stroma, mets possible

23

Histo invasive urothelial carcinoma

Papillary or flat - once invade grouped together as invasive
Penetrate basement membrane -> into LP
See stromal nests

24

How do you stage urothelial cancer?

Invasion and if mets

25

Test q: the difference between which 2 stages of urothelial cancer determines treatment and thus prognosis?

T1 = invade LP
T2 = invade MP, here you're going a partial or complete cystectomy
After T2 - all bad, treat same as T2

26

Treat urothelial cancer

Resect: T1 vs T2
Topical: BCG or intravesicle chemo
Systemic chemo for high stage

27

Symptoms of urothelial cancer

Hematuria
"Elderly male w/ 1 episode hematuria"

28

Dx urothelial cancer

Urine cytology + cytoscopy
Both will find any evidence of flat or pap tumors

29

What cancer does schistosoma hematobium give you?

Bladder SCC
Look for keratin pearls or eggs

30

Bladder tumor in kids

Rhabdo-myo-sarcoma