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Flashcards in Lower Urinary Tract Path (Handorf) Deck (70):
1

What are the layers of the wall of the ureter?

mucosa, muscualris, and adventitia

2

what propels the urine through the ureter?

peristaltic contractions

3

aquired strictures in the ureter are due to ..

chronic inflammation or sclerosing retroperitoneal fibrosis

4

what are the most common tumors in the ureter

mets

5

what are the most common benign primary tumors of the ureter?

fibroepithelial polyps and leiomyomas

6

what is the most common type of malignant tumor of the ureter?

transitional cell carcinoma

7

intrinsic or extrinsic cause of ureter obstruction:
neurogenic causes

intrinsic (interruption of neuronal pathways)

8

what is a the major/serious complication of chronic ureter obstruction?

hydronephrosis (which can lead to renal failure)

**due to distention of renal pelvis and increased pressure on the kidney parenchyma

9

What are causes of periureteral inflammation

salpingitis, diverticulitis, peritonitis, sclerosing retroperitoneal fibrosis

10

a fibrous proliferative inflammatory process thet encases retroperitoneal structures and causes compression of the ureter

sclerosing retroperitoneal fibrosis

11

what are the causes of sclerosing retroperitoneal fibrosis

unknown (70%)
drugs
chron's dz
malignancy (lymphoma and urinary tract carcinoma)

12

ectopic endometrium is...

endometriosis

13

is the endometrial tissue in endometriosis functional?

yes

14

how can endometriosis lead to ureter obstruction?

hormones --> proliferation --> bleeding --> scarring --> compression of uretrer

15

what are 2 outcomes of chronic ureteritis

ureteritis folliculitis and ureteritis cystica

16

gross difference between ureteritis folliculitis and ureteritis cystica

ureteritis folliculitis = fine granularity on mucosal surface

ureteritis cystica = cysts on mucosal surface

17

produced by the accumulation of lymphocytes in the subepithelial region of the ureter in response to chronic inflammation

ureteritis folliculitis

18

male infant with hydronephrosis on the left side

uteropelvic junction obstruction

19

what is the pathophys of uteropelvic junction obstruction

abnormal organization and/or excess STROMAL deposition of COLLAGEN between smooth muscle bundles

20

saccular outpouchings of ureteral wall

diverticula

21

etiology of diverticula

congenital or due to increased pressure secondary to obstruction

22

what is the complication most assc with diverticula?

pockets of stasis = infection

23

congenital anomalies of the ureter

double/bifricated ureters, uteropelvic junction obstruction

24

describe the changes that occur in the bladder with chronic obstruction

increased pressure → hypertrophy → trabeculation → crypts form → diverticula → pyelonephritis or hydronephrosis

25

congenital cause of bladder diverticuIi

focal muscular defect

26

most common aquired cause of bladder diverticuIi

urethral obstruction

27

developmental defect of the closure of the anterior wall of the abdomen and the bladder

exstrophy
*i.e. the bladder communicates with the exterior of the body

28

vestigial structure that located between the apex of the bladder and the umbilicus and connected the bladder to the allantois

urachus

29

result of a totally patent urachus

fistulous urinary tract

30

result of a urachus with only the center obliterated

diverticulum (infections)

31

result of a urachus with only the center persists

urachal cyst --> adenocarcinoma

32

describe the pathogenesis of a cystocele

relaxation of the pelvic support (usually old age/trauma from childbirth) → uterine prolapse → bladder floor pulled downward into vagina = cystocele

33

congenital cause of vesicoureteral reflux

defect in the intravesical portion of the ureter such that there is no longer an oblique connection
**without the oblique connection the bladder musculature cannot act like a sphincter

34

how does vesicoureteral reflux present?

baby with lots of UTIs, pylonephrosis, or hydronephrosis

35

orgs that commonly cause cystitis

E coli, proteus, klebsiella, enterobacter
**presents like a UTI

36

seen in exudate of acute cystitis

neutrophils
*these predominate

37

seen in the exudate of chronic cystitis

lymphocytes, plasma cells, macrophages
*these predominate

38

non-infectious cuases of cystitis

radiation, chemo, trauma

39

lymphoid follicles are formed in the bladder mucosa in ...

follicular cystitis (a form of chronic cystitis)

40

foamy macropahges (PAS +) and michaelis-gutmann bodies

malakoplakia

41

what is the etiology/pathogenesis of malakoplakia

defective host response to bacterial infection

42

middle aged woman
suprapubic pain, uirnary frequency, urgency, and hematuria, without evidence of bacterial infection

interstitial cystitis

43

related to cystitis cystica and is due to chronic inflammation of the bladder

cystitis glandularis

44

90% of bladder tumors originate from

urothelium (transitional epithelium)

45

inflammation and fibrosis of all layers of the bladder wall +/- localized mucosal ulcers (Hunner ulcers)

interstitial cystitis

46

may predispose people to adenocarcinom

cystitis glandularis
exstrophy
urachal remnant

47

morphologic patterns of urothelial bladder tumors

papillary and flat

48

what areas of the bladder do most cancers arise? consequence of this?

lateral and posterior walls at the base --> commonly causes ureteral obstruction

49

risk factors for bladder carcinomas

aniline dyes
smoking
cylophosphamide
phenacetin
schistosomiasis

50

presenting symptoms of bladder carcinoma

painless hematuria
+/- frequency, urgency and dysruia

51

where do bladder carcinomas invade?

bladder wall, prostate, seminal vesicles, ureters, retroperitoneum,
**may produce fistuals to the vagina or rectum

52

where do bladder carcinomas metastasize to?

regional LN, liver, lungs, bone marrow
*heme spread

53

what tends to happen to urothelial tumors after they are removed?

new ones develop and these are typically at a higher grade

54

in general, the higher the grade of the urothelial tumor, the

higher the chance of reoccurance

55

assc with schistosomiasis and chronic irriation (i.e. calculi)

squamous cell carcinoma of the bladder

56

where to squamous cell carcinomas of the bladder tend to airse?

trigone

57

what morphology do squamous cell carcinomas of the bladder commonly have

fungating and invasive

58

focal glandualr changes with mucin production

adenocarcimona

59

adenocarcimona common morphology

solitary and deeply invasive (may ulcerate in center)

60

non-smoker, egyption immigrant with bladder cancer most likely has

squamous cell carcinomas of the bladder

61

benign bladder neoplasms

leiomyoma
hemangioma
granular cell tumor
neurofibroma

62

schistosoma hematobium

squamous cell carcinomas of the bladder

63

malignant mesenchymal bladder neoplasms

rhabdomyosarcoma
leiomyosarcoma
**sarcomas

64

grape like projections into lumen of bladder in an infant or child

embryonal rhabdomyosarcoma (sarcoma botryoides)

65

arthritis + conjunctivitis + urethritis

reiter syndrome

66

structure of the urethra is due to ... and causes...

due to chronic urethritis and can cause outflow obstruction

67

small, red, painful, friable mass about the external urethral meatus in a female pt

urethral caruncle

68

histo of urethral caruncle

leukocytes + fibrous CT (vascularized)

69

tumor at the external meatus of the urethra and has a viral origin

papilloma

70

____ carcinomas occur in the urethra (typically at the external meatus)

squamous cell