LUT Flashcards
(132 cards)
0
Q
normal epithelium thickness from calices to urethra
A
4-8
1
Q
normal lining epithelium
A
transitional or urothelial epithelium
2
Q
anatomical layers of ureter
A
transitional epithelium with umbrella cells
lamina propria
muscularis
adventitia
3
Q
most likely places to have ureteral constriction just from gross anatomy alone
A
uteropelvic junction in the renal hilum
pelvic brim near the bifurcation of iliacarteries
as it enters the bladder in the ureterovesical valve
4
Q
interchangeably called the lamina propria
A
bladder submucosa
5
Q
where would the membranous urethra be?
A
passes through the external urethral sphincter, narrowest part
6
Q
where would the spongy urethra be?
A
aka penile urethra
along the length of the penis on its ventral surface
7
Q
there are very few _____diseases but my ____ of the LUT
A
degenerative
anomalies
8
Q
congenital anomalies of the ureter
A
double and bifid ureters
uretero-pelvic junction obstruction
diverticula
hydroureter
9
Q
totally distinct double renal pelves or with a large kidney having partially bifid pelvis terminating in separate ureters
A
double and bifid ureters
10
Q
results in hydronephrosis
A
ureteropelvic obstruction
11
Q
ureteropelvic obstruction usually affects
A
children esp boys
*in adults, women, unilateral
12
Q
pathogenesis of UPJ obstruction
A
disorganized proliferation of smooth muscles at the UPJ and excess stromal deposition of collagen between smooth muscle bundles
or
excess stromal deposition of collagen between smooth muscle bundles
or rarely due
to congenitally extrinsic compression bu polar renal vessels
13
Q
congenital or acquired saccular outpouching of the ureteral wall
A
diverticula
14
Q
ureter diverticula are prone to have
A
pockets of stasis
secondary infection
15
Q
marked dilatation of the ureter with accompanying hydronephrosis
A
hydroureter
16
Q
massive enlargement of ureter due to functional defect in the ureteral muscle
A
megaloureter
17
Q
usual cause of ureteritis
A
inflammation of the entire LUT secondary to obstruction
18
Q
accumulation of lymphocytes forming germinal centers in the subepithelial region that may cause slight elevations of the mucosa and produce a fine granular mucosal surface
A
ureteritis follicularis
19
Q
ureteral counterpart of cystitis cystica
little mucosal cyst line by columnar epithelium not transitional
A
ureteritis cystica
20
Q
not clinicallly significant in obstructive lesions
A
ureteral dilatation
21
Q
obstructive lesions give rise to
A
hydroureter
hydronephrosis
sometimes pyelonephritis
22
Q
unilateral obstruction typically results from
A
proximal cause
23
Q
bilateral obstruction arises fro
A
distal causes such as nodular hyperplasia of the prostate
24
intrinsic types of obstruction
```
calculi
strictures
tumors
blood clots
neurogenic
```
25
extrinsic types of obstruction
pregnancy
periureteral inflammation
endometriosis
tumors
26
Of renal origin
calculi
27
congenital or acquired cause of obstruction
strictures
28
blood clots come frome
massive hematuria from renal calculi, tumors, or papillary necrosis
29
uncommon cause of ureteral narrowing characterized by a fibrous proliferative inflammatory process encasing the retoperitoneal structures causing hydronephrosis
sclerosing retroperitoneal fibrosis
30
sclerosing retroperitoneal fibrosis occurs
middle to late age
31
microscopic features of sclerosing retroperitoneal fibrosis
prominent infiltrate of lymphocyte, often with germinal centers, plasma cells, and eosinophils
32
treatment for sclerosing retroperitoneal fibrosis
surgical extrication of ureters from the surrounding fibrous tissue aka ureterolysis
33
70% cause of sclerosing retroperitoneal fibrosis
idiopathic
34
general retroperitonal fibrosis
ormond disease
35
drugs causing sclerosing retroperitoneal fibrosis
ergot derivatives
| beta blockers
36
retroperitoneal inflammatory conditions causingsclerosing retroperitoneal fibrosis
vasculitis
diverticulitis
Chron's disease
37
benign tumors of the ureters originate from the
mesenchyme
38
often in children
| tumorlike lesion that grossly presents as a small mass projecting into the lumen
fibroepithelial polyp
39
fibroepithelial polyp is composed of
loose vascularized CT mass lying beneath the mucosea
| blood vessels are dilated
40
localized mass consisting of spindle-shaped lesions
leiomyoma
41
majority of malignant ureteral tumors are
urothelial carcinomas
42
malignant ureteral tumors resemble those arising from
renal pelives
calyces
bladder
43
malignant ureteral tumors happen
at the 6-7th decade of life
44
urethelial carcinoma aka
transitional cell carcinoma
45
gross TCC
irregular, exophytic lesion
46
histo TCC
abnormal capillary proliferation
| dilated and obstructed ureteral lumen
47
in the lower urinary tract all of the papillary tumors are
TRANSITIONAL or urothelial in origin
not adenoca
48
congenital anomalies of the urinary bladder
```
diverticula
exstrophy
vesicoureteral reflux
persisten urachus
fistulas
```
49
pouchlike evagination of the bladder wall
diverticula
50
congenital form of diverticula cause
focal failure of development of the normal musculature or obstruction during development
51
acquired form - more common- cause
result of increased intrevesical pressure often seen in prostatic enlargement by hyperplasia or neoplasia
52
clinically significant diverticula constitute sites of urinary stasis resulting to
infection
| formation of bladder calculi
53
developmental failure in the anterior wall of the abdomen and the bladder
exstrophy
54
exposed bladder mucosa in exstrophy predispose to
glandular metaplasia
| infection
55
arising in the bladder remnant, exstrophy increases risk of
adeno CA
56
prognosis of exstrophy
surgical tx ➡️long term survival
57
most common and serious anomaly in children
vesicoureteral reflux
58
VUR leads to
chronic pyelonephritis
| hydronephrosis
59
canal that connects the fetal bladder with the allantois
urachus
60
totally patent urachus
fistulous urinary tract is created that connects the bladder with the umbilicus
61
only the central urachus persists giving rise to
urachal cysts
62
urachal cysts can lead to
glandular carcinomas
63
urachus proximal to umbilicus
urachal sinus
64
urachus proximal to bladder
urachal diverticulum
65
common etiologic agents of cysitis
E coli
Proteus
Klebsiella
Enterobacter
66
other forms of cystitis
TB
candida albicans, cryptococcus
schistosoma haematobium
viruses
67
clinical manifestations of cystitis
urinary frequency
hypogastric or lower abdominal pain
dysuria
68
good for urinary tract infections
cranberries
69
predisposing factors of cystitis
```
bladder calculi
urinary obstruction
DM
instrumentation
immune deficiency
```
70
nonspecific form of cystitis
hyperemia of the mucosa and edema of the stroma sometimes exudates
71
hemorrhagic cystitis cause
cytotoxic antitumor drugs- cyclophosphamide
| adenovirus infection
72
aggregation of lymphocytes into lymphoid follicle within the bladder mucosa and underlying wall
follicular cystitis
73
typically represents nonspecific subacute inflammation
| rarely a manifestation of a systemic allergic disorder
eosinophilic cystitis
74
resulting from irritation of bladder mucosa- long term catheterization
polypoid cystitis
75
interstitial cystitis aka
chronic pelvic pain syndrome
| Hunner's cystitis
76
clinnical manifestation of interstitial cystitis
intermittent of often severe suprapubic pain
urinary frequency
urgency
hematuria
dysuria with no evidence of bacterial infection
77
histo interstitial cystitis
fissures and punctate hemorrhages - glomerulations in the bladder mucosa after luminal distention
78
some patients in the late, classic, ulcerative phase of interstitial cystitis show morphologic features
chronic mucosal ulcers or Hunner's ulcers
79
gross feature of malacoplakia
soft, yellow slightly raised mucosal plaques
80
histo malacoplakia
large foamy macrophages mixed with occasional multinucleated giant cells and interspersed lymphocytes
81
macrophages in malacoplakia
have abundant granular cytoplasm due to phagosomes stuffed with particulate and membranous debris of bacterial origin
82
defect in malacoplakia
dysfunctional phagocytosis of macrophages
83
malacoplakia occurs in
immunosuppressed patients
84
present within macrophages in malacoplakia resulting form deposition of calcium in enlarge lysosomes, seen better in PAS stain
Michaelis-Gutmann bodies
85
nests of urothelium grow downward into the lamina propria
Brunn nests
86
Brunn nests undergo transformation of their epithelial cells into cuboidal columnar epithelium
cystitis glandularis
87
Brunn nests undergo transformation into cystic spaces filled with clear fluid lined by flattened urothelium
cystitis cystica
88
a variant of cystitis glandularis with goblet cells and intestinal mucosa like lining
intestinal or colonic metaplasia
89
not associated with an increased risk of adenoCA
lesions showing extensive intestinal metaplasia
90
a response to schistosome infections of the bladder- bilharziasis
squamous metaplasia
91
about 95% of bladder tumors are of
epithelial origin
92
most common neoplasm
transitional cell carcinoma of the bladder
93
TCC of the bladder run from
gamut from the small benign lesions that may never recur to aggressive cancers associated with high risk of death
94
TCC of the bladder tend to be
multifocal
95
two primary precursor lesions of TCC bladder
non invasive papillary tumors
96
usually comes from subsequent hyperplasia of papillary urothelial cells with better prognosis
non invasive papillary tumor of the bladder
97
more aggressive TCC of the bladder
flat urothelial carcinoma or carcinomoa in situ
98
the general rule in urothelial tumors
all papillary tumors of the bladder are regarded as cancers or potentially cancer
99
most papillary tumors are
low grade
100
urothelial papilloma is a benign lesion usually seen in
younger px
101
urothelial papillomas are typically seen as
singular nodules that are attached to the mucosa
102
the core of the fingerlike papillae
has loose fibrovascular tissue covered with epithelial cells similar to transitional epithelium
103
histo of urothelial papilloma
```
uniform nuclei
maintained polarity
normal mitotic figures
papilloma does not extend 7 layers
rapidly proliferating
```
104
same as urothelial papilloma but exceeds 7 layers (10) with rare mitotic figures
papillary urothelial neoplasm of low malignant potential
105
papillary urothelial neoplasm of low malignant potential prognosis
low rate of recurrence
106
minimal but definite signs of nuclear atypia that displays scattered hyperchromatic nuclei, infrequent mitotic figures that are found at the base , mild nuclear size and shape variations
low grade papillary urothelial carcinomas
107
dycohesive large hyperchromatic nuclei
frequent mitotic figures
invades the muscular layer
high grade papillary urothelial carcinoma
108
carcinoma grossly seen as reddening and thickening of mucosa
multifocal
ureters and urethra
flat urothelial CA
109
flat urothelial carcinoma leads to
invasive urothelial carcinoma
110
invasive urothelial CA is associated with
CIS
| high grade papillary urothelial CA
111
invasive urothelial CA invades the
muscularis mucosae and propria
112
TCC epidemiology
50-60
| male
113
genetic features of papillary tumors
deletions in chromosome 9
114
invasive, high grade tumors genetic feature
del in chromosome 17
115
risk factors of TCC
```
smoking
arylamines exposure
schistosoma
chronic usage of analgesics
cyclophosphamide
radiation
```
116
Ta staging
non invasive papillary tumor
117
Tis staging
carcinoma in situ
118
T1 staging
lamina propria invaded
119
T2 staging
muscularis propria invaded
120
T 3a staging
microscopically beyond luminal wall
121
T3b staging
gross protuberance beyond the luminal wall
122
T4 staging
invasion of adjacent structures
123
most common cause of urinary bladder obstruction in women
cystocele
124
most common urinary bladder obstruction cause
prostate gland enlargement
125
clinical triad or arthritis, conjunctivits and urethritis
Reiter syndrome
126
urethritis classification
gonococcal
| nongonococcal- E coli, Chlamydia, Mycoplasma
127
originate from the posterior lip of the urethra
fleshy outgrowths of distal urethral mucosa
small, red, painful mass
uretheral caruncle
128
cause of uretheral caruncle
distal uretheral prolapse
| estrogen withdrawal
129
benign neoplasms of urethra
squamous
urothelial papillomas
inverted urothelial papillomas
condyloma
130
urothelial CA. within the proximal urethra show
urothelial
| urothelial differentiation analogous to those within the bladder
131
urothelial CA distal urethra
squamous CA
