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CRRAB II- Week 2 > Tworney- Bladder Disease > Flashcards

Tworney- Bladder Disease Flashcards

(58 cards)

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1
Q

What are diverticular?

A

d/t bladder outlet obstruction (stasis, infection, calculi)

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2
Q

What is a patent urachus/urachal cyst?

A

persistent allantoic duct located in the dome of the bladder if the allantoic duct doesn’t close

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3
Q

What does vesicoureteral reflux cause?

A

pyelonephritis

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4
Q

What is exstrophy?

A

failure of closure of anterior abdominal wall–ureters drain into air, malformed genitals

chronic infections, adenocarcinoma

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5
Q

What causes trabeculated muscular hypertrophy 99% of the time?

A

BPH

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6
Q

What conditions predispose to bladder inflammation/infx?

A 
extrophy
urethral obstruction
fistula- GI or uterus
catheter
cystocele- prolapse from pregnancy
calculi
neoplasm
trauma
diabetes
pyelonephritis
pregnancy
neurogenic (never empty fully)
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7
Q

What is a cystocele?

A

Prolapsed bladder

MCC= pregnancy, also age

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8
Q

What is the triad for cystitis?

A

frequency
pain
dysuria

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9
Q

What are systemic signs of cystitis?

A

fever
chills
malaise
mentation changes (elderly)

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10
Q

What are the MCC of fistula from rectum into bladder?

A

Chron’s disease–> deep ulcerations in colon> extend through wall of colon> into bladder

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11
Q

What are infectious causes of cystitis?

A

Bacterial- e. coli, proteus, enterococcus

fungal- candida, cryptococcus, immunosuppressed, chronic abx use

Younger/sexually active: chlamydia, mycoplasma

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12
Q

What are non infectious causes of cystitis?

A 
radiation
chemo agents (cyclophosphamide)
interstitial cystitis (hunner ulcer)
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13
Q

What is seen histologically w/ acute cystitis?

A

PMN’s hyperemia
suppurative exudate

NEUTROPHILS and pus

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14
Q

What is seen histologically w/ chronic cystitis

A

Lymphocytes

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15
Q

What causes hemorrhagic cystitis?

A

radiation/chemo

adenovirus

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16
Q

What causes interstitial cystitis? What is it?

A

Autoimmune? May be associated w/ SLE

F>M

Persistent and painful
full thickness inflammation and fibrosis
culture negative

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17
Q

What is malacoplakia?

A

see soft raised yellow plaques in surface of mucosa

histologically see lymphocytes, foamy macrophages

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18
Q

What goes with malacoplakia?

A

michaelis gutman bodies

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19
Q

What causes malacoplakia?

A

e coli
proteus

Kidney, prostate, lungs, colon

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20
Q

What makes up the majority of bladder cancers in the US?

A

*Transitional cell carcinoma

Sq cell
adeno
sarcoma

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21
Q

What is the incidence of TCC?

A

90% w/ incidence rising

4-10% of all cancers

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22
Q

What is the typical demo fro bladder cancer?

A

50-80
M:F 3:1
Urban> rural

*smoking

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23
Q

How is TCC a “field effect” cancer?

A

You’ll usually see multiple cancers in multiple locations. Anywhere there is urothelium–you predispose entire lining to cancer.

**bladder cancer pts often have more than one tumor

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24
Q

What is the most common TCC?

Study These Flashcards
A

Villous tumor

25
What are the most serious TCC?
Sessile infiltrating carcinoma--> progress to metasteses
26
What is urine cytology a good screening test for?
High grade tumors
27
What architecture do you normally see w/ bladder cancer?
Papillary projections
28
What is the primary cause of bladder cancer?
tobacco use (50-80% of all cancers)
29
What are other causes of bladder cancer?
Aromatic amines/azo dye (aniline dye)--> no longer used Chronic schistosomiasis- S. haemotobium Long term analgesic use--> no longer used Long term cytoxan exposure (breast cancer and AI diseases) saccharin--sweetener that in high doses causes bladder cancer
30
What are the clinical fxs of bladder cancer?
gross hematuria--large amts of blood in urine frequency/dysuria
31
Unexplained gross hematuria in patient greater than 40 is assumed to be what until proven otherwise?
Bladder cancer
32
If you have a UA that shows blood on the dibstick and micro-casts, rbc?
glomerular bleeding (KIDNEY)
33
What if you see blood on the dipstick but no casts micro?
RBC cytoplasm substance but no intact red cells is a sign of HEMOLYSIS
34
What happens if you see dipstick blood and RBCs?
Could be cancer, sign of something below the kidney. Then to a cystoourethroscopy to find out what's going on.
35
What is urine cytology best for?
high grade 90% sensitivity
36
How do you evaluate upper tracts?
IVP or helical CT
37
How do you determine prognosis w/ bladder cancer?
By stage
38
What stage has a long term survival?
Ta (limited to muscoa)
39
Why are TIS more serious?
higher grade and more likely to form invasive mass
40
When does a tumor get a T2 grade?
invades muscle layer
41
When does a tumor get a T3 grade?
invades perivesical fat
42
When does a tumor get a T4 grade?
adjacent strctures
43
When does a tumor get a M1 grade?
distan metatstases
44
When does a tumor get a N1-3 grade?
dependent on size 3 is >5 cm
45
What does pt age tell you with bladder cancer?
low grade in young pts but are at risk longer
46
How does tumor cell DNA content relate to prognosis of bladder cancer?
polyploid/aneuploid content is an adverse factor aneuploidy correlates w/ higher grade/higher stage
47
What is common tx for low stage?
TURBT fulguration Intravesicular BCG--weekly for 6 wks
48
What is tx for high stage T2/T3?
cystectomy w/ node dissection | little benefit form post-surgical chemoa
49
What is treatment for T2, T3 or metastatic?
1. Chemo | 2. Radiation (not a strong role)
50
Should you screen for bladder cancer?
no
51
What is surveillance like for bladder cancer?
Recommend urine cytology and cystoscopy 3 months after TURBT with or without BCG Periodic screening thereafter 3-6 month intervals
52
Where do you see sq cell carcinoma?
east coast of africa schistosoma--org comes out of snail, penetrates skin, gets in venous circulation and sets up in portal circulation, where the parasites deposit egss in wall of bladder
53
What are the two types of urethral infections?
gonococcal nongonococcal
54
What causes gonococcal? What are the sxs?
Neisseria gonorrhea One of earliest manifestations Pain, itch, frequency need to get to right away--can be destructive
55
What causes non-gonococcal? sxs?
E. coli + other enterics Chlamydia M>F Pain, itch, frequency
56
What is a benign caruncle?
Females Red painful mass 1-2cm At urethral meatus
57
What are benign papillomas?
At meatus | HPV related
58
What causes malignant urethral neoplasms?
sq cell carcinioma in elderly women

CRRAB II- Week 2 (9 decks)

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