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Year 3 Pathology > Urinary 4, 5 and Practical > Flashcards

Urinary 4, 5 and Practical Flashcards

1
Q

What are the different forms of cystitis?

A

Acute- catarrhal, haemorrhagic, necrotic

Chronic- polypoid, follicular, metaplastic

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2
Q

What factors influence cystitis occurence?

A

Protective factors-

  • Frequent voiding
  • Urethral sphincters
  • Chemical features- low pH, urea, osmolatiry
  • Secretory IgA and mucin

Predisposing factors

  • Urine stasis
  • Incomplete voiding
  • Trauma
  • Glycosuria
  • Dilute urine or high pH
  • Short of wide urethra
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3
Q

What agents can cause cystitis?

A

Often intestinal flora

E.coli
Proteus
Strep/ staph
C. renale (cattle)
E. suis (pigs)

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4
Q

What toxic disease primarily affects cattle LUT?

Where is the toxin found that causes the disease?

What does it cause and where are lesions usually found?

A

Enzoonotic haematuria- occasionally sheep

Bracken-associared toxins (quercetin)

  • Leads to hyperplasia/metaplasia with haemorrhagic cystitis and haematuria
  • Chronic squamous or mucous metaplasia
  • Leads to dysplasia to predisposition for malignant transformation

Lesions found at the trigone- neck of bladder- constant urine contact

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5
Q

Why does enzootic haematuria cause haematuria and what other symptoms does it cause?

A

Haematuria as tumours ulcerate and bleed into lumen

Causes:

Chronic weight loss
Epithelial or mesenchymal neoplasms

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6
Q

Where is neoplastic disease usually found in the LUT?

What species are predisposed?

A

Mostly within bladder

Dogs, cats, Cattle

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7
Q

What different mesenchymal neoplasms can form in the LUT?

A

Leiomyoma or leiomyosarcoma- smooth muscle

Fibroma or fibrosarcoma

Rhabdomyosarcoma- striated muscle (urethral sphincter)
Infiltratvie and metastatic

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8
Q

What primary epithelial neoplasms can form in the LUT?

A

Transitional cell papilloma

Squamous cell carcinoma- nodular, ulcerated, invasive

Trasnsitional cell carcinoma- nodule or plaque

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9
Q

What species and signalment do bladder transitional cell carcinomas affect?

A

Dogs- primarily older dogs, neutered dogs, airdale, beagle, scottie

Primarily at trigone

Frequent metastatic spread to:

Lung, lymph nodes, pelvic bones, transperitoneal if spread

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10
Q

How can secondary neoplasia form in the LUT?

A

Occasional site of metastases

Local obstruction of LUT

Local invasion- repro

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11
Q

What do the following terms mean?:

  • Dysuria
  • Haematuria
  • Anuria
  • Oliguria
  • Polyuria
  • Polydipsia
  • Hypovolaemia
  • Isothenuria
  • Hyposthenuria
  • Azotaemia
  • Uraemia
A
  • Dysuria- painful or difficult urination
  • Haematuria- blood in urine
  • Anuria- no urine output
  • Oliguria- low urine output
  • Polyuria- high urine output
  • Polydipsia- high water consumption
  • Hypovolaemia- low blood pressure
  • Isothenuria- cannot concentrate/dilute
  • Hyposthenuria- low specific gravity
  • Azotaemia- higher then normal blood level of urea/nitrogen
  • Uraemia- urea in blood- toxicosis of renal failure
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12
Q

What is renal failure?

What are the three critical requirments for renal function?

A

Progressive loss of renal function

Adequate renal blood flow- generates filtrate, supplies O2

Sufficient functional nephrons

Unimpaired drainage/expulsion of continuois urinary output

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13
Q

What are the three categories of renal failure and briefly describe them?

A

Pre-renal- inadequate blood flow

Renal- intrinsic- inflammation, neoplasia

Post-renal- LUT obstruction, inflammation

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14
Q

What can cause inadequate blood flow to the kidneys for pre-renal failure?

A
  • Haemorrhage
  • Shock
  • Cardiac failure
  • Trauma

Parenchyma initially undamaged and if blood flow restored reversible
Rapidly progressed to intrinsic with ishaemia

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15
Q

When is the urinary ststem in reserve, insufcient and failing?

A

Reserve- Upto 50% capacity

Insufficiency- 30-50% capacity remains

Failure- below 30% capacity

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16
Q

What is acute renal failure?

What are the signs?

What is the prognosis?

A

Sudden loss of 70-100% of capacity

Anuria or oliguria, isothenuric urine

Potentially reversible depending on speed of reversal

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17
Q

What is chronic renal failure?

What are the symptoms?

A

Gradual loss of renal capacity

Polyuria with secondary polydipsia and Hyposthenuria

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18
Q

What are the effects of chronic renal failure?

What causes death?

A

Build up of waste products
Failure of acid-base regulation
Failure of fluid volume regulation
Electrolyte disturbances
Endocrine disturbances

Death due to
Dehydration, acidosis, hyperkalaemia, pulmonary oedeama, hypocalcaemia

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19
Q

What is the difference between azotaemia and uraemia?

What are the clinical signs of uraemic toxicosis?

What types of lesions formed from Uraemia?

A

Azotaemia- biochemical finding of increased urea and creatinine
Uraemia- clinical syndrome of azotaemia

PU/PD, Pallor, Anorexia, Weakness, Muscle wasting, Mouth ulcers, Vomiting, Non-regen anaemia, Skeletal softening, renal pain

Causative lesion- primary disease process (pre/renal/post-renal)

Resultant lesinos- secondary to CRF

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20
Q

What are some secondary problems of uraemia?

A
  • Cachexia- chronic weight loss
  • Pulmonary oedema- toxaemia damaged endothelium
  • GIT ulceration- uraemic vasculitis- necrosis and mucosa sloughing
  • Fibrinous pericarditis- uraemia causes endothelial damage
  • Thrombosis- loss of anti-thrombin III
  • Pulmonary mineralisation- deposition of calcium
  • Non-regen anaemia- reduced eryhtropoietin production
  • Hyperparathyroidism- phosphate retention- rubber jaw
  • Hypertension- renin released from reduced renal blood flow, RAAS
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21
Q

What additions may be found in the urinary system?

A

Inflammatory cells/leucocytes

Fibroblasts

Tumour cells

Exudate/oedema

Aetiological agents

22
Q
A

The renal medulla is diffusely discoloured creamy white in radiating bands

The cortex has a yellow brown colour and appears soft in consistency

23
Q

Describe changes to:

glomeruli (1)

Tubules (4)

A

Glomeruli- intact

Tubules-
Epithelium is vacuolated and necrotising
Lumen contains debris and basophilic to eosinophilic contents

24
Q

Describe lumen contents?

What is your morphological diagnosis?

A

20% tubules contain colourless crystals in tubule lumen with necrotic epithelium

Ethylene glycol toxicity

25
Give a morphological diagnosis?
Kidney: diffusely, the renal pelvis is moderate to severely dilated (hydronephrosis) by 5 multifocal tan to light brown polygranular irregular deposits (uroliths) and clear space. The immediately adjacent pelvic/medullary tissue is pale tan and has multifocal red patches (haemorrhage). The pale tan discolouration extends throughout the kidney. Consistency is expected to be more firm than normal.
26
Describe histological changes?
Multifocal basophilic nodules in procimal medulla Bands on radiating congestion and leucocyte infiltration
27
Describe the histological lesions?
Multifocal to coalescing areas of the cortex shows infiltration by leucocytes and dilation of some tubules with eosoinophilic fluid
28
Describe the histological lesions? Give a morpholigical diagnosis?
Glomeruli detail has been multifocally replaced by eosinophilic material(fibrosis or necrosis). Theres is a moderate infiltration of lymphocytes and plasma cells. Tubules are dilated by protinaceous (eosinophilic) fluid MD- Severe chronic MF necrotising pyelonephritis with calculi
29
There are multifocal ~1mm diameter cream coloured firm raised nodules throughout the cortical surface (and presumably extending into the renal parenchyma)
30
Describe changes to the cortex
Multifocal to coalescing interstitial nodules- distending cortical surface
31
Describe changes: Left Middle Right
Left- Normal Middle- flattened/pressure atrophy of tubules Right- disordered. Necrotic foci with infiltrating macrophages and lymphocytes
32
1. What types of inflammatory cells are visible? 2. Other changes? 3. Aetiology?
1. Macrophages, plasma cells, lymphocytes 2. Central necrosis- liquefactive 3. Ascarid migration with secondary granulomatous nephritis Myobacteriosis (less likely)
33
Give a gross description
Kidney- Diffusely, across the entire cortical surface and also extending down into the medulla, there are multiple raised nodules approx 2- 3mm diameter, separated by grey white strands of material (fibrosis). The overall renal coloration is diffuse pale tan. Tissue consistency is expected to be firm
34
Describe the capsular surface What are the tubular changes?
Widespread undulation Diffusely dilated tubules
35
Describe more features visible on tubules? And interstitium?
Dilation with eosinophilic (proteinaceous) fluid Intersititium- Multifocal fine basophilic stippling (leucocytes but not clear at this low power)
36
What further interstitial tissue change is there? Time course/duration? What is the name of this disease? Give an MD?
Interstitial fibrosis Chronic Renal failure Severe diffuse chronic lymphocytic tubulointerstitial nephritis
37
Describe the gross changes
Multifocal to coalescing areas with a tan/pink area in the renal cortex extending into the medulla and renal pelvis with a wedged shape. The medulla is haemorrhagic and reddened. Appears softer, necrotic. Approximately 5cm
38
Location- cortex Distribution- multifocal to coalescing Describe- coagulatvie necrosis ~5x8mm
39
Left- Focal eosinophilic degeneratoin/coagulative necrosis Left/middle- WBC nuclear debris Right- Some dilated but viable DCT, necrotic PCTs
40
Histomorphological diagnosis- Multifocal moderate subacute ishaemic infarcts Pathogenesis- Necrotic embolie from heart lesions spread haematogenously to renal capillaries Aetiology- Bacterial E. coli
41
Affecting the pelvic rim, extending into the medulla and to a lesser extent the cortex, there are red to brown multifocal linear radiating bands of affected tissue.
42
Undulating/indented surface Radiating bands of material coincide with indents- some multifocal tubule dilation
43
Multifocally dilated tubules with eosinophilic (proteinaceous) material inside or haemorrhage Multifocal leucocyes and fibrous tissue/collagen strands
44
1. Inflammatory infiltrate mainly lymphocytes and plasma cells 2. Fibrosis- wavy bands of collagen in interstitial tissue 3. Tubular dilation with protein leakage MD- Moderate to severe chronic multifocal to coalecing lymphocytic pyelonephritis Pathogenesis-
45
Bladder: affecting the mucosal surface especially caudally, at the trigone, there is a multifocal to coalescing firm mottled pink to red black multinodular mass. There are multifocal, fine - less than 1 mm diameter red spots) petechial mucosal haemorrhage.
46
Diffusely thickened mucosa folds
47
Right- Epithelium is thick, cell dense, poorly contained by basement membrane, irregular Centre- fibrous tissue with a few lymphocytes Bottom left- Cluster of malignant epithelium cells as on right but presnt in capillary or lymphatic
48
Irregular, poorly organised epithelial cells on upper right and lower right extending into centre without any structure- tumour metastasis MD- bladder transitional cell carcinoma
49
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Year 3 Pathology (21 decks)

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