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Renal 20 Bladder

Leonard: Urinary bladder

Obstructive uropathy can occur from ____ to ____ Renal calyces Distal urethral meatus
Obstructive Uropathy Common Causes Pregnancy BPH Calculi Congential anomalies Inflammation
Obstructive Uropathy Common Sequelae Stagnation of urine with -↑ risk of infxn -↑ risk of calculi Loss of renal fxn from hydronephrosis
Obstructive lesions of the urinary tract can be ____ Vs ____ Sudden Vs. Insidious Partial Vs. Complete Intrinsic Vs. Extrinsic Mechanical Vs. Functional
Hydronephrosis Dilation of the renal pelvis and calyces associated with atrophy of the kidney Caused by obstruction of outflow of urine
Obstructive Uropathy Clinical considerations Pain: renal colic Altered U/O: stream, amount, etc Unilateral obstruction may be asymptomatic
Obstructive Uropathy Clinical considerations Bilateral Partial From chronic tubulointerstial nephritis Presents with polyuria, nocturia from inability to concentrate urine
Obstructive Uropathy Clinical considerations Bilateral complete Presents with oliguria or anuria Urine output must be restored for survival
Urolithiasis General Calculi can form at any level Most arise in the kidney ~80% are unilateral
Urolithiasis Clinical 5-10% US population, M>F Familial/hereditary tendencies Smaller stones→ureters→renal colic pain obstruction and hematuria Larger stones→hematuria, hydronephrosis
Urolithiasis Etiology 4 main types 1.Calcium (oxalate/phosphate) ~70% 2.Struvite (triple stone): Mg, NH4, phosphate 3.Uric Acid 4.Cystine
Urolithiasis Etiology/Pathology Urinary supersatutation -Low urine volume -Metabolic abnormalities, altered pH Loss of natural inhibitors Infection
Calculi Calcium Radiopaque ~70% of all stones Hypercalcemic states -Hyperparathyroidism, diffuse bone disease, sarcoidosis Hypercalciuria w/o hypercalcemia
Calculi Magnesium ammonium phosphate ~20% of all stones Bacterial infections -Urea→ammonia (↑ urine pH) +↑precipitation of Mg, NH4, phos Large stones (Staghorn caculi)
Caculi Uric acid Radiolucent ~10% of stones Hyperuricemia (gout) Tendency to excrete urine with pH < 5.5
Caculi Cystine <1% Genetic efects in renal reabsorption of amino acids Stoned form at low urine pH
Urinary bladder Anatomy Superior surface: dome Anteriosuperior: apex Posterior surface: base Trigone: triangular region located at base of bladder Bladder neck: most distal
Urinary bladder Layers of visceral organ Mucosa: urothelium Lamina propria: slips of smooth muscle Muscularis propria: thick bundles of smooth muscle Adventitia (conn tiss)
Urinary bladder disorders/diseases Non-neoplastic (congenital or developmental) Diverticula Exstrophy Urachal cysts VRR (most common) Inflammation Metaplastic changes
Urinary bladder disorders/diseases Neoplastic Urothelial (TCC) Squamous cell carcinoma Adenocarcinoma Mixed carcinoma Small cell carcinoma
Diverticula True:out-pouching of visceral organ consisting of all wall layers Acquired:increased intraluminal pressure Congenital:defect in wall muscle
Exstrophy ~33/1,000,000 live births Anterior bladder wall and abdominal wall are absent Exposes bladder mucosa to external environment ↑ risk of cystitis and carcinoma
Urachus Vestigial remnant of the connection of bladder apex to the allantois Prone to neoplastic transformation→adenocarcinoma <0.5% bladder cancers
Patent urachus Communicating duct between umbilicus and urinary bladder→infection May close spontaneously Typically requires surgical closure
Urachal cysts **Most common urachal anomaly** Suprapubic palpable mass Columnar lining secrets watery secretions
Cystitis Can be acute or chronic Systemic signs are uncommon in uncomplicated cystitis
Infectious Cystitis Bacterial: E.coli Fungal: Candida Parasitic: Schistosomiasis -Middle East, northern Africa Viruses: Chlamydia
Chemical or Physical Agent Cystitis Drugs and other chemicals: -Cytotoxic chemotherapy (cyclophosphamide) hemorrhagic cystitis Radiation Cacluli (mechanical)
Interstitial Cystitis Chronic pelvic pain syndrome Etiology uncertain F>>M Recurrent, severe, intermittent suprapubic pain Hematuria, Urinary urgency
Interstitial Cystitis (cont) May result in transmural fibrosis with dysfunctional bladder *May mimic in situ urothelial carcinoma*
Malacoplakia Macroscopic: soft, tan/yellow slightly elevated mucosal plaques **Micro: large foamy macrophages mixed with multinucleated giant cells -Michaelis-Gutmann bodies**
Malcoplakia (cont) Chronic bacterial infections -E.coli -immunosuppressed transplant pts
Metaplasia Alteration of the epthelium from its typical mature form to a different type of epithelium Mostly transitional to columnar Metaplastic epi offers beneficial protective features
Neoplasms of the Urinary Bladder ~95% are epithelial
Urothelial (Transitional cell) Benign: urothelial papilloma Premalignant: Papillary- PUNLMP Flat- urothelial carcinoma in situ (CIS)
**Urothelial Carcinoma In Situ (CIS)** Multifocal Greater tendency to progress to more aggressive malignant neoplasm Multifocal- pagetoid spread of tumor cells
Cancers of Transitional Epithelium Papillary urothelial carcinoma (TCC): Tend to recur, maybe multifocal Not all are invasive "Flat" (ass. with CIS): Multifocal, invasive, high-grade
Staging of Urinary Bladder Cancers Ta: noninvasive papillary Tis: carcinoma in situ T#: invasive Higher #, more invasion
Squamous cell carcinoma ~3-7% of bladder cancers More common in areas with schistosomiasis Most common ass. with Sch. (70%) Ass. Chronic irritation/infxn
Bladder Cancer Epidemiology M>F More common in developed countries Urban>rural Generally no familial association
Bladder Cancer Pathogenesis Modifiable risk factors *Tobacco *Artlamine chemicals (aromatic hydrocarbons) Long-term analgesic use Radiation exposure
Urinary Bladder Cancer Clinical Features Classic: painless hematuria Risk of recurrence: tumor size, stage, grade, multifocality, presence of CIS Prognosis: grade and stage at Dx most important (early detection)
Urinary Bladder Cancer Treatment Small, localized papillary tumors Transurethral resection of bladder tumor (TURBT) Close follow-up surveillance
Urinary Bladder Cancer Treatment CIS, high grade TCC, etc Topical immunotherapy/chemo Intravesical installation of bacillus Calmette-Guerin (BCG) Local inflammation reaction destroys tumor
Urinary Bladder Cancer Treatment Invasion of muscularis propria Cystectomy Possibly systemic chemotherapt
Created by: bcriss