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Pathology 1 Block 3

NWHSU Pathology 1 Block 3

4 steps of glomerular filtration from filtering blood to form urine. Filtration Re-absorption Secretion Excretion
Two possible causes of protein in urine. Renal Disease Renal Degeneration
Normal urine protein is up to ___-___ mgm per 24 hours. 100-150mgm per 24 hours
What is decreased GFR (Glomerular filtration rate)? Prerenal azotemia
What is urine flow obstruction? Postrenal azotemia
What is a urine D/R test? How long does it take and what are 3 things it measures? Urine detailed report. Very quick. Ca++, Protein, Blood
What is a urine CS test? How long does it take and what does it measure? Urine culture specimen test. 24 hours Bacteria
Two different syndromes can result from glomerular diseases. What are they? Nephritic syndrome or nephrotic syndrome
With _________ syndrome, the primary defect is decreased GFR resulting in oliguria (less urine output). Nephritic syndrome
With ________ syndrome, the primary defect is increased permeability of the glomerular filter to protein resulting in increased protein in the urine (proteinuria). Nephrotic syndrome
Less urine output is ______. oliguria
Protein in urine is _______. Proteinuria
Syndrome associated with inflammation in glomeruli? nephritic syndrome
Syndrome associated with oliguria due to decreased GFR. nephritic syndrome
Syndrome associated with heaturia (RBC in urine), gross or microscopic. Nephritic syndrome
Syndrome associated with proteinuria, less than 3.5 grams per day. Nephritic syndrome
Syndrome associated with increased blood urea nitrogen (BUN) and creatinine. Nephritic syndrome
Syndrome associated with hypertension. Nephritic syndrome
Syndrome associated with Edema. (May or may not be present). Nephritic Syndrome
Syndrome associated with proteinuria, greater than 3.5 grams per day, due to increased permiability of the glomerular membrane to protein, the initiating problem. Nephrotic Syndrome
Syndrome associated with hypoproteinemia (decreased plasma proteins, mainly albumin) due to protein loss in the urine. Nephrotic Syndrome
Syndrome associated with Edema. Nephrotic Syndrome
Syndrome associated with hyperlipidemia (increased plasma lipoproteins). Nephrotic Syndrome
Syndrome associated with lipiduria, lipoproteins in urine. Nephrotic Syndrome
Term used when the kidney fails to fully perform its normal physiologic functions with the resulting metabolic consequencese. Renal Failure
The degree of renal failure can be measured by determining the _________ _________ ______. A decreasing ________ _______ _______ correlates with more severe renal failure. GFR Glomerular Filtration Rate
When the GFR has decreased to 10-20ml per minute from the normal _____ ml per minute the renal failure is severe enough to be termed ______ _________ __________ ________ and requires _______ to live. 125ml per minute End Stage Renal Failure (ESRF) Dialysis
Renal failure can develop ________ (Rapidly) or slowly over many years. Eventually the patient will need a ________ transplant acutely kidney transplant
3 causes of increasing renal failures. Bad diet NSAIDS Genetic predisposition
There are two chemical markers in the blood which are increased in renal failure as it becomes more severe. What are they? Creatinine Urea (Measured in blood urea nitrogen BUN)
What occurs 1-4 weeks after a streptococcal infection of the skin or pharynx? _______ __________ ______________ ____________ Acute proliferative poststreptococcal glomerulonephritis
Most cases of acute proliferative poststreptococcal glomerulonephritis occur in children _-__ years old but also can occur in adults. Presents with _____ syndrome, often with red-brown urine due to ________. 6-10 years old Nephritic syndrome hematuria
Most patients that get acute proliferative poststreptococcal glomerulonephritis recover and return to normal renal function but some progress to rapidly progressive _________ _______. crescentic glomerulonephritis
What is another name for IgA Nephrophathy? Berger disease
IgA nephropathy is mesangial depostion of IgA in children and young adults. ____% will lead to renal failure and can occur over time. Immunoglobin A will lodge itself in the kidneys overtime causing decreased GFR. 50%
Commonly with IgA nephropathy the skin may get purple spots and the patient may experience joint pain. Those are both symptoms of _______ __________ ___________. Henoch schnolein purpura
What is the most common cause of recurrent microscopic and gross hematuria? Berger disease (IgA Nephropathy)
What disease shows crescents composed of cells and protein in the glomerulus? It is poststreptococcal and indicates severe _________- damage. Rapidly progressive (Crescentic) Glomerulonephritis (RPGN) Severe glomerular damage
Rapidly progressive crescentic glomerulonephritis usually progresses to _________ ______________ with clinical end stage renal disease. Chronic glomerulonephritis
Rapidly progressive crescentic glomerulonephritis type 1 is called _____-_____ or ________. Anti-GBM Anti Glomerular basement membrane or Goodpasture
Rapidly progressive crescentic glomerulonephritis type 2 is _______ __________ like lupus or _________. immune complex like lupus or idiopathic
Rapidly progressive crescentic glomerulonephritis type 3 is ____ _________ ANCA like Wegner's granulomatosis Pauci-immune ANCA (Antinuclear antibodies)
What is another name for chronic Glomerulonephritis? Chronic glomerular disease.
Histologic term indicating marked glomerular scarring with obliteration of glomerular capillaries. Correlates with severe impairment of kidney function and end stage renal disease. Chronic Glomerulonephritis or chornic glomerular disease
Chronic Glomerulonephritis can not be determined by histologic study and needs _________ staining showing blue staining of the _________. Trichrome staining showing blue staining collagen
6 causes of Chronic Glomerulonephritis. Poststreptococcal Rapidly Progressive Glomerulonephritis Focal Glomerulosclerosis Membranoproliferative Glomerulonephritis IgA Nephropathy (Bergers disease) Membranous Glomerulonephritis
Clinically what is chronic glomerulonephritis called. End stage renal disease
What is another name for Lipoid Nephrosis? MCD Minimal Change Disease.
With lipoid nephrosis or MCD the glomeruli appear normal by light microscope but electron microscopy shows fusion of ________ foot processes. podocyte
What is the most frequent cause of nephrotic syndrome in children age 1-7? Lipoid nephrosis or MCD Minimal change disease
More then ___% of patients with lipoid nephrosis respond to corticosteroid therapy with return of normal kidney function. 90%
20-30% of nephrotic syndrome are _______ _____________ ___________ (FSGS) Focal segmental glomerulosclerosis FSGS
Focal Segmental Glomerulosclerosis casues _________ syndrome in adults and children and can be hereditary. Nephrotic syndrome
Why is it important to distinguish Focal segmental glomerulosclerosis from lipoid nephrosis? FSGS does not respond to corticosteroid therapy.
More then ___% of patients with focal segmental glomerulosclerosis progress to end stage renal failure. 50%
A cause of nephrotic syndrome between ages 30-50 is called ______ __________ or _________ __________ Membranous Nephropathy (MN) or membranous glomerulonephritis
Membranous glomerulonephritis has a ______ and ______ pattern effacement of foot porcesses. spike and dome
Causes of membranous glomerulonephritis are infections like _________ , _____ , ________ _________, ______ exposure to salts like mercury, drugs such as *_____ Infections like malaria, hepatitis, malignant tumors, SLE, NSAIDS
May present with nephrotic or nephritic syndrome or both. Two answers Membranoproliferative glomerulonephritis (MPGN) or Systemic Lupus Erythematosus (SLE)
Membranoproliferative glomerulonephritis has a _______ appearance. The cause is infection like ____ ___ or ______ infected AV shunts. lobular appearance infection like Hep B or C, lupus infected AV shunts
Type 1 membranoproliferative glomerulonephritis is __________ _________. immune complexes
Type 3 membranoproliferative glomerulonephritis is ______ ________. C3 deposits
Thickening and sclerosis of arterial walls is called benign _________________. Benign arterionephrosclerosis
What has hyaline arteriosclerosis, fibroelastic hyperplasia, and proteinuria? Benign arteriornephrosclerosis
Hypertension causes a thickening of arteriolar walls at different locations of the body including the kidneys. This decreases blood flow in the glomerular capillaries and over time these capillaries shrivel and become obliterated. This causes what? Loss of glomerular function and decrease in GFR requiring dialysis
What is the BP for malignant hypertension? 200/120mmHg
Pinpoint petechial hemorrhages, cortical surface rupture, hyperplastic or fibrinoid arteriosclerosis, papilloedema, encephalopathy and renal failure all happen due to ______ ___________. malignant hypertension
Diabetes mellitus causes hyaline thickening of arteriolar walls at multiple locations in the body. The glomerular arterioles show this change. Diffuse thickening of glomerular basement membranes. Nodular hyaline deposits in glomeruli. Diabetic nephropathy
Nodular hyaline deposits in glomeruli are termed __________ ___________ lesions. kimmelstiel wilson lesions
Proteinuria is a constant finding of _______ _________. This is an important cause of nephrotic syndrome. Early _________ __________ is detected by small increases in urinary protein excretion. 45-50% of patients on dialysis have advnaced __________ ____. Diabetic Nephropathy (all)
A systemic autoimmune disease that is an immune complex disease type 3 hypersensitivity reaction. Immune complexes are deposited in the renal glomeruli and initiate damage. The kidneys are a target organ and evnetually involved in over ___% of cases. Systemic Lupus Erythematosus (SLE) 90%
_______ ___________ lesions may be seen in renal glomeruli in systemic lupus erythematosus (SLE) Wire loop
Urine in the urinary tract is normally sterile due to two defense mechanisms. 1. flushing action of urine 2. presence of secretory IgA on the mucosal surfaces of the urinary tract
______ bacteria, most often __ _______, cause almost all urinary tract infections. Coliform bacteria E Coli
A lower urinary tract infection is ________ .Greater than ___% of all UTIs Cystitis 99%
An upper urinary tract infection is __________. Less than __-__% of all UTIs. Pyelonephritis 1-2%
Any _______ in the urinary tract may predispose to UTI. Some examples are. obstructions Urinary stones, urinary tract tumor, strictures producing narrowing, prostatic hyperplasia or tumor, pregnancy
Another name for a urinary tract stone. Calculi
___-__% of urinary tract stones are composed of calcium oxalateor a mixture of calcium oxalate and calcium phosphate. About 10% are composed of ____ _______. The remainder are composed of other substances such as ________. 80-85% Uric Acid Cystine
Dilation of the renal pelvis and calyces with atrophy of the parenchyma caused by obstruction of outflow of urine is called ___________. Hydronephrosis
Causes of hydronephrosis are ________ of the urethra, stones, foreign bodies, ________ ________ injuries, genitourinary tumors, and pregnancy. Atresia of urethra Spinal cord injuries
A disease characterized by flank pain, intermittent gross hematuria, hypertension and UTI. Polycystic Kidney Disease
Polysistic kidney disease in childhood is ___________ _________. Autosomal recessive
Polysistic kidney disease in adults is ________ _________. Autosomal dominant
Yellow to orange and gray white with prominent areas of cystic softening or hemorrhage (Clear cell), can appear as vacuoles. May see hematuria and a palpable mass. What is this tumor called? These are mostly benign or malignant? Renal cortical adenocarcinoma, hypernephroma Malignant
3rd most common tumor in children younger than 10 years? Contains tissue components mesodermal in orgin. Wilms Tumor (Nephroblastoma)
Removal of cervix and Uterus. Total Hysterectomy
Removal of ovaries Oophrectomy
__________ is caused by Candida Albicans and Tricanomas Vaginalis. Vaginal discharge (leukorrhea) Vaginitis
________ is caused by Candida trachomatis, N Gonorrhoeae, HSV, HPV. Discharge, pain (low back pain), dyspareunia (painful sex). Cervicitis
Dyspareunia is ____ ____. painful sex
HPV 16, 18, 31, and 33 are common. Which two are most aggressive? 16 and 18
CIN stands for _______ _____ _____. Type 1 is koilocytic atypia. Type 2 is progressive atypia. Type 3 is in situ. Cervical Intraepithelia neoplasia
Risk factors for cancer of the cervix include.. early age of intercourse, multiple sex partners, male partners with previous sexual partners, HPV, smoking and HIV
Pap smears are looking for _________ and ___________ cells. anaplastic and dysplastic
Cervical cancers: Squamous cell (__%) Adenosquamous (__%) squamous cell 70% Adenosquamous 20%
Unexpected bleeding, dyspareunia, dysuria, leukorrhea and cone biopsy all involve _______ cancer. cervical cancer
Follicular and luteal cysts are _ -__cm and develop on the _________. 1-1.5cm ovaries
A syndrome in teeage girls and young adults, studded with sub cortical cysts. This is caused by excess _________. Polycystic Ovarian Syndrome (Stein Leventhal Syndrome) Androgens
_______ cases of ovarian tumors annually. 20,000
_______ ___________ is a cystadenocarcinoma. The prognosis is poor after surgery or chemo but good if confined to the ovary. They abdominal or low back pain. Coleomic epithelium
Cystadenocarcinoma: ______ most common __% benign ________ low in malignancy serous most common 60% benign Mucinous
Polycystic ovarian syndrome is linked with ________ and _______. diabetes and obesity
__________ is a benign (Mature) cystic tumor that contains tooth like structure, calcification, bone, or cartilage, hair 90% unilateral on the right side. Teratoma (Germ cell tumor)
An immature malignant germ cell tumor can ____________. Can contain nerve tissue. metastasize
________ ____ contain thyroid tissue causing hyperthyroidism. Struma ovarii
____ _______ tumors are common between age 45-65. Found in family history, germline tumor, and women who have never given birth (nulliparity) Germ cell tumors
Infection of the uterus caused by N gonorrhea, TB, can cause misconception (Fever and abdominal pain) endometritis
Basal layer of endometrium of uterus grown into myometrium is ___________. This causes dysuria, dyspareunia, low back pain, abdominal pain. adenomyosis
Presence of endometrial glands outside uterus. 80% on ovaries. Not a tumor! Endometriosis
Three theories behind endometriosis are? Regurgitation theory (influx of urine or fluid extends lining) Metaplastic theory Lymphatic or vascular theory
Another name for a chocolate cyst? Causes lower abdominal pain, dyspareunia, dysuria, menorrhagia (heavy periods), uterine bleeding, dysmenorrhea (painful periods). Ovarian Endometriosis
Condition where endometrial tissue is not just misplaced by abnormal and is responsive to hormones. Causes infertility Ovarian endometriosis (Chocolate cyst)
Hyperplasia of the uterus is from excessive ___________. estrogen
Endometrial cancer ages 55-65. Endometrial polyps can be cancerous. The survival rate is ______. high
*Endometrial cancer is caused by a mutation in the _________ gene. PTEN gene
Higher risk of endometrial cancer if you are _______ , _________, _________, or _________. obese, diabetic, hypertensive, infertile
A benign uterine tumor caused by _________. (Fibrous, smooth muscle) Leiomyoma
A malignant urterine tumor in postemnopausal women. It can metastasize to the _______. Leiomyosarcoma lungs
1 in 200 pregnancies are ________. They are most common in the _______ ________. Ectopic Fallopian tubes
With ectopic pregnancy dialation leads to _______ _____, rupture and hemorrhage, leading to _______. Abdominal pain shock
To determine if a pregnancy is ectopic you must check for higher levels of _______ and perform an ultrasound. HCG
Complete or partial hydatiform moles, invasive moles, and choriocarcinoma are all __________ ________ diseases. Gestational trophoblastic diseases
A complete hydatiform mole is a volumous mass of swollen _____ (grapelike). This _______ fetal parts. 46XX or XY in the chronic epithelium. swollen villi never contains fetal parts
Partial hydatiform moles ________ fetal parts. Contain
Partial and complete hydatiform moles result from abnormal fertilization and are common before ______ or after __. They happen __-__ weeks of pregnancy. 20 or after 40 12-14 weeks
A hydropic villi that penetrates the uterus, atypical changes in the epithelium. Invasive mole
The villi in an invasive mole can ________ to the _______ and _____. embolize to the lungs and brain
Invasive moles are removed by _______ and monitered by HCG. curettage (surgical removal of cervix and uterus lining) (spoon scoops out tissue)
A malignant tumor that arises from a complete hydatiform mole. It causes bloody brown discharge. Chriocarcinoma
Invasive moles and choriocarcinomas are high in _____-____ and can metastasize to the _____ and _____ _______. Beta-HCG lungs and vaginal walls
cystic dialtion of the breast galactocele
Non proliferative or cystic breast disease can lead to ________ and _______ in situ (VERY RARE) atypia and carcinoma in situ
A glandular rubbery mass in the breast fibroadenoma
Fibroadenoma is found in ages ___-__ and are usually not ________. 20-35 malignant
Fibroadenoma may enlarge during pregnancy and __________ after menopause. regress
Fibroadenoma must be differentiated from a __________. galatocele
Major risk factors for carcinoma of breast. High socioeconomic status, family history, late age of first child, multiple pregnancy, prolonged exposure to estrogens after menopause, radiation, obesity, alcohol, fibrocystic disease, oral contraceptives
Age 30-70 carcinoma of the breast is usually _______ and is significantly higher in North America, highest rate non hispanic white women. malignant
A leaflike tumor that is benign 15% malignant found in the breast. Phyllodes
1/3 of breast cancers will have mutations in the _________ 1 or _________ 2 gene BRCA
A primary malignant neoplasm of the breast that arises from epithelium of the terminal ducts and lobular units. carcinoma in situ
When in situ means _________ is contained above the basement membrane. (Breast cancer) malignancy
Invasive forms of breast cancer are nearly always __________________ 70%. adenocarcinoma
One of 11-13 women develop a ________ ___ _______in the breast in their lifetime. carcinoma in situ
Non-invasive malignant breast cancer can be ______ carcinoma in situ, ________ carcinoma in situ, or ________ disease of the nipple. Ductal carcinoma, lobular carcinoma, or pagets disease of the nipple (crusting exudate from lactiferous ducts fo the nipple)
Invasive Malignant breast cancer can be invasive ______, invasive _________, _________ __________, medullary inflammatory colloid (mucinous) tubular, skin can become thickened peaud' orange (orange peel), adherant to pec muscles. invasive ductal, invasive lobular, cytosarcoma phyllodes
Stage I breast cancer is __ cm of less without direct extension or node mets 2cm
Stage II breast cancer is __-_cm or with homolateral mets but nodes still movable 2-5cm
Stage III breast cancer is greater than __cm with or without node mets, or any tumor with axillary node mets or fixation to underlying muscle. 5cm
Stage IV breast cancer is involvement of ______ _____, skin or mets to homolateral supra or infra-clavicular nodes. chest wall
Created by: T1NWHSU
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