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Renal 20 Bladder
Leonard: Urinary bladder
| Question | Answer |
|---|---|
| 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
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