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CystitisThe acute and chronic form
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Any Relationship !! ??
THE CASE
• 55 yrs old poorly controlled diabetic female presented with burning pain at micturition , excessive need to urinate but each time she goes , she was passing only small amount of cloudy coloured urine that has a fishy odour
Case highlights
• 55 yrs old poorly contolled diabetic female presented with burning pain at micturition , excessive need to urinate but each time she goes , she was passing only small amount of cloudy coloured urine that has a fishy odour
So what to do
• Extended history • Physical examination including the vital
signs ( fever , tachycardia ) and searching for suprapubic tenderness
• Urinalysis to look for the microorganism that caused the trouble
• Complete blood picture will reveal leukocytosis
• Urine culture that takes a day or two
What can cause the trouble? • Bacterial cystitis :1. E.coli 2. Proteus3. Klebsiella• Tuberculous cystitis• Fungal cystitis ( candida albicans) Immunesuppressed and those on long term ABCs • Schistosomal cystitis • Viruses , chlamydia , mycoplasma • Other non infectious causes : drugs (cyclophosphamide) and
radiation ( radiation cystitis)
Predisposing factors 5
• Urinary obstruction ( BPH , bladder calculi and tumors )
• Cystocele or diverticula • D.M• Instrumentation • Immune defeciency
Grossly , what to see ?
• Hyperemia of the mucosa • Hemorrhagic cystitis : (after Radio,Chemo or Adeno)
• Suppurative cystitis : large amounts of suppurative exudate
• Ulcerative cystitis : large mucosal ulcers and sometimes ulceration of entire bladder mucosa !
• IF the infection persists Chronic cystitis that’s seen as Red , Friable , Granular mucosa ANOTHER association is the fibrosing thickening and inelasticity of bladder wall
Post-radiotherapy hemorragic cystitis
Fibrous thickening of bladder wall
Microscopically there is: • acute cystitis acute infammation • chronic cystitis chronic inflammatory
cells ( ? ) with fibrosis• two variants of chronic cystitis :1. Follicular cystitis 2. Eosinophilic cystitis
Schistosomal cystitis • Caused by S. Hematobuim • Eggs (by anastomosis) travel from sup. Rect. V.
to the veins of bladder wall , these eggs are irritating so causing granulomatous cystitis with eosinphilic infiltrate and fibrosis
• These granulomas are seen as minute granules hence the name (sand grain cystitis)
• The eggs die and calcify
What are the complications? • extensive fibrosis ( that may impinge on
ureteric orifices to cause hydronephrosis • CA bladder (squamous type) :
Schistosomal cystitis
Squamous metaplasia Carcinoma
IRAQ …. LIKE A BOSS!!
Special forms of cystitis
1. Interstitial cystitis (Hunner ulcer) :• painful form of chronic cystitis (very painful)• most frequently in women • Cystoscopy shows : fissures and punctate
hemorrhages in the mucosa , sometimes with chronic mucosal ulcers
• mast cell infiltrate is characteristic • Maybe of autoimmune origin
Special forms of cystitis
2. Malakoplakia : • Macroscopically : soft , yellow , slightly raised
mucosal plaques 3-4 cm in diameter • Microscopically : infiltration by large foamy
macrophages with debris of bacterial origin (E.coli) • Michaelis – Gutmann bodies (laminated
mineralized concretions) are typically present• Occurs in increased frequency in immune
suppressed transplant recipients
Special forms of cystitis
3. Polypoid cystitis : • Results from irritation of bladder mucosa by
indwelling catheters • Submucosal Edema causes broad , bulbous ,
polypoid projections
Review • cystitis is either infectious or non infectious • 5 predisposing factors for cystitis • The acute form seen grossly : hyperemia,
hemorrhagic cystitis , suppurative cystitis and ulcerative cystitis microscopically : acute inflammation.
• The chronic form grossly : red , friable , granular ulcerated mucosa, and fibrous thickening and inelasticity of wall , microscopically : chronic cell infiltrate and fibrosis
Review
• schistosomal cystitis : S. hematobium• Eggs in the walls causing granulomas,
eosinophilic infiltrate, fibrosis • granulomas look like sand grains • 2 complications ( extensive fibrosis impenge
ureters causing hydronephosis , and squamous metaplasia and carcinoma of bladder )
Thank You
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