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Cystitis made easy

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Brief discussion of inflammatory conditions of the urinary bladder from pathological point of view

Published in: Health & Medicine
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Cystitis made easy

  1. 1. Cystitis The acute and chronic form Made easy
  2. 2. 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
  3. 3. 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
  4. 4. 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
  5. 5. What can cause the trouble ? • Bacterial cystitis : 1. E.coli 2. Proteus 3. 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)
  6. 6. Predisposing factors5 • Urinary obstruction ( BPH , bladder calculi and tumors ) • Cystocele or diverticula • D.M • Instrumentation • Immune defeciency
  7. 7. 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
  8. 8. Post-radiotherapy hemorragic cystitis
  9. 9. Fibrous thickening of bladder wall
  10. 10. 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
  11. 11. 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
  12. 12. What are the complications ? • extensive fibrosis ( that may impinge on ureteric orifices to cause hydronephrosis • CA bladder (squamous type) : Schistosomal cystitis Squamous metaplasia Carcinoma
  13. 13. 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
  14. 14. 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
  15. 15. Special forms of cystitis 3. Polypoid cystitis : • Results from irritation of bladder mucosa by indwelling catheters • Submucosal Edema causes broad , bulbous , polypoid projections
  16. 16. 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
  17. 17. 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 )

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