Cystitis pathophysiology: Difference between revisions
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===Complicated cystitis=== | ===Complicated cystitis=== | ||
The pathogenesis of complicated cystitis include obstruction and stasis of urine flow. Obstruction leads to overdistension and bacterial growth is facilitated by the residual urine. Stasis of urine flow allows entry of pathogens into the urinary tract.<ref name="pmid10969044">{{cite journal| author=Hooton TM| title=Pathogenesis of urinary tract infections: an update. | journal=J Antimicrob Chemother | year= 2000 | volume= 46 Suppl A | issue= | pages= 1-7 | pmid=10969044 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10969044 }} </ref> | The pathogenesis of complicated cystitis include obstruction and stasis of urine flow. Obstruction leads to overdistension and bacterial growth is facilitated by the residual urine. Stasis of urine flow allows entry of pathogens into the urinary tract.<ref name="pmid10969044">{{cite journal| author=Hooton TM| title=Pathogenesis of urinary tract infections: an update. | journal=J Antimicrob Chemother | year= 2000 | volume= 46 Suppl A | issue= | pages= 1-7 | pmid=10969044 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10969044 }} </ref> | ||
===Interstitial Cystitis=== | |||
The pathogenesis of interstitial cystitis includes:<ref name="pmid16986036">{{cite journal| author=Sant GR| title=Etiology, pathogenesis, and diagnosis of interstitial cystitis. | journal=Rev Urol | year= 2002 | volume= 4 Suppl 1 | issue= | pages= S9-S15 | pmid=16986036 | doi= | pmc=PMC1476007 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16986036 }} </ref> | |||
*Epithelial dysfunction | |||
*[[Mast cell]] activation | |||
*Bladder sensory nerve up-regulation | |||
The urothelium acts as a barrier against damage to the [[bladder]]. The urothelium produces a mucous layer which regulates the entry of [[potassium]] in the bladder interstitium. Damage to the urothelium results in the production of cytokines which activate [[mast cell]]s in the interstitium. Mast cell activation is further triggered by the diffusion of excess [[potassium]] into the bladder interstitium.<ref name="pmid21568251">{{cite journal| author=French LM, Bhambore N| title=Interstitial cystitis/painful bladder syndrome. | journal=Am Fam Physician | year= 2011 | volume= 83 | issue= 10 | pages= 1175-81 | pmid=21568251 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21568251 }} </ref> | |||
===Cystitis cystica=== | ===Cystitis cystica=== | ||
Chronic irritation from infection, calculi or even tumors results in metaplasia of the urothelium, which proliferates into buds, which grow down into the connective tissue beneath the epithelium in the lamina propria. In the case of cystitis cystica, the buds then differentiate into cystic deposits.<ref name=radio>Cystitis Cystica. Radiopaedia 2016. http://radiopaedia.org/articles/cystitis-cystica. Accessed on February 9, 2016</ref> | Chronic irritation from infection, calculi or even tumors results in metaplasia of the urothelium, which proliferates into buds, which grow down into the connective tissue beneath the epithelium in the lamina propria. In the case of cystitis cystica, the buds then differentiate into cystic deposits.<ref name=radio>Cystitis Cystica. Radiopaedia 2016. http://radiopaedia.org/articles/cystitis-cystica. Accessed on February 9, 2016</ref> |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Steven C. Campbell, M.D., Ph.D. Associate Editor(s)-in-Chief: Maliha Shakil, M.D. [2]
Overview
Cystitis occurs when the normally sterile lower urinary tract (urethra and bladder) is infected by bacteria, which leads to irritation and inflammation. Females are more prone to the development of cystitis because of their relatively shorter urethra. Bacteria does not have to travel as far to enter the bladder, which is in part due to the relatively short distance between the opening of the urethra and the anus. The pathogenesis of complicated cystitis include obstruction and stasis of urine flow. Obstruction leads to overdistension and bacterial growth is facilitated by the residual urine. Stasis of urine flow allows entry of pathogens into the urinary tract.[1]
Pathophysiology
Acute uncomplicated cystitis
In women, vaginal colonization of the uropathogens leads to the development of a urinary tract infection.[1] Cystitis occurs when the normally sterile lower urinary tract (urethra and bladder) are infected by bacteria and become irritated and inflamed. Once bacteria enter the bladder, they are normally removed through urination. When bacteria multiply faster than they are removed by urination, infection results. Cystitis is rare in males. Females are more prone to the development of cystitis because of their relatively shorter urethra. Bacteria does not have to travel as far to enter the bladder, which is in part due to the relatively short distance between the opening of the urethra and the anus.
Complicated cystitis
The pathogenesis of complicated cystitis include obstruction and stasis of urine flow. Obstruction leads to overdistension and bacterial growth is facilitated by the residual urine. Stasis of urine flow allows entry of pathogens into the urinary tract.[1]
Interstitial Cystitis
The pathogenesis of interstitial cystitis includes:[2]
- Epithelial dysfunction
- Mast cell activation
- Bladder sensory nerve up-regulation
The urothelium acts as a barrier against damage to the bladder. The urothelium produces a mucous layer which regulates the entry of potassium in the bladder interstitium. Damage to the urothelium results in the production of cytokines which activate mast cells in the interstitium. Mast cell activation is further triggered by the diffusion of excess potassium into the bladder interstitium.[3]
Cystitis cystica
Chronic irritation from infection, calculi or even tumors results in metaplasia of the urothelium, which proliferates into buds, which grow down into the connective tissue beneath the epithelium in the lamina propria. In the case of cystitis cystica, the buds then differentiate into cystic deposits.[4]
References
- ↑ 1.0 1.1 1.2 Hooton TM (2000). "Pathogenesis of urinary tract infections: an update". J Antimicrob Chemother. 46 Suppl A: 1–7. PMID 10969044.
- ↑ Sant GR (2002). "Etiology, pathogenesis, and diagnosis of interstitial cystitis". Rev Urol. 4 Suppl 1: S9–S15. PMC 1476007. PMID 16986036.
- ↑ French LM, Bhambore N (2011). "Interstitial cystitis/painful bladder syndrome". Am Fam Physician. 83 (10): 1175–81. PMID 21568251.
- ↑ Cystitis Cystica. Radiopaedia 2016. http://radiopaedia.org/articles/cystitis-cystica. Accessed on February 9, 2016