650 THE URINARY ORGANS. 



INFLAMMATION. (Cystitis.) 



Acute Catarrhal and Exudative Cystitis. This may be incited by the 

 presence of urine which has decomposed under the influence of bacteria ; 

 by cautharides or other drugs ; by the presence of foreign bodies and 

 calculi ; or it may be due to an extension of gonorrhceal urethritis or 

 vaginitis; or it may occur with acute general infectious diseases. The 

 mucous membrane is swollen and congested, although these alterations 

 may not be very evident after death. There may be ecchymosis : the 

 epithelium is granular and may proliferate and peel off. Leucocytes 

 may infiltrate the subniucosa and pass out between the epithelial cells 



FIG. 412. ACUTE CATARRHAL CYSTITIS. 

 There are exfoliation of epithelium and emigration of leucocytes from the submucosa. 



(Fig. 412). Mixed with the urine there may be shreds of mucus, pus cells, 

 epithelial cells of various shapes, usually more or less swollen and granu- 

 lar, or fragments of such cells; red blood cells, bacteria, and various 

 urinary crystals ; abscess may form in the mucous membrane ; or there 

 may be phlegmonous inflammation in the submucosa and muscularis of the 

 bladder with formation of abscesses. Thus perforations and fistulse may 

 occur. Eesolution may take place after acute catarrhal and exudative 

 cystitis, but it very frequently assumes a chronic character. 



Chronic Cystitis. In this form the mucous membrane may be swollen, 

 succulent, grayish, or mottled with spots of congestion or extravasation, 

 and covered with a layer of mucus and pus. Microscopically the mem- 

 brane may be more or less infiltrated with* pus cells, and pus may be 

 constantly produced and thrown off into the urine. Later the mucous 

 membrane may become thickened either diffusely or in the form of tufts 

 or polypi. In some cases it becomes atrophied. Owing to decompo- 

 sition of the hemoglobin in the extravasated blood the mucosa may 

 become pigmented, brown, or slate-colored. The mucous membrane fre- 

 quently becomes eroded, especially on the most elevated portions, or 

 deep ulcerations may occur. The muscular coats may become paralyzed 

 and the bladder dilated ; or the submucosa or the muscularis, or both, 

 may become hypertrophied. The mucous membrane may become en- 

 crusted with urinary salts. 



