37. Urolithiasis. Disorders of the urination Flashcards
(29 cards)
Causes of urolithiasis
Crystals in urine sediment
- struvite
- calcium oxalate
- urate
- cysteine
Examples of organic sediment
blood
pus
lipid
Pathogenesis of uroliths
Increase of supersaturated urine conc
What can uroliths be secondary to
UTI
hepatopathy
metabolic disease
genetic disease
Occurrence of uroliths
90-95% in bladder
- struvite
- ca oxalate
Clinical signs of uroliths depend on
no. of stones
types of stones
location of stones
Clinical signs of uroliths
signs of cystitis
Urethral obstruction
Post renal uraemia
AKI
Pain
haematuria
hydronephrosus
pyelonephritis
Struvite Stones
40-60% of all uroliths
Alkaline/ Neutral urine
Femals
Dachshund, poodle, mini schnauzer
Cause of struvite stones
UTI
Urease —> alkaline urine –> increased NH4
Calcium oxalate stones
15-50% of all uroliths
acidic urine
Hypercalciuria
Poodle, minischanuzer, yorkie
Urate stones
Ammonium acid urate
Increased urate in urine
Increase ammonium and urate in urine (pss, cirrhosis(
Decreased glycosaminoglycans in urine
Cystein stones
Inherited disorder of renal tubular transport
Acidic urine
Male, middle aged
siamese cates
Diagnosis of uroliths
Contrast xray
US - stone anaylsis
BActerial culture
Re-evaluation of patient
Treatment of Uroliths
emergency urethral obstruction
Catheterisation
Decompression of bladder
Treatment of AKI & its consequences
Surgical removal
Urohydropropulsion
Treat UTI
Diuresis induction
Treatment of struvite stones
Diet - decrease protein, Ca, Mg, P
Increase dietary salt
AB
Acidifier - NH4Cl, Methionine
Treatment of Calcium oxalate stones
Surgery required
Diet - decrease Protein, nucleic acids
Increase dietary salt
Potassium citrate
Treatment of urate stones
If no association with hepatic insufficiency
Diet- decrease purine, nucleic acids, added salts
Treatment of cysteine stones
Diet- decrease protein, salt
Methionine
Urine alkalisation
Thiol contaning drugs - D penicilliamine/ MGP
Disorder of urination
USMI
Urethral Sphincter Mechanism Incompetence
2 types of incompetence
Neurogenic
Non- neurogenic
Cause of Neurogenic Incontinence
UMN (spastic bladder)
LMN (flaccid bladder)
Cause of Non - Neurogenic Incontinence
Anatomic - ectopic ureter, pelvic bladder, rectourethral fistula, enlarged prostate
Hormonal - lack of oestrogen, <3yrs post spay
Inflammatory - cystitis, urethritis, urolithiasis
Predisposed to ectopic ureter
Terrier
Lab
Huskey
Diagnosis of incontenance
History
Physical exam - orifices, palpation, pain, expression (easier in LMN)
Neuro exam
CBC
Urinalysis
Xray
US
Electrophysiological studies
