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Urology > Urinary tract disorders in horses (Reuss) > Flashcards

Urinary tract disorders in horses (Reuss) Flashcards

1
Q

Uroperitoneum about

A
  • Bladder, urethral (perineal, preputial edema), urachal (subcutaneous edema around umbilicus, ureteral (retroperitoneal)
  • Colts >>>fillies
  • birth trauma, congenital abnormality, sepsis
  • Adults - rare
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2
Q

Uroperitoneum CS

A
  • CS
    • abdominal distension, colic
    • stranguria, pollskiutis
    • lethargy, depression, anorexia

*A colt that can urinate through his penis doesn’t R/O uroperitoneum

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3
Q

Uroperitoneum

Lab abnormalities

A
  • Lab abnormalities
    • post-renal azotemia
    • hyponatremia,hypochloremia
    • hyperkalemia
  • Abdominocentesis
    • peritoneal creatinine > 2x serum creatinine
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4
Q

Uroperitoneum TX

A
  • medical treatment
    • IV fluids
      • 0.9% NaCl + 5% dextrose
        • hypoglycemia and
        • pushing K+ intracellularly
      • Calcium gluconate, Sodium bicarbonate
    • antimicrobials
    • abdominal drainage
  • surgical correction
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5
Q

urolithiasis about

A
  • geldings, mean age 10y
  • cystoliths >> urethrolith > nephrolith > ureterolith
  • Nucleation
    • Nidus
      • UTI?
      • NSAID tox
    • Urine stasis
  • Crystallization
    • alkalinity + CaCO3
    • overcome mucus
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6
Q

Urolithiasis stones

A
  • Calcium carbonate
  • Calcium phosphate
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7
Q

urolithiasis

CS

A
  • Cystoliths
    • hematuria post-exercise
    • stranguria, incontinence
    • recurrent colic
  • nephrolith, ureterolith
    • silent until bilateral obstructive disease and CRF
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8
Q

Urolithiasis

DX

A
  • Rectal palpation
    • feeling a ureter is bad, throw a rectal U/S probe on it
  • ultrasound
  • cystoscopy
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9
Q

Urolithiasis

TX

A
  • Mares
    • manual removal
      • crushing
      • lithotripsy
      • urethral sphincterotomy
  • Males
    • pararectal cystotomy
    • perineal urethrostomy
      • lithotripsy, manual crushing
    • cystotomy
      • paramedian, ventral midline
      • laparascopic
  • Flank approach
    • nephrectomy
    • ureterotomy
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10
Q

Urolithiasis

Medical TX

A
  • Medical tx
    • bladder lavage
    • antiinflammatories (PROBS NOT NSAIDS)
    • antimicrobials if urine cultured
    • encourage water consumption
    • eliminate legumes
    • lower DCAD to lower urine pH
      • urinary acidifiers unproven
    • 41% recurrence within 1-32 months
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11
Q

Hematuria

A
  • centrifuge urine to differentiate from pigmenturia
    • hematuria forms pellet
    • hemoglobinuria stays in soln
  • When in stream?
    • throughout
      • kidneys
      • bladder
    • beginning of urination
      • distal urethra
    • end urination
      • proximal urethra
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12
Q

adenocarcinoma

A
  • hematuria, weight loss, colic
  • unilateral, no azotemia
  • nephrectomy
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13
Q

Idiopathic renal hematuria

about

A
  • sudden onset, life-threatening hematuria
    • multiple episodes
  • blood clots from one or both kidneys
  • no age, sex predisposition
  • > 50% arabians
  • PE: acute blood loss
  • No systemic dz
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14
Q

Idiopathic renal hematuria

diagnostic plan

A
  • rule out
    • renal adenocarcinoma
    • coagulopathy
  • Azotemia uncommon
  • endoscopy
  • ultrasound
  • TX
    • supportive care
      • blood transfusion
      • medications to promote hemostasis
        • aminocaproic acid, formalin (no evidence)
    • unilateral nephrectomy
      • often bilateral dz
    • dexamethasone
      • anecdotal evidence
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15
Q

Hematuria

bladder

A
  • Cystolith
  • neoplasia
  • blister beetle toxicity
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16
Q

cantharidin

A
  • cantharadin
    • 1mg/kg (6-8 beetles) can be toxic
    • potent irritant
      • GI and oral mucosa
      • cystitis, nephrosis
      • myocarditis
  • Diagnosis
    • hypocalcemia, hypomagnesemia, azotemia
    • GI contents or urine
    • ID beetle in hay
  • TX
    • fluid and electrolyte support, analgesia (not NSAIDS)
    • charcoal, biosponge
    • Mineral oil is contraindicated (may potentiate absorption)
17
Q

Hematuria

Urethra/external genitalia

A
  • Neoplasia
    • squamous cell carcinoma
    • sarcoid
  • habronemiasis
    • summer sore
    • local hypersensitivity
    • sulfur granules
    • treatment
      • ivermectin, steroids, fly control

*need to submit histo to tell the difference between these two

18
Q

Hematuria

Urethral Tear

A
  • At level of ischial arch, dorsocaudal aspect
  • hemospermia, hematuria
    • end urination
    • bright red
  • no pollakiuria, dysuria
  • quarter horse geldings overrepresented
    • and stallions hemospermia
  • blowout of corpus spongiosum into urethra
  • DX
    • HX
    • endoscopy (normal bladder, back out and find tear)
  • TX
    • benign neglect
    • subischial/perineal urethrotomy
    • buccal mucosal graft (for stallions, blood kills sperm)
19
Q

Bacterial Cystitis

A
  • Rare in horses
    • more common in mares
  • CS: Dysuria pollakiuria, hematuria
  • DX: UA/ Culture
    • Sediment
      • +/- > 10 wbc/hpf, bacteriuria
      • > 10,000 cfu/ml midstream or catheterized
  • Etiology: G- enterics; mixed
  • TX
    • trimethoprim sulfonamide or penicillin or ceftiofur
    • diuresis
    • acidify urine - no shown effective method
20
Q

Pyelonephritis

A
  • less common than bacterial cystitis
  • Etiology
    • secondary to ectopic ureter, bladder paralysis, nephrolithiasis = G-
    • bacteremia
      • actinobacillus, strep equi, salmonella
  • Systemic illness + dysuria, hematuria
  • DX: US, cystoscopy, culture
  • TX: Antibiotics, nephrectomy
21
Q

Urinary incontinence

UMN

LMN

A
  • upper motor neuron
    • inc urethral resistance
    • pollakiuria, sporadic dribbling
    • spinal cord lesions
  • lower motor neuron
    • relaxed bladder and sphincter, continuous dribbling
    • cauda equina syndrome
      • loss of anal/tail tone, perineal analgesia, hind limb weakness/ataxia
    • Etiologies
      • trauma
      • EHV-1 myeloencephalitis
      • Sorghum/Sudan grass toxicity
        • Ataxia and cystitis
        • Cyanide tox?!
22
Q

Urinary incontinence

Myogenic bladder

A
  • Idiopathic or secondary obstruction
  • Weight of sediment stretches detrusor
    • tight junctions broken down
    • inability to depolarize, cannot maintain sphincter
    • accumulate sabulous debris: sand stuff
23
Q

Sabulous cystitis

TX

A
  • TX: nothing really works
    • culture urine/treat bact cystitis
    • lavage bladder
    • stimulate bladder emptying
      • bethanechol
24
Q

Ectopic Ureter

A
  • Usually not clinical in males
    • may go unnoticed in males
  • Constant urine dribbling
25
Q

Polyuria / Polydipsia

A
  • urine output > 50 ml/kg/day
  • water consumption > 100 ml/kg/day
    • > 50 L/day
    • dependent on diet, exercise, activity, repro status
26
Q

Water Deprivation Test

A
  • baseline bloodwork: don’t water restrict if azotemic; UA; body weight (5% BW loss)
  • check at 6, 12, 24 hrs
  • Stop when 5% of body weight is lost
  • Should concentrate USG > 1.025
    • medullary washout
      • modified water deprivation test
      • 40 ml/kg/day for 3-4 days
27
Q

Diabetes Insipidus

A
  • Neurogenic (central)
    • loss of hypothalamic neurons => dec vasopression secretion
    • secondary to ecephalitis
  • Nephrogenic
    • collecting duct insensitive to vasopressin
  • Vasopressin concentration test
    • 60 IU in oil
    • SG > 1.020 = neurogenic
28
Q
A
29
Q

Pituitary pars intermedia dysfunction

A
  • frequently causes PU/PD
  • Impingement on hpothalamus and posterior pituitary
  • cortisol antagonism of vasopressin
  • hyperglycemia and osmotic diuresis
30
Q

Renal Failure

A
  • can cause PU/PD
  • Recovery from AKI, CKD
    • inc tubular flow
    • medullary washout
    • impaired response to vasopressin
31
Q

Causes of PU/PD

A
  • Psychogenic
  • DIabetes Insipidus
  • PPID
  • Renal Failure
  • Sepsis
  • alpha-2 agonists
    • zylazine
    • detomidine

Urology (15 decks)

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