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Flashcards in Equine Urinary Tract Deck (121)
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1
Q

what are the main urinary tract disorders in horses?

A
PUPD
pigmenturia
renal disease
neoplasia
urolithiasis
UTI
developmental disorders
2
Q

what history taking is needed when investigating equine urinary problems?

A
standard history
abnormal urination
abnormal colour
any other problems
measure water intake over 24hrs
3
Q

what water intake is classed as polydipsia in horses?

A

> 100ml/kg/day

4
Q

what will owners of horses with urinary issues most often confuse?

A

polyuria (increased volume)

pollakuria (increased frequency)

5
Q

what are the most common problems associated with urinary issues?

A

abnormal urination

weight loss

6
Q

what is involved in the clinical exam of a horse with urinary issues?

A

standard
rectal
examination of penis
passing of urinary catheter

7
Q

what is a rectal exam used for in the urinary patient?

A

bladder: size, wall thickness, uroliths (bladder stones), masses
caudal pole of left kidney

8
Q

how should the horse be restrained for examination of the penis?

A

sedate with alpha 2 agonist

ACP to encourage protrusion

9
Q

when should a urinary catheter be passed in horses?

A

if obstruction suspected

10
Q

what blood tests will be performed on equine urinary patients?

A

haematology

biochem

11
Q

what is found on haematology that may indicate UTI or infection?

A

leukocytosis

12
Q

what would anaemia in the urinary patient indicate?

A

chronic disease

chronic renal failure leading to reduction in production of erythropoetin (EPO)

13
Q

what does raised urea and creatinine indicate?

A

azotemai

14
Q

when will urea and creatinine levels increase?

A

once 75% of nephrons are non-functional

15
Q

is urea/creatinine useful in early kidney disease?

A

no

16
Q

what is indicated by a doubling of urea and creatinine values once they are elevated?

A

50% decline in remaining kidney function

17
Q

how is a urine sample obtained from a horse for urinalysis?

A
caught midstream (container on a stick)
catheterisation
18
Q

is cystocentesis performed in horses?

A

no

19
Q

what can be done to encourage horses to urinate?

A

freshly bedded stable

20
Q

what should be noted if pigmenturia is present?

A

timing

duration of passage

21
Q

what is involved in urinalysis?

A

USG
dip stick (biochemistry)
sediment analysis of casts

22
Q

what is USG a measure of?

A

urine concentration

23
Q

what is used to measure USG?

A

refractometer

24
Q

what is hyposthenuria?

A

urine that is more dilute than serum (<1.008)

25
Q

what is isosthenuria?

A

urine and serum have similar osmolality - indicates kidney is unable to have any effect on urine
>1.008-1.014

26
Q

what is hypersthenuria?

A

urine more concentrated than serum

27
Q

what is the concentration of normal horse and foal urine like?

A

adult normally concentrated

foal dilute

28
Q

what can ultrasonography be used for in urinary diagnosis?

A

uroliths in kidney and sometimes bladder

size and architecture of kidneys

29
Q

what is cystoscopy useful for?

A

investigation of abnormal urination

30
Q

what can be examined during cystoscopy?

A

urethra
bladder
watching and sampling urine from ureters

31
Q

what will sedation for cystoscopy need to include if patient is male?

A

ACP

32
Q

what is a water deprivation test used for?

A

test for diabetes insipidus or psychogenic polydipsia once all other causes of PUPD are ruled out

33
Q

what must be checked before a water deprivation test is performed?

A

urea and creatinine
USG
weight

34
Q

when should you not proceed with a water deprivation test?

A

if urea and creatinine increased

USG >1.008

35
Q

how is a water deprivation test performed?

A

weighed
water is removed
USG, urea and creatinine checked regularly
monitor for signs of dehydration

36
Q

when is a water deprivation test stopped?

A
24 hours reached 
USG rises to above 1.020 
Azotaemia
Clinical signs of dehydration 
Loss of 5% BW
37
Q

what is involved in the modified water deprivation test?

A

water is restricted to 4% of BW over 24 hours rather than being totally removed

38
Q

what are the main types of haematuria seen?

A

myoglobin
haemoglobin
haematuria

39
Q

what does myoglobin in urine indicate?

A

myopathy

40
Q

what does haemoglobin in urine indicate?

A

haemolysis

41
Q

what does haematuria throughout urination suggest?

A

haemorrhage from kidneys, ureters or bladder

42
Q

what does haematuria at the beginning of urination suggest?

A

haemorrhage from distal urethra

43
Q

what does haematuria at the end of urination suggest?

A

haemorrhage in proximal urethra

44
Q

what can cause PUPD in horses?

A
renal failure
PPID
primary/psychogenic polydipsia
central nephrogenic diabetes insipidus 
DM
45
Q

what is diabetes insipidus caused by?

A

lack of ADH

46
Q

what should you look for on the bloods of a horse with PUPD?

A

renal failure
isosthenuria
azotemia
PPID in older horses

47
Q

when is water deprivation testing only performed?

A

if other causes ruled out
if not azotaemic
USG of >1.008

48
Q

what is acute renal failure?

A

clinical syndrome associated with abrupt reduction in glomerular filtration

49
Q

what does acute renal failure lead to?

A

failure of kidneys to excrete nitrogenous wastes causing azotaemia
disturbances in fluid, electrolyte and acid-base homeostasis

50
Q

what does azotaemia present as?

A

uraemic syndrome - manifestation of clinical signs of azoteamia

51
Q

what are the 3 reasons for acute renal failure?

A

pre-renal
renal
post renal

52
Q

how does AKI result from a pre-renal cause?

A

decreased renal perfusion without associated cell injury

from conditions the decrease cardiac output or increase renal vascular resistance

53
Q

what are some of the reasons for pre-renal AKI?

A
dehydration
diarrhoea
endotoxaemia
septic shock
NSAID use
54
Q

what causes intrarenal AKI?

A

Ischaemic or toxic damage to the tubules, tubular obstruction (e.g. from casts), acute glomerulonephritis, tubulointerstitial inflammation

55
Q

what causes post renal AKI?

A

Obstruction or disruption of urinary outflow tract (e.g. uroliths)

56
Q

what are the clinical signs of AKI?

A
Lethargy 
Inappetence 
Signs of the primary problem e.g. colic 
Dehydration 
Vague and non specific
57
Q

how is AKI diagnosed?

A

presence of oliguria/anuria
Azotaemia
Urine specific gravity
“Casts” in urine – show damage

58
Q

how can cause of AKI be diagnosed?

A

Rule in/out prerenal and postrenal causes, if not is intrarenal
If intrarenal, ultrasound and attempt biopsy

59
Q

how is AKI in horses treated?

A

Reverse underlying cause
Correct fluid and electrolyte imbalances
diuretics to improve urine production
stop NSAIDs where possible

60
Q

what should be done if it is not possible to stop NSAIDs in an AKI patient?

A

monitor serum concentrations

61
Q

what can be done if the AKI patient does not respond sufficiently to IVFT?

A

dopamine infusion to improve renal blood flow

62
Q

what does the prognosis of AKI depend on?

A

Underlying cause
Duration
Response to treatment
Development of complications like thrombophlebitis, laminitis

63
Q

what will often happen to patients who survive AKI?

A

can live long term
often polyuric
must have access to water at all times

64
Q

what causes chronic kidney disease?

A

glomerulonephritis

65
Q

what are the main causes of glomerulonephritis?

A

Immune-mediated
Ischaemia
Toxic insults
Infection

66
Q

when do CKD patients often present?

A

late on in disease

67
Q

what are the signs of CKD?

A
Lethargy due to anaemia
Anorexia
Weight loss** (main)
PU/PD
Dental tartar
Azotaemia + inability to concentrate urine
68
Q

what is the prognosis of CKD like in horses?

A

poor due to number of nephrons destroyed before patient shows signs

69
Q

what are the nursing considerations for CKD?

A

Fluid therapy – to rule out ARF.
Access to water
Encourage eating
Diet

70
Q

what should be monitored when a patient is on IVFT?

A

urine output

signs of volume overload (oedema)

71
Q

how should the diet of CKD patients be altered to support them?

A

reduce protein (avoid alfalfa)

72
Q

why should alfalfa be avoided in CKD patients?

A

high protein and calcium levels

73
Q

are UTIs common in horses?

A

no - and will be underlying issue if present

74
Q

what are the presenting signs of UTI in horses?

A

dysuria

75
Q

how is UTI diagnosed?

A

midstream urine sample with biochemistry

investigation of underlying causes

76
Q

is neoplasia of the urinary tract common in horses?

A

not really other than penile

77
Q

what are the main types of penile cancer in horses?

A

melanoma
sarcoid
papilloma

78
Q

what is the main neoplasia of the penis seen in older geldings?

A

squamous cell carcinoma

79
Q

what are the signs of penile squamous cell carcinoma?

A

malodourous / swollen sheath
haematuria if distal urethra involved
early on no signs

80
Q

is urinary tract obstruction often seen with penile squamous cell carcinoma?

A

uncommon unless tumor is large

81
Q

what does treatment of penile squamous cell carcinoma depend on?

A

position and extent of tumor

82
Q

what are the main treatment methods for penile squamous cell carcinoma?

A

local excision
penile resection
urethrostomy (major surgery)

83
Q

how likely is penile squamous cell carcinoma to reoccur?

A

high rate of recurrence but metastasis is slow

84
Q

where should be checked to look for local invasion of penile squamous cell carcinoma?

A

inguinal lymph nodes through rectal exam

85
Q

in what horses is urolithiosis more common?

A

males

adults (mean age 10)

86
Q

why are males more prone to urolithiosis?

A

shorter and wider urethra makes it easier for mares to pass small calculi

87
Q

where are uroliths most commonly seen?

A

bladder

88
Q

what are all uroliths in horses formed from?

A

calcium carbonate

89
Q

what are the most common types of calcium carbonate urolith?

A

type 1 -
yellow
spiked

90
Q

what are type 2 uroliths like?

A

grey

smooth

91
Q

what is sabulous urolithiosis?

A

accumulation of urine sediment in the ventral bladder

92
Q

what are the clinical signs of cystic calculi?

A
Dysuria
Haematuria
Stranguria
Incontinence
Especially at/after exercise
93
Q

how are cystic calculi diagnosed?

A

Rectal, endoscopy, ultrasound

(must empty the bladder)

94
Q

how is cystic calculi treated surgically?

A

laparotomy and cystotomy

95
Q

what are the long term complications associated with cystic calculi?

A

low

96
Q

where are urethral calculi commonly seen?

A

males

97
Q

what are urethral calcui often formed from?

A

small cystoliths that have passed into the urethra

98
Q

what are the signs of urethral calculi that have caused urethral obstruction?

A

Colic
ARF (postrenal)
Risk of rupture

99
Q

what can repeated, temporary blockage caused by urethral calculi lead to?

A

CRF

100
Q

what surgical procedure can be used to treat repeated urethral calculi?

A

perineal urthrotomy

101
Q

does urolithiosis often reccurr?

A

low recurrence rate

102
Q

is dietary treatment of urolithiosis in horses possible?

A

no - cannot acidify urine

103
Q

how can urolithiosis be prevented?

A

avoid predisposing factors
no supplementary electrolytes
no alfalfa or lucerne due to high Ca2+

104
Q

what should you check for it urolithiosis is recurring?

A

UTI

105
Q

is urinary incontinence common in horses?

A

no

106
Q

what are signs of incontinence exacerbated by?

A

coughing exercise

107
Q

what are the signs of urinary incontinence?

A

similar to urolithiosis which is more common so should be checked for

108
Q

what conditions make urinary incontinence likely?

A

Upper motor neuron (incl. Equine Herpes Virus (EHV) myeloencephalitis), lower motor neuron or myogenic disorders
Sabulous urolithiasis

109
Q

what is bladder paralysis a feature of?

A

neurological diseases (cauda equina syndrome), herpes virus.

110
Q

what are the signs of bladder paralysis?

A

Urinary incontinence, scalding, loss of anal/tail muscle tone

111
Q

what are the nursing considerations for patients with urinary issues?

A

Cleaning of the perineum/hindlimbs to provide protection from urine scalding
Management of urinary catheter (if necessary)
Nursing considerations as colic surgery if abdominal surgery (e.g. cystotomy)
Monitoring of urine output
Monitoring urination

112
Q

what urinary tract issues are seen in foals?

A

Patent urachus

Ruptured bladder

113
Q

what is the most common developmental malformation in horses?

A

patent urachus

114
Q

how does patent urachus occur?

A

Normally, urachus closes at time of parturition

in a congenital patent urachus there is failure to close at birth (tension during parturition a possible cause)

115
Q

what is the urachus?

A

in the foetus urine passes from bladder to allantoic cavity via the urachus

116
Q

what is the sign of a patent urachus?

A

Drip urine from umbilicus

117
Q

how should patent urachus be treated?

A

prophylactic antibiotics, usually close with time

surgical resection if doesn’t resolve

118
Q

when does bladder rupture often occur in foals?

A

Occurs during parturition, usually in males

119
Q

what are the signs of bladder rupture?

A

progressive dullness over first 72 hours

120
Q

what does bladder rupture cause?

A

Results in electrolyte imbalance (hyperkalaemia)

Urine accumulation free in the abdomen

121
Q

how is bladder rupture treated?

A

fluid support then surgery to correct

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