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CVNT2 > Equine Urinary Tract > Flashcards

Equine Urinary Tract Flashcards

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1
Q

what does pollakuria mean?

A

increased frequency of urination

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2
Q

what does dysuria mean?

A

painful urination

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3
Q

what does stranguria mean?

A

painful, frequent urination of small volumes

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4
Q

what does oliguria mean?

A

low urinary output

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5
Q

what does anuria mean?

A

absence of urination

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6
Q

which urinary tract disorders are horses prone to?

A 
PUPD 
pigmenturia 
renal disease 
neoplasia 
urolithiasis 
UTIs 
developmental disorders
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7
Q

what are the most common problems that owners state in a horse with a urinary disorder?

A

abnormal urination

weight loss

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8
Q

what is considered polydipsia for a horse?

A

more than 100ml/kg/day

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9
Q

how should you perform a clinical examination of a horse presenting with urinary issues?

A

standard clinical exam

rectal exam

penis exam under sedation (a2 agonist and butorphanol PLUS ACP to encourage protrusion of penis)

pass urinary catheter if suspected obstruction

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10
Q

what blood tests can be performed to assess for urinary disease?

A

haematology - leukocytosis, anaemia (chronic disease/renal failure)

urea/creatinine (azotemia)

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11
Q

when will creatinine levels in the blood increase?

A

not until >75% nephrons non-functional - little use in evaluation of early/minor changes

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12
Q

what is the relationship between urea/creatinine and kidney function?

A

once elevated, doubling urea/creatinine = 50% decline in remaining function

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13
Q

how is urine caught for urinalysis?

A

usually caught midstream (container on a stick) or obtained by catheterisation

most horses will urinate when placed in a freshly bedded stable

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14
Q

can cystocentesis be performed in horses?

A

no

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15
Q

what urinalysis can be performed?

A

USG

biochemistry (reagent strip analysis)

sediment analysis (casts)

if pigmenturia, note timing and duration of passage of discoloured urine

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16
Q

what is USG? how do you measure it?

A

an estimate of urine concentration

measured with a refractometer

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17
Q

what is the term given for urine that is more dilute than serum?

A

hyposthenuria - low USG (<1.008)

kidney unable to concentrate urine normally

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18
Q

what is the term given for urine with a similar osmolality to serum?

A

isosthenuria (1.008-1.014)

kidneys cannot form urine with a higher or a lower specific gravity than that of protein-free plasma

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19
Q

what is the term given to urine that is more concentrated than serum?

A

hypersthenuria (>1.014)

unusually high specific gravity and concentration of solutes, resulting usually from loss or deprivation of water

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20
Q

what is the normal concentration of equine urine?

A

adults hypersthenuric

foals hyposthenuric

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21
Q

how/why is ultrasonography performed?

A

transrectally/transabdominally

looking for uroliths in kidneys/bladder

checking size and architecture of kidneys

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22
Q

what is cystoscopy useful for?

A

very useful for investigation of abnormal urination

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23
Q

what can be examined under cystoscopy?

A

urethra and bladder

watch urine coming from ureters (may identify a unilateral renal problem)

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24
Q

why might you perform a water deprivation test?

A

assessment of PUPD - tests for diabetes insipidus/psychogenic polydipsia

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25
what is psychogenic polydipsia?
excessive fluid intake in the absence of physiological stimuli to drink
26
what parameters should be checked before a water deprivation test?
urea, creatinine and USG | do not proceed if increased (azotemic) or USG>1.008
27
when should a water deprivation test be stopped?
when 24 hours reached when USG rises to >1.020 if azotemic if any clinical signs of dehydration if loss of 5% BW
28
how is a modified water deprivation test carried out?
water restricted to 4% BW per day and given in small amounts
29
why might a horse have myoglobin or haemoglobin in the urine?
myoglobin - myopathy haemoglobin - haemolysis
30
why might a horse have haematuria throughout urination?
haemorrhage in kidneys/ureters/bladder
31
why might a horse have haematuria at the beginning of urination?
bleeding from distal urethra
32
why might a horse have haematuria at the end of urination?
bleeding from proximal urethra
33
what are the possible causes of PUPD?
renal failure diabetes mellitus pituitary pars intermedia dysfunction (PPID) primary/psychogenic polydipsia central/nephrogenic diabetes insipidus
34
what further tests can be done in horses with PUPD?
look for renal failure - isosthenuria and azotemia investigate for PPID in older horses water deprivation test to differentiate between diabetes insipidus and primary polydipsia
35
what is acute renal failure?
a clinical syndrome associated with abrupt reduction in glomerular filtration
36
what does acute renal injury lead to?
failure of kidneys to excrete nitrogenous wastes, causing azotemia --> uraemic syndrome disturbances in fluid/electrolyte/acid-base homeostasis
37
how does acute renal injury result from pre-renal failure?
decreased renal perfusion without associated cell injury conditions causing decreased cardiac output / increased renal vascular resistance e.g. dehydration, diarrhoea, endotoxaemia, septic shock, +/-use of NSAIDs in these cases
38
how does acute renal injury result from intrarenal failure?
ischaemic or toxic damage to the tubules tubular obstruction (e.g. from casts) acute glomerulonephritis tubulointerstitial inflammation
39
how does acute renal injury result from post-renal failure?
obstruction or disruption of urinary outflow tract (e.g. uroliths)
40
what are the clinical signs of acute renal failure?
lethargy inappetence dehydration signs of the primary problem e.g. colic vague and non-specific signs
41
how is ARF diagnosed?
oliguria azotemia USG casts in urine - show damage rule in/out prerenal and postrenal causes, if not is intrarenal if intra-renal, US, biopsy
42
how is ARF treated?
reverse underlying cause correct fluid and electrolyte imbalances dopamine infusion to improve renal blood flow diuretics to increase urine production stop aminoglycosides where possible (if not, monitor serum concentrations)
43
what are the nursing considerations for ARF?
fluid therapy monitor urine output and signs of oedema, digital pulses encourage appetite - variety of feeds, in-hand grazing monitor for complications e.g. laminitis, thrombophlebitis, swelling/heat at catheter sites
44
what is the prognosis for ARF?
depends on underlying cause, duration, response to treatment, and development of complications can live long-term but usually polyuric - must always have access to water
45
what are the possible causes of chronic renal failure (CRF)?
``` glomerulonephritis (most common) immune-mediated ischaemia toxic insults infection ```
46
what are the clinical signs of CRF?
``` lethargy (anaemia) anorexia weight loss (common) PUPD dental tartar azotemia and inability to concentrate urine ``` signs present late in disease course
47
what are the nursing considerations for CRF?
fluid therapy to rule out ARF - monitor urine output and signs of oedema access to water always encourage eating diet - reduce protein (avoid alfalfa)
48
what is the most common sign of UTI in horses?
dysuria
49
are UTIs common in horses?
no - usually secondary to another issue (e.g, urolithiasis)
50
how can you diagnose a UTI?
mid-stream urine sample for bacteriology investigate for underlying causes
51
what types of neoplasia are common in horses?
penile - usually squamous cell carcinoma (older geldings) can have melanoma, sarcoid, papilloma
52
what are the signs of penile squamous cell carcinoma?
no signs early on malodourous/swollen sheath haematuria if distal urethra involved obstruction is uncommon unless tumours are large
53
how is penile SC treated?
local excision and penile resection penile resection plus urethrostomy
54
what is the prognosis for penile SCC?
high rate of recurrence but slow metastasis (inguinal lymph nodes)
55
which horses are more likely to develop uroliths?
male adults (mean age 10) | shorter, wider urethra makes it easier for mares to pass small caliculi
56
what is the most common site for uroliths to form?
bladder
57
what is the least common site for uroliths to form?
urethra
58
what are the 2 types of uroliths?
type 1 - most common, yellow and spiculated, easily fragment type 2 - grey and smooth
59
what are all uroliths made of in horses?
calcium carbonate
60
what is a sabulous urolithiasis?
accumulation of urine sediment in the ventral bladder
61
what are cystic caliculi?
bladder stones
62
what are the signs of cystic caliculi?
``` dysuria haematuria stranguria incontinence signs especially at/after exercise ```
63
how are cystic caliculi diagnosed?
rectal exam, endoscopy of bladder, US (must empty the bladder)
64
how are cystic caliculi treated?
laparotomy and cystotomy
65
why can't cystic caliculi be dissolved?
horses have alkaline urine due to diet - difficult to alter diet to make urine acidic enough to dissolve stones
66
which horses usually suffer from cystic caliculi?
usually males
67
what are urethral caliculi?
usually small cystoliths that have passed into the urethra
68
what are the signs of urethral caliculi?
dysuria colic, post-renal ARF and risk of rupture if blocked
69
how are urethral caliculi treated?
perineal urethrotomy
70
how can recurrence of urolithiasis be avoided?
avoid predisposing factors no supplementary electrolytes no alfalfa/lucerne check for UTI
71
what are the signs of urinary incontinence in horses?
similar signs to urolithiasis, which is more common, so more beneficial to check for uroliths
72
what can cause urinary incontinence?
upper motor neuron diseases (equine herpes virus, myeloencephalitis) lower motor neuron diseases myogenic disorders sabulous urolithiasis
73
what are the nursing considerations for urolithiasis/urinary incontinence?
cleaning of the perineum/hindlimbs protection from urine scalding management of urinary catheter monitoring urine output and quality
74
which developmental urinary diseases can affect foals?
patent urachus | ruptured bladder
75
what is patent urachus?
developmental malformation congenital patent urachus - failure to close at birth means urine passes out of umbilicus
76
how is patent urachus treated?
prophylactic antibiotics, usually closes with time some may require surgical resection
77
when does bladder rupture occur in foals?
occurs during parturition, usually in males
78
what does a bladder rupture result in?
electrolyte imbalance (hyperkalaemia) urine accumulation free in the abdomen
79
how is bladder rupture treated?
fluid support then surgery to correct

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