Lower Urinary Tract Problems/dz (Specht) Flashcards Preview

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Flashcards in Lower Urinary Tract Problems/dz (Specht) Deck (20):
1

Objectives

  1. Be able to describe common clinical signs of lower urinary tract diseases.
  2. Be able to describe common diagnostic tests used in cases of lower urinary tract disease and what these tests can tell you. 

2

Most common disorder in dogs

  1. uroliths
  2. infections
  3. neoplasias
  4. congenital abnormalities
  5. functional disorders

3

Most common disorders in cats

  1. idiopathic
  2. uroliths
  3. infections
  4. neoplasias
  5. functional disorders

4

Urinary dz must be differentiated from

behavioral shtuffs

5

Primary HX evidence of LUTD

  • dysuria
    • strangury or urgency
    • vocalization
    • pollakiuria
    • abnormal stream
  • incontinence
  • periuria (inappropriate urination)
  • pigmenturia or discoloration
    • not specific, but common

6

Signs not associated with LUTD

  • Generally not PU/PD
  • In most cases w/o obstructions:
    • few systemic signs

7

Diagnosis goals

  • verify problem has a medical origin
  • characterize the problem
    • type of CS or abn test results
    • mechanical/structural vs functional
  • Localize problem to LUT or spec location in LUT
  • Attempt to find specific etiology

8

Methods of diagnosis

  • UA
    • pigmenturia/hematuria
    • pyuria
    • crystalluria
    • bacteriuria
    • neoplasia
  • free catch vs cysto
    • artifacts
    • localization

9

Lab DX tests

  • Chem, CBC
    • values not related to LUT
    • can provide info about
      • underlying risk factors: liver dz, stones
      • concurrent dz: polyneuropathy (incondinence)
  • Microbio (culture): almost always wanted/needed
    • typically aerobic
    • occasional odd bugs
    • not used in uncomplicated 1st offenders

10

Diagnostic imaging

  • rads
    • primary stones
  • ultrasound
    • poor at finding urethral lesions
  • contrast studies
    • positive (contrast)
    • negative (air)
    • double (both)
    • relevant LUT locations (look at entire urinary tract)
  • Endoscopy
    • direct visualization
    • potential for sampling or intervention

11

Other DX

Traumatic catheterization

  • to get tissues
  • cytology
  • biopsy

12

Feline LUTD

about

  • Very common problem
  • non specific CS
    • pollakiuria, hematuria, strangury, periuria, dysuria
  • numerous etiologies
    • urolithiasis, infection, neoplasi

13

Feline LUTD

Terminology

  • FIC (feline idiopathic cystitis)
    • FUS
    • iFLUTD
  • may account for > 50% of all FLUTDs

14

FIC

Biologic behavior

  • variable
  • may be complicated by obstruction (urethral plugs)
  • often resolves in 2-7 days (85%)
    • 39-55% have recurrence
    • some have persistence

15

FIC

DX

  • often presumptive
    • HX
    • physical examination
    • +/- labwork
  • Diagnosis of exclusion
    • R/O all other reasonable causes
  • Average case we recommend
    • UA (w/ sediment exam) - will have inflammation
    • Urine culture
    • Rads
    • other tests may not be necessary

16

If CS of LUTD persist or recur frequently

 

  • serum chem
  • CBC
  • ultrasound
  • contrast urethrocytography
  • urethrocytoscopy
  • +/- biopsy

17

FIC

TX options

  • Do nothing: mild CS, infrequent, episodic
  • inc H2O consumption
    • canned food, lots of water bowls, fountains
    • avoid changing diet frequently
  • Environmental enrichment
    • litterboxes
    • social interaction (+/- people, cats, etc)
  • Feliway
  • Tricyclic antidepressants
    • amitryptyline
    • clomipramine
    • no good evidence for other anti-depressants
  • Analgesics

18

Antidepressants and FIC

  • Tricyclic antidepressants
    • amitryptyline
    • clomipramine
  • should be reserved for severe cases
    • reduce anxiety
    • antiinflammatory
    • other
  • must be withdrawn slowly
    • to avoid rebound
  • drug interactions
  • Other anti-depressants don't have good evidence
    • buspirone
    • fluoxetine

19

TX for FIC that doesn't work

  • Glycosaminoglycans
  • steroids, NSAIDS
  • antibiotics unless culture shows an infection

20

LUTD

Take home points

  1. LUTD is common in felines
  2. Many cats with inappropriate urination have a medical problem
  3. Most often problem is FIC
  4. There are many options for cats that need tx, but little evidence
    • H2O, MEMO, Diet
  5. CLient Education important
  6. Most cats don't require tx

*Spend 20 minutes with client, tell them you understand, and there is not much you can do, decreases euthanasia rate