Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Small Animal Medicine > Micturition > Flashcards

Micturition Flashcards

1
Q

What is micturition? Urination?

A

storage and voiding of urine

voiding urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the difference between urinary incontinence and micturition disorders?

A

involuntary passage of urine

urinary incontinence and retention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How does urine normally flow?

A
  • produced in kidneys
  • ureters undergo peristalsis and deposit urine in the bladder at the trigone
  • bladder stores and eventually expels urine
  • urine flows from the urethra to the distal urethral orifice, then outside of the body
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the 2 neurological controls of micturition?

A

HYPOGASTRIC NERVE - Sympathetic (alpha-adrenergic) innervation Stores urine by relaxing the detrusor and increasing urethral sphincter tone

PELVIC NERVE - Parasympathetic innervation = Pee (void) by activating the detrusor and relaxing urethral sphincter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What occurs in the storage phase of micturition?

A

sympathetic alpha-adrenergic innervation from the hypogastric nerve causes increased urethral sphincter tone and detrusor relaxation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What occurs in the voiding phase of micturition?

A

parasympathetic (inhibits alpha-adrenergic) innervation in the pelvic nerve causes relaxation of the urethral sphincter and detrusor contraction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How does the location of neural disease or injury affect micturition?

A

LMN (sacral) = large, flaccid bladder with decreased tone that is easily expressed

UMN (suprasacral) = large bladder with increased tone that is hard to express

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are 5 causes of large bladders?

A
  1. LMN or UMN injury
  2. detrusor atony - common in blocked cats where prolonged distension damages smooth muscle and neurons
  3. detrusor-urethral dyssynergia - contraction of bladder and relaxation of sphincter not aligned
  4. obstruction
  5. UTI (consequence, rarely cause)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How can the bladder be affected by urinary incontinence?

A

BIG BLADDER = can’t void urine, which eventually overflows out into the urethra (increased pressure overcomes sphincter)

SMALL BLADDER = urine is not entering the bladder or is not being kept within it

failure of storage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are 6 causes of small bladders?

A
  1. urethral sphincter mechanism incompetence from spay or congenital
  2. detrusor instability causes urge or overactivity
  3. ectopic ureters bypass bladder and sphincter
  4. pelvic bladder - decreased pressure in pelvis unable to keep sphincter closed
  5. vaginal abnormalities
  6. UTI - inflammation causes contraction and urges
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is urethral sphincter mechanism incontinence (USMI)? What is the most common sign?

A

spay / estrogen responsive incontinence most common in FS dogs with a varying onset following their spay (days to years)

positional incontinence —> O usually finds spots on couches or beds, not a constant dribbling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How is urethral sphincter mechanism incontinence (USMI) diagnosed?

A

r/o other causes and response to treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What 4 treatments are available for USMI?

A
  1. phenylpropanolamine (Proin) - alpha agonist increases urethral sphincter tone
  2. estrogen (Incurin, DES) - increases urethral sphincter tone
  3. collagen injection - bulks urethral sphincter
  4. hydraulic occluder - cuff around bladder neck with SQ cuff that can be adjusted
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What form of USMI is rare? What treatment is recommended?

A

congenital —> dribbles more often than acquired, may look like ectopic ureters

  • phenylpropanolamine (Proin)
  • delay spay until first heat
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What treatment for congenital USMI is not recommended? Why?

A

estrogen —> congenital form seen in puppies that are still growing and imbalanced hormones can alter this

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the most common sign of ectopic ureters?

A
  • BILATERAL = constant dribbling
  • UNILATERAL = may void normally at times, since one ureter is still going into the trigone
17
Q

What are 2 treatments for ectopic ureters?

A
  1. surgery - extramural or mural ureter relocation
  2. laser ablation - less invasive, only doable on mural ureters
18
Q

How are ectopic ureters diagnosed? What signalment is most common?

A
  • ultrasound
  • cystoscopy with catheter follows mural ectopic ureter tunneling through the bladder wall into the urethra

female Labs, Goldens, etc.

19
Q

How do patients with ectopic ureters commonly present?

A
  • O reports dribbling of urine
  • recurrent UTIs, likely due to pooling of urine allowing bacterial proliferation
20
Q

What things should be considered in patients with possible ectopic ureters?

A
  • historical information: clarify urinary habits
  • animal’s age when incontinence first started (birth vs. after spay)
  • chronologic course of events
  • previous surgeries (neuter, spay)
  • use of medication that may stimulate PU
  • previous or current UT disease or abnormalities
21
Q

What should be noted on physical exams in patients with micturition problems?

A
  • bladder size
  • genital anatomy: juvenile/recessed vulva common in dogs with congenital USMI
  • urine dribbling or urine-stained backend
  • lumbar or sacral neurologic abnormalities
22
Q

What is the normal residual urine volume in dogs? What causes urinary retention?

A

< 2-3 mL/kg

  • urinary tract obstruction
  • functional urine retention
23
Q

What do urinary obstructions do?

A

prevents urine flow

24
Q

What are causes of mechanical and functional urinary obstructions?

A

MECHANICAL - stones, plugs, strictures (congenital vs. acquired from catheterization or stones), TCC tumor

FUNCTIONAL - myelopathies, detrusor urethral dyssynergia (bladder contraction doesn’t correlate with sphincter relaxation), long-standing obstruction

25
Q

How do urinary obstructions affect serum biochemistry?

A

postrenal azotemia

26
Q

What happens when urinary obstructions are not treated?

A

within 3-5 days, there is atony due to disruption of tight junctions between muscle cells

27
Q

What is post-obstructive diuresis?

A

volume expansion from increased pressure caused by urine obstruction impairs tubular function for several days, resulting in massive polyuria for several days

28
Q

What is the most common urinary obstruction in cats? What are 4 causes?

A

functional sympathetic nervous input

  1. neurogenic
  2. direct irritation of urethra
  3. anxiety causes increased sympathetic tone*
  4. urethral spasms
29
Q

What observations can be made to differentiate functional and mechanical obstructions?

A
  • patient’s ability to void normally
  • presence of any straining
  • continued or interrupted stream
  • full or partial stream
30
Q

What is seen on palpation of the bladder and rectum in functional or mechanical obstructions?

A

BLADDER:
- functional = easily expressed, flaccid
- mechanical = hard to express, firm

RECTUM - can palpate urethra for stones, masses, or thickening

31
Q

What is the best way to differentiate functional and mechanical obstructions?

A

ability to pass a catheter

  • YES = functional
  • NO = mechanical (imaging recommended)
32
Q

What imaging is recommended for diagnosing functional and mechanical obstructions?

A
  • abdominal radiographs: “off the butt” shot in males to get entire urethra —> STONES
  • ultrasound (can’t follow urethra)
  • contrast radiography or fluoroscopy
  • CT with contrast
  • cystoscopy
33
Q

How are urinary stones treated?

A
  • urohydropulsion
  • lithotripsy
  • laparoscopic
  • cystotomy
34
Q

How are urethra strictures treated?

A
  • bougienage
  • balloon catheter

teats scar tissue on the urethra

35
Q

How are masses causing mechanical obstruction treated?

A
  • radiation, chemotherapy
  • laser ablation
36
Q

What 4 drugs are recommended for treating functional urethral obstruction?

A
  1. Phenoxybenzamine, Prazosin, and Tamsulosin - alpha-blockers relax alpha-adrenergic tone to the urethral sphincter
  2. Diazepam
  3. Bethanechol - parasympathomimetic activated M receptors on the smooth muscle of the bladder
  4. Cisapride - smooth muscle contraction (?)
37
Q

What are the most common clinical signs of FLUT?

A
  • stranguria
  • pollakiuria: frequent, small
  • hematuria
  • periuria: urination outside of litterbox

60% feline idiopathic cystitis, 20-40% urolithiasis, 15-20% UTI + obstructions due to urolithiasis

38
Q

What is the recurrence of FLUTD like?

A

50% of cats had a recurrence regardless of cause

  • > 50% had more than one recurrent episodes
39
Q

What is the treatment for feline idiopathic cystitis like? What medications are recommended?

A

(stress, neurogenic)

  • multimodal environmental modification (more litterboxes)
  • diet with increased moisture (canned)
  • water fountains (may not increase hydration, but cats enjoy playing in them)
  • pheromones
  • MEDS: Amitriptyline, Gabapentin, Fluoxitine (Prozac)

Small Animal Medicine (52 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions