Nephrology and Urology Flashcards Preview

RUSVM Small Animal Medicine II 2017 > Nephrology and Urology > Flashcards

Flashcards in Nephrology and Urology Deck (302):
1

Azotemia

Abnormal increase in the concentration of non-protein nitrogenous wastes in blood

2

Causes of Pre-Renal Azotemia

Dehydration
Hypoadrenocorticism
Cardiac disease
Shock
Hypovolemia

3

Causes of Renal Azotemia

Parenchymal disease
infections
cysts
inflammation
neoplasia
toxins

4

Causes of Post-Renal Azotemia

Blockage

5

Renal Failure

When the kidneys are no longer able to maintain regulatory function, excretory Function, and endocrine Function

6

When does Renal failure occur?

When greater than 75% of the nephron population is non-functional

7

Characteristics clinical findings associated with Uremia

Hypoalbuminemia
Azotemia
Hypercholesterolemia
Peripheral edema

8

What the indirect methods for measuring Glomerular function?

Serum urea levels
Serum creatinine levels
Cystatin C
SDMA

9

What are the accurate techniques for measuring Glomerular function?

Clearance of radioisotopes with renal scintigraphy
Iohexal/inulin/creatinine clearance tests

10

What percentage of nephrons have to be destroyed before GRF is decreased?

66%

11

What is the gold standard for measuring Glomerular function?

Renal scintigraphy

12

What can cause an increase in urea?

GIT bleeding
Intravascular hemolysis
high protein diets

13

What causes the production of Creatinine?

breakdown of creatine in muscle

14

When do you get a decrease in creatinine?

Reduced muscle mass

15

What are the limitations of Creatinine?

Does not discriminate between causes of azotemia, Acute vs. chronic renal failure, or Reversible or irreversible renal failure

16

Cystatin C

small polypeptide protease inhibitor produced by all cells with a nucleus that is freely filtered by the glomeruli and does not undergo tubular secretion

17

SDMA

methylated form of the amino acid arginine which is produced in every cell and released into the body's circulation during protein degradation and excreted exclusively by the kidneys

18

What is the best method for Urine collection?

Cystocentesis

19

What are the useful tests on the Urine dipstick?

Protein
pH
blood
glucose
ketones

20

What is the gold standard of urine concentration?

Osmolality

21

What test measures concentration of urine relative to plasma?

Urine Specific gravity

22

What is the range of urine specific gravity for hyposthenuria?

1.000-1.007

23

What is the range of urine specific gravity for Isosthenuria?

1.008-1.012

24

What is the range of urine specific gravity for Hypersthenuria?

Greater than 1.012

25

What is the range of urine specific gravity for minimally concentrated?

1.013-1.030

26

What is the range of urine specific gravity for Inadequately concentrated?

1.013-1.022

27

What is the range of urine specific gravity for adequately concentrated urine in dogs?

greater than 1.030

28

What is the range of urine specific gravity for adequately concentrated urine in cats?

greater than 1.035

29

What are the DDx for a urine specific gravity of 1.005?

Diabetes Insipidus
Psychogenic Polydipsia

30

What is a test you can perform for an animal with low concentrating urine?

Partial Water Deprivation Test

31

Fractional excretion of electrolytes

The fraction of electrolyte clearance relative to creatinine clearance

32

What crystals are found in Lhaasa Apsos?

Calcium dihydroxylate

33

What crystals are found in bull dogs?

Cysteine crystals

34

What crystals are created due to Ethylene Glycol?

Calcium monohydrate

35

What crystals are seen in dalmations or with hepatic shunts?

Ammonium biurate

36

What are common crystals seen in cats?

Struvites

37

What causes a false positive on Urine protein creatinine ratio?

Lower Urinary Tract Disease

38

Urine protein creatinine ratio

comparison of protein to creatinine

39

What is the most common bacterial cause of UTI?

E. coli

40

Gross macroscopic hematuria

Sufficient blood to be apparent to the naked eye
Urine is brownish to red

41

Occult microscopic hematuria

Hematuria not present to the naked eye

42

Pseudohematuria

Red to brownish urine without intact red blood cells

43

What are the causes of pseudohematuria?

Hemoglobinuria
myoglobinuria or chemicals

44

What causes systemic hematuria?

Hemostatic defects

45

What causes Renal Hematuria?

Neoplasia
Calculi
Trauma
Infarction
Cysts
Glomerulonephritis
infection

46

What causes Bladder, Ureter, and Urehral Hematuria?

Bacterial infection
calculi
trauma
neoplasia
polyps
cyclophosphamide
Feline idiopathic cystitis

47

What causes Genital tract Hematuria?

Prostatic disease
estrus
infection
neoplasia
trauma

48

What are the clinical manifestations of kidney disease?

PU/PD
Anorexia
GI signs
weight loss
pale MM
Lethargy
Blindness
Distended Abdomen

49

Name some Renal Toxins

Lilies
Ethylene Glycol
Aminoglycosides
Grapes
Raisins

50

Pollakiuria

Frequent Urination

51

Stranguria

Straining to urinate

52

Dysuria

Inappropriate urination

53

How much urine is produced per hour?

1-2ml/kg/hr

54

What are primary causes of enlarged kidneys due to neoplasia?

Renal adenocarcinoma
Renal lymphoma
Renal sarcoma
Nephroblastoma

55

Why does Renal Carcinoma cause Polycythemia?

overproduction of erythropoietin by the tumor or due to renal hypoxia

56

What is the treatment for Renal carcinoma?

Nephrectomy

57

What is the prognosis for an animal with Renal Carcinoma?

16 months with treatment

58

What renal neoplasia is common in cats?

Renal Lymphoma

59

How do you treat Renal lymphoma?

Multi-agent chemotherapy (COP or CHOP)

60

What is the prognosis for Renal lymphoma?

60% have remission

61

What are non-neoplastic causes of renomegaly?

Acute nephrosis
Acute pyelonephritis
FIP
Leptospirosis
Amyloidosis
Hydronephrosis
Polycystic kidney disease
Portosystemic shunts

62

Acute Kidney injury

Encompasses mild damage that does not cause azotemia to severe damage associated with complete anuria

63

Acute renal failure

Decreased GFR leading to retention of nitrogenous wastes

64

What is the criteria for Acute Kidney Injury?

R - Risk
I - Injury
F - Failure
L - Loss
E - End-stage kidney disease

65

IRIS

Intenational renal interest society

66

Grade 1 AKI

Blood creatinine less than 1.6 mg/dl

67

Grade 2 AKI

Blood Creatinine 1.7-2.5mg/dl

68

Grade 3 AKI

Blood Creatinine 2.6-5.0mg/dl

69

Grade 4 AKI

Blood creatinine 5.1-10mg/dl

70

Grade 5 AKI

Blood creatinine greater than 10mg/dl

71

What are the pre-renal causes of AKI?

Hypoxia
Ischemia
Dehydration
hypovolemia
hypotension
decreased effective circulatory volume
anesthesia
hypoadrenocorticism
Trauma
surgery
shock
heatstroke
Hypoalbuminemia
hypoperfusion

72

What are the renal causes of AKI?

Prolonged renal hypoperfusion
Prolonged obstruction
Excessive vasoconstriction
Thrombosis
Transfusion rxns
Infectious causes
Neoplasia
Immune mediated causes
Secondary to systemic disease
NSAIDs
Ethylene glycol
Aminoglycosides

73

Post renal causes of AKI

Urine leakage or obstruction

74

What are the four phases of acute renal failure?

Initial
Extension
Maintenance
Recovery

75

Initial phase of Acute renal failure

decrease in urine output or increase in creatinine without clinical signs

76

Extension phase of Acute Renal Failure

Continued hypoxia and inflammation
Proximal tubule and loop of henle susceptible to toxic and ischemic damage
Compromised Sodium:Potassium pump
Increased cytosolic calcium
Loss of brush border or apical and basal cell surfaces

77

Maintenance phase of Acute Renal Failure

1-3 weeks duration
Urine output is increased or decreased
Urine = ultrafiltrate

78

Recovery phase of Acute Renal Failure

Heralded by polyuria
Extreme Sodium loss

79

What are the risk factors for Renal tubular necrosis/injury?

Dehydration
Hypovolemia
Anesthesia
Hypoxia
Systemic inflammatory syndrome

80

How do you manage the risk factors for Renal tubular necrosis/injury?

Aggressively treat shock
Treat dehydration
Avoid nephrotoxic drugs

81

What are the Renoprotective drugs?

Calcium channel bloackers
Selective DA-2 receptor drugs
Selective DA-1 receptor agonists
Erythropoeitin analogues

82

What is normal urine production per hour?

1-2ml/kg/hr

83

What is abnormal urine production per hour?

less than 0.5ml/kg/hr

84

Diagnosis of AKI/ARF

Identify a predisposing cause
Reduced urine output
Casts - RTE cell casts
Azotemia
Renal tubular biomarkers:
GGT: Creat
NAG:Creat

85

Treatment of ARF

Maintaining fluid balance
Correct hypotension

86

What drugs are use in the treatment for ARF?

Mannitol
Furosemide
Dopamine
Fenoldopam

87

What is the correct shock dose for dogs?

60-90ml/kg/hr

88

What is the correct shock dose for cats?

45ml/kg/hr

89

What is the amount of insensible fluid loss?

22ml/kg/day

90

What is the amount of Maintenance fluids for a dog?

60ml/kg/day

91

What fluids would you use with for treatment of ARF?

Crystalloids
0.9% NaCl
0.45% NaCl + dextrose

92

What are the fluid requirements for ARF?

Dehydration
Insensible losses
Ongoing losses
Sensible losses

93

Oliguria

less than 0.5ml/kg/hr urine producton

94

How do you treat Oliguria?

Mannitol
Furosemide
Dopamine
Calcium Channel blockers

95

Mannitol

Osmotic diuretic that increases circulatory volume and decreases cell swelling

96

Furosemide

Loop diuretic the increases urine production without increasing GFR

97

What does Fenoldopam do?

increased urine output

98

What is the benefit of Dopamine?

a pressor when ARF is secondary to cardiac output failure or severe hypotensive

99

What drug is used in the standard of care for Leptospirosis?

Calcium Channel blockers

100

What do Calcium channel blockers do?

Prevent calcium moving intracellularly

101

What is the definitive treatment of ARF?

Extracorporeal renal replacement therapy/ dialysis
Peritoneal dialysis

102

What are the indications for Dialysis?

FLuid overload with pulmonary edema
Hyperkalemia
Progressive azotemia
Acute toxicity

103

What is the complication of Peritoneal dialysis?

Dialysis disequilibrium syndrome
Blockage of the peritoneal drain by the omentum

104

What is the treatment for Ethylene glycol?

4-methylpyrazole

105

What is the treatment for NSAIDs?

Misoprostal

106

What is the treatment for Leptospirosis?

Penicillin and doxycycline

107

What is the treatment for Pyelonephritis?

Culture
Fluoroquinolones or TMS

108

What is the treatment for Aminoglycoside toxicity?

Ticarcilin IV

109

What is the treatment for TMS toxicity?

Urinary alkalinization

110

What is the treatment for Hyperkalemia?

Insulin
Dextrose infusion
Calcium gluconate
Correct metabolic acidosis

111

What is the treatment for Acidosis?

Sodium Bicarbonate IV

112

What is the treatment for Hypocalcemia?

Calcium gluconate

113

What is the treatment for Hypercalcemia?

Furosemide/glucocorticoids
Calcitonin
Biphosphonates

114

What is the treatment for Hyperphosphatemia?

Aluminum hydroxide/carbonate

115

What is the treatment for Hypertension?

Amlodipine and hydralazine

116

What is the treatment for Gastrointestinal problems associated with ARF?

Prokinetics: Ondansetron, Metoclopramide
Antiemetics: Metoclopramide, maropitant
Omeprazole, pantoprazole, famotidine, ranitidine

117

What is chronic kidney disease?

Loss of functional renal tissue due to prolonged process
Usually progressive and irreversible

118

What are the degenerative causes of CKD?

Chronic interstitial nephritis
Renal infarcts

119

What are the developmental causes of CKD?

Familial renal dysplasia
PKD

120

What is a metabolic cause of CKD?

Hypercalcemia

121

What is the neoplastic cause of CKD?

Renal carcinoma
Renal lymphoma

122

What is an infectious cause of CKD?

Pyelonephritis
Lyme nephropathy
Leptospirosis

123

What is an iatrogenic cause of CKD?

Vitamin D supplementation
Nephrotoxic durgs

124

What is an immune mediated cause of CKD?

Immune-complex mediated glomerulonephritis

125

What are the effects of Hyperphosphatemia?

Drives renal secondary hyperparathyroidism
Causes progression of disease

126

What causes Hypokalemia in CKD?

Reduced intake
Increased renal potassium loss

127

What causes anemia in association with CKD?

Erythropoietin deficiency
Decreased life span of RBC
Effect of PTH on bone marrow and RBCs

128

What causes renal injury in CKD?

Proteinuria

129

What is the treatment for Proteinuria associated with CKD?

ACE inhibitors
ARB (telmisartan)

130

What are the aims of Treatment and Management of CKD?

Treat underlying cause
Improve clinical signs/quality of life
Slow the progression

131

What causes Vomiting and nausea associated with CKD?

Uremic gastritis
Hypergastinemia
Stimulation of the CTZ by uremic toxin

132

What are the appetite stimulants used for the treatment of CKD?

Cyproheptadine in cats
Mirtazapine in dogs and cats

133

How do you treat Hyperphosphatemia associated with CKD?

Dietary phosphate restriction
Intestinal phosphate binders

134

When would you begin a cat on a Renal Diet?

IRIS stage 2

135

When would you begin a dog on a Renal Diet?

IRIS stage 3

136

How would you treat Hypokalemia associated with CKD?

Supplement IV
Oral potassium supplements

137

How would you treat non-regenerative anemia associated with CKD?

Erythropoietin therapy
rHuEPO or Darbopoietin

138

What is the Hypertension therapy for cats?

Amlodipine

139

What is the Hypertension therapy for dogs?

ACE inhibitors

140

How do ACE inhibitors work?

inhibit conversion of angiotensin I to angiotensin II
Reduce glomerular capillary pressure and glomerular size

141

Telmisartan

Angiotensin receptor blocker

142

Management of acute on chronic disease

identify and treat underlying cause
IV fluids

143

What is considered a non-proteinuric UP/C value in dogs?

less than 0.2

144

What is considered a non-proteinuric UP/C value in cats?

less than 0.2

145

What is considered a borderline proteinuric UP/C value in dogs?

0.2 to 0.5

146

What is considered a borderline proteinuric UP/C value in cats?

0.2 to 0.4

147

What is considered a proteinuric UP/C value in dogs?

greater than 0.5

148

What is considered a proteinuric UP/C value in cats?

greater than 0.4

149

What is a physiologic cause of proteinuria?

Strenuous exercise
seizures
fever
stress

150

What is the pre-renal cause of proteinuria?

Abnormal concentrations of protein been presented to the kidneys

151

What is the renal cause of proteinuria?

Defective renal function or inflammation of renal tissue

152

What is the post-renal cause of proteinuria?

Inflammation in the ureter, bladder, urethra or prostate

153

What causes a false positive of Proteinuria on the urine dipstick?

Alkaline urine
Contamination

154

What causes a false negative of proteinuria on the urine dipstick?

Acid urine
Bence-jones proteinuria

155

What causes proteinuria in association with glomerular disease?

Defective renal function: Glomerular pathology or tubular pathology
Inflammation of renal parenchyma: Pyelonephritis or acute tubular necrosis

156

What is a renal cause of Proteinuria?

Increased Glomerular permeability
decreased tubular protein reabsorption

157

Protein losing nephropathy

condition causing severe proteinuria due to primary glomerular disease

158

Glomerulonephritis

condition where immune-complexes are deposited in the glomeruli

159

What is the cause of glomerulonephritis?

Familial nephropathy basement membrane: X-linked hereditary PLN of Samoyeds or Alport syndrome of English Cocker Spaniels
Immune-complex glomerulonephritis
Non immune complex GN
Amyloid deposits in glomeruli

160

What are the infectious causes of Glomerulonephritis?

Borreliosis
Dirofilariosis
Ehrlichiosis
Leishmaniosis

161

What is the cause of Hypercoagulability of Glomerulonephritis?

Mild thrombocytosis
Increased platelet adhesion and aggregation
Loss of antithrombin
Altered fibrinolysis
Increase in large clotting factors

162

How do you measure hypercoagulability?

Thromboelastography

163

How do you indirectly measure hypercoagulability?

Increased/decreased number of platelets
Decreased antithrombin
Increased fibrin
Increased d-dimers

164

Nephrotic syndrome

Kidney disease characterized by edema and loss of protein from the plasma into the urine due to increased glomerular permeability

165

How do you diagnose Glomerulonephritis?

Kidney biopsy
Light microscopy
Transmission electron microscopy
Immunofluorescent antibody assessment

166

What are the findings associated with Nephrotic Syndrome?

Proteinuria
Hypoalbuminemia
Ascites/Edema
Hypercholesterolemia

167

What is the treatment for Glomerulonephritis?

Immunosuppressive therapy

168

What drug should not be used alone for the treatment of Glomerulonephritis?

Glucocorticoids

169

What is the first choice of treatment for Glomerulonephritis?

Mycophenolate

170

If Mycophenolate does not work for Glomerulonephritis then what do you add?

Cyclosporine
Chlorambucil
Azathioprine
Cyclophosphamide

171

How do you treat Protein Losing Nephropathy?

treat proteinuria with ACE inhibitors, ARB, and Renal diets
treat hypercoagulability with aspirin or clopidogrel

172

What is the most significant cause of renal disease and acute uremia?

Ureteral obstruction from calcium oxalate

173

What is the clinical sign that cats with Acute unilateral ureteral obstruction present with?

Acute Abdominal pain
hematuria

174

What is the clinical signs for Acute bilateral ureteral obstruction in cats?

bilaterally enlarged and painful kidneys
Azotemia
oliguria/anuria

175

"Big Kidney Little Kidney" Syndrome

cats with past unilateral ureteral obstruction that causes the kidney to progress to fibrotic end stage. the contralateral hypertrophied kidney becomes acutely obstructed by a ureterolith causing further enlargement

176

Bilateral Chronic Kidney Disease with Concomitant Ureteral Obstruction

Chronic kidney disease secondary to fibrotic changes from previous obstruction predisposes to intrinsic kidney disease and a sudden obstruction causes decompensation of the tenuous residual kidney function

177

What do you see on ultrasound with ureteral obstruction?

hydronephrosis and dilation of the proximal ureter

178

What is the advanced imaging used for diagnosis of ureteral obstruction?

Antegrade pyelography
Computed tomography

179

Antegrade pyelography

guided pyelocentesis and antegrade injection of positive contract media into the renal pelvis and ureter to delineate the size and patency of the ureter

180

What is the medical management for ureteral obstruction?

Stabilize uremia
mannitol
Ureteral relaxants - Prazosin and amitryptilline
Pain management

181

What is an excellent choice of management for ureteral obstruction in dogs?

Lithotripsy

182

What is the standard of car for ureteral obstruction?

Ureteral stents through cystoscopy or Surgically

183

Subcutaneous ureteral bypass system

indwelling bypass using a combination locking loop nephrotomy/cystotomy tube

184

How do you stabilize a cat with ureteral obstruction?

Heat
Fluids
ECG
Emergency panel
Cystocenetesis

185

What is treatment for hyperkalemia in an obstructed cat?

Calcium gluconate
IV insulin
Bicarbonate
Shock fluids

186

How do you relieve the obstruction of a cat?

Retrograde
Penile massage/rectal massage of urethra
Anesthesia and positioning
Cystocentesis
Penis extrusion
Catheterization

187

What is the ongoing management for a blocked cat?

Indwelling U-cath placement
Monitor urine production/urine sediment
Analgesia
Anti-spasmotics

188

What is the treatment for a blocked cat with an owner that cannot afford treatment?

Euthanasia
or
Repeated cystocentesis and anti spasmotics

189

Anti-spasmotics

Prazosin/Phenoxybenzamine
Pheromones for stress

190

What is a clinical finding associated with Urethral rupture?

Hyperkalemia
Hyponatremia
Acidosis

191

What is a consequence of Uretheral rupture?

Stricture
Urethrocutaneous fistula

192

What is the cause of Uroabdomen?

Trauma

193

How do you treat Uroabdomen?

Medical management and urinary catheterisation
Surgery once stable

194

What are non-obstructed lower urinary tract diseases?

Urinary tract infections
Urolithiasis
Feline lower urinary tract disease
Prostatic disease
Neoplasia

195

What are the clinical signs of urinary tract disease?

Dysuria
Pollakiuria/periuria
Stranguria
Pigmenturia
Incomplete voiding
Urinary incontinence

196

What causes Dysuria/Stranguria/Pollakiuria?

Irritation of the bladder: bacterial, uroliths, or interstitial cystitis
Neurological disease
Secondary lower urinary tract disease
Neoplasia

197

How do you diagnose Lower Urinary Tract disease?

Collect urine on free flow and cystocentesis
Urinalysis
urine culture
urethral cytology
Radiography
Ultrasonography
Cystoscopy
Bladder biopsy
Excretory contrast studies
Urethral profilometry

198

Is Bilirubinemia normal in a dog?

Yes

199

Is Bilirubinemia normal in a cat?

No

200

What are the causes of Hematuria?

Renal
Lower Urinary Tract
Reproductive
Systemic disease: Bleeding disorder, Hypertension, or Hyperviscosity

201

What is the number one cause for UTIs?

E. coli

202

What is the most common route of UTI?

Ascending

203

What are the drugs of choice for an uncomplicated UTI?

Amoxicillin
Cephalosporins
TMS

204

Uncomplicated UTI

the first time it presents with bacteria in the urine without stones in the bladder

205

What is classified as a Complicated UTI?

Relapse
Reinfection
Superbugs

206

Reinfection UTI

New/different organism
C and S positive greater than 7 days after last treatment course

207

Superinfection UTI

C and S positive at day 7 after starting antibiotics

208

Relapse

Same organism/strain, 7 days after last treatment course

209

What causes a Relapse?

Inappropriate drug choice
Dose
frequency
duration

210

What causes Lower Urinary Tract Disease?

Anatomic urinary tract abnormalities
Voiding abnormalities
Upper urinary infection
Endocrine diseases
Prostate
Uterine/Vaginal disease
Immune compromise
Iatrogenic diuresis

211

Urachal Diverticulum

cord from the bladder to the mother does ot disappear

212

Patent Urachas

cord from the bladder to the mother has an opening to the skin

213

What is the treatment for Recurrent UTI?

One daily bedtime administration 30-50% of original dose of Nitrofurantoin that is an urinary disinfectant

214

What are the alternative techniques for Recurrent UTI therapy?

Probiotics
Polysulfated glycosaminoglycans
Fosfomycin
Cranberry extract

215

Therapy for Urolithiasis?

Diet
Urohydropulsion
Cystotomy with baskets
Cystrotomy
Lithotripsy

216

Retrograde Urohydropulsion

Hydropulsion of uroliths into the bladder

217

Struvite

Big Smooth Radiodense Magnesium Ammonium phosphate due to Urease producing bacteria when the urine pH is high
In cats it is diet related

218

What breeds of dog get Struvites?

Mini Schnauzers
Lhasa Apso
Cocker Spaniel
Shih tzu
Bichon Frise

219

What is the treatment for Struvites?

Hills S/D diet that dilutes the acidic urine
Walthams S/O

220

Calcium Oxalate

Spiny radio-opaque small stones that are common in male dogs due to acidifying diets, obesity or Hypercalcemia

221

What kind of stone is associated with Ethylene glycol toxicity?

Calcium monohydrate

222

What is the treatment for calcium oxalate crystals?

Therapy for hypercalcemia
Surgical/lithotripsy/cystoscopy

223

How do you prevent Calcium Oxalate formation?

Hills U/D
Walthams S/O
Thiazide diuretics
Potassium citrate
Avoid Vitamins C and D

224

What is the crystal that looks like a "hairy apple"?

Ammonium biurate

225

What causes Ammonium Urate and Xatnthine formation?

Hepatic disease (PSS, cirrhosis)
Genetic tubular defect
Breeds: Dalmations, Black Russian Terrier)
Decreased uptake of uric acid from hepatocytes to form allantoin

226

Ammonium Urate

Radiolucent crystal associated with lower urinary pH

227

What is the treatment for Ammonium Urate formation?

Diet - low protein and increased pH
Xanthine oxidase inhibitors: Allopurinol
Supportive care for hepatic dysfunction

228

What breeds are associated with Cystine Calculi?

Australian cattle dogs
Newfoundlands
Dachshunds
Bulldogs

229

Cystine Calculi

Tubular carrier proteins fail to reabsorb cystine
Radio-opaque crystal

230

How do you treat Cystine crystals?

Alkalinize Urine
Low protein diet

231

Calcium phosphate uroliths

usually secondary to primary hyperparathyroidism

232

Silica Uroliths

Associated with plant sources, poor diets rich in rice and soybean husks, cheap diets devoid of proper protein

233

What are the potential causes of Feline Lower Urinary Tract Disease?

Bacterial
Uroliths
Neoplasia
trauma
anatomical
behavioral
Feline interstitial cystitis

234

What is the gold standard of diagnosis for Feline Interstitial cystitis?

Cystoscopy

235

What are the clinical signs of Feline Idiopathic Cystitis?

Hematuria
Stranguria
Pollakiuria
Inappropriate urination
Palpate a large firm bladder
Inability to urinate

236

How do you diagnose Feline Idiopathic Cystitis?

Exclusion
Cystoscopy

237

Pudendal Nerve

somatic nerves to the external urethral sphincter causing the sphincter to be tight

238

Pelvic Nerve

parasympathetic nerve to the detrusor muscle that allows the animal to pee through contraction and received pain stimulations from the bladder

239

Hypogastric Nerve

Sympathetic nerve allows the detrusor muscle relax and the urethral sphincter to contract and store urine

240

What is the treatment for Feline Lower Urinary Tract Disease?

Reduce stress
Multiple Litter boxes
Plenty of Water sources
Activity/playing

241

What is the preferred method of dislodging an obstruction in Feline Lower Urinary Tract Disease?

Catheterisation
IV fluids

242

What is the treatment of Feline Lower Urinary Tract Disease?

Wet food not dry
Pheromones for stress
Analgesics - opioids

243

What are some Vaginal Diseases?

Hemorrhage
Vaginitis
Hyperplasia
Prolaspe
Neoplasia
Persistent Hymen

244

What is the main cause of Feline Lower Urinary Tract Disease?

Stress
Concurrent disease with stress

245

Persistent Hymen

Persistent sheet of tissue in the vagina

246

Juvenile vaginitis

seen in young females that will resolve in 6 weeks

247

What is the predisposing factor for vaginitis?

sunken vulva

248

Vaginal Hyperplasia/Prolapse

Hyperplasia of the vaginal wall that prolapses when the female comes into heat and will resolve after the dog goes out of heat

249

What are the neoplasias of the Female Genital tract?

Leiomyoma/Leiomyosarcoma
Transmissible Venereal Tumors

250

What are the prostatic diseases?

Benign Prostatic Hyperplasia
Prostatic cysts
Prostatitis
Prostatic Neoplasia

251

What are the clinical signs of Prostatic Disease?

Difficult defecation
Tenesmus

252

What are the clinical signs of Acute Prostatitis?

the dog is very sick

253

What are the clinical signs of Chronic Prostatitis?

recurrent UTIs
preputial discharge
Non-painful prostate
symmetrically enlarged prostate

254

Hoe do you diagnose Chronic Prostatitis?

UA for UTI
Ultrasound

255

What is the therapy for Benign Prostatic Hyperplasia?

Orchidectomy
Medical chemical castration

256

What is the therapy for Prostatic Cysts?

US drainage
Marsupialize

257

What is the therapy for Prostatitis?

Antimicrobials
Surgery - Orchidectomy

258

What is Finasteride used for?

converts testosteron to dihydrotestosterone to avoid castration

259

What antibiotics penetrate the Prostate well?

Fluoroquinolones
Doxycycline
Trimethoprim
Rifampin
Erythromycin

260

What antibiotics do not penetrate the prostate?

Nitrofurantoin
sulfonamides
vancomycin
penicillins
cephalosporins

261

What are the clinical signs of Prostatic Neoplasia?

Lameness
Painful gait with pain in sacrum
prostate palpable
Palpable sublumbar LNs

262

Where would metastasis be located with Prostatic Neoplasia?

LN
Vertebrae
Lungs

263

What is the treatment for Prostatic Neoplasia?

Chemo - Mitoxantrone
radiation
stents

264

Mitoxantrone

Topoisomerase inhibitors disrupt DNS synthesis and repair

265

What are the Neoplasias in the Bladder or urethra?

Transitional Cell Carcinoma
Muscle Neoplasms
Squamous cell carcinoma
adenocarcinoma
fibrosarcoma
hemangiosarcoma

266

How do you diagnose Bladder or Urethra Neoplasia?

Urine sediment
Imaging
Catheter suction samples for cytology
Endoscopy
Cytology
Biopsy

267

What is the treatment for TCC of the bladder?

Piroxicam
Surgery
Chemotherapy - Mitoxantrone
Photodynamic therapy
Urine diversion - catheter

268

What causes Detrusor Atony?

caused by trauma or over distension causing disruption of the nerves

269

Where do you find the parasympathetic innervation to the bladder?

S1-3

270

Where do you find the sympathetic innervation to the bladder?

L1-4 in dogs
L2-5 in cats

271

Where do you find the somatic innervation to the bladder?

S1-3

272

What overrides the Pudendal nerve to increase urethral sphincter tone?

Cerebrum

273

What are the UMN bladder signs?

Detrusor areflexia with sphincter hyperreflexia
Small bladder to large distended bladder
Small volumes of urine
Difficult to express

274

Where is the lesion located when there are UMN bladder signs?

Aboove sacral segment

275

What is the treatment for UMN bladder signs?

Baclofen

276

Baclofen

Antispasmodic causing muscle relaxant

277

What are the LMN bladder signs?

Detruspr areflexia and sphincter areflexia
Large bladder
Easily expressed
Constantly leaks

278

Where is the location of the lesion when LMN bladder signs are seen?

Sacral spinal segment or pelvic segment

279

What is the treatment for LMN bladder signs?

Express bladder 3-4x/day
Bethanecol

280

Bethanecol

parasympathomimetic causing contraction of the bladder

281

Detrusor-sphincter reflex dyssynergia

with initiation of detrusor contraction the urethral sphincter spasms

282

What is the treatment for Detrusor-sphincter reflex dyssynergia?

Alpha-adrenergic blockers (Phenoxybenzamine)

283

In what species do you see Dysautoanomia?

Cats

284

What causes Detrusor Atony?

Overfill due to obstruction

285

How do you treat Detrusor Atony?

Manually express the bladder and keep the bladder small and hope the nerves grow back

286

Detrusor instability/detrusor hyperreflexia (Urge Incontinence)

Detrusor contraction during storage of urine or low compliance of the detrusor muscle which may be confirmed by cystometrography

287

What is the treatment for Detrusor instability/detrusor hyperreflexia (Urge Incontinence) ?

Anticholinergic - Oxybutynin imipramine or dicyclomine

288

Urinary incontinence

the involuntary escape of urine during the storage phase of the urinary cycle
Intermittent or continuous dribbling of urine with a normal voiding episode
Loss of voluntary control of urination and consequent leakage of urine

289

What is the cause of Urinary Incontinence?

Urinary Sphincter Mechanism Incompetence

290

What are the clinical signs of Urinary Sphincter Mechanism Incompetence?

Soiled perineal coat
Urine scald

291

How do you diagnose Urinary Sphincter Mechanism Incompetence

Urethral pressure profile

292

What is the pathophysiology of Urinary Sphincter Mechanism Incompetence?

Lack of estrogen decreases sensitivity of the smooth muscle receptors to sympathetic stimulation
Spaying reduced urinary sphincter pressure

293

What is the Pressure transmission theory for Urinary Sphincter Mechanism Incompetence?

when urethral neck is not in the abdominal cavity it is not subjected to the same pressures as the intra-abdominal bladder, the bladder pressure exceed urethral pressure and the urine leaks

294

What is the Hammock theory for Urinary Sphincter Mechanism Incompetence?

the anatomic structures maintaining the position of the bladder and urethra are abnormal

295

What are the indications to perform a Urethral pressure profile?

Urinary Sphincter Mechanism Incompetence
Detrusor instability
Reflex dyssynergia
Neurogenic abnormalities

296

What is the medical management for Urinary Sphincter Mechanism Incompetence

Estriol therapy + PPA

297

What are the side effects of Estriol?

increased mammary tumors

298

What are the surgical treatment for Urinary Sphincter Mechanism Incompetence?

Bovine Cross-Linked Collagen Implantation
Colposuspension
Urethropexy
Transobturator Vaginal Tape inside out
Static Hydraulic Urethral sphincter

299

What are the clinical signs of Ectopic Ureter?

Wet coat
Inflamed perineum
Excoriations

300

What is the treatment of choice for Ectopic Ureter?

Cystoscopic laser ablation

301

What are the most accurate diagnosis of Ectopic Ureter?

Excretory urogram CT
Cystoscopy

302

How long should you continue antibiotics for UTI associated with Ectopic Ureters?

6-8 weeks