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VET 433c > Renal/ Endo pt.2 > Flashcards

Renal/ Endo pt.2 Flashcards

1
Q

Cushings (Clinical Signs)

A
  1. PU/PD
  2. Polyphagia
  3. Panting
  4. Potbellied
  5. Alopecia, poor hair growth
  6. Weakness (muscle atrophy)
  7. Weight gain
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2
Q

Cushings (PE)

A
  • Typically BAR
  • weight redistribution (muscle atrophy w/ fat gain in trunk)
  • pendulous abdomen
  • derm changes (thin skin, calcinosus cutis)
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3
Q

Cushings (CBC, Chem, UA)

A

CBC –> stress luekogram (high neutro + mono, low eos + lymph)
Chem –> high ALP, high ALT, glc, cholest, TGs, Low BUN
UA –> usually < 1.020 (often isos or hyposthen.)

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4
Q

Cushings (Screening Tests)

A
  1. UCCR
  2. ACTH Stim. Test
  3. Low Dose Dexamethasone Suppression
  4. Endogenous ACTH
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5
Q

Cushings (UCCR)

A
  • urine Cortisol:Creatitine ratio
  • sample from home, non-stressed
  • good to rule out by many false (+)
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6
Q

Cushings (ACTH stim test)

A
  • gold standard for Addison’s
  • if >22 after 1 hr then think Cushings
  • if <2 after 1 hr then think Addison’s
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7
Q

Cushings (Low Dose Dex Suppression)

A
  • screening +/- differentiating
  • gold standard for Cushings
  • 3 samples (0, 4, 8)
  • if:
  • -> 8 hr > 1.4 –> HAC
  • -> 4 hr < 1.4 –> PDH (r/o ADH)
  • -> 4 or 8 < 50% of baseline –> PDH
  • -> neither 4 or 8 suppress –> ADH or PDH
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8
Q

Cushings (Endogenous ACTH)

A
  • typically suppressed w/ ADH

- n or inc response is not diagnostic

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9
Q

Cushings (Imaging)

A
  • ultrasound –> best
  • CT for macroadenoma or pre-op planning
  • MRI expensive, but gold standard for macroadenoma
  • adrenal: n is 7-8mm
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10
Q

Cushings (Treatment)

A
  1. Vetotry (Trilostane)
  2. Lysodren (mitotane) –> necrosis of adrenals
  3. Surgery –> Adrenalectomy or Hypophysectomy
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11
Q

Feline Hyperthyroidism (signalment)

A
  • 13 years of age

- no sex or breed disposition

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12
Q

Feline Hyperthyroidism (Clinical Signs)

A
  • weight loss ( >90%)
  • polyphagia
  • increased acitivity/ restlessness
  • PU/PD
  • vomiting, diarrhea, steatorrhea
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13
Q

Feline Hyperthyroidism (Physical Exam)

A
  • thyroid nodule
  • tachycardia
  • heart murmur
  • gallop
  • skin problems and poor haircoat
  • systemic hypertension (inc Beta-1 activity)
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14
Q

Feline Hyperthyroidism (Lab Findings)

A

CBC: polycythemia, macrocytosis
Chem: inc in liver enzymes, azotemia in 25%
UA; 60% high and 40% low

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15
Q

Feline Hyperthyroidism (TT4)

A
  • most common measurement for confirming hyperthyroidism
  • high sensitivity and specificity
  • TT4 can be ‘normal’ with early dz or non-thyroidal illness
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16
Q

Sensitivity and Specificity

A

Sensitivity –> snout –> rule out

Specificity –> spin –> rule in

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17
Q

Feline Hyperthyroidism (fT4)

A
  • free t4
  • most useful when TT4 in upper half of normal range
  • should not be used alone for diagnosis
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18
Q

Feline Hyperthyroidism (thyroid scintigraphy)

A
  • provides anatomical and functional information
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19
Q

Feline Hyperthyroidism (T3 Suppression Test)

A
  • in hyperthyroid cats, T3 administration should have no effect on TT4 as TSH secretion chronically suppressed
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20
Q

Feline Hyperthyroidism (Hyperthyroidism and the Kidney)

A
  • hyperT4 causees increased GFR and decreased Creatinine to mask CKD (high GFR wornsens CKD as well)
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21
Q

T/F: in feline hyperthyroidism, you want to try for reversible euthyroid treatment for a month prior to pursuing definitive treatment

A

T, this is because hyperthyroidism can mask CKD

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22
Q

Feline Hyperthyroidism (Methimazole)

A
  • used for short-term prior to Sx or I-131 or long-term treatment
  • discontinue if adverse signs present (excoriations, hepatopathy, neutropenia, thrombocytopenia, acquired mg)
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23
Q

Feline Hyperthyroidism (Dietary idione Restriction)

A
  • exclusive feeding for 1-3 months will decrease TT4 in moderate hyperT4 cats
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24
Q

Feline Hyperthyroidism (I-131)

A
  • treatment of choice for feline hyperthyroidism
  • very effective treatment
  • just need the patient to be stable enough for roughly a week of isolation
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25
Q

Feline Hyperthyroidism (Thyroidectomy)

A
  • scintigraphy should be performed prior to Sx for ectopic tissue
  • cats should be stabilized first w/ methimazole
  • irreversible effect on GFR so make sure no kidney disease
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26
Q

Canine Hypothyroidism (Etiology)

A
  • lymphocytic thyroiditis is immune-mediated attack on thyroglobulin and TPO
  • idiopathic atrophy may be primary degenerative disorder
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27
Q

Canine Hypothyroidism (Sigalment)

A
  • middle-aged to older dogs
  • no sex or breed
  • genetic basis for lymphocytic thyroiditis in Beagles and Borzoi
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28
Q

T/F: clinical signs do not develop until > 90% of thyroid gland destroyed

A

F, it’s 80% instead of 90

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29
Q

Canine Hypothyroidism (Clinical Signs)

A
  • lethargy, inactivity, mental dullness
  • weight gain despite no change in appetite or food intake
  • derm signs
  • thin hair coat, rat tail, hyperpigmentation
  • tragic facial expression d/t myxedema
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30
Q

Canine Hypothyroidism (Lab Findings)

A
  • NNN anemia (dec EPO)
  • fasting hypercholesterolemia, hypertriglyceridemia (T4 stimulates lipid metabolism)
  • No PU/PD
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31
Q

Canine Hypothyroidism (Diagnosis)

A
  • low TT4 (not specific) (low TT4 does not rule in hypothyroidism)
  • low fT4 (diagnostic)
  • High TSH (must be paired with fT4 or TT4)
  • Thyroglobulin auto-antibodies (good during acute phase)

There is overlap between healthy, hypothyroid, and euthyroid sick

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32
Q

Renal Biopsy (Indications)

A
  • suspected glomerular disease causing proteinuria
  • CKD/ AKI (if dialysis is needed)
  • Neoplasia
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33
Q

Renal Biopsy (Technique)

A
  • sample from Cortex
  • 3 reasons: safety, cortex has glomeruli, avoid puncturing renal pelvic
  • 3 types: wedge, punch, needle-core
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34
Q

Nephrectomy (indications and technique)

A

Indications:

  • neoplasia
  • hydronephrosis
  • renal abscess
  • cystic disease (PKD)
  • trauma

Technique:
- remove as far down the ureter as possible

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35
Q

Ureteral Surgery (indications)

A
  • benign obstructions
  • trauma
  • ectopia, neoplasia
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36
Q

Ureteral Surgery (Difficulties and Complications)

A

Difficulties: both size and location
Complications: urine leakage, stricture w/ subsequent obstruction

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37
Q

Ureteral Surgeries (4 of them)

A
  • Ureterotomy
  • Ureteral Resection and Implantation
  • Ureteral Re-implantation
  • Ureteral Stenting
  • Ureteral SUBS
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38
Q

UTI (define)

A
  • implies the patient has bacteria within the lower urinary tract with clinical signs
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39
Q

Sporadic Bacterial Cystitis

A
  • 3 or fewer UTI in 12 months w/ no know co-morbidities

- previously known as simple uncomplicated

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40
Q

T/F: young cats unlikely to have UTI when LUTS present. a more likely differential is FIC

A

T

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41
Q

Sporadic Bacterial Cystitis (Physical Exam)

A
  • usually normal
  • thick bladder
  • firm, irregular urethra
  • prostate
  • enlarged, painful kidneys
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42
Q

Sporadic Bacterial Cystitis (Diagnostics)

A
  • clinical signs and aerobic bacterial culture
  • collect urine via a cysto (assume no clotting disorder)
  • CBC and BioChem usually normal
  • Urine Sediment (pyuria and bactinuria, RBC and protein common) (pyuria can be absent with Cushings and dilute urine)
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43
Q

Top Bacteria for UTI infections

A

E. coli

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44
Q

T/F: susceptibility testing is often done for serum concentrations so you might still be able to use an abx for a ‘resistant’ bacteria when it is isn’t in the tissue yet

A

T

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45
Q

Name one tissue penetrating abx and one that isn’t (but will still concentrate well in urine)

A

Tissue penetrating –> TMS, fluoroquinolones

Not –> Penicillins + Clavamox

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46
Q

Culture Timing

A
  • immediately preferred

- plate w/in 24 hours

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47
Q

Treating UTI (sporadic cystitis)

A
  • Empirical Therapy –> antimicrobials or NSAIDs while waiting
  • Antimicrobial Choices –> Amoxicillin (+/- clav), TMS
  • duration –> 3-5 days
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48
Q

TMS

A
  • good tissue penetration
  • side effects (immune-mediated disease, hepatotoxicity)
  • don’t use for stones
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49
Q

Fluoroquinolones

A
  • good tissue penetration
  • ciprofloxacin has poor tissue penetration
  • enrofloxacin is good tho
  • side effects: not in growing dogs, acute blindness in cats
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50
Q

Clinical Cure vs Microbiological Cure

A

CC –> resolution of clinical signs

MC –> negative urine culture

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51
Q

Recurrent UTI

A 
- 3 or more UTI in 12 months; 2 or more in 6 months
3 types:
1. Reinfections - diff organism
2. Relapsing - same organism
3. Recurrent bacteriuria
52
Q

Reinfections Urinary tract Related: micturition

A
  • poor voiding causing inc residual urine ( reduced blood flow due to distension)
  • urinary incontinence
53
Q

Reinfection urinary tract: abnormal anatomy, other causes

A
  • Ectopic Ureters
  • cystic diverticulum
  • bladder cyst
  • also U cath
  • owner/ vet related issues (wrong dose, not giving all the meds)
54
Q

Causes of Relapse/ Persistent UTI

A
  • immunocompromised
  • Cushings
  • CKD - ureteral stent
  • neoplasia
  • Nidus (stones) (stones also cause obstruction to urine flow)
  • biofilms
  • foreing bodies
  • bladder polyps
  • prostatitis
55
Q

Treatment of Recurrent UTI

A
  • primary objective is CC

- long-term therapy not always warranted by may be indicated ( 7-14 days on abx)

56
Q

Alternative Therapies for UTI (Cranberry)

A
  • Anthocynanidin/ proanthocyanidin inhibits adhesion of Type 1 and p-fimbriated uropathogens via mannose specific structures
57
Q

Alternative Therapies for UTI (NSAIDs)

A
  • no studies for prevention of rUTI
58
Q

Alternative Therapies for UTI (E. coli)

A
  • possesses anti-infective and analgesic activity
59
Q

Pyelonephritis (Diagnosis)

A
  • CS: AKI signs (lethargy, hyporexia, fever, PU/PD, renal pain
  • ClinPath: Azotemia, glucosuria, neutrophilia, WBC casts in urine
60
Q

Pyelonephritis (Ultrasound Findings)

A
  • Renal Pelvic Dilation
  • Blunting of the renal papilla
  • Echogenic debris in the pelvis
  • Ureteral dilation
61
Q

Pyelonephritis (treatment)

A
  • fluoroquinolones for 10-14 days

- recheck for MC after 1-2 weeks

62
Q

Subclinical bactinuria

A
  • presence of bacteria in urine w/ no CS
  • treatment rarely indicated unless:
  • -> urease producing bacteria
  • -> systemic disease
  • -> prior to UT interventional procedures
63
Q

Prostate (endocrine)

A
  • produces testosterone that is converted into 5a-DHT (principal androgen)
  • share same receptor but 5aDHT has higher affinity and slower dissociation
64
Q

Prostate (normal defences)

A
  • urine flow
  • high pressure zone
  • prostatic fluid
  • local IgA production
65
Q

Prostate Dz (CS)

A
  • can have none
  • urethral discharge (bloody)
  • Tenesmus
  • Hematuria
66
Q

Benign Prostatic Hypertrophy (BPH) (Signalment, Cause, Treatment)

A
  • older, intact dogs
  • hypertrophy and hyperplasia
  • as age increases, decreased androgens, increased estrogens –> estrogen primes prostate to 5aDHT
  • treatment: castration, 5a-reductase inhibitors (Finasteride)
67
Q

Prostatitis (Clinical Signs, diagnostics)

A
  • CS: prostatic pain, fever, lethargy, hematuria
  • Diagnostics: large prostate on rectal and US (mineralization –> carcinoma), urine culture, prostate aspirate, prostatic wash
68
Q

Prostatitis (Treatment)

A
  • Chloramphenicol (need higher dose)
  • TMS
  • Enrofloxacin (best)

-> in acute cases, any abx should work due to barrier comprimisation, but chronci cases require high lipid solubility, low protein binding

69
Q

Bladder TCC (presentation)

A
  • Pollakiuria, stranguria, hematuria

- Terries (esp scotties), beagles, shelties

70
Q

Bladder TCC (Diagnosis)

A
  • catheterization
  • cystoscopy: expensive but allows for biopsy
  • FNA: cheap, quick, only sedation necessary
  • BRAF: genetic test, sensitivity not affected by active sediment, 100% specific
71
Q

Bladder TCC (Treatment)

A
  • Piroxicam only (ok if the client doesn’t want chemo) MST 6 months
  • Piroxicam + Chemo (ideal therapy) MST 9-12 months
72
Q

Canine Hypothyroidism (TSH response test)

A
  • assesses thyroid gland’s responsiveness to TSH
  • differentiates between hypoT4 and euthyroid sick
  • no response is consistent with hypoT4
73
Q

T/F: you can use TT3 and fT3 to differentiate hypoT4 from ESS

A

F: they do NOT differentiate the two

74
Q

Euthyroid Sick Syndrome

A
  • decrease in thyroid hormone due to concurrent illness and magnitude reflects severity of illness
75
Q

HypoT4 (treatment)

A
  • Levothyroxine - BID and does down if possible

- prognosis excellent

76
Q

HypoT4 (treatment monitoring)

A
  • measure peak TT4 and TSH 8 weeks after starting treatment:

- -> TT4 should be upper reference range

77
Q

HypoT4 (myxedema coma) (CS, Treatment)

A
  • accumulation of acid and neutral mucopolysaccharides and hyaluronic acid that bind water
  • CS: mental dullness, weakness, stupor/ coma
  • Treatment: stabilize and give IV T4
78
Q

Anesthesia for DM (concerns)

A
  • delay until stable (reduced change of DKA)
  • Concerns: volume status (PU/PD), Electrolyte abn (hypotension, arrhythmias)
  • Drugs: short duration and/or reversible
79
Q

Anesthesia for DM (Drugs)

A
  • Drugs: short duration and/or reversible

- think opioids

80
Q

Crystalluria facts

A
  • itself is not a disease
  • struvite and CaOx can precipitate in teh cold
  • Urate and Cystine stones require further diagnostics
81
Q

Urolithiasis (Rads)

A
  • Radiodense: CaOx, struvite, (silica, CaP)

- Not radiodense: Purine and Cystine

82
Q

5 Options for Stone Removal

A
  1. Dissolution
  2. Voiding urohydropropulsion
  3. Basket Retrieval
  4. Holmium:YAG laser
  5. Surgery
83
Q

T/F: after stone removal, you should always submit them for analysis

A

T

84
Q

CaOx Stones (location, signalment)

A
  • most often seen in bladder (or ureter in cats)

- Signalment: middle aged, male fluffy breed dogs

85
Q

CaOx Stones (Prevention)

A
  • evaluate patient, environment, diet

- Intrinsic Factors: evaluate serum calcium, hypertriglyceridemia (mini schnauzer)

86
Q

CaOx Stones (Dietary)

A
  • risk inc from –> high protein, calcium, Na, vit C, vit D… low vit B6, calcium, moisture
  • goal to minimize hypercalciuria, hyperoxaluria
  • give low calcium, low oxalate, high moisture, low fat diet
87
Q

Continued Recurrence of CaOx crystals

A
  • Potassium Citrate –> citrate binds to Ca

- Thiazide Diuretics (hydrochlorothiazide) –> dec Ca excretion in urine

88
Q

Canine Struvite (dogs)

A
  • almost always ass. with urease producing bacteria (Staph, Proteus, Klebsiella)
  • most common in LUT
89
Q

When to suspect struvite in dogs

A
  • UTI w/ urease producing bacteria
  • Hx in cats
  • maybe urine pH
  • stone shape (eliptical in cats, large angular in dogs)
90
Q

T/F: dietary dissolution works very well for struvite

A

T

91
Q

Dissolution of Struvite

A
  • Mg, Ammonium, and Phosphate crystals so diet should be low in all them
  • acidic diet
  • USG should be dilute
92
Q

T/F: many dissolution diets are not meant for long term treatment

A

T

93
Q

Why might you see struvite dissolution failure

A
  • owner compliance
  • mixed urolith
  • large stone burden
94
Q

Struvite prevention in Dogs

A
  • no special diet needed as this is from urease producing bacteria in dogs
  • culture and monitor for UTI
95
Q

Struvite prevention in Cats

A
  • high moisture, non-alkalanizing diet
  • USG < 1.030
  • same as those marketed for dissolution
96
Q

Urate Stones (general, purine metabolism)

A

3rd most common stone in dogs

  • must be confirmed w/ infrared spectroscopy
  • hypoxanthine – (XO)–> xanthine –(XO)–> uric acid –(uricase)–> allantoin
97
Q

Urate Stones (Dalmations)

A
  • lack the transporter to move uric acid into the liver

- end up excreting uric acid into the urine

98
Q

Urate Stones (Management)

A
  • goal: dec purine consumption via dairy proteins or egg or some plant sources
  • dilute, alkaline urine
  • monitor for USG < 1.020
  • lack of crystalluria important
99
Q

Urate Stones (Management)

A
  • Drugs: Allopurinolol –> XO inhibitor (never give unless on a purine restricted diet)
  • for urate stones from PSS then treat those
100
Q

Cystine Stones

A
  • younger, middle age male dogs
  • prox. tube of kidney cannot reabsorb cystine via genetic mutation
  • Tx: dissolution reported
  • Prevention: low protein diet, same diets used for urate, alkaline urate
101
Q

Silica Stones

A
  • uncommon in dogs
  • jack-like appearance
  • Tx: high moisture in diet, try to reduce silica in diet
  • recurrence rates usually low
102
Q

Causes of Pollakyuria

A
  • FIC
  • UTI
  • stones
  • neolaisa
  • polyps
103
Q

Ectopic Ureters (signalment, Diagnostics, Tx)

A 
- usually young female 
Diagnostics:
--> cytoscopy (see vestibule, detect fenestrations, evaluate mucosa) (can't see upper tract, and scoping is hard)
--> US (allows full view, but expensive)
--> contrast CT
Treatment:
--> Sx (rare)
--> Laser correction
104
Q

Urethral Sphincter Mech. Incompetence (Diagnostics)

A
  • USMI
  • don’t spay before 3 months of age
  • Diagnostics: USG, neuro exam, urethral pressure profile (gold standard)
105
Q

Urethral Sphincter Mechanism Incompetence (treatment)

A
  1. PPA (phenylpropanolamine)
    - -> alpha-adrenergic agonist (sympathomimetic)
    - -> maybe refractory over time
    - -> PPA > pseudoephedrine
  2. Estrogens (Estriol)
    - -> sensitizes alpha receptor
    - -> side effects: wipe out bone marrow
  3. Urethral Bulking Agents (collagen)
  4. Urethral Occluder
106
Q

Urge Incontinence

A
  • important to rule out all underlying causes

- Tx: w/ anticholinergics (muscarinic) –> tolterodine or oxybutinin

107
Q

Overflow Incontinence/ reflex dyssnergia

A
  • obstruction in urethra
  • initial signs are stranguria and progresses to leakage as the bladder pressure builds
  • caused by stones, foreign body, mass, stricture
  • if no cause is found then it is called reflex dyssnergia
    –> tx with prazosin (alpha antagonist) to relax urethra and
    bethanechol (parasympathomimetic) to contract bladder
108
Q

Cystotomy (indications)

A
  • cystic/ urethral calculi
  • cystic neoplasia
  • urethral bipass
  • ruptured bladder
109
Q

Cystotomy (closure)

A
  • 1 or 2 layers
  • submucosa is holding layer
  • absorbable suture
110
Q

Cystotomy Tube Placement (indications)

A
  • post-bladder obstruction
  • trigone/ prostatic neoplasia
  • drainage during uroabdomen
  • facilitate cystoplexy
111
Q

Cystopexy (indications)

A
  • congenitally displaced bladder
  • herniation
  • incontinence
112
Q

Urethrotomy (indications)

A
  • urethral stones

- urethral biopsy

113
Q

Urethrostomy (indications)

A
  • recurrent stones
  • lodged calculi
  • stricture
  • neoplasia
  • trauma
114
Q

Episioplasty (indications)

A
  • recurrent UTI

- peri-vulvar dermatitis

115
Q

T/F: a first time presenting cat for lower UT signs between the ages of 1-10 has a 65% change of it being FIC.

A

T

116
Q

FIC (first presentation diagnostics) (return diagnostics)

A

1st. Radiograph

Return. UA and culture

117
Q

FIC is a diagnosis of

A

Exclusion

118
Q

FIC (urethral plugs)

A
  • blood from inflammation causes increased pH –> causes struvite to fall out of solution –> binds to proteins, rbcs, and mucuous to form plugs
119
Q

FIC (“Neuronal” Bladder Problems)

A

damage to the tight junctions (uroepithelium) –> urine comes into contact with the sub-epithelial neurons –> pain

120
Q

FIC –> Stress response

A
  • -> Heightened SNS (Epi/ NorEpi)

- -> blunted cortisol response

121
Q

Risk Factors for FIC

A
  • exclusively dry diet
  • indoor environment
  • nervous disposition
  • obesity
  • multi-cat household
122
Q

Cystourethrogram vs PU (perineal urethrostomy)

A
  • cystourethrogram should be done prior to every PU
123
Q

FIC (Acute Management)

A

Pain Control:
–> buprenorphine

Alpha Antagonists:
–> Prazosin, Phenoxybenzamine

Do not put them on tri-cyclic antidepressants (Amitryptiline)

124
Q

FIC (Chronic Management)

A
  • stabilize and pain
  • BCS and weight
  • Environmental History and Diet plan
125
Q

T/F: MEMO (tailored environmental treatment) is a very effective treatment for FIC

A

T

126
Q

FIC (how to increased hydration)

A
  • canned food
  • varied water sources
    etc.
127
Q

FIC (Anti-stress Diets)

A
  • L-tryptophan
  • Alpha Casozepine

–> no studies in cats with FIC

VET 433c (6 decks)

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