Topic 37 - Physical and additional examination of the urinary system. Abnormalities of urination.

Question 1

We have lower and upper urinary tract, what is part of the upper urinary tract?

Answer 1

kidneys

Question 2

We have lower and upper urinary tract, what is part of the lower urinary tract?

Answer 2

Bladder
Urethra
Prostate (male dog)

Question 3

Examination steps of the kidneys:

Answer 3

Anamnesis
Clinical exams: Physical + additional

Question 4

Additional exams for kidneys:

Answer 4

are almost always needed because anamnesis and physical findings are generally nonspecific

Question 5

Name some symptoms that are typically seen in kidney disease:

Answer 5

Oliguria, anuria
Anorexia
Apathy, weakness
Dehydration
Anaemia
CNS signs
Respiratory signs
GI signs: vomiting, diarrhoea

Question 6

What is oliguria?

Answer 6

Less urine than 1 ml/kg/hour

Question 7

What is polyuria?

Answer 7

More urine than 50ml/kr/day

Question 8

Findings during physical exam, indicating kidney disease:

Answer 8

1. Poor body condition
2. Dehydration
3. Anaemia
4. Oral diseases: ulcers, gingivitis, halitosis
5. Palpate kidneys!!

Question 9

What is halitosis?

Answer 9

Uremic breath

Question 10

Name some specific signs of kidney disease found in advanced cases:

Answer 10

1. Halitosis
2. Uremic ulcers
3. Abnormal kidneys upon palpation

Question 11

Which kidney(s) is palpable in dogs?

Answer 11

Only left!!

Question 12

Which kidney(s) is palpable in cats?

Answer 12

Both

Question 13

Parameters to describe the findings of the kidneys:

Answer 13

location
size
shape
relation to their neighborhood
painfulness
surface
consistency
structure
(symmetry)

Question 14

Normal description of renal palpation in CAT:

Answer 14

Bean shape
Cherry like size
Surface is smooth
Not painful
Firm consistency
Slightly movable
Homogenic structure
Symmetric

Question 15

Causes for enlarged kidney:

Answer 15

• renal disease
• Renal tumour
• Viral infections in cat
• ## polycystic kidney disease (PKD)

Question 16

Causes for small kidneys:

Answer 16

Renal fibrosis
Renal dysplasia

Question 17

Causes for pain upon palpation:

Answer 17

• acute nephritis
• kidney stones
• tumor
• pyelonephritis

Question 18

Laboratory test to check the glomerular function:

Answer 18

GFR = Glomerular filtration rate
Urinary protein

Question 19

What is the function of Glomeruli?

Answer 19

network of blood vessels that are the “cleaning units” of the kidney

Question 20

How can we check the GFR?

Answer 20

Urea, Creatinine
SDMA = Symmetric dimethylarginine

Question 21

How to check for proteinuria?

Answer 21

= High levels of protein

1. Dipstick
2. UPC: Urine protein/creatinine ration
3. MAU: Microalbumin

ALWAYS check the sediment: matter on the bottom

Question 22

How to check the tubular function?

Answer 22

1. Specific gravity
2. Refractometer: same scale in dog and cat
3. Dip stick is unreliable

Question 23

Name the abnormal findings we can have in specific gravity:

Answer 23

HYPOstenuric
ISOstenuric
HYPERstenuri

Question 24

Normal specific gravity in dogs and cats:

Answer 24

Dog: 1013-1029
Cat: 1013-1034

Question 25

HYPOstenuric values:

Answer 25

1007

Question 26

ISOstenuric values:

Answer 26

Often found in dogs with CRF = Chronic Renal Failure 1008-1012

Question 27

HYPERstenuric values:

Answer 27

Dog: Above 1030 Cat: Above 1035

Question 28

Important steps to recieve a proper diagnosis:

Answer 28

1. Fasted, well hydrated animals 2. Urinalysis: specific gravity and protein 3. US (4. Cytology or biopsy - sometimes!!)

Question 29

Name problems/causes related to urination:

Answer 29

1. Dysuria = painful urination 2. Stranguria = painful, SLOW urination 3. Hematuria = blood in urine 4. Pollakiuria = Frequent, abnormal urination 5. Incontinence = cannot control the urination 6. Periuria = Urination in places where they're not supposed to

Question 30

What are the first steps in examination of lower urinary tract problems?

Answer 30

1. Urinary bladder size, tone and compressibility - Catheterization in case of suspected obstruction 2. Complete physical exam, to check for other diseases

Question 31

Examination method of urinary bladder:

Answer 31

Inspection Palpation

Question 32

Parameters to examine for the bladder:

Answer 32

Size Shape Painfulness Surface Location Abnormal findings (wall thickness + content)

Question 33

Size of the bladder:

Answer 33

- empty - moderately filled - full - dilated

Question 34

Abnormal findings in the urinary bladder:

Answer 34

Dilation = Acute or chronic Pain = cystitis, stones Abnormal surface = tumour Thickened wall = tumour, cystitis

Question 35

Differentiate acute and chronic dilation of the urinary bladder:

Answer 35

Acute = overdistended, turgid, firm, urinary bladder that cannot be expressed Chronic = flaccid

Question 36

Additional examination of the lower urinary tract

Answer 36

1. Rectal examination 2. Catheterization 3. Diagnostical imaging: contrast 4. Urinanalysis (ALWAYS NEEDED)

Question 37

Examination methods of male urethra:

Answer 37

Rectal examination: Palpation Examination of the perineum: inspection, palpation Examination of prepuce and penis: Inspection, catheterisation

Question 38

Examination methods of female urethra:

Answer 38

Vaginal examination: inspection, palpation, catheterization

Question 39

Examination methods of prostate in male dogs:

Answer 39

Palpation X-ray, US Urinalysis Examination of prostatic fluid Cytology, biopsy