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vet med 4 > Urinary > Flashcards

Urinary Flashcards

1
Q

Does the presence of bacteria always lead to clinical signs?

A

no
subliclinical bacteriuria

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2
Q

a true urinary tract infection (and not a subclinical bacteriuria) is called

A

sporadic bacterial cystitis

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3
Q

How do we differentiate subclinical bacteriuria with sporadic bacterial cystitis?

A

bacteriuria

and

LUT clinical signs:
- pollakiuria
- stranguria
- haematuria
- dysuria

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4
Q

A patient with sporadic bacterial cystitis usually have how many episodes per year?

A

<3

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5
Q

does sporadic bacterial cystitis affect dogs or cats more commonly?

A

common in dogs
rare in cats

patients are otherwise healthy :)

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6
Q

What are host risk factors for UTI

A
  • obesity
  • female
  • inability to void (neurological)
  • urinary sphincter mechanism incompetence
  • increasing age
  • anatomical abnormalities of the urinary tract
  • urolithiasis
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7
Q

What are the hosts defence mechanisms against UTI

A
  • normal micturition
  • anatomy of the UT
  • mucosal defense (ie exfoliation of cells, GAG, exfoliation of cells)
  • antimicrobial properties of urine (low or high ph, peptides, Lmw CHO)
  • systemic immunity
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8
Q

what is recurrent bacterial cystitis?

A

> 3 times/ year
2 times/ year

will show clinical signs

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9
Q

Does urolithiasis predispose to bacterial infections?

A

yes

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10
Q

risk factors for bacterial UTI

A
  • recent use of Ab
  • catheterisation
  • immunosuppression
  • conditions resulting in dilute urine (DM, CKD)
  • secondary to inflammation or trauma to UT
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11
Q

bacterial uropathogens are usually

A

commensals that infect via ascending infection

usually a single causative agent (90%)

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12
Q

What are the 4 most common uropathogens in SM?

A
  • proteus
  • E.Coli
  • enterococcus
  • CN staphylococcus
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13
Q

What are the most common uropathogens in LA?

A

same as SA

and Corynebacterium (can result in pyelonephritis)

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14
Q

How do bacteria persist in UTI?

A
  • replicate within tissues
  • Biofilm
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15
Q

How do you start your investigation on a UTI

A
  • consider cx
  • urinalysis
  • definitive dx and tx based on quantitative urine culture
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16
Q

What is the most appropriate sample collection for urine for assessing UTI

A
  • cystocentesis (gold standard)
  • alternative option: aseptic catheterisation

can also perform cultures on:
- bladder biopsy
- cystolith

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17
Q

What is the least ideal sample collection for urine for assessing UTI

A

free catch

(sometimes this is the only method available, may need to follow up with a cystocentesis, consider difficulties in interpretation)

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18
Q

What does urinalysis not tell us about that we need to know for treatment

A

which antibiotic to use

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19
Q

What information is provided on a urinalysis

A
  • SG: is urine concentrated?
  • dipstick: proteinuria? hematuria? glucosuria?
  • sediment
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20
Q

Does sporadic bacterial cystitis require further diagnostic investigation

A

no

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21
Q

Does recurrent bacterial cystitis require further diagnostic investigation

A

yes

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22
Q

What are the 1st line antimicrobials used for tx of sporadic bacterial cystitis?

A
  • Amoxicillin
  • TMPS
  • (Amoxi-clav reasonable)
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23
Q

What does the sediment tell us?

A
  • hematuria?
  • pyuria (wbc)?
  • crystalluria?
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24
Q

If a young cat has a suspected UTI should you do Culture?

A

YES, as it is rare for them to have bacterial UTI

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25
Q

if a male dog has recurrent UTI what antibiotic may you choose?

A

antibiotics that can penetrate the prostate
ie TMPS or fluoroquinolone

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26
Q

How do we monitor for resolution of a case of sporadic bacterial cystitis?

A
  • resolution of clinical signs within 48H
    (no need to repeat UA, or Urine culture)
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27
Q

If following treatment of a sporadic bacterial cystitis signs not resolving what do you do?

A
  • switch to antibiotic based on C & S
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28
Q

how long are antibiotics for sporadic bacterial cystitis prescribed for?

A

3-5 days

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29
Q

If treatment sporadic bacterial cystitis fails- what may be the causes?

A
  • infection not the cause of the clinical signs?
  • inadequate delivery of Ab (poor owner compliance, animal factors, inappropriate drug so poor penetration)
  • antibiotic resistance? (intrinsic or acquired)
  • undiagnosed predisposing factors (urolithiasis)
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30
Q

Should you treat recurrent bacterial cystitis with longer course treatment?

A

No
still do 3-5 days

Unless kidney or prostate involvement (7- 14d)

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31
Q

If you have a patient with recurrent bacterial cystitis how would you investigate?

A

Will depend on other clinicals signs

  • bloods
  • imaging
  • endocrinology testing
  • urine C& S
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32
Q

urine output goes down if

A

filtration is not occurring

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33
Q

urine output goes up if

A

reabsorption is not occurring

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34
Q

problem with urinary filtration

A

urine output decreases

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35
Q

problem with absorption of filtrate

A

urine output increases

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36
Q

99% of urine filtrate is

A

reabsorbed

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37
Q

Storage of urine is controlled by the

A

SNS (hypogastric)

allows bladder to relax and fill

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38
Q

the PNS Pelvic nerve allows the bladder to

A

void via contraction bladder wall

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39
Q

Which nerves control the voluntary control of the urethra

A

pudendal nerves

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40
Q

polyuria*

A

greater than normal urine output

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41
Q

anuria*

A

no urine output

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42
Q

oliguria*

A

less than normal urine output

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43
Q

what is the normal urine output of dog and cat

A

15-45ml/kg/day

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44
Q

pollakiuria*

A
  • frequent passage of urine (small amounts)
  • total daily amount of urine not increased
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45
Q

urinary incontinence

A

involuntary passage of urine

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46
Q

nocturia

A

urination at night

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47
Q

periuria

A

innappropriate urination (wrong time wrong place)

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48
Q

dysuria

A

difficult painful urination

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49
Q

stranguria

A

slow and painful. used interchangeably with dysuria

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50
Q

Is it easier to feel the kidneys in a dog or a cat?

A

the cat

very difficult to feel in dog, but can still try!

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51
Q

Which kidney is more difficult to feel in the cat?

A

the right one
tucked under ribs

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52
Q

is blood work useful in investigating LUT disease

A

No

more useful for Upper urinary tract

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53
Q

during a cystotomy where do you place the stay suture to hold in place and where do you cut the bladder?

A
  • place stay suture on apex
  • cut the median ligament
  • cut ventral midline
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54
Q

Why would you do a cystotomy?

A
  • remove cystic and urethral calculi
  • to do an incisional/ excisional biopsy
  • treat ectopic ureters
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55
Q

urolithiasis can affect which parts of the UT?

A
  • Upper
  • Lower
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56
Q

How would you approach a urinary tract obstruction?

A
  • history
  • stabilise (bloods, ECG, fluids)
  • urinary diversion
  • imaging (localise uroliths/ obstruction)
  • remove uroliths and send for analysis
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57
Q

where may you make the stoma for a permanent urethrostomy in the male dog?

A

scrotal

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58
Q

where may you place a permanent urethrostomy in the male cat?

A

perineal

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59
Q

following a cystotomy, when closing up the incision which layer must you include?

A

the submucosa

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60
Q

If you have a urolith in the urethra how can you remove them?

A
  • retropropulse them back into bladder
  • cystotomy
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61
Q

If during a cystectomy you need to remove part of the trigone, what will need to be done next?

A
  • ureteral re-implantation (referral)
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62
Q

what is more risky- urethrotomy or a cystotomy?

A

urethrotomy!!

increased risk of rupture
increased risk of hemmorhage

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63
Q

When do you consider doing a urethrotomy

A

ONLY when a cystotomy is not possible

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64
Q

what are the complications of cystotomy

A
  • urolith recurrence
    (or failure to completely remove)
  • cystotomy breakdown–> uroabdomen
  • hematuria/ blood clot
  • dysuria
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65
Q

urethrotomy will vary according to which part of the ureters are affected in the MALE dog- which parts are these?

A
  • glans penis
  • prescrotal
  • (perineal) less common
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66
Q

What surgery is this? in which part?

A

Urethrotomy

prescrotal

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67
Q

the preferred site for urethrostomy in the dog

A

scrotal

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68
Q

the preferred site for urethrostomy in the cat

A

perineal

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69
Q

urethrostomy you make an opening in the urethra and suture the sides to

A

the skin

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70
Q

Permanent urethrostomy in the male cat usually involves amputation of the

A

penis

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71
Q

Permanent urethrostomy of the female patients involves which sites

A

-transpelvic, subpubic,prepubic

VERY COMPLICATED procedure!

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72
Q

What suture pattern do you make on the bladder when placing a cystostomy tube?

A

purse string, the catheter will go inside it

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73
Q

What are the treatments for USMI?

A

bladder neck relocation
bladder neck lengthening
increasing urethral resistance (prosthetic sphincter, bulking agents)

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74
Q

How do you treat intramural ectopic ureters

A
  • side to side neo-uterocystotomy
  • uteroneonephrectomy
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75
Q

During a cystotomy you make an incision on the bladder where

A

ventrally

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76
Q

what are the risks associated with pre-pelvic urethrostomy

A

increased risk of infection as urethra is shorter

urinary incontinence

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77
Q

a cystostomy tube is secured externally with which suture?

A

Roman sandle

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78
Q

Which muscles do you cut in a permanent urethrostomy in cat

A
  • retractor muscle
  • ventral penile ligament
  • ischiocavernosus muscles

increases mobility of the urethra

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79
Q

What is the reference landmark for perineal urethrostomy in cats

A

bulbourethral gland

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80
Q

If performing a scrotal permanent urethrostomy in a dog- will you need to castrate?

A

yes

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81
Q

Should you take rectal temperature and clean following a permanent urethrostomy?

A

No

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82
Q

How do you surgically correct extramural ureters?

A

ureteral re-implantation

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83
Q

Functional urethral obstruction is dyssynergia between

A

the detrusor muscle contraction and urethral relaxation

no anatomic reason for obstruction

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84
Q

Diagnosis of functional urethral obstruction is a diagnosis of

A

exclusion

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85
Q

What is the most common cause of UT obstruction

A

urethral

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86
Q

What is the most common cause of urethral obstruction in the dog?

A

urolithiasis

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87
Q

What is the most common cause of urethral obstruction in the cat?

A

urethral spasm

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88
Q

Name some extra-mural causes of urethral obstruction

A
  • perineal rupture
  • trauma (ie penile)
  • bladder mass
  • prostate disease
  • pelvic mass
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89
Q

Name some intra-urethral causes of obstruction

A
  • calculi
  • inflammation (proliferative urethritis)
  • tumours
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90
Q

lesions cranial to the sacral segments may lead to firm bladder or a flaccid bladder?

A

firm bladder (UMN)

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91
Q

Where is the most common site for urinary obstruction in the male dog?

A

1) os penis
2) just after the ischium

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92
Q

Where is the most common site for urinary obstruction in the male cat?

A

os penis

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93
Q

If you suspect a urinary obstruction, and pass a catheter and find no blockage does that exclude obstruction?

A

NO

  • may have:
    functional obstruction
    partial obstruction
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94
Q

clinical signs associated to urinary tract obstruction will vary according to

A
  • partial or complete obstruction
  • acute/ chronic
  • underlying cause
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95
Q

urinary obstruction can be mistaken for

A
  • constipation
  • other disease if animal collapsed
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96
Q

Is azotemia due to severe urethral obstruction reversible ?

A
  • yes
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97
Q

What are the effects of urinary obstruction on the bladder?

A
  • bladder distention
  • ischemia
  • oedema
  • hemmorhage
  • mucosal sloughing
  • ureteral reflux
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98
Q

urinary obstruction will lead to what systemic effects?

A
  • hypotension
  • hypovolaemia
  • biochemical changes
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99
Q

What are the biochemical changes seen. in urinary obstruction? Are they reversible?

A
  • azotemia
  • hyperglycemia (cats)
  • hyperphosphatemia
  • hypocalcemia
  • hyperkalaemia

YES REVERSIBLE

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100
Q

In a urinary obstruction what happens to blood potassium?

A

hyperkalaemia

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101
Q

What are the effects of hyperkalaemia on the CVRS system?

A
  • bradycardia
  • ventricular arrhythmmias
  • prolonged PR interval
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102
Q

Why is urinary obstruction an emergency?

A
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103
Q

Indwelling urinary catheters with closed urinary system post obstruction - should we use them?

A

only when necessary- sometimes make urethral spasms worse

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104
Q

When should antibiotics be given when using indwelling catheters?

A

give antibiotics only after removal

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105
Q

What is the preferred method for managing urethral calculi in male dogs and cats

A

retrograde hydropropulsion

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106
Q

How do you manage an emergency urinary obstruction?

A

1) Take bloods
2) correct hyperkalaemia
3) give fluids
4) give calcium
5) cystocentesis
6) sedate and place a urinary catheter
7) take samples
8) bladder lavage

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107
Q

After unblocking a patient prepare for

A
  • hypokalaemia
  • diuresis
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108
Q

How are uroliths formed?

A

supersaturation—> nucleation

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109
Q

Can you have crystals without uroliths and uroliths without crystals?

A

YES

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110
Q

How can crystals dissolve?

A

decrease solute concentration

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111
Q

Are cystoliths palapable?

A

generally not

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112
Q

urethroliths can lead to what type of obstruction?

A

post renal azotemia (obstruction)

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113
Q

What clinical signs are seen with uteroliths and nephroliths?

A

usually asymptomatic

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114
Q

urethroliths give what clinical signs?

A
  • abdominal discomfort
  • poor or no urine stream
  • enlarged painful bladder
  • may be palpable
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115
Q

what type of contrast radiography do we use to visualise the urethra?

A

retrograde

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116
Q

what type of contrast radiography do we use to visualise the nephroliths and uteroliths?

A

excretory urogram

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117
Q

what type of contrast radiography do we use to visualise the bladder?

A

double contrast

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118
Q

What is renal colic?

A

pain that occurs when stone moves down the ureter

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119
Q

What is this?

A

US of cystolith

note the acoustic shadows

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120
Q

What factors help determine a stone type?

A
  • SIGNALMENT (70%)
  • urine ph
  • radioopaque Vs radioluscent
  • history of a particular stone type
  • disease associations
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121
Q

UTI are associated with which stone type?

A

struvite

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122
Q

urolith analysis- quantitative or qualitative

A

quantitative

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123
Q

nephrolith tx

A
  • if asymptomatic leave alone
  • surgical removal
  • lithrotripsy
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124
Q

uterolith treatment

A

referral (lithotripsy for dogs)

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125
Q

What urolith is not amenable to dietary dissolution ?

A

Calcium oxalate

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126
Q

treatment for cystolith

A
  • medical dissolution
  • hydropropulsion
  • surgery (cystotomy)
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127
Q

treatment for urethrolith

A
  • retrograde flush
  • surgery (avoid if possible)
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128
Q

When can we consider medical management for uroliths?

A
  • no obstruction
  • no contraindications to dietary therapy
  • stone amenable to dissolution (strucite, urate, cysteine)
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129
Q

What causes struvite crystals in dogs?

A

bacteria (proteus..) with urease that convert urea into ammonium and bicarbonate

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130
Q

In cats struvite crystals are …

A

sterile

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131
Q

treatment of struvite crystals

A

acidifying diets

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132
Q

The use of acidifying diets for … crystals have predisposed the formation of …. crystals

A
  • struvite
  • calcium oxalate
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133
Q

Can you treat calcium oxalate crystals by changing the ph with diet?

A

no

surgery is required

134
Q

Calcium oxalate crystals- radio opaque or radioluscent?

A

radioopaque

135
Q

Acidifying diets for struvite crystal dissolution contain less ….

A

protein—> less urea

136
Q

Does E coli cause struvite crystal formation

A

no

does not have the urease enzyme

137
Q

Struvite acidifying diets are contraindicted in which patients?

A
  • pregnant
  • lactating
  • young
  • liver disease
  • metabolic acidosis
  • pancreatitis
138
Q

Is solubility of calcium oxalate crystals pH dependent?

A

no

139
Q

The is a …% recurrence of calcium oxalate crystals within 3 years

A

60%

140
Q

Calcium oxalate crystals are more common in upper or lower urinary tract?

A

upper urinary tract

141
Q

Calcium oxalate crystals are more common in young or old? male or female?

A

old males

142
Q

Which stone are radioluscent?

A

ammonium urate
cysteine crystals

143
Q

What causes the formation of ammonium urate crystals?

A
  • decreased conversion of uric acid into allantoin –> increased concentration of uric acid in the urine
144
Q

Which breed is predisposed to ammonium urate crystal formation?

A

dalmation

145
Q

treatment for ammonium urate crystals

A
  • allopurinol
  • decreased purines in diet (otherwise risk of xanthine crystal formation)
146
Q

Cysteine crystals results from excess

A

urine cystein
congenital

147
Q

Cysteine secretion can be decreased by what surgical procedure?

A

castration

148
Q

Can we use dietary dissolution to dissolve a cysteine crystal?

A

yes but very expensive!!

149
Q

AKI is different to ARF - how?

A

in AKI , patient does NOT necessarily have azotemia

ARF is less than 2 weeks
AKI is within 48h

150
Q

what is uraemia?

A

it is the clinical signs of azotemia

all patients that are uraemic are azotemic but not all azotemic patients will have uraemia

151
Q

azotemia*

A

increase in non- protein nitrogenous waste products (urea and creatinine) in the blood

152
Q

azotemia is a marker for

A

GFR

153
Q

What can cause “little kidney big kidney” in cats

A

obstructive nephropathy

calcium oxalate crystals block ureter(s)

154
Q

What are the signs associated to obstructive nephropathy?

A

asymptomatic if just one ureter affected

clinical signs present when both ureters become obstructed

155
Q

What is the most common cause of CKD in the cat?

A

chronic tubulointerstitial nephritis

garbage diagnosis

fibrosis and inflammation of the kidneys

156
Q

What happens to kidneys of cats with polycystic kidney disease?

A

they become enlarged

157
Q

What are the most common causes of CKD in dog?

A
  • 1ry glomerular disease
  • familial disease syndrome (boxers, cocker spaniels)
  • tubulointerstitial nephritis (older dogs)
158
Q

What common factors are associated with increased morbidity in the CKD patient?

A
  • HYPOkalaemia
  • anaemia (decreased EPO)
  • dehydration
  • UTI (dilute urine)
  • systemic hypertension (target end organ)
  • acidosis
159
Q

what renoprotectants do we use in Stage 2 and 3 of CKD?

A

ACE i
ARBS

160
Q

What metabolic disorder occurs when GFR decreases?

A

2ndary hyperparathyroidism

( inability to excrete Phosphorus–> increases PO4–> increased PTH—> calcium is taken out from bones—> rubber jaw)

161
Q

AKI*

A
  • decrease in urine output
  • abrupt increase in serum creatinine >26.4umol/L
162
Q

Creatinine levels remain almost unchanged until GFR has increased or decreased?

A

decreased

163
Q

AKI is usually on suspected when there is …

A

azotemia

all other clinical signs are NON-SPECIFIC

164
Q

What 2 questions should you ask with a suspected AKI case?

A

1) chronic or acute
2) pre-renal/ renal/ post renal azotemia?

165
Q

If an AKI patient has small kidneys what may that indicate?

A

chronic AKI

166
Q

feline urologic syndrome*

A

fine struvite crystals fill a mucoid protein matrix

167
Q

Name some developmental abnormalities that can lead to lower urinary tract obstruction

A
  • ureteral aplasia
  • ectopic ureter
  • patent urachus (foals- channel between the umbilicus and the bladder)
  • cysts
168
Q

Oxalate form at .. pH

A

acidic

169
Q

Struvite and carbonates form at … pH

A

alkaline

170
Q

In progressive juvenile nephropathy (familial renal disease) what occurs to the kidney

A

initially have normal renal capacity
as animals matures increasing fibrosis

171
Q

is kidney hypoplasia uncommon?

A

not uncommon to have one kidney small than the other

172
Q

ectopic kidney

A

kidney in an abnormal location

173
Q

What is this disease? Which breed is typically affected?

A

Polycystic kidney disease

Persian cat

174
Q

List the filtration layers of the glomerulus

A

fenestrated endothelium
bm
podocytes

175
Q

What is this? What may cause this?

A

immune mediated glomerulonephritis
(note the granular cortex and pin point tan foci)

Causes:
FeLV, FIV,
chronic parasitism
auto-immune disease
neoplasia

176
Q

What is this?

A

Glomerular amyloidosis

associated with:
- chronic inflammatory disorder
- systemic infectious diseases
- neoplasia

177
Q

What can be seen histologically with glomerular amyloidosis?

A

eosinophilic homogenous material

tubules dilated with protein

178
Q

What can cause acute suppurative glomerulitis?

A

bacteremia

—> neutrophils —> formation of microabcesses

179
Q

What are the consequences of glomerular damage?

A
  • nephrotic syndrome –> protein losing nephropathy ( loss of ATIII and albumin) —> oedema, effusion, hypercoagulability
  • loss of capillaries and blood flow–> glomerular sclerosis—> atrophy of renal tubules
180
Q

How can toxins cause nephrotoxin associated ischaemia

A

vasocontriction–> hypoxia

181
Q

What will happen if the BM is injured with a nephrotoxin

A

fibrosis- loss of function of the nephron

182
Q

How does ethylene glycol damage the tubules?
(this also applies to oxalate containing plants)

A

oxidised into toxic metabolites—> oxalate crystals precipitate in tubular lumen —> obstruction

183
Q

What causes pulpy kidney?

A

Clostridium Perfringens

Epsilon toxin

causes acute tubular necrosis/ degeneration

184
Q

Fanconi Syndrome *

A

Basenji dogs hereditary defect in tubular resorption of protein, a.a., renal insufficiency –> renal failure

185
Q

Cystinuria is an inherited abnormality that can predispose to

A

calculus formation

186
Q

Primary renal glycosuria is an inherited disorder in Norwegian Elkhounds that predisposes to

A

LUT infections (increased glucose in the filtrate)

187
Q

If you decrease Glomerular blood flow you decrease blood flow to the rest of the nephron because

A

no anastomoses

the arterial blood supply of the cortex is terminal

188
Q

Hemmorage of the kidney is secondary to

A

trauma
dic
septicaemia
FIP (vasculities)
etc etc

189
Q

What can lead to renal thrombosis

A
  • Hypercoagulability (ie loss of ATIII)
  • Endothelial damage (ie FIP, endotoxin)
  • dynamics of BF (ie cardiac disease or hypovolaemia)
190
Q

Renal infarcts can occur due to occlusion of arteries or venous drainage?

A

Both

191
Q

Acute, subacute or chronic?

A

acute

192
Q

Acute, subacute or chronic?

A

chronic- fibrosis and scarring

193
Q

What is this? what can cause this?

A

Hydronephrosis

increased renal pelvic pressure–> dilatation of the pelvis–> atrophy of parenchyma

194
Q

What is this? Which species does it commonly affect? what agents can cause this?

A

Pyelonephritis

cow and sow

Corynebacterium, E Coli, Strep…

195
Q

What may cause vesicoureteral reflux? (ie urine flow goes from bladder —> kidneys)

A

bacteria

bacterial toxins inhibit peristalsis

196
Q

How do NSAIDs reduce renal perfusion?

A

Decrease PG—> afferent arteriole vasoconstriction—> papillary necrosis

197
Q

What is papillary necrosis?

A

response of the inner medulla to ischaemia

198
Q

What is the most common kidney neoplasm in the dog?

A

renal carcinoma

199
Q

Kidney neoplasia represents <1% of tumours but when it happens

A

its nasty

highly malignant
highly metastatic

200
Q

If a cat is >10 yo and has FLUTD what is the likely cause?

A

UTI
urolith

201
Q

If a cat is 0-10 yo and has FLUTD what is the likely cause?

A

idiopathic

202
Q

Is use of antibiotics justified in idiopathic FLUTD

A

no

only justified in older cats or where culture is positive

203
Q

Most cats with blockage just have…

A

urethral spasm

204
Q

What are the risk factors for idiopathic FLUTD?

A
  • obesity
  • male
  • multicat household with conflict
  • dry food (increases recurrence)
  • pedigree
  • long haired
205
Q

Idiopathic FLUTD is typically

A

self limiting!

206
Q

What are the current theories for Idiopathic FLUTD

A

Interstitial cystitis ( like humans):
GAG defect allows harmful substances to cross the bladder wall activating nerves causing increase in substance P. Substance P causes mast cell degranulation, extravasation, sm bladder.
(note picture with glomerulations)

  • neuroendocrine imbalance. Decreased receptors in the adrenal cortex for ACTH, means negative feedback pathway does not work—> activated SNS on bladder persists
207
Q

Idiopathic FLUTD is a diagnosis of

A

Exclusion
need to exclude uroliths andUTI

208
Q

How do we currently treat Idiopathic FLUTD?

A

Multimodal environmental modification:

  • avoid punishing cat
  • wet food
  • have an additional littertray in house
  • increase water intact
  • resolution of conflict
  • increase interaction with owner
209
Q

The current understanding of Idiopathic FLUTD is that is it both physical and emotional- and is a systemic syndrome classified as a

A

anxiopathy

210
Q

Do all dogs with USMI have intra-pelvic bladders?

A

No

Some dogs with USMI do not have caudally displaced bladders and some dogs with caudally displaced bladders have normal urination.

211
Q

Is a caudally displaced bladder diagnostic for USMI?

A

no- but it is supportive

Note caudally displaced bladder has a shorter urethra

212
Q

USMI is most commonly reported in

A

neutered bitches

213
Q

With USMI, dogs are fine when walking but when they are …. they leak

A

recumbent

214
Q

USMI is congenital or acquired?

A

both

215
Q

If an ectopic ureter inserts into the vestibule- what is the level of incontinence?

A

Very incontinence

216
Q

If an ectopic ureter inserts into the proximal urethra- what is the level of incontinence?

A

Mild incontinence

217
Q

What is this showing?

A

a mesonephric remnant

218
Q

Only 50% of treated ectopic ureters have resolved incontinence- this is due to…

A

Other concurrent problems

(ie small bladder, hydronephrosis, poor urethral tone, USMI, hydroureter…)

219
Q

dogs- more likely to have intramural or extramural ectopic ureters?

A

intramural

220
Q

cats- more likely to have intramural or extramural ectopic ureters?

A

extramural

221
Q

How do we surgically treat intramural ectopic ureters?

A

laser ablation

222
Q

How do we surgically treat extramural ectopic ureters?

A

ureter reimplantation

223
Q

Who has ectopic ureters more commonly- dogs or cats?

A

dogs

224
Q

What is this?

A

genitourinary dysplasia

congenital developmental abnormality affecting vagina and urethra (1 common cavity)

225
Q

Pervious urachus*

A

dribbling of urine and wetting of area around umbilicus

(seen in calves)

226
Q

What diagnostic imaging is the gold standard for assessing ectopic ureters?

A

cytoscopy

227
Q

If a patient is incontinent even when walking what could this be?

A

ectopic ureters

228
Q

What do you need to rule out when approaching a urinary incontinent case?

A
  • paradoxical incontinence
  • urge incontinence
  • PU/PD
229
Q

With USMI and ectopic ureters- can the patient urinate normally?

A

yes can urinate normally

230
Q

Paradoxical incontinence*

A

obstruction —> bladder distention
can only leak when recumbent or pressure applied

patient cannot urinate normally

231
Q

urge incontinence*

A

inability to store urine (urolith, neoplasm, mass)
patient cannot urinate normally

232
Q

Is urolithiasis common in horses?

A

uncommon

233
Q

Is urolithiasis common in small ruminants?

A

common

234
Q

Is urolithiasis common in cattle?

A

common

235
Q

Does urolithiasis affect ruminant female or males more?

A

incontinence is seen more in males as their urethra is narrow

236
Q

Where is a common site of obstruction of urolithiasis in small ruminants

A
  • urethral process
  • distal sigmoid flexure
237
Q

Where is a common site of obstruction of urolithiasis in cattle

A

distal sigmoid flexure

238
Q

What are common complications of urolithiasis in ruminants

A
  • bladder rupture–> uroperitoneum
  • urethral process rupture
  • hydronephrosis (if chronically obstructed)
239
Q

Renal amyloidosis commonly affects which animal?

A

cow

240
Q

What predisposes small ruminants to pizzle rot/ ulcerative posthitis?

A
  • high protein diets–> urea
  • Corynebacterium renale break down urea–> ammonia
241
Q

What is most common cause of renal failure in the horse- primary or secondary

A

secondary to hypovolaemia ( pre-renal failure)

242
Q

What is the cause of enzootic hematuria in small ruminants?

A
  • Bracken poisoning
243
Q

In amyloidosis in cattle what may you see on biochem

A
  • increased SAA
  • fibrinogen
  • hypoalbunemia
  • azotemia
244
Q

What is a useful tool for differentiating an umbilical hernia from an umbilical infection

A

US
(palpation- if it is a hernia you can squeeze it back in!)

245
Q

If a cow has generalised septicaemia with an infected umbilicus - how should you tx?

A
  • Surgery not advised as septicaemic
  • Broad spec antibiotics (usually mixed infection)
246
Q

If you have an umbilical hernia that is <2cm how should you treat?

A
  • if not infected can self resolve in 2 months
247
Q

What emergency can occur with umbilical hernias?

A
  • gut strangulation

EMERGENCY

248
Q

What is this?

A

Ulcerative vulvitis (same pathogenesis as ulcerative posthitis)

249
Q

Is pyelonephritis common in horses?

A

No

250
Q

How can you tell if there is am umbilical infection via US?

A

arteries and veins should be < 1cm

anechoic/ hyperechoic material

251
Q

If there is localised umbilical infection with no septicaemia how may you treat?

A

umbilical resection
broad spec antibiotics

or just broad spec antibiotics and monitor with US to see if umbilicus continues to enlarge

252
Q

patent urachus*

A

was closed then opens

253
Q

persistent urachus*

A

Open from birth (trauma at parturition?)

254
Q

Contrarily to the cat, renal failure in the horse is seen with a …. in phosphate and a …. calcium

A

increase in calcium
decrease in phosphate

255
Q

list some clinical signs seen with horses in renal failure

A
  • encephalopathy
  • ventral oedema
  • oral ulcerations
  • PU/PD
256
Q

How do you treat acute renal failure in a horse

A

Fluids
diuresis

257
Q

List some causes of acute renal failure in the horse

A
  • toxins (NSAID, Acorn, Aminoglycosides)
  • hypotension–> hpovolaemia
258
Q

Clinical signs of bladder rupture in a foal usually manifest when?

A

2-3 days after parturition

259
Q

What may cause bladder rupture in a foal?

A
  • parturition makes the bladder pop
  • 2ndary to infection
260
Q

How do you dx bladder rupture in a foal?

A

US
sample peritoneal fluid to assess the serum creatinine ratio

261
Q

How do you manage bladder rupture in a foal?

A
  • usually not an emergency
  • stabilise first
  • IV fluids
  • drain peritoneal fluid
  • surgery

(Good px is stabilised prior to surgery)

262
Q

In both cats and dogs SBP increases with

A

age

263
Q

Sighthounds and brachycephalics have higher or lower SBP

A

higher SBP

264
Q

The ACVIM classification of systemic hypertension is largely based around the risk of ….?

A

risk of future target organ damage

265
Q

Name the Target organs (subsequent to HT)

A
  • ocular
  • CNS
  • heart
  • kidney

(note image left ventricular hypertrophy)

266
Q

Target organ damage of the eye is more commonly seen in cats or dogs?

A

Cat

267
Q

How does the kidney get damaged by increased SBP?

A
  • autoregulation stops working ( as higher than >80-160 mmHG)
  • Glomerular capillary pressure increases
268
Q

In vet medicine do we care abut systolic or diastolic hypertension?

A

Systolic HT (diastolic not clinically relevant to our patients)

269
Q

What are the 3 types of hypertension

A
  • idiopathic
  • situational (ie white coat)
  • 2ndary hypertension
270
Q

What is the most common cause of hypertension in the dog?

A

secondary hypertension

271
Q

What is the gold standard for measuring BP

A

direct arterial catheterisation

(used in intensive care for high risk patients)

272
Q

Cuffs should be …..of limb circumference

A

30-40%

273
Q

When to start anti-hypertensive tx? (3)

A
  • > 160 mmHg with TOD
  • > 160 mmHg with predisposing condition (i.e CKD)
  • > 160mmHg and old !
274
Q

If a young cat or dog has a BP >160mmH what is the most likely cause?

A

white coat hypertension

275
Q

What us the target SBP when treating cats and dogs with anty-hypertensive therapy?

A

< 160mmHg

276
Q

The ACVIM classification of systemic hypertension defines hypertension as >…mmHg

A

> 160mmHg

277
Q

Amlodipine causes vasodilation of the efferent or afferent arteriole?

A

afferent

278
Q

Telmisartan causes vasodilation of the efferent or afferent arteriole?

A

efferent

279
Q

What approach is used to treat hypertension in dogs

A

multimodal approach

280
Q

if a dog had hypertension and hyperadrenocorticism how would you treat?

A

Trilostane (for HAC) and Telmasartan (1st line)

281
Q

What is the effect of 1.25 vit D on PO4 and Cal?

A
  • increases PO4
  • increases Ca

(absorption in the GIT)

282
Q

What is the effect of PTH on PO4 and Cal?

A
  • increases Ca
  • decreases PO4 (excretions via the kidneys)
283
Q

When you are checkin calcium levels - ALWAYS check what other 2 things

A
  • albumin (this will give you an idea of protein bound calcium and therefore the ionised Ca)
  • Phosphate
284
Q

If Calcium is high and PO4 is high- what is the risk?

A

formation of CaPO4—> mineralisation of soft tissues—> irreversible organ damage (ie nephron destruction)

285
Q

Is hypercalcemia a diagnosis?

A

NO

286
Q

repeatable hypercalcemia should always be

A

investigated

287
Q

Will CKD in the cat increase or decrease calcium?

A

increase

288
Q

Dog hypercalcemia is most commonly due to

A

neoplasia (PTHrp)
primary parathyroidisms (heritable)

289
Q

How does calcium cause PU/PD

A
  • it interferes with medullar tonicity at the LoH
  • Stops ADH binding at collecting tubules
290
Q

What are non- PTH factors or PTH-like factors that cause hypercalcemia

A
  • Vit D increase (psoriasis cream
  • granulomatous inflammation
  • CKD
291
Q

If a cat has increased Ca and PO4 and a shrunken kidney- what is likely diagnosis?

A

CKD :(

292
Q

If a cat has increased Ca and decreased PO4 and a shrunken kidney- what is likely diagnosis?

A

hypercalcemia- not CKD so treatable yay!

293
Q

In a lateral-caudal view you pull the legs

A

cranially

294
Q

In a lateral view you pull the legs

A

caudally

295
Q

Is it possible to view the ureters in a radiograph

A
  • not for dog
  • sometimes yes for fat cats
296
Q

Kidney size is references based on which vertebra

A

L2

Dog 2.5-3.5 x L2
Cat 2.1-3.2 x L2 ( if neuterered then smaller)

297
Q

the 3 parts of the urethra are

A
  • Prostatic
  • Pelvic
  • Pelvic
298
Q

Can you radiographically see the prostate of a neutered dog?

A

generally not

299
Q

Can you radiographically see the prostate of a cat?

A

no

300
Q

What is this?

A

the uterus
dorsal to the urinary bladder
ventral to the colon

301
Q

ureteral jets (US) can be useful for detecting … but these are not always normally seen

A

ectopic ureters

302
Q

Urine is hyperechoic or anechoic?

A

anechoic black- this is what a normal bladder looks like

303
Q

What is this?

A

prostate with central anechoic urethra

top: entire dog
bottom: neutered - so smaller

304
Q

What is this? The GIT is displaced in which direction?

A

nephromegaly- GIT displaced ventrally

305
Q

What is this disease?

A

nephrolithiasis

306
Q

What is this disease?

A

neoplasia in the uterus
could be leiomyoma, leiosarcoma or TCC

307
Q

What is this?

A

blod clot in the bladder

308
Q

What is this?

A

blod clot in the bladder

309
Q

What are these?

A

cytoliths

310
Q

What is this?

A

calculi in the bladder, kidney and ureter

311
Q

Excretory has 3 phases which phase is this?

A

nephrogram phase

312
Q

Excretory has 3 phases which phase is this?

A

pyelogram phase

313
Q

What is this showing

A

renal agenesis

314
Q

What is this showing?

A

ectopic ureters- these are tortuous

note these are normal ureters

315
Q

What is this?

A

penumocystogram showing a pelvic cadually displaced bladder

316
Q

What is this type of contract imaging? What abnormality can be seen?

A

positive contrast cystography

bladder rupture

317
Q

What is this type of contract imaging? What abnormality can be seen?

A

positive contrast cystography

Traumatic inguinal hernia

318
Q

What abnormality can be seen? What is this type of contract imaging?

A

cytoliths

double contrast cystography

319
Q

What is this type of contrast imaging? What abnormality can be seen?

A

blod clot
can be attached to wall or free in the lumen

320
Q

What is this type of contrast imaging? What abnormality can be seen?

A

mural lesion

neoplasia- transitional cell carcinoma is usually found in the trigone

321
Q

If i wanted to assess the distal ureters and bladder size what contrast cytography would i do?

A

pneumocystography

322
Q

If i suspected a bladder rupture w or check for peritoneal effusions - what contrast cytography would i do?

A

positive contrast pneuomocystography

323
Q

If I wanted to evaluate the mucosal detail and suspected neoplasia in the bladder - what contrast cytography would i do?

A

double contrast

324
Q

What is this?

A

air bubble in the urethra

retrograde urethrography

325
Q

What is this?

A

urethral calculi

326
Q

What is this?

A

urethral tear

327
Q

What is this?

A

trauma in the penile urethra

328
Q

Renal disease diets - what is increased and decreased

A
  • protein (decreased quantity- increased quality)
  • decreased phosphorus
  • Omega FA3
  • increase caloric intake (palatability is key)
  • possibly alkalising agent (acidemia occurs in late stages of renal disease due to loss of A/B function)
329
Q

What happens to K in renal disease

A

can increase or decrease

this is why most renal diets have Normal K levels

330
Q

Should we decrease NaCl in renal diets

A

no-
no link between hypertension and NaCl in animals

331
Q

Which stages should you give a renal diet to a dog?

A

stage 1 and 3

332
Q

Which stages should you give a renal diet to a cat?

A

stage 2 and 3

vet med 4 (11 decks)

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