Urinary Flashcards
1
Q
Does the presence of bacteria always lead to clinical signs?
A
no
subliclinical bacteriuria
2
Q
a true urinary tract infection (and not a subclinical bacteriuria) is called
A
sporadic bacterial cystitis
3
Q
How do we differentiate subclinical bacteriuria with sporadic bacterial cystitis?
A
bacteriuria
and
LUT clinical signs:
- pollakiuria
- stranguria
- haematuria
- dysuria
4
Q
A patient with sporadic bacterial cystitis usually have how many episodes per year?
A
<3
5
Q
does sporadic bacterial cystitis affect dogs or cats more commonly?
A
common in dogs
rare in cats
patients are otherwise healthy :)
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
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
8
Q
what is recurrent bacterial cystitis?
A
> 3 times/ year
2 times/ year
will show clinical signs
9
Q
Does urolithiasis predispose to bacterial infections?
A
yes
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
11
Q
bacterial uropathogens are usually
A
commensals that infect via ascending infection
usually a single causative agent (90%)
12
Q
What are the 4 most common uropathogens in SM?
A
- proteus
- E.Coli
- enterococcus
- CN staphylococcus
13
Q
What are the most common uropathogens in LA?
A
same as SA
and Corynebacterium (can result in pyelonephritis)
14
Q
How do bacteria persist in UTI?
A
- replicate within tissues
- Biofilm
15
Q
How do you start your investigation on a UTI
A
- consider cx
- urinalysis
- definitive dx and tx based on quantitative urine culture
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
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)
18
Q
What does urinalysis not tell us about that we need to know for treatment
A
which antibiotic to use
19
Q
What information is provided on a urinalysis
A
- SG: is urine concentrated?
- dipstick: proteinuria? hematuria? glucosuria?
- sediment
20
Q
Does sporadic bacterial cystitis require further diagnostic investigation
A
no
21
Q
Does recurrent bacterial cystitis require further diagnostic investigation
A
yes
22
Q
What are the 1st line antimicrobials used for tx of sporadic bacterial cystitis?
A
- Amoxicillin
- TMPS
- (Amoxi-clav reasonable)
23
Q
What does the sediment tell us?
A
- hematuria?
- pyuria (wbc)?
- crystalluria?
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
25
if a male dog has recurrent UTI what antibiotic may you choose?
antibiotics that can penetrate the prostate
ie TMPS or fluoroquinolone
26
How do we monitor for resolution of a case of sporadic bacterial cystitis?
- resolution of clinical signs within 48H
(no need to repeat UA, or Urine culture)
27
If following treatment of a sporadic bacterial cystitis signs not resolving what do you do?
- switch to antibiotic based on C & S
28
how long are antibiotics for sporadic bacterial cystitis prescribed for?
3-5 days
29
If treatment sporadic bacterial cystitis fails- what may be the causes?
- 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)
30
Should you treat recurrent bacterial cystitis with longer course treatment?
No
still do 3-5 days
Unless kidney or prostate involvement (7- 14d)
31
If you have a patient with recurrent bacterial cystitis how would you investigate?
Will depend on other clinicals signs
- bloods
- imaging
- endocrinology testing
- urine C& S
32
urine output goes down if
filtration is not occurring
33
urine output goes up if
reabsorption is not occurring
34
problem with urinary filtration
urine output decreases
35
problem with absorption of filtrate
urine output increases
36
99% of urine filtrate is
reabsorbed
37
Storage of urine is controlled by the
SNS (hypogastric)
allows bladder to relax and fill
38
the PNS Pelvic nerve allows the bladder to
void via contraction bladder wall
39
Which nerves control the voluntary control of the urethra
pudendal nerves
40
polyuria*
greater than normal urine output
41
anuria*
no urine output
42
oliguria*
less than normal urine output
43
what is the normal urine output of dog and cat
15-45ml/kg/day
44
pollakiuria*
- frequent passage of urine (small amounts)
- total daily amount of urine not increased
45
urinary incontinence
involuntary passage of urine
46
nocturia
urination at night
47
periuria
innappropriate urination (wrong time wrong place)
48
dysuria
difficult painful urination
49
stranguria
slow and painful. used interchangeably with dysuria
50
Is it easier to feel the kidneys in a dog or a cat?
the cat
very difficult to feel in dog, but can still try!
51
Which kidney is more difficult to feel in the cat?
the right one
tucked under ribs
52
is blood work useful in investigating LUT disease
No
more useful for Upper urinary tract
53
during a cystotomy where do you place the stay suture to hold in place and where do you cut the bladder?
- place stay suture on apex
- cut the median ligament
- cut ventral midline
54
Why would you do a cystotomy?
- remove cystic and urethral calculi
- to do an incisional/ excisional biopsy
- treat ectopic ureters
55
urolithiasis can affect which parts of the UT?
- Upper
- Lower
56
How would you approach a urinary tract obstruction?
- history
- stabilise (bloods, ECG, fluids)
- urinary diversion
- imaging (localise uroliths/ obstruction)
- remove uroliths and send for analysis
57
where may you make the stoma for a permanent urethrostomy in the male dog?
scrotal
58
where may you place a permanent urethrostomy in the male cat?
perineal
59
following a cystotomy, when closing up the incision which layer must you include?
the submucosa
60
If you have a urolith in the urethra how can you remove them?
- retropropulse them back into bladder
- cystotomy
61
If during a cystectomy you need to remove part of the trigone, what will need to be done next?
- ureteral re-implantation (referral)
62
what is more risky- urethrotomy or a cystotomy?
urethrotomy!!
increased risk of rupture
increased risk of hemmorhage
63
When do you consider doing a urethrotomy
ONLY when a cystotomy is not possible
64
what are the complications of cystotomy
- urolith recurrence
(or failure to completely remove)
- cystotomy breakdown--> uroabdomen
- hematuria/ blood clot
- dysuria
65
urethrotomy will vary according to which part of the ureters are affected in the MALE dog- which parts are these?
- glans penis
- prescrotal
- (perineal) less common
66
What surgery is this? in which part?
Urethrotomy
prescrotal
67
the preferred site for urethrostomy in the dog
scrotal
68
the preferred site for urethrostomy in the cat
perineal
69
urethrostomy you make an opening in the urethra and suture the sides to
the skin
70
Permanent urethrostomy in the male cat usually involves amputation of the
penis
71
Permanent urethrostomy of the female patients involves which sites
-transpelvic, subpubic,prepubic
VERY COMPLICATED procedure!
72
What suture pattern do you make on the bladder when placing a cystostomy tube?
purse string, the catheter will go inside it
73
What are the treatments for USMI?
bladder neck relocation
bladder neck lengthening
increasing urethral resistance (prosthetic sphincter, bulking agents)
74
How do you treat intramural ectopic ureters
- side to side neo-uterocystotomy
- uteroneonephrectomy
75
During a cystotomy you make an incision on the bladder where
ventrally
76
what are the risks associated with pre-pelvic urethrostomy
increased risk of infection as urethra is shorter
urinary incontinence
77
a cystostomy tube is secured externally with which suture?
Roman sandle
78
Which muscles do you cut in a permanent urethrostomy in cat
- retractor muscle
- ventral penile ligament
- ischiocavernosus muscles
increases mobility of the urethra
79
What is the reference landmark for perineal urethrostomy in cats
bulbourethral gland
80
If performing a scrotal permanent urethrostomy in a dog- will you need to castrate?
yes
81
Should you take rectal temperature and clean following a permanent urethrostomy?
No
82
How do you surgically correct extramural ureters?
ureteral re-implantation
83
Functional urethral obstruction is dyssynergia between
the detrusor muscle contraction and urethral relaxation
no anatomic reason for obstruction
84
Diagnosis of functional urethral obstruction is a diagnosis of
exclusion
85
What is the most common cause of UT obstruction
urethral
86
What is the most common cause of urethral obstruction in the dog?
urolithiasis
87
What is the most common cause of urethral obstruction in the cat?
urethral spasm
88
Name some extra-mural causes of urethral obstruction
- perineal rupture
- trauma (ie penile)
- bladder mass
- prostate disease
- pelvic mass
89
Name some intra-urethral causes of obstruction
- calculi
- inflammation (proliferative urethritis)
- tumours
90
lesions cranial to the sacral segments may lead to firm bladder or a flaccid bladder?
firm bladder (UMN)
91
Where is the most common site for urinary obstruction in the male dog?
1) os penis
2) just after the ischium
92
Where is the most common site for urinary obstruction in the male cat?
os penis
93
If you suspect a urinary obstruction, and pass a catheter and find no blockage does that exclude obstruction?
NO
- may have:
functional obstruction
partial obstruction
94
clinical signs associated to urinary tract obstruction will vary according to
- partial or complete obstruction
- acute/ chronic
- underlying cause
95
urinary obstruction can be mistaken for
- constipation
- other disease if animal collapsed
96
Is azotemia due to severe urethral obstruction reversible ?
- yes
97
What are the effects of urinary obstruction on the bladder?
- bladder distention
- ischemia
- oedema
- hemmorhage
- mucosal sloughing
- ureteral reflux
98
urinary obstruction will lead to what systemic effects?
- hypotension
- hypovolaemia
- biochemical changes
99
What are the biochemical changes seen. in urinary obstruction? Are they reversible?
- azotemia
- hyperglycemia (cats)
- hyperphosphatemia
- hypocalcemia
- hyperkalaemia
YES REVERSIBLE
100
In a urinary obstruction what happens to blood potassium?
hyperkalaemia
101
What are the effects of hyperkalaemia on the CVRS system?
- bradycardia
- ventricular arrhythmmias
- prolonged PR interval
102
Why is urinary obstruction an emergency?
103
Indwelling urinary catheters with closed urinary system post obstruction - should we use them?
only when necessary- sometimes make urethral spasms worse
104
When should antibiotics be given when using indwelling catheters?
give antibiotics only after removal
105
What is the preferred method for managing urethral calculi in male dogs and cats
retrograde hydropropulsion
106
How do you manage an emergency urinary obstruction?
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
107
After unblocking a patient prepare for
- hypokalaemia
- diuresis
108
How are uroliths formed?
supersaturation---> nucleation
109
Can you have crystals without uroliths and uroliths without crystals?
YES
110
How can crystals dissolve?
decrease solute concentration
111
Are cystoliths palapable?
generally not
112
urethroliths can lead to what type of obstruction?
post renal azotemia (obstruction)
113
What clinical signs are seen with uteroliths and nephroliths?
usually asymptomatic
114
urethroliths give what clinical signs?
- abdominal discomfort
- poor or no urine stream
- enlarged painful bladder
- may be palpable
115
what type of contrast radiography do we use to visualise the urethra?
retrograde
116
what type of contrast radiography do we use to visualise the nephroliths and uteroliths?
excretory urogram
117
what type of contrast radiography do we use to visualise the bladder?
double contrast
118
What is renal colic?
pain that occurs when stone moves down the ureter
119
What is this?
US of cystolith
note the acoustic shadows
120
What factors help determine a stone type?
- SIGNALMENT (70%)
- urine ph
- radioopaque Vs radioluscent
- history of a particular stone type
- disease associations
121
UTI are associated with which stone type?
struvite
122
urolith analysis- quantitative or qualitative
quantitative
123
nephrolith tx
- if asymptomatic leave alone
- surgical removal
- lithrotripsy
124
uterolith treatment
referral (lithotripsy for dogs)
125
What urolith is not amenable to dietary dissolution ?
Calcium oxalate
126
treatment for cystolith
- medical dissolution
- hydropropulsion
- surgery (cystotomy)
127
treatment for urethrolith
- retrograde flush
- surgery (avoid if possible)
128
When can we consider medical management for uroliths?
- no obstruction
- no contraindications to dietary therapy
- stone amenable to dissolution (strucite, urate, cysteine)
129
What causes struvite crystals in dogs?
bacteria (proteus..) with urease that convert urea into ammonium and bicarbonate
130
In cats struvite crystals are ...
sterile
131
treatment of struvite crystals
acidifying diets
132
The use of acidifying diets for ... crystals have predisposed the formation of .... crystals
- struvite
- calcium oxalate
133
Can you treat calcium oxalate crystals by changing the ph with diet?
no
surgery is required
134
Calcium oxalate crystals- radio opaque or radioluscent?
radioopaque
135
Acidifying diets for struvite crystal dissolution contain less ....
protein---> less urea
136
Does E coli cause struvite crystal formation
no
does not have the urease enzyme
137
Struvite acidifying diets are contraindicted in which patients?
- pregnant
- lactating
- young
- liver disease
- metabolic acidosis
- pancreatitis
138
Is solubility of calcium oxalate crystals pH dependent?
no
139
The is a ...% recurrence of calcium oxalate crystals within 3 years
60%
140
Calcium oxalate crystals are more common in upper or lower urinary tract?
upper urinary tract
141
Calcium oxalate crystals are more common in young or old? male or female?
old males
142
Which stone are radioluscent?
ammonium urate
cysteine crystals
143
What causes the formation of ammonium urate crystals?
- decreased conversion of uric acid into allantoin --> increased concentration of uric acid in the urine
144
Which breed is predisposed to ammonium urate crystal formation?
dalmation
145
treatment for ammonium urate crystals
- allopurinol
- decreased purines in diet (otherwise risk of xanthine crystal formation)
146
Cysteine crystals results from excess
urine cystein
congenital
147
Cysteine secretion can be decreased by what surgical procedure?
castration
148
Can we use dietary dissolution to dissolve a cysteine crystal?
yes but very expensive!!
149
AKI is different to ARF - how?
in AKI , patient does NOT necessarily have azotemia
ARF is less than 2 weeks
AKI is within 48h
150
what is uraemia?
it is the clinical signs of azotemia
all patients that are uraemic are azotemic but not all azotemic patients will have uraemia
151
azotemia*
increase in non- protein nitrogenous waste products (urea and creatinine) in the blood
152
azotemia is a marker for
GFR
153
What can cause "little kidney big kidney" in cats
obstructive nephropathy
calcium oxalate crystals block ureter(s)
154
What are the signs associated to obstructive nephropathy?
asymptomatic if just one ureter affected
clinical signs present when both ureters become obstructed
155
What is the most common cause of CKD in the cat?
chronic tubulointerstitial nephritis
garbage diagnosis
fibrosis and inflammation of the kidneys
156
What happens to kidneys of cats with polycystic kidney disease?
they become enlarged
157
What are the most common causes of CKD in dog?
- 1ry glomerular disease
- familial disease syndrome (boxers, cocker spaniels)
- tubulointerstitial nephritis (older dogs)
158
What common factors are associated with increased morbidity in the CKD patient?
- HYPOkalaemia
- anaemia (decreased EPO)
- dehydration
- UTI (dilute urine)
- systemic hypertension (target end organ)
- acidosis
159
what renoprotectants do we use in Stage 2 and 3 of CKD?
ACE i
ARBS
160
What metabolic disorder occurs when GFR decreases?
2ndary hyperparathyroidism
( inability to excrete Phosphorus--> increases PO4--> increased PTH---> calcium is taken out from bones---> rubber jaw)
161
AKI*
- decrease in urine output
- abrupt increase in serum creatinine >26.4umol/L
162
Creatinine levels remain almost unchanged until GFR has increased or decreased?
decreased
163
AKI is usually on suspected when there is ...
azotemia
all other clinical signs are NON-SPECIFIC
164
What 2 questions should you ask with a suspected AKI case?
1) chronic or acute
2) pre-renal/ renal/ post renal azotemia?
165
If an AKI patient has small kidneys what may that indicate?
chronic AKI
166
feline urologic syndrome*
fine struvite crystals fill a mucoid protein matrix
167
Name some developmental abnormalities that can lead to lower urinary tract obstruction
- ureteral aplasia
- ectopic ureter
- patent urachus (foals- channel between the umbilicus and the bladder)
- cysts
168
Oxalate form at .. pH
acidic
169
Struvite and carbonates form at ... pH
alkaline
170
In progressive juvenile nephropathy (familial renal disease) what occurs to the kidney
initially have normal renal capacity
as animals matures increasing fibrosis
171
is kidney hypoplasia uncommon?
not uncommon to have one kidney small than the other
172
ectopic kidney
kidney in an abnormal location
173
What is this disease? Which breed is typically affected?
Polycystic kidney disease
Persian cat
174
List the filtration layers of the glomerulus
fenestrated endothelium
bm
podocytes
175
What is this? What may cause this?
immune mediated glomerulonephritis
(note the granular cortex and pin point tan foci)
Causes:
FeLV, FIV,
chronic parasitism
auto-immune disease
neoplasia
176
What is this?
Glomerular amyloidosis
associated with:
- chronic inflammatory disorder
- systemic infectious diseases
- neoplasia
177
What can be seen histologically with glomerular amyloidosis?
eosinophilic homogenous material
tubules dilated with protein
178
What can cause acute suppurative glomerulitis?
bacteremia
---> neutrophils ---> formation of microabcesses
179
What are the consequences of glomerular damage?
- 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
How can toxins cause nephrotoxin associated ischaemia
vasocontriction--> hypoxia
181
What will happen if the BM is injured with a nephrotoxin
fibrosis- loss of function of the nephron
182
How does ethylene glycol damage the tubules?
(this also applies to oxalate containing plants)
oxidised into toxic metabolites---> oxalate crystals precipitate in tubular lumen ---> obstruction
183
What causes pulpy kidney?
Clostridium Perfringens
Epsilon toxin
causes acute tubular necrosis/ degeneration
184
Fanconi Syndrome *
Basenji dogs hereditary defect in tubular resorption of protein, a.a., renal insufficiency --> renal failure
185
Cystinuria is an inherited abnormality that can predispose to
calculus formation
186
Primary renal glycosuria is an inherited disorder in Norwegian Elkhounds that predisposes to
LUT infections (increased glucose in the filtrate)
187
If you decrease Glomerular blood flow you decrease blood flow to the rest of the nephron because
no anastomoses
the arterial blood supply of the cortex is terminal
188
Hemmorage of the kidney is secondary to
trauma
dic
septicaemia
FIP (vasculities)
etc etc
189
What can lead to renal thrombosis
- Hypercoagulability (ie loss of ATIII)
- Endothelial damage (ie FIP, endotoxin)
- dynamics of BF (ie cardiac disease or hypovolaemia)
190
Renal infarcts can occur due to occlusion of arteries or venous drainage?
Both
191
Acute, subacute or chronic?
acute
192
Acute, subacute or chronic?
chronic- fibrosis and scarring
193
What is this? what can cause this?
Hydronephrosis
increased renal pelvic pressure--> dilatation of the pelvis--> atrophy of parenchyma
194
What is this? Which species does it commonly affect? what agents can cause this?
Pyelonephritis
cow and sow
Corynebacterium, E Coli, Strep...
195
What may cause vesicoureteral reflux? (ie urine flow goes from bladder ---> kidneys)
bacteria
bacterial toxins inhibit peristalsis
196
How do NSAIDs reduce renal perfusion?
Decrease PG---> afferent arteriole vasoconstriction---> papillary necrosis
197
What is papillary necrosis?
response of the inner medulla to ischaemia
198
What is the most common kidney neoplasm in the dog?
renal carcinoma
199
Kidney neoplasia represents <1% of tumours but when it happens
its nasty
highly malignant
highly metastatic
200
If a cat is >10 yo and has FLUTD what is the likely cause?
UTI
urolith
201
If a cat is 0-10 yo and has FLUTD what is the likely cause?
idiopathic
202
Is use of antibiotics justified in idiopathic FLUTD
no
only justified in older cats or where culture is positive
203
Most cats with blockage just have...
urethral spasm
204
What are the risk factors for idiopathic FLUTD?
- obesity
- male
- multicat household with conflict
- dry food (increases recurrence)
- pedigree
- long haired
205
Idiopathic FLUTD is typically
self limiting!
206
What are the current theories for Idiopathic FLUTD
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
Idiopathic FLUTD is a diagnosis of
Exclusion
need to exclude uroliths andUTI
208
How do we currently treat Idiopathic FLUTD?
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
The current understanding of Idiopathic FLUTD is that is it both physical and emotional- and is a systemic syndrome classified as a
anxiopathy
210
Do all dogs with USMI have intra-pelvic bladders?
No
Some dogs with USMI do not have caudally displaced bladders and some dogs with caudally displaced bladders have normal urination.
211
Is a caudally displaced bladder diagnostic for USMI?
no- but it is supportive
Note caudally displaced bladder has a shorter urethra
212
USMI is most commonly reported in
neutered bitches
213
With USMI, dogs are fine when walking but when they are .... they leak
recumbent
214
USMI is congenital or acquired?
both
215
If an ectopic ureter inserts into the vestibule- what is the level of incontinence?
Very incontinence
216
If an ectopic ureter inserts into the proximal urethra- what is the level of incontinence?
Mild incontinence
217
What is this showing?
a mesonephric remnant
218
Only 50% of treated ectopic ureters have resolved incontinence- this is due to...
Other concurrent problems
(ie small bladder, hydronephrosis, poor urethral tone, USMI, hydroureter...)
219
dogs- more likely to have intramural or extramural ectopic ureters?
intramural
220
cats- more likely to have intramural or extramural ectopic ureters?
extramural
221
How do we surgically treat intramural ectopic ureters?
laser ablation
222
How do we surgically treat extramural ectopic ureters?
ureter reimplantation
223
Who has ectopic ureters more commonly- dogs or cats?
dogs
224
What is this?
genitourinary dysplasia
congenital developmental abnormality affecting vagina and urethra (1 common cavity)
225
Pervious urachus*
dribbling of urine and wetting of area around umbilicus
(seen in calves)
226
What diagnostic imaging is the gold standard for assessing ectopic ureters?
cytoscopy
227
If a patient is incontinent even when walking what could this be?
ectopic ureters
228
What do you need to rule out when approaching a urinary incontinent case?
- paradoxical incontinence
- urge incontinence
- PU/PD
229
With USMI and ectopic ureters- can the patient urinate normally?
yes can urinate normally
230
Paradoxical incontinence*
obstruction ---> bladder distention
can only leak when recumbent or pressure applied
patient cannot urinate normally
231
urge incontinence*
inability to store urine (urolith, neoplasm, mass)
patient cannot urinate normally
232
Is urolithiasis common in horses?
uncommon
233
Is urolithiasis common in small ruminants?
common
234
Is urolithiasis common in cattle?
common
235
Does urolithiasis affect ruminant female or males more?
incontinence is seen more in males as their urethra is narrow
236
Where is a common site of obstruction of urolithiasis in small ruminants
- urethral process
- distal sigmoid flexure
237
Where is a common site of obstruction of urolithiasis in cattle
distal sigmoid flexure
238
What are common complications of urolithiasis in ruminants
- bladder rupture--> uroperitoneum
- urethral process rupture
- hydronephrosis (if chronically obstructed)
239
Renal amyloidosis commonly affects which animal?
cow
240
What predisposes small ruminants to pizzle rot/ ulcerative posthitis?
- high protein diets--> urea
- Corynebacterium renale break down urea--> ammonia
241
What is most common cause of renal failure in the horse- primary or secondary
secondary to hypovolaemia ( pre-renal failure)
242
What is the cause of enzootic hematuria in small ruminants?
- Bracken poisoning
243
In amyloidosis in cattle what may you see on biochem
- increased SAA
- fibrinogen
- hypoalbunemia
- azotemia
244
What is a useful tool for differentiating an umbilical hernia from an umbilical infection
US
(palpation- if it is a hernia you can squeeze it back in!)
245
If a cow has generalised septicaemia with an infected umbilicus - how should you tx?
- Surgery not advised as septicaemic
- Broad spec antibiotics (usually mixed infection)
246
If you have an umbilical hernia that is <2cm how should you treat?
- if not infected can self resolve in 2 months
247
What emergency can occur with umbilical hernias?
- gut strangulation
EMERGENCY
248
What is this?
Ulcerative vulvitis (same pathogenesis as ulcerative posthitis)
249
Is pyelonephritis common in horses?
No
250
How can you tell if there is am umbilical infection via US?
arteries and veins should be < 1cm
anechoic/ hyperechoic material
251
If there is localised umbilical infection with no septicaemia how may you treat?
umbilical resection
broad spec antibiotics
or just broad spec antibiotics and monitor with US to see if umbilicus continues to enlarge
252
patent urachus*
was closed then opens
253
persistent urachus*
Open from birth (trauma at parturition?)
254
Contrarily to the cat, renal failure in the horse is seen with a .... in phosphate and a .... calcium
increase in calcium
decrease in phosphate
255
list some clinical signs seen with horses in renal failure
- encephalopathy
- ventral oedema
- oral ulcerations
- PU/PD
256
How do you treat acute renal failure in a horse
Fluids
diuresis
257
List some causes of acute renal failure in the horse
- toxins (NSAID, Acorn, Aminoglycosides)
- hypotension--> hpovolaemia
258
Clinical signs of bladder rupture in a foal usually manifest when?
2-3 days after parturition
259
What may cause bladder rupture in a foal?
- parturition makes the bladder pop
- 2ndary to infection
260
How do you dx bladder rupture in a foal?
US
sample peritoneal fluid to assess the serum creatinine ratio
261
How do you manage bladder rupture in a foal?
- usually not an emergency
- stabilise first
- IV fluids
- drain peritoneal fluid
- surgery
(Good px is stabilised prior to surgery)
262
In both cats and dogs SBP increases with
age
263
Sighthounds and brachycephalics have higher or lower SBP
higher SBP
264
The ACVIM classification of systemic hypertension is largely based around the risk of ....?
risk of future target organ damage
265
Name the Target organs (subsequent to HT)
- ocular
- CNS
- heart
- kidney
(note image left ventricular hypertrophy)
266
Target organ damage of the eye is more commonly seen in cats or dogs?
Cat
267
How does the kidney get damaged by increased SBP?
- autoregulation stops working ( as higher than >80-160 mmHG)
- Glomerular capillary pressure increases
268
In vet medicine do we care abut systolic or diastolic hypertension?
Systolic HT (diastolic not clinically relevant to our patients)
269
What are the 3 types of hypertension
- idiopathic
- situational (ie white coat)
- 2ndary hypertension
270
What is the most common cause of hypertension in the dog?
secondary hypertension
271
What is the gold standard for measuring BP
direct arterial catheterisation
(used in intensive care for high risk patients)
272
Cuffs should be .....of limb circumference
30-40%
273
When to start anti-hypertensive tx? (3)
- >160 mmHg with TOD
- >160 mmHg with predisposing condition (i.e CKD)
- > 160mmHg and old !
274
If a young cat or dog has a BP >160mmH what is the most likely cause?
white coat hypertension
275
What us the target SBP when treating cats and dogs with anty-hypertensive therapy?
< 160mmHg
276
The ACVIM classification of systemic hypertension defines hypertension as >...mmHg
>160mmHg
277
Amlodipine causes vasodilation of the efferent or afferent arteriole?
afferent
278
Telmisartan causes vasodilation of the efferent or afferent arteriole?
efferent
279
What approach is used to treat hypertension in dogs
multimodal approach
280
if a dog had hypertension and hyperadrenocorticism how would you treat?
Trilostane (for HAC) and Telmasartan (1st line)
281
What is the effect of 1.25 vit D on PO4 and Cal?
- increases PO4
- increases Ca
(absorption in the GIT)
282
What is the effect of PTH on PO4 and Cal?
- increases Ca
- decreases PO4 (excretions via the kidneys)
283
When you are checkin calcium levels - ALWAYS check what other 2 things
- albumin (this will give you an idea of protein bound calcium and therefore the ionised Ca)
- Phosphate
284
If Calcium is high and PO4 is high- what is the risk?
formation of CaPO4---> mineralisation of soft tissues---> irreversible organ damage (ie nephron destruction)
285
Is hypercalcemia a diagnosis?
NO
286
repeatable hypercalcemia should always be
investigated
287
Will CKD in the cat increase or decrease calcium?
increase
288
Dog hypercalcemia is most commonly due to
neoplasia (PTHrp)
primary parathyroidisms (heritable)
289
How does calcium cause PU/PD
- it interferes with medullar tonicity at the LoH
- Stops ADH binding at collecting tubules
290
What are non- PTH factors or PTH-like factors that cause hypercalcemia
- Vit D increase (psoriasis cream
- granulomatous inflammation
- CKD
291
If a cat has increased Ca and PO4 and a shrunken kidney- what is likely diagnosis?
CKD :(
292
If a cat has increased Ca and decreased PO4 and a shrunken kidney- what is likely diagnosis?
hypercalcemia- not CKD so treatable yay!
293
In a lateral-caudal view you pull the legs
cranially
294
In a lateral view you pull the legs
caudally
295
Is it possible to view the ureters in a radiograph
- not for dog
- sometimes yes for fat cats
296
Kidney size is references based on which vertebra
L2
Dog 2.5-3.5 x L2
Cat 2.1-3.2 x L2 ( if neuterered then smaller)
297
the 3 parts of the urethra are
- Prostatic
- Pelvic
- Pelvic
298
Can you radiographically see the prostate of a neutered dog?
generally not
299
Can you radiographically see the prostate of a cat?
no
300
What is this?
the uterus
dorsal to the urinary bladder
ventral to the colon
301
ureteral jets (US) can be useful for detecting ... but these are not always normally seen
ectopic ureters
302
Urine is hyperechoic or anechoic?
anechoic black- this is what a normal bladder looks like
303
What is this?
prostate with central anechoic urethra
top: entire dog
bottom: neutered - so smaller
304
What is this? The GIT is displaced in which direction?
nephromegaly- GIT displaced ventrally
305
What is this disease?
nephrolithiasis
306
What is this disease?
neoplasia in the uterus
could be leiomyoma, leiosarcoma or TCC
307
What is this?
blod clot in the bladder
308
What is this?
blod clot in the bladder
309
What are these?
cytoliths
310
What is this?
calculi in the bladder, kidney and ureter
311
Excretory has 3 phases which phase is this?
nephrogram phase
312
Excretory has 3 phases which phase is this?
pyelogram phase
313
What is this showing
renal agenesis
314
What is this showing?
ectopic ureters- these are tortuous
note these are normal ureters
315
What is this?
penumocystogram showing a pelvic cadually displaced bladder
316
What is this type of contract imaging? What abnormality can be seen?
positive contrast cystography
bladder rupture
317
What is this type of contract imaging? What abnormality can be seen?
positive contrast cystography
Traumatic inguinal hernia
318
What abnormality can be seen? What is this type of contract imaging?
cytoliths
double contrast cystography
319
What is this type of contrast imaging? What abnormality can be seen?
blod clot
can be attached to wall or free in the lumen
320
What is this type of contrast imaging? What abnormality can be seen?
mural lesion
neoplasia- transitional cell carcinoma is usually found in the trigone
321
If i wanted to assess the distal ureters and bladder size what contrast cytography would i do?
pneumocystography
322
If i suspected a bladder rupture w or check for peritoneal effusions - what contrast cytography would i do?
positive contrast pneuomocystography
323
If I wanted to evaluate the mucosal detail and suspected neoplasia in the bladder - what contrast cytography would i do?
double contrast
324
What is this?
air bubble in the urethra
retrograde urethrography
325
What is this?
urethral calculi
326
What is this?
urethral tear
327
What is this?
trauma in the penile urethra
328
Renal disease diets - what is increased and decreased
- 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
What happens to K in renal disease
can increase or decrease
this is why most renal diets have Normal K levels
330
Should we decrease NaCl in renal diets
no-
no link between hypertension and NaCl in animals
331
Which stages should you give a renal diet to a dog?
stage 1 and 3
332
Which stages should you give a renal diet to a cat?
stage 2 and 3
