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Year 4 small animal > Urinary > Flashcards

Urinary Flashcards

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1
Q

Indications for nephrectomy

A

Normal function of contralateral
Renal/ureteral neoplasia
Trauma
Persistent renal haematuria
Polynephritis - polycystic disease
End stage hydronephrosis
Chronic end stage pyelonephritis
Ectopic ureter

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2
Q

Contraindications for nephrectomy

A

Azotaemia
Persistent isosthenuria

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3
Q

Indications for renal biopsy

A

Renomegaly
Acute renal failure
Familial - renal amyloidosis, renal dysplasia, polycystic kidneys, basement membrane disorders, tubular disorders

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4
Q

What is a nephrotomy

A

Removal of renal calculi

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5
Q

Nephrectomy key points

A

Ligate vein and artery
2 ligations on ureter and divide between ligatures

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6
Q

Complications of renal surgery

A

Renal pain
Haemorrhage - haemoabdomen, haematuria
Retroperitoneal/peritoneal urine leakage
UTI
Compromised renal function

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7
Q

Points for removing calculi

A

Place stay sutures to hold bladder
Incise into ventral wall
Handle as little as possible
Close with absorbable monofilament
4/0 or 3/0 in cats and 4/0,3/0 or 2/0 in dogs
Single layer full thickness inverting or two later
Atraumatic needs
Drape omentalise

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8
Q

Complications of bladder surgery

A

Haemorrhage
Peritoneal urine leakage
Urinary tract infection
Urothelial oedema
Dysuria
Small bladder volume
Reflex dyssynergia

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9
Q

Indications for tube cystotomy

A

Functional or mechanical bladder/urethral obstruction
Excessive urine retention
Post bladder/urethral surgery

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10
Q

Sites of urethral obstruction

A

Kidney
Ureter
Bladder
Urethra

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11
Q

What is a SUBS

A

Submucosal urethral bypass system

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12
Q

Urethral obstruction in the dog

A

Dalmatians struggle with urate stones
Get stuck in caudal ospenis
Treated by retrograde urethral flushing
Cystotomy and further flushing

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13
Q

Neoplasms of the kidney

A

Most common malignant is renal carcinoma
Cystoadenocarcinomas in GSD
Benign tumours uncommon
Middle aged/older animals
Male more common
Nephroblastoma usually unilateral, can get very large
Metastatic can be unilateral or bilateral

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14
Q

Clinical signs of kidney neoplasms

A

Haematuria
Dysuria
Stranguria
Pollakiuria
May show abdominal pain, large palpable kidney, uraemia may be apparent
Bladder wall can be thickened, can palpate caudally

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15
Q

Diagnosis of kidney neoplasia

A

History
Clinical signs
Ultrasonography
Urinalysis
Radiography - excretory urogram
CT

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16
Q

Treatment of kidney neoplasia

A

Surgical removal except lymphosarcoma
Lymphosarcoma combination chemotherapy

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17
Q

Clinical findings for lower urinary neoplasia

A

Chronic obstruction to urine flow - secondary hydronephrosis
Urethral more like to cause acute obstructive uropathy
Reflex dyssynergia

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18
Q

Diagnosis of lower urinary tract neoplasia

A

History and clinical signs
Haematuria on urinalysis
Neoplastic cells in sediment
cysto/retrograde urethrogram

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19
Q

Categories of acute kidney injury

A

Haemodynamic - volume responsive
Intrinsic renal - damage to kidneys
Postrenal - urethral obstruction

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20
Q

What is haemodynamic AKI

A

Reduced renal blood supply common causes include hypovolemia, anaesthetia and use of NSAIDs
Rapidly resolved by correcting the cause, if not corrected progresses to intrinsic renal damage ischaemia and hypoxia

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21
Q

Intrinsic renal AKI

A

Renal damage caused by ischaemia, hypoxia or toxins
Ischaemia causes - hypovolemia, common following bitch spays, deep/prolonged anaesthesia, thrombosis/DIC, hyperviscosity/polycythemia, NSAIDs - normally in relation to overdose
Primary renal disease - infection, immune mediated or neoplastic
Secondary disease - infection, malignant hypertension, hepato renal syndrome, sepsis
Nephrotoxins

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22
Q

Post Renal AKI

A

Urinary obstruction - ureteral or urethral obstruction
Urinary leakage - ureteral, bladder or proximal urethra damage

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23
Q

Intrinsic AKI phases

A

1 - asymptomatic with azotaemia starting towards the end
2 - hypoxia and inflammatory responses propagating renal damage
3 - change in urine output, either improves or gets worse, lasts ~ 3 weeks
4 - recovery phase, weeks-months, can result in severe polyuria and can return to phase 1

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24
Q

Diagnosis of AKI

A

History - <1 week anorexia, V+, PUPD, lethargy, D+
Clinical exam - fluid loss, concurrent illness, specific signs - renal pain, uremic halitosis, jaundice
Biochemistry - azotaemia, hyperphosphataemia, hyperkalemia (dangerous), hypo also possible, hypocalcemia
Urinalysis - inappropriate USG, proteinuria, glucosuria
Ultrasound - POCUS, can appear normal/enlarged, peri-renal free fluid, hydronephrosis
Radiography/CT - obstructions/stones

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25
Leptospirosis AKI
Always causes renal damage Sometimes hepatic damage/DIC Often leptospira pulmonary haemorrhage syndrome Findings include thrombocytopenia, anaemia and electrolyte disturbances Imaging - lung patterns, hepatomegaly, splenomegaly, free fluid in abdomen SNAP for lepto
26
Treatment for AKIv
Underlying cause Fluid therapy - match losses and avoid volume overload Monitor body weight Time!
27
Classification of Oliguria and anuria
Oliguria <1ml/kg/hour urine in the hydrated and perfused patient Anuria little to no urine Treat with diuretics but high risks of causing AKI Renal replacement dialysis best Peritoneal dialysis possible in first opinion
28
Complications of AKI
UTI - amoxy-clav first line, doxycycline for lepto Metabolic acidosis - Hartmann's Tachyarrythmia - ECG, consider lidocaine Hyperkalemia - glucose, insulin, bicarbonate Hypertension Nutrition - feeding tube
29
Prognosis for AKI
Good depending on finances and practices facility for 24/7 care
30
CKD presenting signs
PUPD Anorexia Weight loss Dehydration Pallor V+/D+ Mucosal ulcers Uraemic breath
31
Predispositions for CKD
Breed - dogs - westie, shar pei, bull terrier, cocker, ckcs. Cats - Persian, Abyssinian, Siamese, ragdoll, Burmese, Russian blue, Maine coon Age - older animals but can be young with familial disease Co-morbidities - hyperthyroidism, hypercalcemia, heart disease, peritoneal disease, cystitis, urolithiasis, diabetes Nephrotoxic drugs
32
Pathophysiology of CKD
nephron loss causes other nephrons to compensate leading to increased pressure and further damage this can lead to a uraemic crisis due to build up of normally excreted products
33
Diagnosis of CKD
early stage rarely picked up soon - abnormal renal imaging, known renal insult - persistent elevation/increasing creatine or SDMA - persistent renal proteinuria Later stages - consistent clinical signs - azotaemia, persistently elevated creatinine/SDMA AND usg <1.035 cats or <1.030 dogs Does not have to be isosthenuric to be at inappropriate concentrations
34
Treatment of CKD
treat underlying cause recommendations around controlling proteinuria, hypotension and hyperphosphataemia Diet is important Later stages treating anaemia/acidosis/nausea, maintaining hydration and adequate nutrition
35
What is a uraemic crisis
build up of urea and other toxins usually excreted by kidneys to intolerable levels CS - V+/nausea, anorexia, lethargy, depression, oral ulcers, melaena, anaemia, weakness, hypothermia, muscle tremors, seizures
36
Treatment of ureamic crisis
ivft hartmann's assess/treat acidosis if present Treat nausea/GI ulceration Nutritional support - appetite stimulants, feeding tube
37
Treatment of renal hypertension
ACEi - benazepril, enalapril Angiotensin receptor blocker - telmisartan, spirolactone Calcium channel blockers - amlodipine
38
Pyelonephritis
bacterial infection of the renal pelvis and parenchyma Diagnosis - clinical signs - fever, abdo pain, PUPD. Left shift neutrophilia. Ultrasound - renal pelvis dilation , hyperechoic mucosa Treatment - renally excreted antibiotics - amoxycillin/amoxyclav best
39
Renal neoplasia
commonly metastatic benign primary - adenoma/lipoma/fibroma often incidental findings Malignant primary - carcinoma, multicentric, lymphoma
40
Polycystic kidney disease
hereditary condition - fluid filled cysts from birth in the kidney, size and number increase with age similar presentation to CRF with large irregular kidneys. Diagnosed on ultrasound. Screen pre-breeding
41
Fanconi's syndrome
disease of proximal tubules leading to reduced resorption of solutes idiopathic/hereditary/gentamycin nephrotoxicosis Signs - PUPD, weight loss, lethargy Treat - remove cause oral nacl, k+ and bicarb
42
Glomerular disease
can be primary or secondary signs - CKD/uraemia Diagnosis - haematology/biochemistry similar to crf, likely hypoproteinaemia urinalysis - proteinuria, hyaline casts common
43
Indications for renal biopsy
protein losing nephropathy AKI mass lesions
44
contraindications for renal biopsy
late stage ckd severe anaemia/azotaemia uncontrolled hypertension/coagulopathy severe hydronephrosis/large mass cysts pyelonephritis/perirenal abscesses recent NSAIDs
45
Nephrotic syndrome
results of protein losing nephropathies - pathognomonic for glomerular disease CS - pitting oedema, ascites, pleural effusion, hypoalbuminaemia, hyperlipidaemia Treatment - antiproteinurics - acei - benazepril/enalapril. anti-coagulents - aspirin/clopidogrel. fluid removal - abdominal/pleural tap, diuretics
46
what does iris staging allow
identification of CKD advise treatment focussing on nutrition/hydration, control of hypertension, minimising proteinuria, controlling serum phosphate
47
Definition of polyuria
>50ml/kg/day urine
48
definition of polydipsia
>100ml/kg/day intake in dogs and >50ml/kg/day intake in cats
49
Primary polydipsia causes
altered thirst centrally mediated disease - neoplasia - seocndary to osmolarity/endocrine effects loss compensation Physiological - salt toxicity, exercise, high temperature
50
Causes of polyuria
Central diabetes insipidus Reduced ADH sensitivity/response Osmotic diuresis Glucose - diabetes mellitus sodium - post obstructive diuresis/addisons reduced medullary/interstitial tonicity mixed/unknown cause - crf/aki
51
Initial treatment for blocked bladded
pain relief
52
initial diagnostics for blocked bladder
potassium acidosis post renal azotaemia/AKI ECG
53
Types of catheter for bladder
jackson tomcat - rigid with metal stylet slippery sam - soft but no suitable adapter Katkath - soft, adjustable length and suitable
54
Care with urine
must look at within 15-20 mins or crystals will form doesn't strongly suggest stones/not
55
what are struvite crystals
magnesium ammonium phosphate supersaturation of urine turns into a urolith
56
Struvite Uroliths in dogs
associated with UTIs females higher tendency 40% of urinary stones risk factors - abnormal urine retention, conditions predisposing to UTIs, lack of movement, breeds (mini schnauzer/shih tzu, bichon)
57
Struvite uroliths in cats
90% sterile 50% of stones in LUT Risk factors - abnormal urine retention (not going out when its cold), formation of concentrated urine, urine alkalising metabolites in diet
58
calcium oxalate uroliths
poorly understood risk factors - acidifying diet, oral calcium outside of mealtimes, excessive protein in diet hypercalciuria - increased intestinal reabsorption of calcium/reduced renal reabsorption hypercalcaemia - renal tubular mechanisms over whelmed
59
Urate uroliths
made of uric acid/sodium/ammonium urate impaired conversion of uric acid to allantoin increases concentration in serum and urine dalmatians/black russians are pre-disposed associated with porto-systemic shunt risk factors - high purine intake (offal), persistent aciduria in pre-disposed
60
cysteine uroliths
inborn metabolic error caused by defective tubular resorption of cysteine and amino acids Breed - newfoundland, labradors, australian cattle dogs, mastiffs, bulldogs Intact males urine retention increases chances
61
Calcium phosphate uroliths- rare
often minor component of struvite and calcium oxalate uroliths risk factors - excessive dietary calcium, primary hyperparathyroidism, UTI
62
Xanthine uroliths
impaired xanthine oxidase activity leading to hyperxanthinaemia/xanthinuria risk factors - genetic - ckcs, acidic/concentrated urine, urine retention, allopurinol treatment
63
Clinical signs of urolithiasis
Lower urinary tract signs - dysuria, haematuria, pollakiuria +/- urinary obstruction signs
64
Diagnosis of urolithiasis
urinalysis - not massively useful, pH good imaging key - radiopaque uroliths - calcium oxalate, struvitem calcium phosphate. Xanthine radiolucent. Urate/cysteine variable ultrasound sound acoustic shadowing
65
treatment of urolithiasis
analgesia antibiotics - if UTI present specific treatments and diets surgery for calcium oxalate, calcium phosphate and large struvite
66
diets for uroliths
all types high moisture all alkalinising except struvite (acidifying) and calcium phosphate
67
treatment of lower urinary tract neoplasia
excision most beneficial transitional cell commonly at trigone requires reconstruction surgery prognosis poor urethral stenting can be useful
68
causes of urethral obstruction
intraluminal - plugs, uroliths, sloughed tissue mural/extraluminal - neoplasia, strictures, anomalies, reflex dyssynergia
69
complications of perineal urethrocystotomy
haemorrhage wound dehiscence subcut urine leakage urinary incontinence UTO urethral stricture
70
what is true urinary incontinence
patient is unaware they are leaking urine normally due to poor sphincter function
71
what is urge incontinence
patient is aware of the need to urinate but has a lack of control can be caused by bladder irritation
72
what is overflow incontinence
patient usually unaware they are urinating, urine pressure in the bladder higher than than of urethral sphincter
73
most common presentation of urethral sphincter mechanism incontinence
female spayed older large breed overweight
74
glucose related PUPD
diabetes mellitus primary renal glycosuria fanconi's syndrome (basenjis) genetic
75
sodium related PUPD
post obstructive diuresis high salt diet addisons diuretics
76
diagnosis of PUPD
history/signalment clinical exam important - BCS, dehydration, neurological disease, endocrinopathic signs
77
USG in PUPD
>1.030 normal hydration - nromal or polydipsia driving polyuria (or intermittent) >1.030 with dehydration - check for glucosuria, diabetes mellitus indication/fanconis <1.030 normal hydration - primary polydipsia consideration, expect consistency < 1.030 dehydrated - primary polyuria/intrinsic renal disease or extrinsic effects on renal function <1.006 - diabetes insipidus/primary polydipsia, hypercalcaemia, hypoadrenocorticism. kidneys actively diluting
78
primary polyuria suspected
history rule of pyometra, addisons, aki, DM, diabetic ketoacidosis, haemangiosarcoma Triage (pocus, elecs, bg etc)
79
intrinsic renal disease suspected
further urinalysis biochemistry imaging rnal biopsy
80
extrinsic renal disease suspected
further urinalysis haematology/biochemistry imaging physiological assessment
81
azotaemia
elevated urea and creatinine
82
pre-renal
fluid loss and haemoconcentration must be hypovolaemic phosphorus likely high rapid response to fluids
83
post renal
POCUS hyperkalaemia can develop rapidly
84
renal disease
aki/crf poorly concentrated but not dilute urine phosphorus likely high albumin and upcr - protein losing nephropathy non-regenerative anaemia with CKD
85
neurogenic incontinence
cerebral - rare, loss of voluntary control, empties normally at inappropriate times brainstem to l7 - umn bladder, absence of voluntary micturition, hard to express, increased sphincter tone, high volume of retention S1-s3 or nerve root - lmn bladder (paralytic) - absent voluntary micturition, atonic, flaccid and easy to express, absent detrusor, can have overflow incontinence - empty for them
86
USMI aetiology
low urethral tone hormonal - lack oestrogens/change in urethral structure breeds - irish setterm doberman, bearded collie, rough collie, dalamatian
87
management of USMI
sympathomimetic agents - mimic storage of urine phase, rapid response, can cause restlessness, aggression,tachycardia, weightloss Estriol - cannot use in entire, can appear in season surgery (referral)
88
anatomical incontinence
intersex ectopic ureters detrusor instability (urge incontinence)
89
detrusor atony
over distension of the bladder leading to uncoordinated contraction attmeps secondary condition
90
LMN disorders
detrusor atony/sphincter areflexia causes - cauda-equina syndrome, si luxation, IVDD, tail pull, neoplasia management - bethanecol nursing care/manual expression , cleaning and monitoring
91
UMN bladder
uninhibited spincter spasticity often paralised hind limbs impossible to empty in early disease later becomes automatic - empties when capacity is reached treatment - urethral smooth muscle relaxants and skeletal muscle relaxants monitor for UTI
92
idiopathic reflex dyssynergia
loss of coordination between setrusor contraction and sphincter release cause - inflammation can cause incomplete emptying, overstretch, atony treatment - prevent over distension in short term, help restore detrusor contraction (parasympathomimetic agents) commonly male large breed
93
non-neurogenic urinary retention
blockage functional obstruction - urethral spasm trauma to ureters/bladder detrusor atony - overdistension
94
bladder issue treatment overview
behavioural - pheromones/psychotrophic pain - analgesia high urethral tone - sympatholytics (prazosin)/muscle relaxants (benzodiazepines) Low urethral tone - alpha-adrenergic agonists (phenylpropanolamine), orstrogen analogues detrusor dysfunction (bethanecol)
95
colour of myoglobinuria
brown
96
diagnosis for red/brown urine
dipstick - dots = blood, homogenous = myo/haemoglobin sediment exam - RBC = precipitate cytology confirms, haemo/myoglobin = no precipitate haemoglobin/myoglobin likely - blood sample and centrifuge - red plasma = haemoglobin, clear = test muscle markers
97
orange urine testing
USG - >1.040 reduces but doesnt rule out bilirubin dipstick - -ve for RBC/Hb, +for bilirubin blood biochem - hyperbilirubinaemia, jaundice
98
further diagnostics
assess for trauma urolithiasis - sediment, ultrasound, xray uti - urine cytology/ultrasound inflammation neoplasia - cbc CBC for coagulopathy/neoplasia AST/CK for myoglobinuria
99
diagnostic approach to big bladder
electrolytes/biochemistry pocus history CE - pain, discharge, rectal exam urinalysis - crystalluria, wbcs, c+s imaging urinary catheter to relieve pressure/can treat cystocentesis - quick but risks rupture
100
normal bladder wall thickness
1.4-2.3mm dog 1.3-1.7mm cat

Year 4 small animal (18 decks)

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