Urinary System

Question 1

Kidneys

Answer 1

Located in the dorsal cr. retroperitoneal space
Smooth margins, similar size and shape
R. kindey obscured by ribcage

Question 2

Renal size

Answer 2

2.5-3.5x the length of L2- dog
2-3x the length of L2- cat

Question 3

Contrast radiography

Answer 3

Needed to visualize the lumen and mucosal surface, assess motility or locate a structure
Cystography, excretory urogram and urethrograms

Question 4

Filling defects

Answer 4

Space-occupying lesions in hollow organs that appear lucent when surrounded by radiopaque contrast material

Question 5

Examples of filling defects

Answer 5

Calculi, blood clots, masses and air bubbles

Question 6

Aqueous iodide

Answer 6

Intravasc. and urinary studies
Water soluble for GI perforation
Ionic contrast can cause pulm. edema if aspirated

Question 7

Negative contrast media

Answer 7

Air, oxygen, CO2, nitrous oxide
Appears radiolucent on rads

Question 8

Excretory urogram (EU) or Intravenous Pyelogram (IVP) phases

Answer 8

1. Angiogram: contrast arteries (often missed on rads)
2. Nephrogram
3. Pyelogram
   contraindicated in dehydrated pets

Question 9

Nephrogram phase of EU/ IVP

Answer 9

Contrast in renal parenchymal “renal blush” visualized on immediate (0 minute) films
Evaluates renal size, location and intraparenchymal lesions (filing defects)

Question 10

Pyelogram phase of EU/IVP

Answer 10

Contrast in collecting system renal pelvis, diverticuli visualized on 3-5 min films
Nephrogram should be fading
Used to evaoluate collecting system

Question 11

____________ is followed by EU

Answer 11

Pneumocystogram
Positive contrast in ureters and negative contrast in UB

Question 12

Unilateral renal pelvis dilation hydroureter

Answer 12

Hydronephrosis from masses and calculi in renal pelvis, ureteral obstruction, ectopic ureter

Question 13

Bilateral renal pelvis dilation and hydroureter

Answer 13

Pyelonephritis (asc. infection from UB), mass at trigone of the UB and ectopic ureter

Question 14

What causes bilateral renomegaly

Answer 14

Acute renal failure
Renal lymphoma*
Bilateral obstructive hydronephrosis
Polycystic kidney dz

Question 15

What causes unilateral renalmegaly

Answer 15

Obstructive hydronephrosis
Renal mass
Polycystic kidney disease

Question 16

Causes of small kidney (microrenally)

Answer 16

Chr. renal dz
Renal dysplasia, hypoplasia
LK <2.5 x L2

Question 17

What is emphysematous cystitis associated with

Answer 17

UTI predisposition
Associated with DM
with glucosuria

Question 18

Urothelial carcinoma (transitional cell carcinoma) etiology

Answer 18

Dogs: older females
Cats: rare (males > females)
Scottish terriers*, sheepdogs, beagles and collies

Question 19

Where are bladder masses usually?

Answer 19

Most commonly in the trigone region (dogs)
Outflow obstruction with ureter, urethral or prostate involvement
+ regional LN metastasis

Question 20

Other metastatic sites for Urothelial carcinoma (TCC)

Answer 20

Lung*, liver, kidney, spleen, uterus, GI, bone, muscle and cystocentesis needle tracts

Question 21

Secondary _________________ is common with urothelial carcinoma

Answer 21

bacterial cystitis

Question 22

CS of urothelial carcinoma

Answer 22

Hematuria, stranguria, pollakiruia
Tenesmus, abdominal pain/ distention, lamness and joint thickening

Question 23

Dx for urothelial carcinoma

Answer 23

Vet bladder tumor Ag test (VBTA)
BRAF test (PCR- common mutant gene cancer)
UA: protienuria and hematuria
Cystography

Question 24

What should be avoided if urothelial carcinoma (TCC) is suspected?

Answer 24

Cystocentesis: needle tract neoplastic cell implantation

Question 25

Tx for urothelial carcinoma

Answer 25

Sx with rupture or if mass is operable Tx UTI if present Piroxicam, firocoxib alone or with chemotherapeutics

Question 26

Patients with what condition should be screened for bladder masses?

Answer 26

Recurrent UTIs Dogs of @-risk breeds

Question 27

Uroabdomen

Answer 27

Accumulation of urine within the peritoneal and/ or retroperitoneal spaces and caused by leakage of urine from the kidneys, ureters, bladder or prox urethra

Question 28

What causes uroabdomen

Answer 28

Urinary obstruction Iatrogenic Abdominal or pelvic trauma

Question 29

CS of uroabdomen

Answer 29

Abdominal distention or discomfort on palpation Lethargy, anorexia, V, depression Trauma/ obstruction (stranguria) Bruising and bradycardia (hyperkalemia)

Question 30

Dx uroabdomen

Answer 30

Abdominocentesis- fluid: serum ratios for dogs U/S: abdominal effusion (free fluid) Positive contrast cystourethrography or IV excretory urography

Question 31

Tx of uroabdomen

Answer 31

Intensive IV therapy Correct hyperkalemia Place urethral catheter (bladder decompression) Place of peritoneal drainage catheter Surgical exploration to repair

Question 32

Radiopaque types of calculi

Answer 32

Struvite (magnesium, ammonium, phosphate/MAP) Oxalates

Question 33

Which stones are radiolucent (soft tissue)

Answer 33

Cystine or urates Not visualized on survey rads

Question 34

Most common sites for urethral obstruction in males

Answer 34

Proximal os Ischiatic/ pelvic arch Prostatic urethra

Question 35

Free luminal filling defects

Answer 35

Air bubbles (round, smooth margins, middle or periphery) Blood clots: irregular and indistinct borders Calculi: various shapes, distinct edges, sink to bottom

Question 36

Pelvic bladder

Answer 36

Cdlly positioned oblong-shaped bladder Associated with incontinence (urethral sphincter mechanism incompetence/ USMI) Congenital

Question 37

Etiology of perineal hernia

Answer 37

Male, middle aged to older, intact CS: swelling in perineal region, tenesmus, enlarged prostate (BPH) Dx: rectal palpation

Question 38

Vaginourethrogram evaluation

Answer 38

If vagina is mildly distended and flow is readily into bladder (USMI) Bladder neck is rounded and in pelvic canal (pelvis bladder) Urethra short/dilated Filling of ureters (ectopic ureters)