Urinary System Dieases and Theraputics Flashcards Preview

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Flashcards in Urinary System Dieases and Theraputics Deck (553)
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1
Q

where are the kidneys located within the body?

A

dorsal cranial abdomen

2
Q

which kidney is more cranial in the abdomen of domestic species?

A

right

3
Q

where are kidneys located in relation to the peritoneum?

A

retroperitoneum

4
Q

what info can be gained through performing an IV urogram /urography?

A

illustrates the structural integrity of the urinary system and can show if there are any blockages or leaks

5
Q

what is involved in an IV urogram/urography?

A

injection of dye that is excreted by the kidneys so it shows movement through the urinary system and can illustrate any issues

6
Q

what is the nephron?

A

filtration component of the kidney

7
Q

what is the glomerulus?

A

capillary bed within the kidney where glomerular filtrate is formed

8
Q

what processes occur within the glomerulus?

A

filtration of blood to form glomerular filtrate

9
Q

in a healthy kidney are proteins filtered into the Bowman’s capsule by the glomerulus?

A

no - they remain in the blood

10
Q

why is there high pressure in the glomerulus?

A

the capillary bed is in the middle of 2 arteries in series

11
Q

what occurs in the proximal convoluted tubule of the kidney?

A

reabsorption of glucose, electrolyte handling (reabsorption or secretion)

12
Q

what occurs in the loop of Henle?

A

counter current flow to enable production of concentrated urine, water reabsorption

13
Q

what occurs in the distal convoluted tubule and collecting duct?

A

electrolyte and acid base regulation

site of ADH action and water reabsorption (fine tuning of urine conc.)

14
Q

define azotemia

A

elevation of urea +/- creatinine in the blood stream

15
Q

in health what normally happens to urine and creatinine?

A

excreted through the kidneys

16
Q

what is uraemia?

A

clinical signs associated with azotemia (nausea and innappetance)

17
Q

what are the clinical signs associated with azotemia?

A

nausea

inappetance

18
Q

what is polyuria?

A

excessive urination

19
Q

what is oliguria?

A

a small amount/inadequate urine production

20
Q

what is anuria?

A

absence of urine production - life threatening

21
Q

what is polydipsia?

A

excessive water intake

22
Q

what is pyelonephritis?

A

bacterial kidney infection (either uni or bilateral)

23
Q

what is glomerulonephritis?

A

inflammation of the glomeruli

24
Q

what is renal insufficiency?

A

measurable reduction in kidney function

25
Q

what is renal disease?

A

specific, underlying disease of the kidneys which may be acute or chronic

26
Q

what is acute kidney injury?

A

sudden onset kidney disease

27
Q

what is chronic kidney disease?

A

> 3 months duration of kidney disease

28
Q

what is the most readily measurable sign of kidney disease?

A

inability to concentrate urine

29
Q

what is the name of appropriate / well concentrated urine?

A

hypersthnuric

30
Q

define hypersthenuric

A

appropriate / well concentrated urine

31
Q

what is the urine specific gravity in dogs of hypersthenuric urine?

A

> 1.030

32
Q

what is the urine specific gravity in cats of hypersthenuric urine?

A

1.035

33
Q

what is submaximally concentrated urine?

A

urine where there has been some concentration by the kidney

34
Q

what is the USG of submaximally concentrated urine in cats?

A

1.012 - 1.035

35
Q

what is the USG of submaximally concentrated urine in dogs?

A

1.012 - 1.030

36
Q

what is isosthenuria?

A

no modification of urine concentration - kidneys have done nothing to concentrate urine

37
Q

what USG suggests isosthenuria in all species?

A

1.008-1.012

38
Q

what USG suggests hyposthenuria in all species?

A

<1.008

39
Q

what is hyposthenuria?

A

active dilution of urine, kidneys are actively getting rid of more water than usual

40
Q

what are the 4 main methods of urine collection?

A

free catch
non-absorbable cat litter
catheterisation
cystocyntesis

41
Q

when should a free catch urine sample be taken?

A

mid flow

42
Q

what device can be used to aid free catch urine sampling?

A

uripet

43
Q

what animals can be catheterised conscious?

A

male dogs

44
Q

what animals must be anaesthetised in order to be catheterised?

A

cats and female dogs

45
Q

what is the only sterile method of urine collection?

A

cystocyntesis - use of a needle directly into the bladder

46
Q

what is the preferred method of urine collection?

A

cystocyntesis

47
Q

why are all other methods of urine collection non sterile?

A

involve some way of bacteria / cell contamination (either from the environment or the animal itself)
catheterisation can lead to contamination with cells from the urethra and vulva/prepuce

48
Q

what are the 2 methods of performing cystocentesis?

A

blind by palpation of bladder

ultrasound guided

49
Q

what are the 5 main areas of urinalysis?

A
urine specific gravity (USG)
dipstick
microscopy
cytology 
bacterial culture
50
Q

what equipment is used to perform USG measurements?

A

refractometer

51
Q

what can be analysed reliably on a urine dipstick?

A
pH
glucose
ketones
protein
blood
52
Q

what can be identified in urine using microscopy?

A

crystals or casts

53
Q

what are renal casts?

A

impression of the insides of renal tubules, formed from a variety of materials, e.g. protein (hyaline), cells (cellular)

54
Q

what is the aim of bacterial culturing of urine?

A

to check for presence of bacteria by allowing them to grow

55
Q

are some crystals found in healthy animals?

A

yes - struvite are one example

56
Q

what will urine cytology look at?

A

cells and bacteria present

57
Q

what can be identified on blood tests that would indicate urinary system problems?

A

urea and creatinine

58
Q

where do urea and creatinine originate from?

A

endogenous waste products excreted by the kidneys

59
Q

where does urea originate from?

A

protein breakdown anywhere in the body

60
Q

what can falsely raise urea value on a blood test?

A

recent protein meal

61
Q

how can falsely elevated urea be avoided?

A

using fasted samples

62
Q

where is creatinine derived from?

A

breakdown of muscle creatinine

63
Q

what no pathological reason may cause an apparently lowered creatinine level?

A

poorly muscled animal

64
Q

what does azotemia indicate?

A

reduced glomerular filtration of blood

65
Q

what are the 3 types of azotemia?

A

pre-renal
renal
post renal

66
Q

what is pre-renal azotemia due to?

A

inadequate renal perfusion - kidneys are not filtering enough blood due to reduced flow

67
Q

what could be a cause of pre-renal azotemia?

A

hypovolaemia

68
Q

what is renal azotemia due to?

A

reduced functional mass of the kidneys due to underlying kidney disease (less blood filtered by kidney)

69
Q

what is post-renal azotemia due to?

A

kidneys are functioning but waste products are not excreted

70
Q

what are the 2 main causes of post renal azotemia?

A

obstruction of the urinary tract (urethral, ureteral)

rupture of the urinary tract

71
Q

what can rupture of the urinary tract lead to?

A

uroabdomen - leads to urine being reabsorbed by peritoneaum

72
Q

what test must be performed in a azotemic patient?

A

urinalysis

73
Q

what is the body’s normal response to pre-renal azotemia?

A

to preserve as much water as possible and prevent further fluid loss - production of more concentrated urine

74
Q

what indicates renal azotemia?

A

with poorly concentrated urine (less than hypersthenuria)

75
Q

how can post-renal azotemia be diagnosed?

A

imaging

76
Q

is it normal to produce dilute urine if non azotemic?

A

it can be

77
Q

what are other findings on blood tests often seen alongside azotemia?

A

hyperphosphataemia
electrolyte derangements
anaemia

78
Q

why may azotemia be associated with hyperphosphataemia?

A

reduced renal excretion so phosphate is not being excreted either

79
Q

what electrolyte derangements are common as a result of kidney disease?

A

hypo or hyperkalaemia

80
Q

why is hypokalaemia common in kidney disease?

A

excessive potassium loss due to kidney damage

81
Q

what symptoms does hypokalaemia contribute to in dogs/cats with kidney disease?

A

weakness and inappetance

82
Q

why can kidney disease lead to anaemia?

A

EPO (erythropoetin) is synthesised by the kidneys less in disease so fewer RBC are produced
RBC in uraemic patients have a reduced life span

83
Q

what can radiography of the urinary tract be used to show?

A
size and shape of kidneys
radiopaque stones
radiolucent stones
evaluation of ureteric course / insertion
evaluation of morphology
84
Q

how can radiolucent stones be shown on radiography?

A

with double contrast using dye and air

85
Q

what can urinary tract ultrasound show?

A

parenchymal detail of kidney and prostate
evaluation of bladder wall morphology
evaluation of some causes of a post-renal azotemia - location of ureteric obstruction and free fluid associated with uroabdomen

86
Q

why is cytology/biopsy not often used for kidneys?

A

due to large blood supply and potential for heavy bleeding

87
Q

how can the risk of heavy bleeding following a kidney biopsy be avoided?

A

check animals clotting

samples taken from cortex only

88
Q

what may a kidney biopsy be used to diagnose?

A
renal lymphoma (via FNA)
glomerular disease (trucut biopsy)
89
Q

how are kidney biopsies performed?

A

percutaneous - ultrasound guided

90
Q

what is cytology / biopsy commonly used for in the prostate?

A

prostatic wash

suction biopsy

91
Q

what is cystoscopy used for?

A

direct visualisation of lower urinary tract
collection of guided biopsy samples
laser lithotripsy of stones

92
Q

what is acute kidney injury?

A

acute nephron damage / dysfunction

93
Q

how do symptoms present during AKI?

A

very quickly, animal becomes profoundly ill due to sudden accumulation of toxins

94
Q

what is chronic kidney disease?

A

chronic nephron loss

95
Q

how do symptoms present during chronic kidney disease?

A

more gradual onset due to gradual decline in renal function

96
Q

why are kidneys highly susceptible to toxic / ischaemic injury?

A

receive / require 20% of cardiac output despite being only 0.5% of body weight due to being hugely metabolically active so will be damaged by any reduction in blood flow/volume. They also produce many waste products which are toxic if not cleared

97
Q

what urine output is AKI most commonly associated with?

A

anuria /oliguria - kidneys suddenly stop working

98
Q

what urine output is AKI less commonly associated with?

A

polyuria

99
Q

why is AKI with polyuria easy to manage?

A

toxins are still being removed so less damage is occuring

100
Q

what are the main causes of intrinsic AKI?

A

toxic
ischaemic
infectious
cutaneous and renal glomerular vasculopathy (CRGV) in dogs

101
Q

what can cause AKI due to toxins in dogs?

A

raisins/ grapes
NSAIDs - particularly human
diuretics - lead to hypovolaemia
cholecalciferol - leave mineral deposits in kidneys

102
Q

what can cause AKI due to toxins in cats?

A
lilies
ethylene glycol
NSAIDs - particularly human
diuretics - lead to hypovolaemia
cholecalciferol - leave mineral deposits in kidneys
103
Q

why do NSAIDs cause AKI?

A

inhibition of prostaglandins which have a role in control of renal plasma flow

104
Q

what are the infectious causes of AKI?

A

leptospirosis (dogs)

pyelonephritis

105
Q

what is AKI caused by cutaneous and renal glomerular vasculopathy (CRGV) in dogs accompanied by?

A

skin lesions

106
Q

what is cutaneous and renal glomerular vasculopathy (CRGV) also known as?

A

alabama rot

107
Q

what are the clinical findings of AKI?

A

azotemia, uraemia
hyperkalaemia (in anuric or oliguric patients)
hyper or hypoperfusion
other signs relating to intoxication

108
Q

what are the signs of azotemia (uraemia)?

A

lethargic
depressed
inappetant
nauseous

109
Q

why can cases of AKI with an/oliguria develop hyperkalaemia?

A

potassium is not being excreted so will build up

110
Q

what can hyperkalaemia lead to?

A

cardiac arrhythmias / arrest

111
Q

when may a patient with AKI become hyperperfused?

A

an/oliguria so fluid is not being lost and volume overload can occur

112
Q

when may a patient with AKI become hypoperfused?

A

polyuric - lots of fluid loss

113
Q

what signs are associated with ethylene glycol toxicity?

A

hypocalcaemia

tremors

114
Q

why does ethylene glycol toxicity result in hypocalcaemia?

A

production of calcium oxalate crystals causes excessive calcium use

115
Q

what additional signs may be seen with leptospirosis?

A

icterus - indicating liver damage

116
Q

how can AKI be diagnosed through blood tests?

A

short clinical illness
acute azotemia with increased urea, creatinine, phosphate and K+ (if an/oliguric)
reduced K+ if polyuric
with inappropriately concentrated urine
no evidence of urinary tract obstruction or rupture

117
Q

how can you tell that azotemia due to AKI is not pre - renal?

A

will be accompanied by inappropriately concentrated urine

118
Q

how can you tell that azotemia due to AKI is not post - renal?

A

no evidence of urinary tract obstruction / rupture

119
Q

what are the urinalysis findings associated with AKI?

A

submaximally concentrated urine - often isosthenuric
casts are commonly seen indicating tubular injury
calcium oxalate monohydrate crystals will indicate ethylene glycol toxicity
inflammatory cells or positive bacterial culture indicating pyelonephritis

120
Q

what is indicated by the presence of casts in urine?

A

tubular injury

121
Q

what is indicated by the presence of calcium oxalate monohydrate crystals in urine?

A

ethylene glycol toxicity

122
Q

what is indicated by the presence of inflammatory cells or a positive bacterial culture in urine?

A

pyelonephritis

123
Q

what type of calcium crystals are seen in healthy animals?

A

calcium oxalate dihydrate

124
Q

how should urine output be monitored?

A

catheterisation ideally but can use pads and weigh (1g=1ml of urine)

125
Q

what does monitoring of urine output show?

A

differentiation between an/oliguria and polyuria

126
Q

what are the main steps involved in AKI management?

A

remove underlying cause
supportive management, pending renal recovery
specific treatment if available

127
Q

how can removal of underlying cause of AKI be achieved?

A

stop known nephrotoxic drugs (even if prescribed)
proceed with gastric decontamination / absorption of substance ingested (if applicable) to prevent further uptake by the body

128
Q

what is involved in the supportive management of AKI?

A

manage fluid balance, electrolytes, renal toxins - encouraging urination and removal of toxins
supplementary management including nutrition, nausea and pain

129
Q

how can nausea be managed?

A

anti-emetics

130
Q

what analgesia may be given to patients with AKI?

A

opioids NOT NSAIDs

131
Q

what fluid type should be initially used in patients with AKI?

A

crystalliods - Hartmann’s

132
Q

what should be treated first when giving IVFT to an AKI patient?

A

correct any hypovolaemia (pre-renal)

133
Q

what IVFT bolus should be given to cats to correct hypovolaemia?

A

5ml/kg over 10-15 mins

134
Q

what is euvolaemia?

A

normal circulatory or blood fluid volume in the body

135
Q

once an AKI patient is euvolaemic what should be corrected?

A

any dehydration

136
Q

how should dehydration be corrected in the euvolaemic patient?

A

replace over 6 hours

137
Q

if an animal with AKI appears clinically euhydrated what % dehydration should be assumed?

A

5%

138
Q

when should IVFT not be given to a patient with AKI?

A

if overhydrated as can lead to volume overload

139
Q

what level of blood K+ is classed as hyperkalaemia?

A

> 6.5-7 mmol/l

140
Q

what can hyperkalaemia lead to?

A

cardia arrhythmias and/or standstill

141
Q

why may AKI lead to hyperkalaemia?

A

kidneys are major route of body K+ excretion

an/oliguria can cause build up of K+

142
Q

describe features of an ECG of a patient with hyperkalaemia

A

flattened P
wide QRS
spiked T

143
Q

what heart rate may hyperkalaemic patients have?

A

bradycardia

144
Q

what is involved in the ongoing treatment of AKI?

A

fluid therapy
treatment of hyperkalaemia
specific therapy for cause (if available)

145
Q

what is the role of IVFT in ongoing treatment of AKI?

A

maintain hydration and euvolaemia

replacement of ‘outs’

146
Q

how is hyperkalaemia treated?

A

crystalliod IVFT to ensure renal perfusion
calcium gluconate
glucose
insulin

147
Q

what is the role of calcium gluconate in the treatment of hyperkalaemia?

A

stabilises the myocardiocytes to make them less prone to arrhythmias

148
Q

why are glucose and insulin administered to hyperkalaemic patients?

A

glucose stimulates insulin release which will stimulate uptake of glucose and potassium alongside - reduces K+ within blood

149
Q

what is the specific therapy for ethylene glycol toxicity?

A

ethanol to reverse crystal formation

150
Q

what is the specific therapy for Leptospirosis and pyelonephritis?

A

antibiotics

151
Q

what are the key areas of nursing care for the patient with AKI?

A
ensure euhydrated, avoid overhydration
ensure renal prefusion 
manage inappetance and nausea
analgesia
provide nutrition
152
Q

how can hydration levels be monitored?

A

weigh patient to ensure body weight is maintained

153
Q

what value should systolic BP be to ensure adequate renal perfusion?

A

120-150 mmHg

154
Q

what is the minimum value of systolic BP to ensure adequate renal perfusion?

A

> 80mmHg

155
Q

how can inappetance and nausea be managed?

A

maropitant - anti emetic

156
Q

how may nutrition be provided to AKI patients?

A

orally or assisted

157
Q

what must be done if feeding liquid food to a patient on IVFT?

A

it should be incorporated into fluid therapy calculation

158
Q

what should be done if kidneys fail to respond to initial supportive therapies?

A

trial diuretic to stimulate urination

159
Q

what does of diuretic should be given to see if patient can be encouraged to urinate?

A

2mg/ml frusemide ONCE

160
Q

what is indicated by persistent anuria (+/- volume overload and +/- unmanageable hyperkalaemia)?

A

renal replacement (dialysis) or euthanasia

161
Q

what clinical findings in an AKI patient would indicate dialysis or euthanasia?

A

persistent anuria -

+/- volume overload and +/- unmanageable hyperkalaemia

162
Q

what is the survival rate for AKI in dogs?

A

34-59%

163
Q

what is the survival rate for AKI in cats?

A

27-42%

164
Q

why do patients presenting with polyuria alongside AKI have a better prognosis than those presenting with an/oliguria?

A

they are able to flush toxins from their body and so there is less damage

165
Q

what do ~50% of AKI sufferers have long term?

A

CKD - chronic kidney damage

166
Q

what is the most common kidney disease in cats and dogs?

A

chronic kidney disease

167
Q

in what species is chronic kidney disease the most common?

A

cats

168
Q

in what age group is CKD most commonly diagnosed?

A

older patients

169
Q

define chronic kidney disease

A

functional and/or structural kidney disease of >3 months duration

170
Q

can CKD be reversed?

A

no - irreversible and progressive

171
Q

is the onset of CKD acute or gradual?

A

gradual

172
Q

what is the management of CKD aimed at?

A

protecting remaining nephrons and managing clinical consequences

173
Q

what is the aim of protecting the remaining nephrons of animals with CKD?

A

reducing progression of the disease

174
Q

what are the 6 main causes of CKD?

A
chronic interstitial nephritis
glomerulonephropathy
undiagnosed / untreated infections
chronic obstructive disease
congenital issues
neoplastic
175
Q

what causes chronic interstitial nephritis?

A

often unknown, it is the end of many pathological processes

176
Q

what is chronic interstitial nephritis?

A

chronic inflammation within the kidney

177
Q

what congenital diseases can lead to CKD?

A

poly-cystic kidney disease and renal displasia (dogs - cysts replace functional renal tissue)

178
Q

what are the findings within an animals history that will suggest CKD?

A
subtle or non-specific initially in some patients
PUPD
weight loss
lethargy
weakness
inappetance
179
Q

what GI signs may be seen in an animal with CKD?

A
vomiting
diarrhoea
haematemesis
melaena
constipation second to dehydration in cats
180
Q

what signs associated with hypertension may be seen in an animal with CKD?

A

blindness

neurological

181
Q

what findings on a clinical exam suggest CKD?

A
catabolic state - reduced body (muscle) condition
typically dehydrated
weakness 
uraemic ulcers/ uraemic halitosis
hypertensive retinopathy
182
Q

why are patients with CKD typically dehydrated?

A

uncontrolled polyuria - kidneys are unable to concentrate urine
may also be v+/d+

183
Q

what causes weakness in the patient with CKD?

A

polyuria and associated excretion of K+

184
Q

what can excessive loss of K+ in the CKD patient lead to?

A

neck ventroflexion

hypokalaemic myopathy

185
Q

what causes uraemic ulcers and uraemic halitosis?

A

increased urea present in saliva - this is converted to ammonia by bacteria in the mouth

186
Q

what will kidneys feel like on palpation in a patient with CKD?

A

small and irregular

187
Q

what is rubber jaw?

A

soft bone of jaw seen in young animals with CKD

188
Q

what are the target organs of hypertension?

A

eyes (ocular)
renal
cardiac
neurological

189
Q

what is hypertensive retinopathy?

A

renal oedema and hemorrhages due to the effects of hypertension on the capillaries there

190
Q

what can hypertensive retinopathy lead to?

A

acute blindness

191
Q

what are target organs?

A

organs within the body that are particularly susceptible to damage in the small blood vessels within them due to hypertension

192
Q

How can CKD lead to worsening kidney function due to its hypertensive effects?

A

kidney disease causes increased blood pressure which in turn damages kidneys causing further BP increase

193
Q

what is an additional complication of systemic hypertension outside of the target organs?

A

epistaxis

194
Q

what is considered normal systolic blood pressure?

A

120-140 mmHg

195
Q

what is normal systolic BP for sighthounds/deerhounds in hospital settings?

A

10-20 mmHg higher than others

196
Q

why do sighthounds/deerhounds have a recognised higher systolic BP than other animals?

A

clear predisposition to in-hospital situational hypertension

197
Q

what would a systolic BP of <140mmHg be described as?

A

normotensive

198
Q

what systolic BP is considered hypertensive?

A

160-179 mmHg

199
Q

what is the risk of organ damage once the systolic BP is deemed hypertensive?

A

moderate

200
Q

at what point is treatment for hypertension warranted?

A

> 160 mmHg

201
Q

what is the ideal method of BP measurement?

A

direct arterial line

202
Q

how many blood pressure readings hsould be taken?

A

5-7 consistent readings

203
Q

what blood pressure readings should be discounted?

A

first reading and those before the plateau of meaurement

204
Q

when should a second set of blood pressure readings be taken?

A

2 hours later

205
Q

what is the correct BP cuff width if using indirect measuring techniques?

A

30-40% circumference of limb/tail

206
Q

what must be demonstrated to diagnose CKD?

A

renal azotemia

207
Q

what is diagnostic for CKD?

A

inappropriately concentrated urine

with azotemia

208
Q

what is the name of the new blood test used for diagnosis of CKD?

A

symmetric dimethylarginine (SDMA)

209
Q

how does the SDMA blood test for CKD work?

A

approximated GFR

210
Q

what other laboratory findings may be seen alongside azotemia in a CKD patient?

A

anaemia
increased phosphate
reduced K+

211
Q

what blood pressure findings would suggest CKD?

A

hypertension

212
Q

why may imaging be performed in a CKD patient?

A

to rule out any other cause of issues that may be treatable/ require different treatment

213
Q

what is involved in the initial management of CKD cases?

A

discontinue nephrotoxic drugs
find and treat any underlying correctable cause
correct and maintain fluid balance

214
Q

what may be an underlying correctable cause of CKD?

A

hypertension
urinary tract infection (pyelonephritis)
ureteroliths

215
Q

how can fluid balance of a CKD patient be managed?

A

encourage oral intake of water
give wet/soaked food
SQ fluids (owner or vet administered)
oesophageal tube

216
Q

how can oral water intake be encouraged?

A

different water stations in different places
different types of bowls
ensure water in bowl is high enough so cat doesn’t have to move eyes below level of bowl to drink

217
Q

how can progression of CKD be delayed?

A

renal diet - improves survival
control - hypertension, proteinuria, hyperphosphataemia and hyperkalaemia
avoid further kidney insult

218
Q

how can further kidney insult be avoided?

A

prevention of secondary infections

careful/no use of NSAIDs

219
Q

what is the aim of a renal diet?

A

maximise quality/longevity of life
limit clinical manifestations of disease
slow progression

220
Q

how should cats eating/weight be managed to ensure they are receiving proper nutrition to manage CKD?

A

calculate and feed RER
weigh food eaten and any left to calculate deficit to animals intake
monitor bodyweight and condition (BCS and weighing)
adjust intake based on any changes

221
Q

what must be avoided in a renal diet?

A

protein calorie malnutrition - ensure animal eats sufficient calories
avoid food aversion

222
Q

how can food aversion be avoided?

A

feed new diet at home not in hospital

223
Q

what is the purpose of renal diets?

A

minimise uraemic episodes (nausea/sickness)
minimise mortality
prolong survival

224
Q

what substances are restricted within renal diets?

A

protein
phosphorus
sodium

225
Q

why are protein, phosphorus and sodium restricted in renal diets?

A

limit the accumulation of uraemic toxins

226
Q

what are renal diets supplemented with?

A
omega 3 - polyunsaturated fatty acids
antioxidants
B vitamins
K+ (cats)
soluble fibre
227
Q

why must cats not be syringe fed?

A

risk of food aversion

228
Q

what should you do if a CKD patient is unwilling to eat?

A

ensure euhydrated, normokalaemic
offer according to animal preferances (environmental and dietary)
potentially give anitemetic if nauseous

229
Q

what can be done if a CKD patient will not eat after if is offered food it likes within its preferred environment and nausea/dehydration/hypokalaemia are ruled out?

A

try appetite stimulant

230
Q

when may a naso-oesophageal tube be an option for CKD patients?

A

if they haven’t eaten for a few days as a short term solution

231
Q

what is additional management of CKD determined by?

A

IRIS guidelines

232
Q

what does IRIS stand for?

A

international renal interest guidelines

233
Q

what may be given to a patient who is hyperphosphataemic?

A

phosphate binders

234
Q

what do phosphate binders do?

A

prevent absorption of phosphate from food to bring blood level down

235
Q

what can be given to a hypokalaemic CKD patient?

A

potassium supplementation at home (orally)

236
Q

how is systemic hypertension managed in cats?

A

amlodipine

237
Q

how is systemic hypertension managed in dogs?

A

angiotensin converting enzyme inhibitor (ACEi)

238
Q

how can progress of CKD patients be monitored?

A

nurse clinics

239
Q

how frequently should CKD cases be seen in a nurse clinic?

A

every 3 months if all is well

240
Q

what should be assessed in CKD nurse clinics?

A
appetite
demenor
weight
BP
urinalysis
specific biochem (fasted sample)
PCV
241
Q

what biochemistry is needed to assess progress of CKD patient?

A
urea
creatinine
phosphorus
Ca2+
Na+
K+
242
Q

what does PCV of a CKD patient test for?

A

anaeamia

243
Q

what does prognosis for CKD depend on?

A

IRIS stage

244
Q

what should be done before a prognosis is given?

A

address reversible component - if any

245
Q

how well do cats cope with CKD?

A

well - can often live years

246
Q

how do dogs cope with CKD?

A

those presenting with significant clinical signs often do poorly (weeks to months)

247
Q

what is nephrotic syndrome a complication of?

A

glomerular disease

248
Q

what does glomerular disease cause?

A

protein loosing nephropathy

249
Q

how does glomerular disease cause protein losing nephropathy?

A

glomerulus becomes leaky, proteins are lost into the nephron and then out through the urine

250
Q

what is the result of protein losing nephropathy?

A

renal albumin loss leading to hypoalbuminaemia

251
Q

what can hypoalbuminaemia caused by protein losing nephropathy lead to?

A

reduction in oncotic pressure leading to effusions and oedema as fluid is able to seep out of blood vessels

252
Q

how is nephrotic syndrome managed?

A

as for CKD

ACEi to reduce proteinuria

253
Q

why are ACEi given to animals suffering with nephrotic syndrome?

A

affects BP within glomerulus meaning that less albumin is forced into nephron and then lost in urine

254
Q

what is the role of omega 3 PUFA in the patient with nephrotic syndrome?

A

renoprotective

255
Q

why is aspirin/Clopidogrel given to patients with nephrotic syndrome?

A

reduce risk of thrombembolytic disease due to low albumin

256
Q

where are surgical diseases of the urinary tract most commonly encountered?

A

lower urinary tract rather than kidneys/ureters

257
Q

what ensures that the correct surgical approach is taken when treating disease?

A

adequate investigations, history taking and clear surgical plan

258
Q

what questions should be asked of an owner when presented with a potential urinary tract surgical case?

A

continent?
normal urine voiding?
is the animal urinating in the house / overnight?
does the animal strain to urinate unproductively?
does the animal strain to produce small amounts of urine or cry when urinating?
does the urine smell?
haematuria?
polydipsia?
is the animal neutered?

259
Q

what is involved in the initial investigation of a potential surgical urinary case?

A

bloods
urinalysis
radiography
ultrasonography

260
Q

what will be assessed on bloods taken for initial investigation of a potential surgical urinary case?

A

haematology - anaemia

biochemistry - markers for kidney function (e.g. urea, creatinine, K+)

261
Q

during urinary tract surgery what is a potential infection source?

A

incision into urinary tract is a potential source of wound contamination / infection

262
Q

what should be done before urinary tract surgery to reduce infection risk?

A

use antibiotic cover, particularly in presence of known UTI

263
Q

how would you know a patient has a UTI?

A

pre-op culture of urine

264
Q

how can the spillage of urine from the bladder be avoided during surgery?

A

laparotomy swabs soaked in saline packed around bladder before any incision is made

265
Q

what equipment may be useful intra-operatively to contain any urine produced?

A

urethral catheters

266
Q

what may need to be provided to the patient after urinary surgery to aid bladder drainage?

A

urethral catheter or cystotomy tube

267
Q

what are the main surgical instruments required for urinary system surgery?

A
fine instruments and suture material
abdominal retractors
stay sutures or small retractors for bladder
tubes for cystotomy
urethral catheters
suction
spoons 
magnification (Loupes or microscope)
sterile cotton buds
268
Q

what tubes are used for cystotomy?

A

foley

mushroom tip

269
Q

what are spoons used for during urinary tract surgery?

A

gentle removal of stones

270
Q

what are the main surgical diseases of the kidney?

A

neoplasia
trauma
renoliths (renal stones)
secondary to ureteric disease

271
Q

what is the most common renal tumor in dogs?

A

carcinomas

272
Q

what are the clinical signs of renal neoplasia?

A
haematuria
palpable abdominal mass
vague signs (lethargy / inappetant)
273
Q

what is present in half of dogs with kidney neoplasia?

A

pulmonary metastatis

274
Q

when is surgery to resolve renal neoplasia not indicated?

A

patients with pulmonary metastasis or bilateral neoplasia

275
Q

what is the most common renal tumor in cats?

A

lymphoma

276
Q

how can renal lymphoma in cats be treated?

A

chemotherapy

277
Q

what may cause renal trauma?

A

RTA or bite injury

278
Q

what is a nephrectomy?

A

removal of kidney

279
Q

what can indicate need for a nephrectomy?

A

uncontrolled haemorrhage as a result of renal trauma

280
Q

in what animals are renal stones often seen?

A

in animals with concurrent chronic renal failure

281
Q

when is surgery indicated for renal stones?

A

only if there is a blockage

282
Q

how can most renal stones be dissolved?

A

diet

antibiotic therapy

283
Q

what causes uroliths?

A

supersaturation of minerals within the urinary tract

284
Q

what is a nephrotomy?

A

incision through the body of the kidney

285
Q

why is there a risk of short term renal function reduction in nephrotomy patients?

A

placing of ‘rummel’ tourniquet around renal vessels during surgery which temporarily occludes blood flow. this reduces RPF and so kidney function may suffer

286
Q

what should be closely monitored after nephrotomy?

A

renal function and urine output

287
Q

why is a ‘rummel’ tourniquet placed around renal vessels during nephrotomy?

A

reduces risk of bleeding as kidneys are highly vascular

288
Q

when is subcutaneous ureteral bypass usually required?

A

in patients with a blocked ureter, potentially due to calcium oxalate stones which cannot be medically dissolved

289
Q

what uroliths cannot be medically dissolved?

A

calcium oxalate stones

290
Q

what is a subcutaneous ureteral bypass formed from?

A

tubing placed within the kidney and connected to the bladder via a port located under the skin, essentially provides a new ureter

291
Q

what does the port of a subcutaneous ureteral bypass allow to happen?

A

urinary samples are taken and tubes can be flushed to remove any further stones

292
Q

when are ureters at particular risk of trauma?

A

during spaying

293
Q

what are viable treatment options if only one ureter is damaged during spaying?

A

removal of the kidney/ureter

if possible the ureter can be cut upstream of traumatised area and re-impanted

294
Q

how can ureteral obstruction be managed?

A

nephrectomy and removal of stones
ureterotomy and removal of stones
by-passing of the stone with intra-ureteral stent

295
Q

what is nephrectomy?

A

removal of the kidney

296
Q

what are the indications for nephrectomy?

A
renal neoplasia
renal trauma
chronic pyelonephritus
idiopathic haematuria
uretral abnormalities
297
Q

what must the patient have in order to be a viable candidate for nephrectomy?

A

must have a normal functioning contralateral kidney

298
Q

where is the incision made to perform nephrectomy?

A

midline laperotomy

299
Q

how is nephrectomy performed?

A

kidney is isolated and freed from the peritoneum
renal artery and vein are ligated
the ureter is ligated and transected adjacent to the bladder

300
Q

why should a nephrectomy patient be blood typed pre-op?

A

as there is potential for severe haemorrhage

301
Q

what are the surgical diseases of the ureters?

A

ureters at risk of trauma during spaying
occasional stones ‘uroliths’ (cats and rabbits)
ureteral ectopia

302
Q

what is ureteral ectopia?

A

congenital anomaly in dogs (most common in females) resulting in ureters opening into urethra (not bladder) - most cases are bilateral and intramural

303
Q

what is the surgery used to treat ureteral ectopia known as?

A

neoureterostomy

304
Q

how is a neoureterostomy performed?

A

incision is made through the bladder and uretal mucosa into the lumen of the ectopic ureter close to it’s entry in to the bladder wall
the ureteral and bladder mucosa are sutured together to create a new stoma

305
Q

what must be closely monitored for in ureteral ectopia?

A

stranguria - inability to pass urine

306
Q

what is the outcome of 50% of neoureterostomy surgeries?

A

50% of animals remain incontinent due to congenital urethral sphincter mechanism incompetance

307
Q

what are the main surgical diseases of the bladder?

A

uroliths
neoplasia
trauma

308
Q

what is the most common bladder stone type in the UK?

A

struvite

309
Q

what uroliths are amenable to medical dissolution?

A

struvite and urate

310
Q

in what dog breed are urate uroliths common?

A

dalamations

311
Q

how are all other uroliths (not amenable to medical dissolution/causing obstruction) removed?

A

cystotomy

312
Q

what can prevent recurrence of uroliths?

A

prescription diets

313
Q

how do patients with bladder uroliths present?

A

haematuria
increased frequency or urgency to urinate
complete obstruction (emergancy)

314
Q

in what animals is bladder neoplasia not uncommon?

A

elderly animals

315
Q

how do patients with bladder neoplasia present?

A

haematuria
increased frequency / urgency to urinate
obstruction

316
Q

what do symptoms of bladder neoplasia depend on?

A

location

317
Q

can bladder neoplasia be excised?

A

not if it affects the bladder trigone/neck as many do

318
Q

is bladder neoplasia malignant?

A

mostly, yes

319
Q

what may be done to aid palliative care of bladder neoplasia?

A

partial cystectomy

320
Q

what can blunt abdominal trauma cause?

A

bladder rupture

321
Q

what is a consequence of bladder trauma?

A

uroabdomen

post renal failure

322
Q

what should be done before surgical repair of bladder trauma?

A

IVFT

323
Q

what may aid bladder trauma healing after repair?

A

indwelling catheter

324
Q

when is cystotomy indicated?

A

removal of bladder stones

325
Q

where is the incision for cystotomy made?

A

caudal midline laperotomy

326
Q

how is cystotomy to remove bladder stones preformed?

A

caudal midline laparotomy
exteriorise bladder and isolate with swabs (wet)
incision in ventral midline of bladder
all stones carefully removed

327
Q

why should a uretheral catheter be placed prior to cystotomy?

A

to flush urethra and bladder neck to remove any stones

328
Q

what equipment is useful during cystotomy for the removal of bladder stones?

A

urethral catheters

Volkmann spoon / sterile teaspoon

329
Q

what should happen to stones removed from the bladder?

A

submitted for lab analysis for composition and culture and sensitivity

330
Q

what should be observed post operatively in a cystotomy patient?

A

absence of urination or abdominal distention

abdomen should be ultrasound scanned if patient is on IVFT and not urinating

331
Q

when may urinary catheter placement be indicated after cystotomy surgery?

A

if bladder is very traumatised

332
Q

what must be ensured about patient care after cystotomy surgery?

A

they are given plenty of opportunities to urinate

333
Q

what are the main urethral diseases?

A
urolithiasis
incontinence
feline lower urinary tract disease (FLUTD)
trauma
neoplasia
334
Q

what are the most common urethral stones in the UK?

A

struvite

335
Q

what may cause struvite crystals to form?

A

UTI

336
Q

what can urethral stones cause?

A

urethral obstruction

337
Q

why are urethral obstructions more common in males?

A

due to their anatomy (curve in urethra)

338
Q

what can urethral blockage lead to?

A

post renal azotemia and shock

339
Q

how should a patient with urethral obstruction be treated?

A

restore circulating volume
reduce hyperkalaemia
relieve obstruction

340
Q

what should be avoided before the urethral obstruction patient is stabilised?

A

anaesthesia

341
Q

what should be looked for on the ECG of patients with urethral obstruction?

A

spiked T waves (hyperkalaemia)

342
Q

how can the urethral obstruction be relieved?

A

empty bladder by cystocentesis
catheterise urethra
once flushed into bladder remove stones by cystotomy

343
Q

what can be done if urethral catheterisation and flushing has not moved stone into bladder?

A

retrograde flushing attempted under GA with sterile saline

344
Q

what happens if the bladder is allowed to become distended again when there is urethral obstruction?

A

can lead to urine leakage into the abdomen

345
Q

what are the two main causes of incontinence?

A

congenital

aquired

346
Q

how may incontinence be acquired?

A

age

surgical complications

347
Q

in what sex is incontinence more common?

A

females - due to anatomy

348
Q

in what species is incontinence rare?

A

cat

349
Q

should incontinence be investigated?

A

yes

350
Q

what is USMI?

A

urethral sphincter mechanism incontinence

351
Q

what may cause USMI?

A

breed predisposition (old english sheepdog)
obesity
neutering
tail docking if nerves are interfered with

352
Q

what is the most common type of USMI?

A

spay bitch incontinence, intrapelvic bladder

353
Q

how are most cases of USMI managed?

A

medically with oestrogen or phenylpropanolamine

354
Q

how may non-responsive cases of USMI be treated surgically?

A

colposuspension
urethroplexy
hydraulic artificial urethral spincters

355
Q

what is FLUTD?

A

feline lower urinary tract disease

356
Q

what is FLUTD secondary to?

A

some kind of bladder disease

357
Q

what does FLUTD lead to in some male cats?

A

urethral obstruction

358
Q

when does FLUTD become a surgical disease?

A

when males suffer repeated episodes of urethral obstruction

359
Q

how can FLUTD often be managed?

A

medically to avoid surgery

360
Q

what type of cats are predisposed to FLUTD?

A

middle aged
obese
dry diet
neutered

361
Q

what bladder disease may FLUTD be secondary to?

A

neoplasia
urethral spasming
infection
feline idiopathic cystitus

362
Q

is urethral neoplasia a common cause of urethral obstruction?

A

no

363
Q

in what animals may urethral neoplasia be an issue?

A

elderly bitches

364
Q

what is the most common form of urethral neoplasia?

A

transitional cell carcinoma

365
Q

can urethral neoplasia usually be excised?

A

no - often recognised too late

366
Q

what can be done to provide palliation to urethral neoplasia cases that cannot urinate?

A

by-passing urethra

367
Q

what are two methods used to bypass the urethra?

A

urethral stents

tube cystotomy

368
Q

what is urethrotomy?

A

incision into the urethra

369
Q

what is urethrotomy used for?

A

last resort for stones that cannot be flushed back up into the bladder for removal

370
Q

what is urethrostomy?

A

creation of a new, permanent opening

371
Q

what is urethrostomy used for?

A

last resort for recurrent obstruction, severe trauma or stricture

372
Q

where must a urethrostomy be made?

A

‘upstream’ from the diseased urethra

373
Q

what technique can be used to confirm where urethrostomy should be placed?

A

retrograde urethrogram

374
Q

what urethrostomy is most often performed in cats?

A

perineal or occasionally pre pubic

375
Q

what type of urethrostomy is most often performed in the dog?

A

scrotal or occasionally perinial

376
Q

what is tube cystotomy used for?

A

urethral diversion technique

377
Q

when is tube cystotomy indicated?

A

diverting urine away from urethral surgical sites

palliation of urinary obstruction due to neoplasia and detrusor atony

378
Q

what is detrusor atony?

A

A distended flaccid bladder that is easily expressed

379
Q

how is tube cystotomy performed?

A

purse string suture is placed in the bladder and a foley or mushroom tip catheter is placed through a stab incision in the middle of the suture
the suture is tightened
the catheter is passed through an incision in the lateral abdominal wall and a cystopexy is performed
catheter is sutured to the skin via a chinese finger trap suture

380
Q

for how long following a tube cystotomy must the tube be kept in place?

A

7 days

381
Q

what is a side effect of tube cystotomy?

A

often lots of UTIs - no treatment unless clinical signs

382
Q

in what animals is a urethrostomy performed?

A

usually males

383
Q

what must be placed prior to urethrostomy?

A

urinary catheter

384
Q

what equipment is required for urethrostomy?

A

fine instruments
fine non-absorbable suture
illumination

385
Q

what happens during urethrostomy?

A

urethra is redirected out through a new hole in the skin

386
Q

what are complications associated with urethrostomy surgery?

A

heavy bleeding
stricture
cystitus

387
Q

what is crucial about post op care after urethral surgery?

A

absolute prevention of patient interference

388
Q

what is commonly see after urethral surgery?

A

haematuria and bleeding from site

observe for dysuria

389
Q

what is a key concern following urethral surgery in cats?

A

care with litter - use shredded newspaper

390
Q

what may be required to safely remove sutures post urethral surgery?

A

GA/sedation

391
Q

what key parameters should be monitored following urethral surgery?

A

urine output
BP
pain score

392
Q

where is the prostate located?

A

surrounds male urethra

393
Q

is prostatic disease seen in cats?

A

rare

394
Q

what are the possible causes of prostatic disease in cats?

A
benign hyperplasia
prostatitis
abscessation
cysts
neoplasia
395
Q

what is benign prostatic hyperplasia (BPH)?

A

non-cancerous enlargement of the prostate

396
Q

what does BPH cause?

A

dysuria or dyschezia

397
Q

what is dyschezia?

A

difficulty defecating

398
Q

in what animals is BPH often seen?

A

older entire males

399
Q

how is BPH managed?

A

medical management with anti-androgens (e.g Tardak

400
Q

what is the preferred definitive treatment for BPH?

A

castration

401
Q

what is prostatitis?

A

inflammation of prostate gland

402
Q

what causes prostatitis?

A

bacterial infection, usually alongside BPH

403
Q

what animals is prostatitis seen in?

A

entire males

404
Q

what are the symptoms of prostatitis?

A

dysuria
pyrexia
purulent penile discharge

405
Q

how is prostatitis managed?

A

antibiotics
Tardak
casteration

406
Q

when are prostatic abscesses seen?

A

alongside prostatitis

407
Q

in what animals are prostatic abscesses seen?

A

entire males

408
Q

what are the signs of prostatic abscess?

A

variable systemic signs (male pyometra)
dysuria
dyschezia

409
Q

what is the treatment of prostatic abscess?

A

omentalisation following de-roofing and flushing of abscess

castration

410
Q

what is omentalisation?

A

the placement of omentum around organs or within cavities to improve vascularization or drainage

411
Q

when is rapid surgical intervention required with prostatic abscesses?

A

if it has burst with signs of septic peritonitus

412
Q

what additional care will be needed during surgery if prostatic abscess has burst?

A

antibiotics

flush abdomen

413
Q

what causes prostatic cysts?

A

ducts become blocked and fluid builds up leading to cyst

414
Q

in what animals are prostatic cysts seen?

A

entire males often with BPH

415
Q

how are prostatic cysts treated?

A

de-roof
omentalisation
castration

416
Q

what can prostatic cysts occasionally be caused by?

A

prostatic neoplasia - biopsy sent from de-roofing

417
Q

what animals is prostatic neoplasia seen in?

A

elderly male dogs - more common in castrated

418
Q

is prostatic neoplasia painful?

A

yes

419
Q

is the prognosis of prostatic neoplasia usually good?

A

no - usually skeletal metasitis

420
Q

how may palliative care be given to prostatic neoplasia patients?

A

urethral stents to aid urination if a clinical sign is inability to urinate

421
Q

why is prostatectomy not often performed?

A

complex

often causes incontinence

422
Q

what is lower urinary tract disease?

A

diseases of the bladder and urethra

423
Q

what is cystitis?

A

bladder inflammation

424
Q

what are the symptoms of cystitis/ LUTD?

A
dysuria
stranguria
vocalisation
licking prepuce
inappetance
lethargy
haematuria
pollakiuria
periuria
425
Q

what is stranguria?

A

straining to urinate - may be reported as consitpation

426
Q

what is pollakiuria?

A

increased frequency of urination

427
Q

what is periuria?

A

voiding in inappropriate places due to pain association formed with normal site

428
Q

do clinical signs of LUT differ depending on aetiology?

A

no - reflect the pathology / inflammation which accompanies

429
Q

what is the most common cause of cystitis in cats?

A

feline idiopathic cystitis

430
Q

what is the most common cause of cystitis in female dogs?

A

bacterial urinary tract infection

431
Q

what are the main causes of cystitis in both cats and dogs?

A

urolithiasis
neoplasia - especially in dogs
drug induced (some chemotherapy drugs)
implants or indwelling devices

432
Q

what is the most crucial question when triaging a patient with clinical signs of LUT disease?

A

as they still able to pass urine

433
Q

when is urinary obstruction possible?

A

with any LUT disease

434
Q

when is LUT disease an emergency?

A

if there is any evidence of inability to pass urine

435
Q

what is a urolith?

A

urinary stone - organised crystal aggregates of minerals in small amounts of organic matrix

436
Q

when are uroliths visible?

A

they are macroscopic - visible with the naked eye

437
Q

what are crystals?

A

microscopic mineral precipitate

438
Q

how can you ensure that crystals are truly found in urine and not artefact?

A

ensure urine is fresh and at room temperature

439
Q

what is crystalluria?

A

crystals in the urine

440
Q

does crystalluria and uroliths occur at the same time?

A

can do or occur seperately

441
Q

are crystals and uroliths formed of the same constituents?

A

not necessarily - may have been formed at different times in different urine pH

442
Q

what are the 3 main types of urinary stones and crystals?

A

struvite
calcium oxalate
urate

443
Q

identify this urolith and crystal

A

struvite

444
Q

identify this urolith and crystal

A

calcium oxalate

445
Q

identify this urolith and crystal

A

urate

446
Q

how are crystals formed?

A

urine is saturated with compounds
increased saturation leads to increased risk of precipitation of crystals as the compound can no longer be held in solution
crystals are formed

447
Q

how are uroliths formed from crystals?

A

further supersaturation of crystals and then growth / aggregation of many crystals

448
Q

why should water intake be encouraged?

A

the more dilute the urine, the less the risk of crystal and stone formation

449
Q

does crystalluria require treatment?

A

mostly normal, asymptomatic and does not need treatment

some crystals are abnormal and require further investigation

450
Q

what crystal types will require further investigation?

A

urate

451
Q

what types of uroliths need treatment?

A

symptomatic

452
Q

what are nephroliths?

A

kidney stones

453
Q

what are the signs of nephroliths?

A

abdominal pain (leading to anorexia, inappetance, lethargy)
haematuria
pyelonephritis

454
Q

what can ureteroliths cause?

A

may lead to ureteric obstruction and post renal azotemia

455
Q

what are the upper urinary uroliths?

A

nephroliths

ureteroliths

456
Q

in what species are upper urinary uroliths more common?

A

cats

457
Q

in what species are lower urinary uroliths more common?

A

dogs

458
Q

what are the main signs of urethroliths?

A

unproductive / minimally productive urination

459
Q

what are cystoliths?

A

bladder stones

460
Q

what are the signs of cystoliths?

A

pollakuria
stranguria
dysuria
haematuria

461
Q

what may uroliths predispose?

A

UTI

462
Q

why is identification of urolith type important?

A

changes management requirement

463
Q

how will urolith type affect management requirement?

A

some can be dissolved
some need surgical removal, intervention or bypass
some will ave associated infections that need treating

464
Q

what diagnostic tool can aid ‘guessing’ stone type?

A

radiolucency/opacity

465
Q

can presence of crystals predict stone type?

A

no

466
Q

what is the only definitive way to identify stone type?

A

analysis of stone

467
Q

how may stones be dissolved?

A

diet or medication

468
Q

how large do uroliths need to be to be visualised on radiographs?

A

> 2-3mm

469
Q

what type of uroliths will be shown by plain radiographs?

A

radiopaque

470
Q

what type of uroliths will be shown by contrast/double contrast radiographs?

A

radiolucent

471
Q

what is the main feature of urolith treatment and management?

A

encourage water intake

472
Q

why is high water intake so crucial with urolith management?

A

if urine is dilute, supersaturation, and so crystal/stone formation, cannot occur

473
Q

how can water intake be encouraged?

A

plentiful water

wet diet +/- add water to diet

474
Q

what USG should be aimed for in animals with uroliths?

A

cats: 1.030
dogs: 1.020

475
Q

why should voiding of urine be encouraged?

A

to avoid urine sitting in the bladder for too long

476
Q

what is a risk factor for urolith formation?

A

obesity

477
Q

what animals are dissolution diets not suitable for?

A

growing or lactating animals

long term use in any animals

478
Q

can some dissolution diets tackle more than one stone type?

A

yes - may aim to make urine pH neutral and so unsuitable for alkaline and acidic stones

479
Q

how do dissolution diets work?

A

don’t contain constituents of stone that needs breaking down which prevents further formation and allows breakdown by urine

480
Q

what are the main nursing considerations associated with a patient with urolithiasis?

A

observe and monitor patient for anuria / stranguria - re-obstruction possible at any time
maintain hydration and urine output
manage urinary catheter
analgesia requirements

481
Q

what is the aetiology of feline idiopathic cystitis?

A

common with unknown cause

482
Q

what is the signalment (common characteristics) of feline idiopathic cystitis?

A
young to middle aged (2-7)
overweight
inactive
indoor - litter tray user
multi-animal household
nervous disposition
dry diet
stressors
autumn/winter
483
Q

what makes a cat susceptible to feline idiopathic cystitis?

A

neuroendocrine modulation

GAG layer hyperfunction

484
Q

what is neuroendocrine modulation?

A

adjusted sensory nerve function
abnormalities of the CNS stress response
- when compared to normal cats

485
Q

what does environmental stress manifest as in susceptible cats?

A

FLUTD

486
Q

what is GAG layer hypofunction?

A

underfunction of proteins in lining of bladder leaving it more susceptible to irritation / inflammation

487
Q

what must be ruled out before FIC can be confirmed?

A

all other potential causes of cystitis as they present the same

488
Q

what tests are involved in diagnosing FIC?

A

urinalysis
radiographs
ultrasonography
if nothing found - FIC

489
Q

what can be excluded by urinalysis?

A

UTI - rare

490
Q

what can be excluded by radiography (plain, contrast and double contrast)?

A

uroliths
masses
contrast useful for stricture assesment

491
Q

what can ultrasound show about the urinary tract?

A

structural architecture / evaluation of upper urinary tract

492
Q

what are the 2 presentations of FIC?

A

non - obstructed

obstructed

493
Q

what are the signs of non - obstructed FIC?

A
signs of LUTD
pollakiuria
stranguria
dysuria
haematuria
still able to void urine
494
Q

how long may non - obstructed FIC last?

A

self - limiting so may well last a few days and then go away

495
Q

does FIC often reoccur?

A

yes

obstructed recurs in 40% of patients within 6-12 months

496
Q

what caused obstructed FIC?

A

urethral spasm or plug

497
Q

what are the signs of obstructed FIC?

A

unproductive attempts to urinate

498
Q

in what animals is obstructive FIC more common?

A

males - rarely / never in females

499
Q

what presentation of FIC is an emergency?

A

obstructed

500
Q

what is the consequence of urinary obstruction?

A

back pressure on kidneys as no voiding

kidneys unable to filter blood leading to post-renal azotemia and then hyperkalaemia (and associated bradyarrhythmias)

501
Q

how may cats with FIC seem in terms of mentation?

A

painful

agitated or depressed

502
Q

what must be done to the obstructed FIC cat before they are anaesthetised for catheterisation?

A

stabilised - resolve hyperkalaemia and azotemia

503
Q

what may owners report that can indicate urinary obstruction?

A

constipation - as urination and defication can appear the same

504
Q

urinary catheter RCards if none on urinary catheter lecture

A

e.g. equipment and assisting with placement

505
Q

what are the key management considerations for indwelling urinary catheters?

A
closed, clean system
wear gloves when handling
keep bag off floor
keep connections clean
change bag daily
avoid antibiotics
tape collection system to tail while tail is raised to avoid pulling
use buster collar
506
Q

what should be monitored post-catheterisation?

A

urine output
hydration / volaemic status
electrolytes
urine sediment / cytology

507
Q

what is commonly seen post relief of obstruction that may contribute to hypokalaemia?

A

post obstruction diuresis - kidney may be damaged so not concentrating urine

508
Q

what is urine sediment / cytology examined for?

A

shows presence of infection

509
Q

how is UOP calculated?

A

weight of bag now - weigh of bag 4hrs ago = UOP for past 4 hours
divide by 4 to get UOP for 1hr
then divide by patient weight (kg) to calculate UOP (ml/kg/hr)

510
Q

what is the main medical management of FIC in non-obstructed / post - obstructed cats?

A

analgesia
opioids - buprenorphine
NSAIDs - only once normovolaemic, azotemia gone and euhydrated
gabapentin in severely affected cases

511
Q

how can environmental modification help long term management of FIC?

A

alleviate predisposing stressor - remove if known
address negative cat-cat interactions
ensure resource availability (especially clean toileting stations)
feliway - pheremone

512
Q

how can urinary health in FIC be promoted?

A

encourage water intake
slowly introduce dietary modifications
avoid obesity
GAG supplementation

513
Q

how can encouraging water intake in cats promote urinary health?

A

dilute inflammatory mediators / noxious substances in urine

514
Q

what dietary changes can be made to promote urinary health?

A

wet diets

urinary diets - often contain anti-anxiety compounds

515
Q

why may GAG supplementation help to promote urinary health?

A

reduced GAG in FIC cats which means they have lower protection against noxious substances in urine
supplementation can help

516
Q

when are antispasmodics often used?

A

post obstruction

517
Q

what is the role of Prazosin?

A

alpha1 blocker which relaxes smooth muscle

518
Q

what is the downside of Prazosin?

A

may cause hypotension due to smooth muscle relaxation

519
Q

what is the effect of Dantrolene?

A

skeletal muscle relaxant - acts on external urethral sphincter

520
Q

what are other FIC therapies?

A

owner education
behavioral consultation
psychoactive medications

521
Q

what must be done before using behavioral / psychoactive therapies for FIC treatment?

A

seek refurral or advice

522
Q

what is urinary incontinence?

A

loss of normal, voluntary control of micturition

523
Q

what is involved in normal control of micturition?

A

local sensory reflexes and conscious control - micturition centre in brainstem will initiate relaxation of urethral sphincter and contraction of bladder leading to conscious voiding

524
Q

what is neurogenic incontinence?

A

incontinence due to damage to nerves

525
Q

what are the 2 types of neurogenic incontinence?

A

upper motor neurone lesion

lower motor neurone lesion

526
Q

what nerves are damaged in neurogenic incontinence caused by damage to upper motor neurones?

A

some in brain or spinal cord

527
Q

what nerves are damaged in neurogenic incontinence caused by damage to lower motor neurones?

A

peripheral

528
Q

what is the bladder like in a patient with an upper motor neuron lesion?

A

spastic and difficult to express

529
Q

what is the bladder like in a patient with an lower motor neuron lesion?

A

flaccid

easy to express

530
Q

what sort of incontinence is common in animals with neurogenic incontinence?

A

overflow - unable to void bladder so it becomes too full and urine leaks out

531
Q

what are the 3 types of non-neurogenic incontinence?

A

urethral sphincter mechanism incompetence
anatomical defects
urge incontinence
dyssynergia

532
Q

what causes urethral sphincter mechanism incompetence?

A

failure of normal sphincter function

533
Q

when do animals with urethral sphincter mechanism incompetence normally leak?

A

during recumbancy

534
Q

what is an example of an anatomical defect which causes incontinence?

A

ectopic ureters

535
Q

what are ectopic ureters?

A

ureter voids directly into urethra leading to frequent dribbling and risk of ascending infection

536
Q

what causes urge incontinence?

A

instability of detrusor muscle due to bladder disease / irritation of bladder

537
Q

what is dyssynergia?

A

failure of coordination of bladder contraction with urethral relaxation

538
Q

what is the most common cause of non-neurogenic incontinence in dogs?

A

urethral sphincter mechanism incompetance

539
Q

in what dogs is USMI more common?

A

larger breed, spayed bitches

540
Q

within what timeframe does USMI often occur/

A

within a few years of neutering

541
Q

what are the causes of USMI?

A

multifactorial -
intra-pelvic bladder
neutering
obesity

542
Q

why may neutering be associated with USMI?

A

increased collagen to muscle ration in pelvic floor composition
oestrogen deficiency

543
Q

what is the treatment for USMI?

A

tighten urethral sphincter

544
Q

what methods may be used to tighten the urethral sphincter in USMI cases?

A

alpha-agonists
oestrogens
urethral cuffs
surgical repositioning of bladder

545
Q

why are alpha agonists used to treat USMI?

A

sympathomimetic - alpha adrenergic receptors at sphincter - drugs cause sphincter to contract

546
Q

what alpha agonists are often given to treat USMI?

A

Phenylpropanolamine (PPA)

547
Q

what drugs are given alongside PPA in the treatment of USMI?

A

oestrogens - enhance effect

548
Q

how do urethral cuffs treat USMI?

A

artificial urethral sphincter placed over normal urethral sphincter to enhance effect

549
Q

how does surgical repositioning of the bladder treat USMI?

A

bladder is moved back into abdomen from pelvis - this means that when the dog is in lateral recumbancy the weight of the body wall falls on the bladder neck and urethra (aiding sphincter).

550
Q

where does weight of the body wall, when in lateral recumbancy, fall in patients with USMI?

A

all onto bladder and none onto bladder neck and urethra as it is within bony cage of pelvis - causes leaking of urine

551
Q

what are the management considerations for neurogenic incontinence?

A

treat neurological disease
express bladder
avoid catheterisation - risk of ascending infection

552
Q

how may anatomic incontinence be treated?

A

laser to reposition ureteric entry into bladder

surgical re-implantation of ureter into bladder

553
Q

what must be maintained in all cases of incontinence to prevent ascending infection?

A

peri-vulval / preputial hygiene

Decks in X Clinical Veterinary Nursing Theory Class (70):