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Veterinary Nursing > Urinary System Diseases > Flashcards

Urinary System Diseases Flashcards

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1
Q

Define azotemia and uraemia.

A 
Azotemia = elevation of urea +/- creatinine in the bloodstream
Uraemia = the clinical signs associated with azotemia
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2
Q

What is pyelonephritis?

A

Bacterial kidney infection - may be unilateral or bilateral

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3
Q

What methods can we use to collect a urine sample?

A

Free catch
Non-absorbable cat litter
Catheterisation
Cystocentesis

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4
Q

What methods can we use for urinalysis?

A 
Urine specific gravity by refractometer
Dipstick analysis
Microscopy
Cytology
Bacterial culture and sensitivity
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5
Q

What three places can azotemia originate?

A

Pre-renal - inadequate renal perfusion
Renal - reduced functional mass of kidneys due to underlying kidney disease
Post-renal - kidneys are functional but waste products are not excreted (obstruction/rupture of urinary tract)

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6
Q

What is the difference between acute kidney injury (AKI) and chronic kidney disease (CKD)?

A 
AKI = acute nephron damage/dysfunction
CKD = chronic nephron loss, gradual decline in renal function
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7
Q

What are the causes of intrinsic AKI?

A

Toxins
Ischaemia
Infection - leptospirosis/pyelonephritis
Cutaneous and renal glomerular vasculopathy

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8
Q

What clinical findings might we see with AKI?

A

Azotemia, uraemia - lethargic, depressed, inappetent, nauseous
An/oliguria - increased potassium leads to cardiac arrhythmias/arrest
+/- hyper/hypoperfusion
+/- other signs related to intoxication

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9
Q

How can we diagnose AKI from a blood sample?

A

Acute azotemia - increased urea/creatinine/phosphate
Increased potassium with an/oliguria
Decreased potassium with polyuria
Appropriately concentrated urine with no evidence of urinary tract obstruction/rupture

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10
Q

What might we expect to see on urinalysis findings?

A

Isosthenuric
Casts - indicate tubular injury
Crystals
Inflammatory cells or positive culture - may be pyelonephritis

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11
Q

How do we manage an AKI?

A

Remove underlying cause - gastric decontamination/adsorption
Supportive management - fluid balance, electrolytes, nutrition/nausea/pain
Specific treatment (where available)

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12
Q

How do we conduct initial fluid therapy for an AKI?

A

Crystalloids - Hartmann’s usually appropriate
Correct any hypovolaemia
Correct any dehydration

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13
Q

How can hyperkalaemia complicate an AKI?

A

Kidneys = major route of K excretion
Reduced pacemaker activity, may be bradycardic
Ventricular fibrillation, cardiac arrest

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14
Q

What supportive nursing care can we provide for AKI patients?

A

Ensure hydration, avoid overhydration - weigh regularly
Ensure renal perfusion - monitor systolic BP
Manage inappetence and nausea
Analgesia
Nutrition - assisted vs oral

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15
Q

What is the definition of chronic kidney disease (CKD)?

A

Functional and/or structural kidney disease of > 3 months duration
Irreversible and progressive kidney damage and dysfunction, usually gradual

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16
Q

What can cause CKD?

A 
Chronic interstitial nephritis
Glomerulonephropathy
Undiagnosed/untreated infections
Chronic obstructive disease
Congenital
Neoplastic (lymphoma)
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17
Q

What historical findings might we see in a CKD patient?

A 
PUPD
Weight loss
Lethargy, weakness
Inappetence
Vomiting +/- diarrhoea +/- haematemesis/malaena
\+/- signs associated with hypertension
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18
Q

What might we find on examination of a CKD patient?

A

Catabolic state, reduced body muscle condition
Dehydration
Weakness (neck ventroflexion, hypokalaemic myopathy)
Uraemic ulcers/halitosis
Hypertensive retinopathy

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19
Q

What are the ‘target organs’ of systemic hypertension?

A

Ocular (hypertensive retinopathy) - retinal oedema, haemorrhages, acute blindness
Renal
Cardiac
Neurological

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20
Q

What is the normal systemic BP?

A

120-140 mmHg.

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21
Q

What findings can we use to diagnose CKD?

A 
Inappropriately concentrated urine, with azotemia
SDMA = new blood test for kidney disease
Anaemia
Increased phosphate, decreased potassium
Hypertension
Renal ultrasound
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22
Q

How do we initially manage CKD?

A

Discontinue any nephrotoxic drugs
Find and treat any underlying correctible cause
Correct and maintain fluid balance

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23
Q

How do we manage fluid balance in CKD patients?

A

Encourage oral intake
Wet/slurry/soaked food
Subcut fluids
Oesophageal tube

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24
Q

How do we delay progression of CKD?

A

Renal diet
Control of hypertension, proteinuria, hyperphosphataemia, hypokalaemia
Avoid further insults

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25
What nutrition should be provided to a CKD patient?
Must have sufficient protein calorie intake! Renal diet Restricted protein, phosphorous and sodium
25
What additional management should we provide for a CKD patient?
As determined by IRIS guidelines Hyperphosphataemic - phosphate binders with every meal Hypokalaemic - potassium supplementation Manage systemic hypertension
26
How do we monitor progress in CKD patients?
``` Appetite, demeanour Body weight Blood pressure Urinalysis Urea, creatinine, phosphorous, calcium, sodium, potassium PCV ```
27
What questions should we ask to determine the history of urinary tract disorder patients?
Is your pet continent? Can the animal void urine normally? Does the animal urinate over the house or 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? Has there been blood in the urine? Is the animal urinating more frequently? Is the animal drinking more? Is the animal neutered?
28
What are the general principles of urinary tract surgery?
Potential source of wound contamination/infection - use antibiotic cover and minimise spillage of urine Urethral catheters may be useful intra-op May need to provide bladder drainage post-op
29
What equipment might be necessary during surgery?
``` Fine instruments/surgical material Abdominal retractors Stay sutures/small retractors for bladder Tubes for cystotomy Urethral catheters Suction Spoons for bladder stones Magnification for ureteral surgery Sterile cotton buds ```
30
Describe renal neoplasia.
Carcinomas/lymphoma/pulmonary metastasis and bilateral neoplasia Clinical signs include - haematuria, palpable abdominal mass, vague signs
31
Describe renal trauma.
May follow RTA or bite injury | Uncontrolled haemorrhage may require nephrectomy (rare)
32
Describe renal stones.
Often seen in animals with concurrent chronic renal failure so surgery not recommended Many can be dissolved with diet/antibiotic therapy Surgical removal - nephrotomy (incision through body of kidney), risk of renal reduction in renal function in the short term
33
Describe kidney disease secondary to ureteric disease.
Ureters at risk of trauma during spaying - removal of kidney/ureter or ureter re-implanted in some cases Ureteral obstruction may be managed by nephrectomy
34
Describe ureteral ectopia.
Congenital anomaly in (female) dogs resulting in ureters opening into urethra (not bladder) Most cases bilateral and intramural Surgical treatment by neoureterostomy 50% of animals remain incontinent post-op
35
Describe bladder stones.
Struvite most common in UK Struvite and urate uroliths can be medically dissolved, others removed by cystotomy Prescription diets post-op to prevent reoccurrence Clinical signs - haematuria, frequency/urgency to urinate, complete obstruction
36
Describe bladder neoplasia.
Common in elderly animals Clinical signs - haematuria, frequency/urgency to urinate, obstruction Most are malignant Partial cystectomy for palliative care Many affect trigone/bladder neck and cannot be excised
37
Describe bladder trauma.
Blunt abdominal trauma can cause bladder rupture Can cause uroabdomen and post-renal failure IVFT to stabilise, then surgical repair or indwelling catheter
38
Describe cystotomy.
Removal of bladder stones Essential all stones removed Stones submitted for lab analysis (for prevention treatment) Post-op - observe carefully for absence of urination or abdominal distension
39
Describe management and relief of urethral stone obstruction.
Rapidly leads to post-renal azotaemia and shock Restore circulating volume, reduce hyperkalaemia and relieve obstruction Correct hypovolaemia, electrolyte and acid-base disturbance Empty bladder by cystocentesis, but if allowed to become distended again can lead to urine leakage in abdomen Careful urethral catheterisation If unsuccessful, attempt retrograde flushing with sterile saline under GA Once flushed back into bladder, remove via cystotomy
40
What are the three main types of incontinence?
Urethral Sphincter Mechanism Incontinence (USMI) Feline Lower Urinary Tract Disease (FLUTD) Urethral neoplasia
41
Describe Urethral Sphincter Mechanism Incontinence (USMI).
Most common type of incontinence (bitch spay, intrapelvic bladder) Medically managed with oestrogen or phenylpropanolamine Can be treated surgically - colposuspension / urethropexy / hydraulic artificial urethral sphincters
42
Describe Feline Lower Urinary Tract Disease (FLUTD).
Secondary to some kind of bladder disease Leads to urethral obstruction in some male cats Mostly medically managed to avoid need for surgery - however is an option when males suffer repeated episodes of urethral obstruction
43
Describe urethral neoplasia.
Rare but important in elderly bitches Most common form is transitional cell carcinoma Usually too advanced for surgical excision Bypassing urethra may provide palliation in cases that are well but cannot urinate - urethral stents/tube cystostomy
44
Define urethrotomy.
Urethrotomy = incision into urethra | Used as a last resort for stones that cannot be flushed back into bladder (very rare)
45
Define and describe urethrostomy.
Urethrostomy = creation of a new urethral opening (permanent) Used as last resort for recurrent obstruction or severe trauma or stricture Must be made upstream from diseased urethra Scrotal urethrostomy performed most commonly in dog, perineal urethrostomy in cat
46
How is a tube cystotomy carried out?
Used as urinary diversion technique - urine away from urethral surgical sites/palliation of obstruction due to neoplasia and detrusor atony Purse string suture placed in bladder and Foley/mushroom tip catheter placed through stab incision in middle of suture Suture is tightened Catheter is passed through incision in lateral abdominal wall and a cystopexy is performed Catheter is sutured to skin via a Chinese finger trap suture Tube must be kept in place for 7 days before removal
47
What are the 5 main types of prostatic disease?
``` Benign hyperplasia (BHP) Prostatitis Abscessation Cysts Neoplasia ```
48
Describe benign hyperplasia (BHP).
Causes dyschezia / dysuria Seen in older entire males Managed medically with anti-androgens (e.g. Tardak) Often castration preferred as definitive treatment
49
Describe prostatitis.
Bacterial infection, often together with BHP Disease of entire males Dysuria, pyrexia, purulent penile discharge Managed with antibiotics and Tardak or castration
50
Describe abscessation of prostrate.
Usually with prostatitis in entire males Variable systemic signs (male version of pyometra), plus dyschezia/dysuria Omentalisation following re-roofing and flushing of abscess - also castration Rapid surgical intervention required if abscess has burst with signs of septic peritonitis
51
Describe prostatic cysts.
Entire males - often associated with BHP, less commonly "paraprostatic" Treat with de-roof and omentalisation and castration Occasionally due to underlying neoplasia (so biopsy sent from de-roofing)
52
Describe prostatic neoplasia.
Disease of elderly dogs Usually very painful Unlike other prostate diseases, slightly more common in castrated animals Poor prognosis - can be palliated with urethral stents if main clinical sign is inability to urinate
53
Define cystitis.
Cystitis = bladder inflammation.
54
Define pollakiuria.
Pollakiuria = increased frequency of urination
55
Define periuria.
Periuria = voiding in inappropriate places
56
What can cause cystitis?
``` Feline idiopathic cystitis Bacterial urinary tract infection Urolithiasis Neoplasia Drug-induced Implants/indwelling devices ```
57
What are the three main types of urinary crystals/uroliths?
Struvite Calcium oxalate Urate
58
How are uroliths formed from urine crystals?
Urine frequently saturated with compounds Increased saturation = increased risk of precipitation, leading to crystal formation Further supersaturation may lead to urolith formation
59
What are the main types of symptomatic upper urinary uroliths?
Nephroliths - abdominal pain (anorexia/inappetence, lethargy), haematuria, pyelonephritis Ureteroliths - may cause ureteric obstruction, post-renal azotemia More common in cats!
60
What are the main symptomatic lower urinary uroliths?
Urethroliths - cause obstruction, unproductive/minimally productive urination Cystoliths - cystitis signs (pollakiuria, stranguria, dysuria, haematuria) Uroliths may predispose UTIs
61
What are the nursing considerations for a patient with urolithiasis?
Vigilance - observe and monitor for un/productive urination (re-obstruction can occur at any time) Maintain hydration/urine dilution/output Urinary catheter care and management Analgesia requirements
62
What are the signalments for feline idiopathic cystitis (FIC)?
``` 2-7 years old Overweight, inactive Indoor, litter tray users Multi-animal household Nervous disposition Dry diet Stressors Autumn/winter ```
63
How do we rule out other causes before diagnosing feline idiopathic cystitis?
Urinalysis Radiographs - plain, contrast and double contrast Ultrasonography If nothing found = FIC
64
How does non-obstructed FIC present?
Signs of LUTD - pollakiuria, strang/dysuria, haematuria Still able to void Often self-limiting May experience recurrent episodes
65
How does obstructed FIC present?
Urethral spasm or plug Unproductive attempts to urinate More common in males, high recurrence rates (>40% within 6-12 months)
66
How do we care for a urinary catheter?
``` Closed, clean system Wear gloves for handling Keep bag off the floor Keep connections clean Change bag daily Avoid antibiotics Tape collection system to tail to avoid pulling Buster collar ```
67
What should we monitor post-catheterisation?
Urine output - ins vs outs Hydration/volaemia status Electrolytes Urine sediment/cytology (infection?)
68
What factors can we manage to help manage FIC?
Medical management Environmental modification Promote urinary health Antispasmodics
69
How can we modify the environment to help FIC?
Alleviate predisposing stressor Address negative cat-cat interactions Resource availability Feliway
70
How can we promote urinary health to help FIC?
Encourage water intake Dietary modification - wet diets/urinary diets (anti-anxiety compounds) Avoid obesity GAG supplementation
71
What are some examples of neurogenic incontinence?
Upper motor neurone lesion - spastic bladder, difficult to express Lower motor neurone lesion - flaccid bladder, easy to express Both lead to overflow incontinence
72
What are some examples of non-neurogenic incontinence?
Urethral sphincter mechanism incompetence Anatomical defects, e.g. ectopic ureters - frequent dribbling, risk of ascending infection Urge incontinence - detrusor instability due to bladder disease Dyssynergia - failure of coordination of bladder contraction with urethral relaxation
73
How can Urethral Sphincter Mechanism Incontinence (USMI) be treated?
Alpha-agonists = sympathomimetic Oestrogens Urethral cuffs Surgical repositioning of intrapelvic bladders

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