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Flashcards in Urinary tract disease 3 Deck (93)
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Outline the clinical signs of lower UTI

- May be none
- Stranguria/dysuria, pollakiuria
- Urine scalding
- Pyuria, haematuria
- Bladder may be painful on palpation, thickened
- Abdominal pain


Outline the clinical signs of an upper UTI

- May be none, often non-specific
- May be pyrexic, abdominal pain
- Kidney may be enlarged, painful
- PUPD or signs of renal failure possible
- Anorexia, inappetance
- Sudden death in pigs


Discuss the diagnosis of a UTI

Urinalysis: cysto if poss
- Dipstick: blood, WBC, alkaline pH (but not always)
- Urine sediment: large no.s of WBCs, bacteriuria
- Urine culture: definitive diagnosis, ideally prior to treatment
- Antimicrobial sensitivity: ideal, but not always practical

Blood tests and imaging not so useful inless ruling out upper UTI
- may or may not see signs of inflammation on haematology, may see evidence of renal compromise
- Ultrasonography good for identifying pyelonephritis

Microbial identification
- Not generally performed
- MaldiTof may become more common


Outline the basic approach treatment of UTIs

- Generally empirical therapy first (impractical to wait for results)
- Empirical: TMPS, Beta lactams, fluoroquinolones
- 7-14 day course for uncomplicated UTIs, 4-6 weeks if complicated (pyelonephritis, prostatitis, recurrent)
- C+S at end before stopping


Discuss the advantages and disadvantages of using TMPS for treatment of a UTI

- AD: good prostate penetration, achieves high concentrations in urine, cheap
- Disad: crystals form in kidney if animal poorly hydrated/renal function compromised, immune mediate hypersensitivity reactions in Dobermann


Discuss the advantages and disadvantages of using betalactams for the treatment of a UTI

- Ad: amoxyclav effective against most bacteria, good first line in most cases
- Disad: widespread resistance in some areas, potential for penicillin allergy, not for use in hind-gut fermenters e.g. guinea pigs


Discuss the use of fluoroquinolones for the treatment of a UTI

- Good penetration, may be first choice in entire males
- But critically important in humans, avoid use where possible
- May have effects on tendons, cartilage, CNS


What antibiotics are most appropriate for empirical treatment of these scenarios?
A: cystitis in a dog
C: prostatitis
D: pyelonephritis

A: Amoxyclav, TMPS
B: None - usually not needed
C: TMPS, fluoroquinolones
D TMPS, fluroquinolones, amoxyclav


What are the main causes of recurrent UTIs?

- Failure of initial therapy e.g. discontinued too early, antibiotic resistance
- Re-infection (predisposing causes e.g. immunosuppression, anatomical abnormality)
- Involvement of upper urinary tract


Outline your approach to a recurrent UTI

- C+S
- Assess for upper tract involvement: definitive rule out requires urine collection from ureter/renal pelvis, but may be seen on ultrasound as dilated renal pelvis, or on bloods as renal compromise
- Follow therapy with C+S to assess success, must be negative before stopping
- Consider nephrectomy if only one affected


Discuss the use of urinary acidification for the treatment of UTIs

- Urease producing bacteria alkalinise urine
- Unclear as tobenefit of acidification
- Common in humans: ammonium chloride, vit C, cranberry juice
- Best bet is to ensure adequate hydration (avoid diuresis with drugs, may predispose to infection)


Discuss potassium supplementation in cats and dogs and give examples of products

- Oral or IV possible
- IV: potassium chloride to IV fluids, must be well mixed and clearly labelled, do not infuse faster than 0.5mmol/kg/hr, monitor continuously with ECG
- Oral: Ipakitine, Kaminox, safe if eating or feeding tube in place


Outline hypokalaemic nephropathy

HypoK leads to impaired responsiveness to ADH, leads to PU and further renal losses


At what level is hyperkalaemia a cause for great concern

- When ECG abnormalities are evident
- Or >6.5mmol/l (normal range 3.5-5.5mmol/l)
- Myocardial toxicity occurs at 7.5mmol/l


Outline the treatment of hyperkalaemia

- IV calcium gluconate (0.5-1.5ml/kg 10% soln over 5-10 mins)
- Regular soluble insulin with dextrose
- Sodium bicarb (rarely, only if acid base can be monitored)
- Terbutaline (stimulates NaK ATPase to translocate K+ intracellularly_


Outline the treatment of hyperphosphataemia

- Diet most effective way of controlling increased phosphate in CRF patients.
- Calcitriol can be used once hyperphosphataemia has been resolved to help reduce PTH


What is the mechanism of action of benazepril hydrochloride?

- ACE inhibitor, blocks effects of angiotensin II and aldosterone
- Prevents vasoconstrition, retention of sodium and water and remodelling effects in kidney
- Normalises glomerular capillary pressure and reduces systemic blood pressure


Outline the initial approach to NSAID intoxication

- Assess cardiovascular function
- Take blood sample for haem and biochem (assess potassium status)
- IVFT (0.9% NaCl)
- Ideally urinary catheter to accurately measure urine output
- Monitor blood pressure
- If olig/anuric consider diuretics (mannitol, loop diuretics e.g. furosemide)


Outline some complications and contraindications that may occur as a result of diuretic use in an anuric/oliguric patient

- Mannitol: may result in hyponatraemia, care in patients with electrolyte abnormalities. Contraindications include intracellular dehydration, hypovolaemia


What are the main causes of urinary incontinence in adult bitches?

- Detrusor instability
- Vaginal pooling
- Lower UTI
- Neurogenic disorders


What are the main causes of urinary incontinence in adult male dogs?

- Prostatic disease
- Detrusor instability
- Neurogenic disorders


What are the main causes of urinary incontinence in juvenile dogs?

- Ectopic ureter
- Urethral or bladder hypoplasia
- Congenital USMI
- Vaginal anomalies
- Intersex disorder
- Patent urachus


What are the main causes of urinary incontinence in cats?

- Overflow
- Neurogenic disorders
- FeLV associated


Identify the neurogenic causes of urinary incontinence

- Sacral fracture
- Pelvic nerve/plexus trauma
- Lumbosacral disease e.g. IVDD, lumbosacral stenosis, neoplasia
- Sacral malformation (Manx cat)
- FeLV associated
- Generalised peripheral lower motor neuron disease
- Dysautonomia


Identify non-neurogenic causes of urinary incontinence

- Urethral hypoplasia
- Lower urinary tract inflammation
- Detrusor instability
- Ectopic ureter
- Partial outflow obstruction e.g. uroliths, neoplasia, polyps
- Patent urachus
- Vestibulovaginal stenosis/septumm
- Primary detrusor atony with overflow


What are the 2 treatment options for urinary sphincter mechanism incompetence?

- Sympathomimetics (phenylpropanolamine e.g. propalin, urilin)
- Oestrogens (estriol e.g. incurin)


Outline the mechanism of action of sympathomimetics for the treatment of USMI

Increases stimulation of alpha-adrenergic receptors to improve urethral tone


Outline the indications and contraindications for sympathomimetics for the treatment of USMI

- Indications: males or females, dogs or cats, poor response to oestrogen
- Contra: hypertension, some cardiac diseases, anxiety disoders


Give the administration frequency and residual effect duration of sympathomimetics used for the treatment of USMI

- Administer q4-24 hours
- Short residual effects


Outline the adverse effects of sympathomimetics used for the treatment of USMI

- Hyperactivity
- Hypertension
- Anxiety
- Tachycardia
- Anorexia
- Weight loss