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Flashcards in Urinary tract disease 3 Deck (93)
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1

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

2

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

3

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

4

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

5

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

6

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

7

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

8

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

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

9

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

10

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

11

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)

12

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

13

Outline hypokalaemic nephropathy

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

14

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

15

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_

16

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

17

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

18

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)

19

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

20

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

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

21

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

- Prostatic disease
- USMI
- Detrusor instability
- Neurogenic disorders

22

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

23

What are the main causes of urinary incontinence in cats?

- USMI
- Overflow
- Neurogenic disorders
- FeLV associated

24

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

25

Identify non-neurogenic causes of urinary incontinence

- USMI
- 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

26

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

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

27

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

Increases stimulation of alpha-adrenergic receptors to improve urethral tone

28

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

29

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

- Administer q4-24 hours
- Short residual effects

30

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

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