Urinary tract disorders in horses (Reuss) Flashcards Preview

Urology > Urinary tract disorders in horses (Reuss) > Flashcards

Flashcards in Urinary tract disorders in horses (Reuss) Deck (31):
1

Uroperitoneum about

  • Bladder, urethral (perineal, preputial edema), urachal (subcutaneous edema around umbilicus, ureteral (retroperitoneal)
  • Colts >>>fillies
  • birth trauma, congenital abnormality, sepsis
  • Adults - rare

2

Uroperitoneum CS

  • CS
    • abdominal distension, colic
    • stranguria, pollskiutis
    • lethargy, depression, anorexia

*A colt that can urinate through his penis doesn't R/O uroperitoneum

3

Uroperitoneum

Lab abnormalities

  • Lab abnormalities
    • post-renal azotemia
    • hyponatremia,hypochloremia
    • hyperkalemia
  • Abdominocentesis
    • peritoneal creatinine > 2x serum creatinine

4

Uroperitoneum TX

  • medical treatment
    • IV fluids
      • 0.9% NaCl + 5% dextrose 
        • hypoglycemia and
        • pushing K+ intracellularly
      • Calcium gluconate, Sodium bicarbonate
    • antimicrobials
    • abdominal drainage
  • surgical correction

5

urolithiasis about

  • geldings, mean age 10y
  • cystoliths >> urethrolith > nephrolith > ureterolith
  • Nucleation
    • Nidus
      • UTI?
      • NSAID tox
    • Urine stasis
  • Crystallization
    • alkalinity + CaCO3
    • overcome mucus

6

Urolithiasis stones

  • Calcium carbonate
  • Calcium phosphate

7

urolithiasis

CS

  • Cystoliths
    • hematuria post-exercise
    • stranguria, incontinence
    • recurrent colic
  • nephrolith, ureterolith
    • silent until bilateral obstructive disease and CRF

8

Urolithiasis

DX

  • Rectal palpation
    • feeling a ureter is bad, throw a rectal U/S probe on it
  • ultrasound
  • cystoscopy

9

Urolithiasis

TX

  • Mares
    • manual removal
      • crushing
      • lithotripsy
      • urethral sphincterotomy
  • Males
    • pararectal cystotomy
    • perineal urethrostomy
      • lithotripsy, manual crushing
    • cystotomy
      • paramedian, ventral midline
      • laparascopic
  • Flank approach
    • nephrectomy
    • ureterotomy

10

Urolithiasis

Medical TX

  • Medical tx
    • bladder lavage
    • antiinflammatories (PROBS NOT NSAIDS)
    • antimicrobials if urine cultured
    • encourage water consumption
    • eliminate legumes
    • lower DCAD to lower urine pH
      • urinary acidifiers unproven
    • 41% recurrence within 1-32 months

11

Hematuria

  • centrifuge urine to differentiate from pigmenturia
    • hematuria forms pellet
    • hemoglobinuria stays in soln
  • When in stream?
    • throughout
      • kidneys
      • bladder
    • beginning of urination
      • distal urethra
    • end urination
      • proximal urethra

12

adenocarcinoma

  • hematuria, weight loss, colic
  • unilateral, no azotemia
  • nephrectomy

13

Idiopathic renal hematuria

about

  • sudden onset, life-threatening hematuria
    • multiple episodes
  • blood clots from one or both kidneys
  • no age, sex predisposition
  • > 50% arabians
  • PE: acute blood loss
  • No systemic dz

14

Idiopathic renal hematuria

diagnostic plan

  • rule out
    • renal adenocarcinoma
    • coagulopathy
  • Azotemia uncommon
  • endoscopy
  • ultrasound
  • TX
    • supportive care
      • blood transfusion
      • medications to promote hemostasis
        • aminocaproic acid, formalin (no evidence)
    • unilateral nephrectomy
      • often bilateral dz
    • dexamethasone
      • anecdotal evidence

15

Hematuria

bladder

  • Cystolith
  • neoplasia
  • blister beetle toxicity

16

cantharidin

  • cantharadin
    • 1mg/kg (6-8 beetles) can be toxic
    • potent irritant
      • GI and oral mucosa
      • cystitis, nephrosis
      • myocarditis
  • Diagnosis
    • hypocalcemia, hypomagnesemia, azotemia
    • GI contents or urine
    • ID beetle in hay
  • TX
    • fluid and electrolyte support, analgesia (not NSAIDS)
    • charcoal, biosponge
    • Mineral oil is contraindicated (may potentiate absorption)

17

Hematuria

Urethra/external genitalia

  • Neoplasia
    • squamous cell carcinoma
    • sarcoid
  • habronemiasis
    • summer sore
    • local hypersensitivity
    • sulfur granules
    • treatment
      • ivermectin, steroids, fly control

*need to submit histo to tell the difference between these two

18

Hematuria

Urethral Tear

  • At level of ischial arch, dorsocaudal aspect
  • hemospermia, hematuria
    • end urination
    • bright red
  • no pollakiuria, dysuria
  • quarter horse geldings overrepresented
    • and stallions hemospermia
  • blowout of corpus spongiosum into urethra
  • DX
    • HX
    • endoscopy (normal bladder, back out and find tear)
  • TX
    • benign neglect
    • subischial/perineal urethrotomy
    • buccal mucosal graft (for stallions, blood kills sperm)

19

Bacterial Cystitis

  • Rare in horses
    • more common in mares
  • CS: Dysuria pollakiuria, hematuria
  • DX: UA/ Culture
    • Sediment
      • +/- > 10 wbc/hpf, bacteriuria
      • > 10,000 cfu/ml midstream or catheterized
  • Etiology: G- enterics; mixed
  • TX
    • trimethoprim sulfonamide or penicillin or ceftiofur
    • diuresis
    • acidify urine - no shown effective method

20

Pyelonephritis

  • less common than bacterial cystitis
  • Etiology
    • secondary to ectopic ureter, bladder paralysis, nephrolithiasis = G-
    • bacteremia
      • actinobacillus, strep equi, salmonella
  • Systemic illness + dysuria, hematuria
  • DX: US, cystoscopy, culture
  • TX: Antibiotics, nephrectomy

21

Urinary incontinence

UMN

LMN

  • upper motor neuron
    • inc urethral resistance
    • pollakiuria, sporadic dribbling
    • spinal cord lesions
  • lower motor neuron
    • relaxed bladder and sphincter, continuous dribbling
    • cauda equina syndrome
      • loss of anal/tail tone, perineal analgesia, hind limb weakness/ataxia
    • Etiologies
      • trauma
      • EHV-1 myeloencephalitis
      • Sorghum/Sudan grass toxicity
        • Ataxia and cystitis
        • Cyanide tox?!

22

Urinary incontinence

Myogenic bladder

  • Idiopathic or secondary obstruction
  • Weight of sediment stretches detrusor
    • tight junctions broken down
    • inability to depolarize, cannot maintain sphincter
    • accumulate sabulous debris: sand stuff

23

Sabulous cystitis

TX

  • TX: nothing really works
    • culture urine/treat bact cystitis
    • lavage bladder
    • stimulate bladder emptying
      • bethanechol

24

Ectopic Ureter

  • Usually not clinical in males
    • may go unnoticed in males
  • Constant urine dribbling

25

Polyuria / Polydipsia

  • urine output > 50 ml/kg/day
  • water consumption > 100 ml/kg/day
    • > 50 L/day
    • dependent on diet, exercise, activity, repro status

26

Water Deprivation Test

  • baseline bloodwork: don't water restrict if azotemic; UA; body weight (5% BW loss)
  • check at 6, 12, 24 hrs
  • Stop when 5% of body weight is lost
  • Should concentrate USG > 1.025
    • medullary washout
      • modified water deprivation test
      • 40 ml/kg/day for 3-4 days

27

Diabetes Insipidus

  • Neurogenic (central)
    • loss of hypothalamic neurons => dec vasopression secretion
    • secondary to ecephalitis
  • Nephrogenic
    • collecting duct insensitive to vasopressin
  • Vasopressin concentration test
    • 60 IU in oil
    • SG > 1.020 = neurogenic

28

Q image thumb

A image thumb
29

Pituitary pars intermedia dysfunction

  • frequently causes PU/PD
  • Impingement on hpothalamus and posterior pituitary
  • cortisol antagonism of vasopressin
  • hyperglycemia and osmotic diuresis

30

Renal Failure

  • can cause PU/PD
  • Recovery from AKI, CKD
    • inc tubular flow
    • medullary washout
    • impaired response to vasopressin

31

Causes of PU/PD

  • Psychogenic
  • DIabetes Insipidus
  • PPID
  • Renal Failure
  • Sepsis
  • alpha-2 agonists
    • zylazine
    • detomidine