Urolithiasis in Ruminants and Camelids (Carman)

Question 1

(T/F) Ruminant urine is normally alkaline, due to their hay-based diet

Answer 1

True

Question 2

___________ urine is a predisposing factor for precipitation of many different crystal types

Answer 2

Alkaline

Question 3

Ruminants or camelids on high grain diet will have a urinary pH _______ than those on hay-only diets

Answer 3

Lower

Question 4

(T/F) Since ruminants have an alkaline urine pH, trace or 1+ protein is considered to be positive using urine dipsticks

Answer 4

False, False positive

Question 5

What are some of the drugs that can cause glucosuria un ruminants?

Answer 5

Alpha-2 agonists such as xylazine

Question 6

List predisposing factors for the development of clinical urolithiasis in ruminants/camelids:

Answer 6

• Male
• Inappropriate Ca:P
  - should be 2:1
  - High phosphorus diet -> Grain
  - High calcium diet -> Alfalfa
• Poor water management/ Weather

Question 7

What helps male ruminants develop wider urethral diameter?

Answer 7

Testosterone influence (age)

Question 8

What age range of animals is less likely to develop Ca carbonate type stone?

Answer 8

Young ruminants

Question 9

(T/F) Female>Males ruminants have longer, narrower urethra

Answer 9

False

Question 10

(T/F) Silicate & oxalate stones are common in Ohio

Answer 10

False

Question 11

(T/F) In both males and females, they have a urethral diverticulum

Answer 11

True

Question 12

In males, what are the two most common places where stones will get lodged and cause a problem?

Answer 12

• Urethral Process
• Distal Sigmoid flexure

Question 13

What is the following describing?
- Blind Pouch
- Ischial arch
- Retrograde passage of the urinary catheter
- <50% success
- Ball-valve effect

Answer 13

Urethral diverticulum

Question 14

What is the following describing?
- Extension of the urethra at the distal tip of the penis
- Narrowed diameter
- Young animals may adhere to the prepuce
- Amputation of process
- Often first step in tx
- no effect on breeding

Answer 14

Urethral process

Question 15

What is the following describing?
- Site for retractor penis mm. insertion
- Tight turn, decreased diameter

Answer 15

Distal Sigmoid flexure

Question 16

What are the two stones most commonly seen in Ohio?

Answer 16

• Struvite
• Calcium Carbonate

Question 17

What is the following describing?
- Magnesium ammonium phosphate
- Conditions
- Diets high in P, low in Ca (low Ca:P)
- Alkaline urine
- “coffin lid” crystals
- gritty white-tan sand
- NOT radiopaque

Answer 17

Struvite

Question 18

What is the following describing?
- Formed preferentially with high calcium ingestion
- spherical
- RADIODENSE
- Survey radiographs help w/ tx plan
- CaCO3

Answer 18

Calcium Carbonate

Question 19

What is commonly mistaken for struvites?
- Can be problematic for treatment/prevention recommendation

Answer 19

Amorphous magnesium calcium phosphate (AMCP)

Question 20

In relation to bloodwork diagnostics, what is going to give you the most information?

Answer 20

A chemistry
- +/- dehydration
- Azotemia
- Abnormal K
- decreased P
- decreased Na
- decreased Cl

Question 21

What are some values that you would most likely see in a Urobdomen?

Answer 21

• increased PCV/TP
• increased BUN & creatinine
• increased K

Question 22

(T/F) Hyperkalemia is not an emergency

Answer 22

False

Question 23

Treatment of hyperkalemia:
- NO direct effect on K+, but it is cardioprotective
- Calcium can counteract the bradycardia by shifting the membrane potential to be less negative, making it more excitable and easier to contract

Answer 23

Calcium gluconate

Question 24

Treatment of hyperkalemia:
- Will encourage the pancreas to produce insulin in response to extra glucose
- Insulin will drive potassium into the cell through the action of the Na+/K+ ATPase pump

Answer 24

IV dextrose

Question 25

Treatment of hyperkalemia: - Can be given, directly stimulating the action of the Na+/K+ ATPase pump and pumping K+ ions

Answer 25

Insulin

Question 26

Treatment of hyperkalemia: - Can affect K+ in two ways: - increases blood pH, K+ moves into the cell via the H+/K+ exchanger so that pH neutrality can be maintained by adding an acid molecule to the system - Increased blood pH facilitates K+ excretion in the urine

Answer 26

Sodium bicarbonate

Question 27

Treatment of hyperkalemia: - Will encourage renal potassium excretion in small amounts - Dilution is the solution to pollution!

Answer 27

Diuresis

Question 28

Diagnostic - imaging - about 85% of cases - Assessment of bladder size, rupture

Answer 28

Ultrasound

Question 29

Diagnostic - imaging - about 60% of cases - Radio-opaque vs radiolucent stones

Answer 29

Plain radiography

Question 30

What are the treatment goals?

Answer 30

1. Stabilize 2. Allow for decompression of the bladder 3. Diuresis/ waste removal 4. Restore functionality to the urinary tract

Question 31

Regarding treatment options, what do we do in every case?

Answer 31

Urethral process amputation

Question 32

What treatment option will you consider for the following: - Intact urethra, complete obstruction

Answer 32

- Tube cystostomy - PU = perineal urethrostomy (inappropriate for breeding males) - Urethrotomy

Question 33

What treatment option will you consider for the following: - Intact urethra, partial obstruction

Answer 33

- Medical management - Tube cystostomy - PU

Question 34

What treatment option will you consider for the following: - Urethral rupture

Answer 34

- Tube cystostomy - PU

Question 35

Medical management - Only works for dissolvable stones - Ammonium chloride (can be a risk)

Answer 35

Urine Acidification

Question 36

Medical management - Acepromazine - Midazolam

Answer 36

Urethral relaxation

Question 37

(T/F) 80%-90% of these animals are still "blocked" after a urethral process amputation

Answer 37

True

Question 38

A ruminant on a high-grain diet will be predisposed to forming this type of stone

Answer 38

Struvite

Question 39

A ruminant on a diet of primarily alfalfa will be predisposed to this type of stone

Answer 39

Calcium carbonate

Question 40

This type of stone can easily be confused for struvite on a macroscopic level

Answer 40

Amorphous magnesium calcium phosphate