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Leah URO > Week 7 > Flashcards

Week 7 Flashcards

1
Q

Calculate RER for a pregnant 30kg dog

(early stage pregnancy factor = 1.8)

A
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2
Q

When should a pregnant bitches feed intake be increased?

A

during last 3rd of pregnancy when the foetuses rapidly put on weight

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3
Q

How much additional weight should a bitch gain in percent between mating & whelping

A

15-25%

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4
Q

What is the percentage increase in demand for Ca and P in the last 35 days of pregnancy and why?

A

60% increase due to rapidly developing skeletons of the foetuses

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5
Q

What is the expected weight gain for a pregnant cat?

A

~40% of pre-pregnant BW
~5% per week

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6
Q

Describe diet for a pregnancy cat into lactation

A

Normal diet first 2-3 weeks after mating

Increase energy requirement with ad lib kitten food for remaining pregnancy and lactation

supplement with taurine to prevent abortion

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7
Q

What can be done to make transition from liquid to solid/semi-solid diet in puppies/kittens?

A

Dry food or canned food can be mixed with milk/milk replacer

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8
Q

What is different in cat a renal diet compared to a normal diet

A

Reduced phosphorous to slow renal deterioration

Moderate protein restriction to reduce clinical signs caused by uraemia (but adequate to prevent breakdown of lean body mass for AAs)

Potassium to prevent hypokalaemia

Vitamin B for polyuria

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9
Q

What is food aversion

A

Learned behaviour associated with negative experiences

e.g. GI upset, stressful experiences like force feeding)

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10
Q

How can nutrition be maintained in animals that cannot eat?

A

supportive enteral feeding
Naso-oesophageal feeding
Oesophagostomy tube
Gastrotomy feeding
Liquid renal diets

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11
Q

define oliguria

A

low urine output

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12
Q

What dietary modifications can you use to prevent/treat urinary crystals

A

Reduce intake of minerals directly related to crystal type found

Adjust pH of urine to an uncomplimentary level for the crystal found

Control calorie intake to maintain healthy weight

Increase water intake and urine output

Calcium stones will need to be removed surgically

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13
Q

What is the normal urination/defecation posture for cattle

A

standing
lift tail
hunched back

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14
Q

How do dogs use elimination behaviour to signal breeding information

A

females urinate in presence of males

Males can tell if female is in heat by her faeces

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15
Q

How do dogs use elimination behaviour for territorial marking

A

females & (esp.) males urinate on vertical objects

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16
Q

What is the normal urination/defecation posture for dogs

A

defecate:
- squat, arch back & raise tail

urinate:
- males raise 1 leg
- females squat

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17
Q

How do cats use elimination behaviour for territorial marking

A

spray urine containing their scent on walls

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18
Q

What is the normal urination/defecation posture for cats

A

squat with raised tail to defecate

squat without raised tail to urinate

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19
Q

Do cats have a preference for which sites to eliminate in

A

preferred substrate

litter tray separate from other social groups

secluded, quiet place

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20
Q

How do horses use elimination behaviour to signal breeding information

A

stallions mark over mare’s faeces

females urinate in presence of stallion

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21
Q

How do horses use elimination behaviour for territorial marking

A

males leave stud piles

mare’s urinate over other unknown mare’s faeces

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22
Q

What is the normal urination/defecation posture for horses

A

urinate by standing, leaning forward with limbs extended backwards

defecate by standing with tail raised

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23
Q
A
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24
Q

What is middening behaviour in meerkats, badgers etc

A

use of communal latrines for territory marking/communication

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25
Q

What is renal clearance of drugs

A

volume of plasma containing the drug removed by the kidney per unit time

Cu = urinary concentration
Vu = rate of flow of urine
Cp = plasma concentration

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26
Q

What are the 3 fundamental processes in renal clearance of drugs

A
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27
Q

Describe the renal clearance of drugs

A
  1. glomerular filtration of drugs
    - Most drugs are small so can cross glomerulus freely
    - Drugs bound to albumin cannot cross
  2. tubular secretion of drugs
    - Drugs can be transferred into tubular lumen by non-selective carrier systems:
    * organic anion transporter (OATs) - acidic drugs against electrochemical gradient
    * organic cation transporters (OCTs) - organic based drugs down gradient
  3. passive tubular resorption of drugs
    - Lipid soluble drugs are poorly excreted as they are reabsorbed
    - Drug excretion is influenced by degree of ionisation and urinary pH:
    * ionised drugs cannot cross plasma membrane
    * acidic drugs are more rapidly excreted if urine is alkaline
    * basic drugs are more rapidly excreted if urine is acidic
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28
Q

How can aminoglycosides cause nephrotoxicity

A

Cause tubular cell toxicity by:
- accumulating in lysosome of PCT epithelial cells
- impair mitochondrial function => increasing oxidative stress and free radicals
- interfere with tubular transport

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29
Q

Describe the interactions between NSAIDs & the kidney

A

Prostaglandins dilate afferent arteriole

NSAIDs (COX2 inhibitors) block prostaglandin production => decrease blood flow to kidneys => acute kidney injury

NSAIDs can induce an immunological reaction after a period of exposure => inflammatory cells infiltrate kidney interstitium => acute interstitial nephritis => AKI

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30
Q

How can a non-toxic drug cause toxicity due to dosage?

A

Multiple repeated doses results in increasing plasma concentration and potentially toxicity

Decreasing dose frequency allows levels to return to normal

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31
Q

Why is drug clearance important consideration in elderly patients or those with renal disease

A

Drugs removed predominantly by renal excretion are liable to cause toxicity

Polar drugs remain in lumen and get progressively more concentrated - these drugs need special care in patients with renal dysfunction

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32
Q

What are diuretics

A
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33
Q

Why do we need diuretics?

A
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34
Q

What are the different groups of diuretics

A

Osmotic diuretics
Loop diuretics
Thiazides
Amiloride
Spironolactone

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35
Q

Describe the mechanism of action of osmotic diuretics

A

Indirectly act on cells of nephron:
- drug is filtered in glomerulus but cannot be reabsorbed
- increase the osmolarity of filtrate in PCT, descending limb & collecting ducts
- water is retained in urine to maintain osmotic balance
- => decreases concentration Na+ in lumen and decreases reabsorption of Na+

IV administration

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36
Q

What is the effect of osmotic diuretics if given orally

A

Will not be absorbed &
cause water to be retained in intestines => diarrhoea

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37
Q

What are the indications of osmotic diuretics (mannitol)

A

forced diuresis (intoxication, impending kidney failure)

Emergency treatment of acutely raised intracranial or intraocular pressure

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38
Q

What are the unwanted effects of osmotic diuretics (mannitol)

A

transient expansion of extracellular fluid volume

hyponatraemia (acute)

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39
Q

Describe the mechanism of action & use of Carbonic anhydrase inhibitors

A
  1. Block reaction of CO2 with H2O
  2. Thus prevents Na+/H+ exchange & HCO3- reabsorption in proximal convoluted tubule & Na+ absorption is also reduced
  3. Increased HCO3- in filtrate opposes water reabsorption

Used for:
- glaucoma, idiopathic intracranial hypertension, altitude sickness

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40
Q

Describe mechanism of action of loop diuretics

A

Act from within the tubule:
- Na+, K+ and Cl- enter blood by a co-transport system
- loop diuretics act on NKCC2 symporter in the thick ascending loop of LoH
- inhibits Na, K and Cl reabsorption => diuresis

Interfere with tubular feedback control of GFR => no decrease of GFR

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41
Q

Describe pharmacokinetics of loop diuretics

A

Tightly bound to plasma protein:
- do not pass directly into glomerular filtrate
- secreted into tubule by organic anion transporters
- action reduced if proteinuria is present

Rapid onset of action - 30 mins after administration

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42
Q

What are the unwanted side effects of loop diuretics (e.g. furosemide)

A

excessive water loss

Na and K loss following long-term use

Hypocalcaemia

Adaptive changes in circulation - RAAS activation

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43
Q

What are the indications of loop diuretics (e.g. furosemide)

A

Oedema
heart failure
Forced diuresis (intoxication, renal failure)

44
Q

Describe the mechanism of action of thiazides

A

Act from within tubule:
- bind to Cl- site of distal tubule Na/Cl co-transport system
- inhibit Na+ reabsorption
- inhibit water reabsorption

45
Q

What are the unwanted side effects of thiazides

A

adaptive changes in circulation

K loss following long-term use

46
Q

What are the indications of thiazides

A

oedema
heart failure

47
Q

What is the mechanism of action of potassium-sparing diuretics (e.g. Triamterene and amiloride)

A

Act from within tubule:
- directly block epithelial Na+ channel
- inhibits Na+ reabsorption in collecting ducts
- promotes loss of Na+ and water without depleting K+

48
Q

What are the unwanted side effects of potassium sparing diuretics

A

hyperkalaemia because K is retained

49
Q

What is the mechanism of action of aldosterone antagonists (e.g. Spironolactone) (diuretics)

A

Act from within tubule:
- tubule cells are impermeable to Na+ in absence of aldosterone
- spironolactone competes with aldosterone at its receptor
- causes mild diuresis and potassium retention

50
Q

Describe the pharmacokinetics of spironolactone (aldosterone antagonist)

A

Well absorbed after oral administration and extensively metabolised by the liver to active metabolite

Slow onset of action - effects peak after 2-3 days

51
Q

What factors can exacerbate CKD?

A
52
Q

How does hyperphosphataemia exacerbate CKD & how can we treat it?

A

Mechanism:
- GFR reduction reduces phosphate excretion (system copes initially due to PTH)
- Once overwhelmed Ca and P build up
- Mineralisation of tissues including kidney
- Mineralisation + PTH => worsens CKD

Treatment:
- restricted phosphate intake (renal diets)
- Oral phosphate binders
* Aluminium hydroxide
* Calcium carbonate
* Calcium acetate
- Calcitriol therapy

53
Q

How does systemic hypertension exacerbate CKD & how can we treat it?

A

Mechanism:
- Renal disease predisposes hypertension:
* RAAS altered Na handling
* excessive SNS activation
- Kidney is main target organ of hypertensive damage
- Glomerular hypertension => glomerular sclerosis => proteinuria => progresses CKD

Treatment:
- Dietary sodium restriction (renal diet)
- Anti-hypertensive drugs
* ACEi (e.g. benazepril)
* Ang II receptor blockers (e.g. telemartizan)
* Dihydropyridine Calcium Channel Blockers (e.g. amlodipine besylate)

54
Q

How does proteinuria exacerbate CKD & how can it be treated

A

Mechanism:
- protein processing by proximal tubular cells => increase in pro-inflammatory mediators
- Tubulointerstitial inflammation => structural disease

Treatment:
- reduced protein diet
- polyunsaturated fatty acids (PUFA) - calms inflammation
- Pharmacological reduction in GFR
* e.g. ACEi

55
Q

How do hypoperfusion, hypoxia & ischaemia exacerbate CKD & how can they be treated?

A

=> inflammation, oxidative stress, increased damage

treatment:
- hydration
- PUFA

56
Q

How can hypokalaemia caused by CKD be treated?

A

supplementation in renal diets

57
Q

How can metabolic acidosis caused by CKD be treated?

A

prescription diets are alkalinizing

58
Q

How can inappetance/nausea caused by CKD be treated?

A

H2 blockers (e.g. cimetidine)

Protein pump inhibitors (e.g. omeprazole)

Maropitant citrate (cerenia)

Appetite stimulators (mirtazepine)

59
Q

what are the main attributes of prescription renal diets for CKD?

A

Low protein (high quality protein)
Reduced Na
Restricted phosphate
Alkalinising
PUFA (antioxidants)

60
Q
A
61
Q

How can AKI & pre-renal azotaemia be differentiated

A

Pre-renal azotaemia usually has hypersthenuria

62
Q

What is acute renal failure

A

Result of AKI

Azotaemia with inability to concentrate urine

63
Q

What is the treatment for AKI?

A

Aim: minimise damage & buy time for tubular repair

replace fluids to improve renal perfusion and reduce ongoing hypoxia/ischaemia

Monitor and correct electrolytes and acid-base

Maybe instigate controlled diuresis once hydrated

64
Q

How do you treat struvites

A

Antibiotics

Urinary acidifiers (struvites like alkaline environment)

NSAIDs if signs of inflammation/discomfort

65
Q

How do you treat calcium oxalate crystals

A

promote hydration

alkalinise urine via diet

66
Q

describe urate stones in dogs & the treatment

A

due to Purine metabolism alteration => uric acid in urine

Treatment:
- xanthine oxidase inhibitors
- protein restriction
- promote hydration

67
Q

What are treatment options for feline non-obstructive idiopathic/interstitial cystitis (FIC)

A

Opiates or NSAIDs for pain and inflammation

Diet, hydration and antibiotics for urolithiasis

Behavioural support

Surgery, chemotherapy or NSAIDs for neoplasia

68
Q

Name some common causes of AKI

A
69
Q

Why might general anaesthesia contribute to kidney injury

A

can cause hypotension & hypovolaemia which reduce renal perfusion & thus kidney function

drug reactions

70
Q

Why do cats mark/spray?

A

Sexual behaviour - advertise presence and availability

Reactional behaviour - results of change in environment
- Anxious cat makes area smell like themself to reduce anxiety

71
Q

Define pigmenturia

A

presence of component that causes abnormal color to urine

72
Q

define periuria

A

urination outside litter box/ house soiling

73
Q

What are the 5 pillars of a healthy environment for cats

A
  1. provide safe place
  2. multiple separated key resources
  3. Provide opportunity for play & predatory behaviour
  4. Provide positive, consistent & predictable human-cat social interactions
  5. Provide environment that respects importance of cat’s sense of smell
74
Q

What are examples of medical issues are associated with latrine problems in cats?

A

Renal insufficiency
Hepatic disease with UTI

75
Q

What are examples of medical issues related to spraying problems?

A

renal insufficiency
Idiopathic cystitis
diabetes
Urolithiasis

76
Q

Where are feline latrine areas typically located?

A

periphery of territory

quiet or secluded area

different for urination and defecation

on soft rakeable substrates

77
Q

Where are feline marked areas typically located?

A

areas of prominence/significance

separate to latrine areas

78
Q

What are the principles of cleaning areas of house soiling?

A

Biological/enzymatic cleaner

rinse off with water

Wipe with surgical spirit

allow to dry

DO NOT use bleaches or ammonia based detergents

79
Q

Why might a cat be spray marking?

A

High arousal (sexual or reactional)

Stressors in environment

80
Q

What are the treatment options for feline spray marking?

A

physical intervention (neutering)

Psychological therapies

Chemical therapies

Environmental manipulations:
- L-shaped litter box
- pheromonal products
- controlling the stressor

81
Q

Describe causes of cat latrine behaviour issues

A

Medical disorders

Latrine aversion:
- litter box size
- substrate
- location

Substrate preference

Inadequate house training

Lack of indoor latrine

82
Q

Describe treatment for latrine behavioural problems in cats

A

Restriction:
- ensure resources are available to all cats
- confine for short periods

Resolution:
- address cause e.g., stressor
- create attractive latrine area
- retrain

83
Q

Describe possible medical causes of elimination problems in dogs

A

Neoplastic - bladder tumours

Metabolic disorders - diabetes

Dietary - obesity

Pain related

Infectious/inflammatory - urolithiasis

Neurological

84
Q

Describe possible behavioural causes of elimination problems in dogs

A

Lack of or incomplete house training

Sexual signalling - marking

Social signalling

Arousal

Owner relater - seeking attention

Physical distress - fear, anxiety

Social distress - separation

Secondary to psychogenic polydipsia

85
Q

What are separation related problem behaviours in dogs

A

Destructive behaviours
Vocalisation
Elimination
Anorexia
Psychosomatic/medical - diarrhoea, excessive licking
Over-activity

86
Q

What are common differentials for elimination when alone:
1. when the dog displays no distress at owner departure
2. When dog displays distress at owner departure

A
87
Q

Fill in the horse assessment of fluid deficit table

A
88
Q

How does hypotonic fluid loss (water) affect the tonicity of remaining body fluid and blood volume?

A

increases tonicity of remaining body fluid

increases blood volume as water is drawn from cells into blood as blood is hypertonic so water is drawn from hypotonic cells

89
Q

How does isotonic fluid loss (water & electrolytes) affect the tonicity of remaining body fluid and blood volume?

A

No effect on tonicity

Decreases blood volume

90
Q

Describe the initial effect of water loss (hypotonic)

A

Loss of water from blood and interstitium increases ECF tonicity

=> osmosis and movement of water from ICF into ECF

=> cells lose fluid to plasma and interstitium

=> this compensates for volume loss in blood at the expense of cellular blood volume

LOSS OF HYPOTONIC FLUID LEADS TO DEHYDRATION INITIALLY

91
Q

Describe the initial effect of water & electrolyte loss (isotonic)

A

No change in tonicity of remaining body fluids

No osmotic effect

No net fluid change between cells, interstitial space and blood

LOSS OF ISOTONIC FLUID LEADS TO HYPOVOLAEMIA INITIALLY

92
Q

Fill in the table

A
93
Q

What is the effect of a hypertonic saline bolus on a hypovolaemic patient

A

draws fluid from interstitial space and cells

acts in short term and cause temporary expansion of plasma volume

NaCl will redistribute over time reducing this effect so must be followed with isotonic fluid to restore total fluid deficit and maintain perfusion

94
Q

What is the effect of administering sterile water intravenously in a hypovolaemic patient

A

dangerously hypotonic
likely result in major electrolyte disturbances
can cause RBC swelling and bursting

95
Q

Describe the ultrasound procedure for diagnosing pregnancy in the bitch

A
  1. animal can be standing or in R lateral recumbency
  2. curvilinear transducer
  3. apply transducer cranial to pubic brim (sagittal or transverse)
  4. direct beam dorsally
  5. find bladder and colon
  6. uterus between bladder and colon
  7. non-pregnant uterus hard to find
96
Q

At what stage (days) of pregnancy is ultrasound of pregnant bitch best done?

A

28-32 days

97
Q

What stage of pregnancy is this bitch

A

d22 (embryo just visible)

98
Q

What stage of pregnancy is this bitch

A

d23

99
Q

What stage of pregnancy is this bitch

A

d27

100
Q

What stage of pregnancy is this bitch

A

d32

101
Q

What stage of pregnancy is this bitch

A

d38

102
Q

What stage of pregnancy is this bitch

A

d48

103
Q

Why should rectal temp be measured twice daily in late pregnancy of bitch

A

to detect prepartum hypothermia that precedes parturition by 24-36 hrs (mediated by sudden progesterone drop)

temp drops from 39C to 37C

104
Q

What are signs of bitch preparing for parturition

A

whelping nest (shredding and ripping up bedding)

restlessness

increased mucous discharge and swollen vulva

105
Q

What are signs of onset of parturition in bitches

A

Uterine contractions

increasingly restless

pant and/or shiver

frantic nesting behaviour

refuse food or vomit last meal

allantoic fluid from vulva as foetus ruptures allantochorion

106
Q

Fill in the table with changes in the vaginal smear of bitches

A

Leah URO (8 decks)

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