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112 Cards in this Set

  • Front
  • Back
What is important to exam if you find stranguria in a dog with no other apparent signs?
palpate vagina and vestible
What are key ways to localize a problem to the upper urinary tract?
-Body weight change
- fever or hypothermia
- PU/PD
-vomiting
What are key ways to localize a problem to the lower urinary tract?
-discharges
-dysuria, stranguria, pollakiuria
-incontinence (most often due to LUT)
What will a CBC with leukocytosis point to if there are urinary problems?
lepto, pyelonephritis, prostatitis, rupture
What will a CBC with thrombocytopenia point to if there are urinary problems?
lepto, DIC
Azotemia is an increase in BUN, creatine and P. When there is renal failure, what is damaged?
nephrons
Azotemia is an increase in BUN, creatine and P. When there is prerenal azotemia, what does this mean?
-decreased perfusion or increased production (eating blood or bleeding inside)
What does it mean where there is high BUN and normal creatine?
GI bleeding
Azotemia is an increase in BUN, creatine and P. When there is post-renal azotemia, what is the cause?
obstruction or disruption
What will the SG be if there is renal failure?
1.008-1.012
What endocrine abnormalities can affect USG?
1 - hypoadrenocortism (collecting duct)
2 - hyperadrenocortisms (antagonists to V2 vasopresin)
3 - ketoacidosis, DM
4 - hyperthyroidism
What are "other" diseases that affect the USG?
1 - hypercalcemia (antagonists to vasopresin)
2 - hepatic disease (PSS and severe hepatitis)
3 - pyometra (antagonists to V2 vasopressin)
4 - urinary obstruction
What % of nephrons must be damaged to be:
1 - isothenuric
2 - azotemic
1 - 66%
2 - 75%
What is the best estimator of GFR?
creatinine
When can you get false positives on protein dip stick?
alkaline urine
What does protein in the urine mean?
1 - lower urinary tract problem (infection, inflammation, infection)
2 - renal disorder
3 - excess serum protein
What is an ABNORMAL amount of protein in the urine?
> or equal to 2 + in <1.035

-check UPC
What are the steps to determining the cause of protein in the urine?
1 - R/O post-glomerular proteinuira (pyuria, hematuria);
-if present, treat
-if not present, find UPC
2 - R/O preglomerular proteinuria
-if UPC is increased with RENAL azotemia or hypoalbuminemia
3 - if not pre or post, it is renal
What are causes of preglomerular proteinuria?
-Bence Jones proteins (myeloma)
-hemoglobin (hemolysis)
-myoglobin
-fever
seizures
-extreme exercise
If you rule out post ans pre glomerular protein loss and find it is renal, a UPC of > 2 means what?

<2?
UPC > 2 = glomerular disorder

UPC < 2 = tunulointerstitial disorder
What is a normal UPS in a dog and cat?
dog = <.5
cat = <.2
What is a granular cast a sign of?

a waxy cast?
necrosis of infection of the kidney

acute kidney failure
Where are the majority of obstructions?
lower urinary tract
-if complete, cause uremia in 24-48 hours
What are common anatomic causes of obstruction?
mucus plugs, urolithiasis, neoplasia (TCC, protstate)
What are the most common signs of obstruction of the lower urinary tract?
stranguria, pollakiuria, +/-hematuria, DISTENDED bladder
What are clinical signs of upper urinary tract obstruction?
ulilateral, occult, enlarged kidney (hydronephrosis), pain on palpation of kidney or retroperitoneal space
What are the causes of disruption?

What is the most common cause?
rupture (most common)
avulsion
necrosis

-trauma = motor vehicle accidents, fights, improper cath.
What are the two main causes of obstruction?
functional or anatomic
WHERE are the majority of distruptions?
the lower urinary tract (mostly bladder)
How do you treat disruptions from trauma?
treat for shock --> rehydrate and get ECG

- diagnostics

- urine drainage
What are common biochem lab abnormalities of an animal with a disrupted bladder?

What is the treatment?
-hyperkalemia and metabolic acidosis --> rehydration); if K > 7.5, use bicab, insulin/glucose, Ca gluconate as glucose is a cotransporter for K into the cell

-azotemia
How do you tell if there is uroabdomen?
if fluid azostick is > serum azostick

- if fluid creatine/K: serum creatine/K ratio is >2:1
If there is a obstruction in a cat, what should you try first to remove it?
urethral massage
What is the first step with trying to remove a urethral obstruction?
-advance catheter to obstruction and flush with NaCl and lube
-may need indwelling if uremic or obstruction remains in UT
How do you remove stones in the urethra if you can't get the cath to go in?
retrograde urohydropulsion
When would you likely perform a urethrostomy?
1 - when can't relieve
2 - when likely to reobstruct
What must you watch out for when performing post obstructive diuresis?
hypokalemia
Although primary renal neoplasia is rare, what is the most common?

what is the prognosis?
adenocarcinoma - usually occult
-unilateral renomegaly

3-4 months
What is the most common type of renal neoplasia?
secondary neoplasia - lymphoma

-more common in cats and is bilateral
Is upper or lower neoplasia more common in the urinary tract?

is it primary or secondary?
lower

almost exclusively primary neoplasia --> TTC
What sex and breeds are predisposed to LUT neoplasia with TCC?

What environements?
females
scotties - 18 xmore common

industrial
How often is the urethra involved with TCC?
15%
What are CS of TCC?
hematuria, stranguria, pollakiuria - LUT signs

recurrent UTIs can also cause these signs

-palpation
-sometimes see dystrophic mineralization
Why is the veterinary bladder tumor antigen test bad?
specificity is low - 78%
therefore 22% get false positive

-hematuria causes these
What always works for identification of a TCC??
traumatic catheterization
What drug is used to treat TCC in the bladder?
piroxicam
-COX inhibitor and causes shrinkage 30% of time
What disease do cats get that dogs don't?
idiopathic cystitis (54%) --> lower urinary tract signs

AKA interstitial cystitis
Cats with lower urinary tract disease get idiopathic cystitis 54%? What are the other problems they get and in what percentage?
-urolithiasis (21%)
-urethral plugs (22%)
-UTI (<2%)
n-eoplasia (0.3%)
What are possible pathogenesis for feline interstitial cystitis?
1 - viral infection --> calicivirus, synchitial virus
2 - GAG def.
3 - neurogenic inflammation
4 - abnormal stress response
What are predisposing factors to a cat getting feline interstitial cystitis?
fat, lazy, indoor, neutered cats on dry food
-multi-cat household
What does a UA normally look like in a cat with interstitial cystitis and LUT signs?
hematuria only
Most cases of feline idiopathic cystitis go away in a week with you doing nothing. When do you tell an owner to come back in?
-can't urinate
-signs persist for more than 10 days


-reoccurance (in 30-70%)
What is the most important factor when treating feline idiopathic cystitis?
client communication
When you bring a cat back in for idiopathic feline cystitis, what diagnostics do you preform?
-imaging (plain and contrast) to make sure no stones or infection
-CBC/Chem
-urine culture
- FeLV/FIV
What general method do you use to help reduce stress in cats with idiopathic cystitis?
Multimodal Environmental Modifications (MEMO)

-goal is to reduce stress with food, litter, environmental enrichment, anti-depressant/tranquilizer
What anti-depressants might you try in cats with idiopathic cystitis?
amitriptyline (anti-histamine effect)
What ways might you try in cats to decrease urethral contractility with idiopathic cystitis?
phenoxybenzamine
prazosin
valium
What are the most common causes of male cat urethral obstruction?
1 - urethral plugs
2 - urolitiasis
3 - obstructive idiopathic cystitis (urethral spasm, blood clots)
4 - neoplasia
5 - blood clots
What is the minnisota olive-tipped catheter for?
Unobstructing MALE Cats

-safest in the cat and for unobstructing only
What is the Tom Cat (polypropylene) catheter used for?
Draining only

-stiff and end is blunt so it could tear urethra
When should you leave a cath in after unabstructing a male cat?
1 - patient azotemic or hyperkalemic
2 - obstructing object still in the cat
3- bladder atonic
4- bladder/urethra perforation
5 - no overnight care available
What bacteria are common with urinary tract infections?
Staph, Proteus, E. coli, Enterococcus
What two things help bacteria from adhering to the bladder?
IgA and GAG
What are the 3 key factors of an uncomplicated UTI?
-one organism
-no impaired host defenses or renal/protatic involvement
-easy to treat
What animals are automatically considered to have complicated UTIs?
cats and adult male dogs
What type of deep infections are considered to have a complicated UTI?
-pyelonephritis
-prostatitis
What type of diseases that impair the host defenses are classified as complicated UTIs?
-cushings
-DM
-CRF
-micturition disorders
-immunosuppression
What type of other abnormalities that impair the host defenses are classified as complicated UTIs?
-uroliths
-foreign bodies
-bacterial resistance
What type of anatomic abnormalities that impair the host defenses are classified as complicated UTIs?
-urinary fistulas
-ureteral ectopia
-urinary diversion Sx
-neoplasia
-obstruction
-hypoplastic vulva
What are typical UTI findings?

What other disease can this also be found in?
-WBC> 3-5
-RBC > 5
-proteinuria
-bacteriuria
-ketones

-hypoadrenocortism, hypothyroidism, DM
Does lack of bacteruria rule out a UTI?
no - verify by culture and smear
What is best for determining bacterial susceptibility for a UTI?
serial dilution is best
-determination of a MIC
-choose S and avoid R
Do you need to culture all cases of UTI?
no - esp. if first time or infrequent LUT sings in a dog without complicating factors
What are 1st line antimicrobials for UTIs?
amoxicillin, TMS, tetracyclines
What are 2nd line antimicrobials for UTIs?
-fluroquinolones (Baytril)
-1st generation cephalosporins
-amoxicillin and clauvulonic acid (clavamox)
What are 3rd line antimicrobials for UTIs?
-2nd and 3rd generation cephalosporins, imipenem, aminoglycosides

-most expensive and most likely to be toxic and inject able
How long are most UTI drugs given?
-What is the exception?
TID

BID for TMPS and fluroquinolones
1/day for aminoglycosides
What is the duration of therapy for uncomplicated UTIs?

Complicated?
10-14 days

4-6 weeks or 2 weeks PAST a complicating factor
When should a UA be cone for UTIs?

culture?
comlicated - UA and culture 5-7 days after antibiotic therapy starts and then 7-10 days post

uncomplicated - 7-10 days post antibiotics
What is the most common urinary tract disease in the dog?

How much higher is the incidence in female dogs?
bacterial urethrocystitis

2-4 x higher
What are CS to bacterial urethrocystitis?
-stranguria
-dysuria
-pollakiuria
Why might the pH be high in a UA?
urease producing bacteria (Staph and Proteus)
What does a polypoid cyst look like?
grape like structures (TCC)

- caused by recurrent and chronic UTIs
What type of cystitis is common with DM?
emphysematis cystitis
What is the etiology of bacterial pyelonephritis?
ascending urinary, hematogenous, or spread from adjacent infection
How do you diagnose bacterial pyelonephritis?
-culture of renal tissue or renal pelvic urine
-azotemia, neutrophilia
-diagnostic imaging (US) -- hyperechoic cortex with anechoic fluid in the center
CS of UTI
What is the treatment for acute and chronic bacterial pyelonephritis?
acute - broad spectrum parenteral antimicrobials with ampicillin and enrofloxacin until systemic signs resolve then as for complicated UTI

chronci - as for complicated UTI
What are CS of urolithiasis?
same as for the lower UT

-hematuria, stranguria, pollakiuria
-uremia is urethral obstruction
What are struvite stone made of?
magnesium, ammonia, and Phos
Do males are females more often get struvite stones?
females because almost always induced by infection (UTI)

-min. schnauzer, bichon, cocker
What causes stone formation with struvite stones?
pH
-bacteria produce urease (by proteus and E. coli) and ammonium can bind to P more easily
What does a struvite stone look like and what is the ph of the uirne?
radioopaque, round, smooth
neutral to alkaline
crystals are coffin shaped
UTI with Stap of proteus
How do you dissolve a struvite stone?
feed s/d-low protein, acidifying, high Na

-antibiotics - clavamox
-montly rads and UA (+/- cultures)
How long does it take to dissolve a struvite stone?
1/5-3.0 months
Will urethral struvite stones dissolve?
no
What is the most common urolith in the cat?
struvite (48%)

-they are sterile in the cat so most don't need antibiotics
HOw do you prevent struvite?
- do UA often to detect infection early (3-6 months)
-may need reduced protein and Mg
-increase water intake
How do Ca oxalate look in the bladder?
-sharp and irregular, opaque
What are known causes of calcium ocalate in dogs?
-hyperPT
-hyperAC
-becoming more common due to breed popularity (min schnauzers) and acidifiying diets
What should you evaluate a dog for if they have calcium oxalate stones?
-hypercalcemia
Can you dissolve Ca oxalate stones?
no
What is the recurrence rate of Ca ocalate stones?
40% in 3 years
What SG do you want to keep the urine at to avoid ca oxalate?
SG<1.020 and pH of 6.5-7.5
What are the most common uroliths in dogs and cats?
CaOx and MAP
What percentage of animals with ammonium urate stones are males?
>97%
Why are dalmations prone to ammonium urate stones?
purine handling is abnormal
Other than being a dalmations, what other conditions predispose an animal to getting ammonium urate stones?
-portovascular anomalies (PSS, MVD)
-urease produciing bacteria
-breed - english bulldogs, min schnauzers, shih tzu, yorki
What is the pH of urine in animals with ammonium urate stones?
acid to neutral
What must you use in order to see ammonium urate stones?
contrast rads
-they are smooth
How do you dissolve ammonium urate crystals and what is the success rate?
hills u/d - to make more alkaline urine
-protein restricted diet

-allopurinol blocks conversion of purines to uric acid

-30-40% success rate
What are prevention diets, esp. for dalmations, to prevent ammonium urate crystals?
low protien, low purine diets
-hills u/d or Hills k/d
-pH>7
-low dose of allopurinol
What stones are most common with neprholiths and ureteroliths?

young or old?
Ca OX
old