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73 Cards in this Set

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What is the common signalment for canine UTIs? What is the most common pathogen?
beeeeeeeeeyyyyyyyyyyyaaaaaatch!!!! (females > males)
E. coli
What are the 2 types of UTIs in dogs?
Recurrent (>2 in 12 months)
Persistent
What are the normal barriers to urinary infection?
urethral high pressure zones (internal/external sphincter)
Urethral peristalsis
Urethral length
Ureterovesical flap valves
Bulk flow of urine provides normograde rinsing
What are some anatomical disorders in females that predispose for UTIs?
Urachal diverticulum
Ectopic ureters
Vestibulovaginal stenosis
Recessed vulva
What is the normal ratio of vestiuble to vagina?
>0.35
What are some disorders that suppress immunity leading to UTIs?
Hyperadrenocorticism (exogenous or endogenous)
Diabetes mellitus
Iatrogenic (chemotherapy)
Which of the following is NOT true regarding DM and UTIs?
a) Decreased neutrophil chemotaxis and phagocytosis
b) Decreased monocyte chemotaxis and phagocytosis
c) Glucosuria provides bacterial substrate for growth
d) depresses cell-mediated and adaptive immunity
e) allows for increased adherence of bacteria to cells
c) Glucosuria provides bacterial substrate for growth (FALSE-O-RINO)
What factors in urine contribute to its bacteriostatic principles?
low pH
high urea concentration
high osmolality
Which conditions can alter urine composition, thereby predisposing to UTIs?
DM, DI, Cushing's, Hepatic insufficiency, CRF
What are the 2 stages of micturation?
passive storage
active voiding
What dog breeds get TCC more often?
Scotties and Shelties
Which bacteria can cause a primary UTI? How does it accomplish this?
UTEC (via type I pili and intracellular biofilms)
Which of the following are true regarding UTI diagnostics and treatments?
a) culture every animal you're treating
b) begin empirical treatment of an animal with bactiuria
c) use clavulinic acid due to the presence of beta lactamase in most urinary bacteria
d) cranberry extract inhibits type I pili adhesion
a) culture every animal you're treating
d) cranberry extract inhibits type I pili adhesion
(no empirical treatment unless there is complicated UTI then modify after C&S)
T or F:
Broad spectrum antibiotics are good for UTIs.
False! Use narrow spectrum!
How long should uncomplicated UTIs be treated? Complicated? Renal/prostate involvement?
Uncomplicated (7-14d)
Complicated (4-6 wks); with renal/prostate involvement (6-8wks)
What are ancillary therapies for UTI prevention?
Methenamine mandelate
Cranberry extract
Low dose abx
Where do uroliths like to lodge usually?
proximal to os penis
T or F:
30% of dogs w/stones also have pyonephritis.
True!
Blood at the beginning of urination indicates a lesion where? Blood at the end?
Beginning (urethra, prostate, genital tract)
End (bladder)
Put the following in order of most common to least common sources of hematuria for dogs For cats
a) inflammation
b) urolithiasis
c) infection
d) neoplasia
Dogs (Infxn, stones, neoplasia, inflammation)
Cats (inflammation, stones, neoplasia, infection)
T or F:
There is always an underlying issue with urolith formation.
True
Which of the following describe a metastable supersaturation?
a) new stones don't form
b) existing stones may dissolve but won't grow
c) crystals aggregate when added
d) existing stones may grow
e) new stones form
a) new stones don't form
d) existing stones may grow
(also crystals dissolve; existing stones don't dissolve)
What are the 2 most common types of uroliths?
Ca oxalate dihydrate
Struvite
Place these in order from most radiodense to most radiolucent:
Cysteine
Oxalate
Struvite
Urate
Silica
Oxalate (most dense)
Silica
Struvite
Cysteine
Urate
What parameters are used to identify uroliths?
urine pH
Crystal morphology
stone radiopacity
breed
Chemical analysis of stone
What are possible therapies for stone removal?
Surgery
Medical dissolution
Lithotripsy (shock or laser)
Voiding urohydropropulsion
Which dogs get struvites? Oxalates?
Struvites (young dogs and dogs w/infections)
Oxalate (old dogs)
What is the chief cause of struvites (which bacteria)?
Staphylococcus
NAME THAT STONE!!!!
Grows rapidly
Smooth surface and large
Very pH dependent...
STRUVITE!
Also seen more in females
NAME THAT STONE!!!
Bichon/Yorkies/Schnauzers
Laminated appearance
Associated with primary hyperparathyroidism
OXALATE!!!
How are struvites treated/prevented?
Treat the underlying condition!
Medical dissolution
Reduced protein, Mg, and acid pH
How are oxalates treated?
Surgery or uropropulsion if small enough.
No dissolution diet.
Na and protein restriction; find when they recur via radiograph and have scheduled hydropropulsion.
NAME THAT STONE!!!
Dalmations or dogs w/liver dz!!
URATE
How are urates treated/prevented?
Tx: dissoltion, urine dilution, K-citrate alkalinization, Allopurinol to prevent urate excretion
Sx: to fix PSS
Prevention:
Allpurinol and alkaline pH
NAME THAT STONE!!!!
Dissolved by 2-mercaptopropinol glycine...
Corgies, Dachschunds, young female Newfies...
Cystine!!!!
How are cystine stones treated/prevented?
Tx:
Sx, medical dissolution w/mercaptopropionol (MPG), low protein (low Na and alkaline pH)
Prevent:
Diet, high pH, K-citrate, maybe MPG
What is the common presentation of FLUTD?
Pollakuria, dysuria, hematuria
Maybe stones, or obstruction
What are the 3 populations of FLUTD? Which is an EMERGENCY?
Hematuria w/obstruction (EMERGENCY)
Hematuria w/dysuria and no obstruction
Hematuria w/inappropriate urination
What pharmaceuticals can be used to manage a cat w/hematuria and inappropriate urination?
Fluoxetine
Buspirone
Pheromones
Which tests should be performed on a cat with hematuria, dysuria, and no obstruction?
UA (look for pyuria, hematuria, bacteriuria)
Rads/US of urinary tract
C&S
Maybe contrast rads
What are the most common uroliths in cats?
Struvites and oxalates!
T or F:
Struvites in cats are usually sterile.
True (they're metabolic stones)
What is the age/sex distribution for stones in cats?
<2yo males/<5yo females get struvites
>7yo males and >11yo females get oxalates
Kidney stones in kitties are commonly which type?
Oxalate
How do you get rid of struvites in cats?
Surgery
Hydropropulsion (females)
Diet dissolution (need pH 6.1-6.5)
Which cat breeds are predisposed to oxalates?
Himalayan, Persians, Ragdoll, Burmese
Which of the following are true?
a) hypercalcemia is a risk factor for oxalates in cats
b) hypercalcemia in cats is due to primary hyperparathyroidism
c) K-citrate can be used to treat feline oxalates
d) oxalates form in acidic urine
a) hypercalcemia is a risk factor for oxalates in cats
c) K-citrate can be used to treat feline oxalates
(Hyper Ca is IDIOPATHIC; oxalates form in ALKALINE urine)
How are oxalates treated/prevented in cats?
Surgery only!
Correct hyper calcemia
Keep urine pH between 7 and 7.5
use appropriate diet
What is the new name for idiopathic feline cystitis?
Interstitial cystitis
Which are NOT true regarding idiopathic feline (interstitial) cystitis?
a) common in older cats
b) diagnosis of attrition
c) stress is a major factor
d) more common in fall/summer
e) hematuria, pyuria, and crystalluria are commonly the only signs
a) common in older cats (NO, common in indoor, obese 2-6yo cats)
d) more common in fall/summer (NO, more common in spring/winter)
When is crystalluria treated?
When xanthine, cystine, or ammonium urate crystals are found
What is the ONLY thing that makes a difference in idiopathic feline (interstitial) cystitis?
Increased water consumption (wet food)
Amitriptyline (pain control, bladder/urethra relax, anxiolytic) may increase interval between crises
What effect does sympathetic tone have on the urinary system?
Detrusor relaxation (filling)
Internal sphincter contraction
What effect does parasympathetic tone have on the urinary system?
Detrusor contraction
Overrides sympathetic tone
What innervates the external urinary sphincter?
Pudendal nerve
T or F:
Normally, ALL urine is voided with micturation.
True!
What is going on if an animal only leaks with a full bladder?
Paradoxical (obstructive) incontinence; full bladder forces urine around a stone
Where is the lesion in an animal with a difficult to express bladder with no attempts to void?
Brain stem to L7
What are the signs of an UMN bladder?
REALLY FULL bladder
Hypertonic sphincter
Cannot feel that bladder is full and cannot contract bladder.
Where is the lesion in an animal with a really full, difficult to express bladder that is experiencing signs of pain?
L4 to L7 (still UMN) but pain fibers work
Where is the lesion in an animal with an easy to express bladder, no attempts to void, residual urine, and possible incontinence?
Sacral lesion (LMN)
What are the signs of a LMN bladder?
Flabby bladder
Easy to express
Residual urine
Where is the lesion in an animal with normal voiding but with leakage during stress, coughing, and is easy to express?
ONLY in pudendal nerve (no control over external sphincter);
More commonly urethral sphincter mechanism incompetence
What are the 3 scenarios of incontinence?
Normal voiding + incontinence
Unfruitful voiding attempts
Don't even try to void
What is the common signalment for urethral sphincter mechanism incompetence?
middle-aged spayed females
How is urethral sphincter mechanism incompetence diagnosed?
Clinical signs and history; rule-out UTIs!!!
How is urethral sphincter mechanism incompetence treated?
Phenylpropanolamine
Diethylstilbestrol
Imipramine
(maybe surgery w/collagen or hydraulic occluder)
What is the #1 and #2 reason for incontinence in young dogs? Spayed female dogs?
Young (ectopic ureters and UTI)
Spayed female (UTI and urethral sphincter mechanism incompetence)
What is the most common cause for urge incontinence (normal voiding with increased frequency)?
UTI
If urination starts then stops suddenly, what should you suspect?
Obstruction!
stones, prostatitis, urethritis, or neoplasia
(maybe reflex dyssynergia)
If you see an animal with constant leakage and an empty bladder, what should you suspect?
Anatomical defect (ectopic ureters & etc)
How should an animal with an overdistended bladder be treated? What is a possible sequel to overdistention?
EMERGENCY!!! Unblock w/o manual expression (indwelling catheter for 7 days);
Rupture and separation of tight junctions (loss of coordinated contraction)
What are the two main causes of detrusor arreflexia?
Normal or increased sphincter tone (UMN bladder)
Decreased sphincter tone (LMN lesion)