Bryan - Sa Med Ii - Renal And Urinary Dz Part 2 - Winter 3Rd Year

Front 1

Where do uroliths like to lodge usually?

Back 1

proximal to os penis, prostate, pelvic flexure

Front 2

T or F:
30% of dogs w/stones also have pyonephritis.

Back 2

True!

Front 3

Blood at the beginning of urination indicates a lesion where? Blood at the end?

Back 3

Beginning (urethra, prostate, genital tract)
End (bladder)

Front 4

What type of stones are seen in the kidney

Back 4

oxalate

Front 5

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

Back 5

Dogs (Infxn, stones, neoplasia, inflammation)
Cats (inflammation, stones, neoplasia, infection)

Front 6

T or F:
There is always an underlying issue with urolith formation.

Back 6

True

Front 7

What is the most likely cause of a cysto with no blood but the animal is voiding blood during urination

Back 7

Problem is urethral or distal (ie, not in the bladder)

Front 8

Why would you have blood in a cystocentesis if the patient isn't voiding blood in the urine?

Back 8

contamination

Front 9

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

Back 9

a) new stones don't form
d) existing stones may grow
(also crystals dissolve; existing stones don't dissolve)

Front 10

Undersaturation, metastable, or oversaturation?
Spontaneous crystal formation
Added crystals will aggregate
New stones will form
Existing stones will grow

Back 10

oversaturation

Front 11

Undersaturation, metastable, or oversaturation?
All added crystals will dissolve
Stones cannot form
Existing struvites will dissolve and oxalates won't grow

Back 11

undersaturation

Front 12

What are the 2 most common types of uroliths?

Back 12

Ca oxalate dihydrate
Struvite

Front 13

Place these in order from most radiodense to most radiolucent:
Cysteine
Oxalate
Struvite
Urate
Silica

Back 13

Oxalate (most dense)
Silica
Struvite
Cysteine
Urate

Front 14

What parameters are used to identify uroliths?

Back 14

urine pH
Crystal morphology
stone radiopacity
breed
Chemical analysis of stone

Front 15

What are possible therapies for stone removal?

Back 15

Surgery
Medical dissolution
Lithotripsy (shock or laser)
Voiding urohydropropulsion

Front 16

Which dogs get struvites? Oxalates?

Back 16

Struvites (young dogs and dogs w/infections)
Oxalate (old dogs)

Front 17

What is the chief cause of struvites (which bacteria)?

Back 17

Staphylococcus

Front 18

NAME THAT STONE!!!!
Grows rapidly
Smooth surface and large
Very pH dependent...

Back 18

STRUVITE!
Also seen more in females

Front 19

NAME THAT STONE!!!
Yorkies/Schnauzers/Bichons
Laminated appearance
Associated with primary hyperparathyroidism
Usually older dogs

Back 19

OXALATE!!!

Front 20

How are struvites treated/prevented?

Back 20

Treat the underlying condition!
Medical dissolution (8-10 wks)
Reduced protein, Mg, and acid pH

Front 21

How are oxalates treated?

Back 21

Surgery or uropropulsion if small enough.
No dissolution diet.
Na and protein restriction
K-citrate
find when they recur via radiograph and have scheduled hydropropulsion.

Front 22

NAME THAT STONE!!!
Dalmations or dogs w/liver dz!!

Back 22

URATE

Front 23

How are urates treated/prevented?

Back 23

Tx: litholytic food, urine dilution, K-citrate alkalinization, Allopurinol to prevent urate excretion
Sx: to fix PSS
Prevention:
Allpurinol and alkaline pH

Front 24

NAME THAT STONE!!!!
Dissolved by 2-mercaptopropinol glycine...
Corgies, Dachschunds, young female Newfies...

Back 24

Cystine!!!!

Front 25

T or F
98% of Cysteine stones are found in femlaes

Back 25

False!
Stones grow very very slowly and ladies piss them out before they become a problem

Front 26

How are cystine stones treated/prevented?

Back 26

Tx:
Sx, medical dissolution w/mercaptopropionol (MPG), low protein (low Na and alkaline pH)
Prevent:
Diet, high pH, K-citrate, maybe MPG

Front 27

What is the common presentation of FLUTD?

Back 27

Pollakuria, dysuria, hematuria
Maybe stones, or obstruction

Front 28

What are the 3 populations of FLUTD? Which is an EMERGENCY?

Back 28

Hematuria w/obstruction (EMERGENCY)
Hematuria w/dysuria and no obstruction
Hematuria w/inappropriate urination

Front 29

What pharmaceuticals can be used to manage a cat w/hematuria and inappropriate urination?

Back 29

Fluoxetine
Buspirone
Pheromones

Front 30

Which tests should be performed on a cat with hematuria, dysuria, and no obstruction?

Back 30

UA (look for pyuria, hematuria, bacteriuria)
Rads/US of urinary tract
C&S
Maybe contrast rads

Front 31

What are the most common uroliths in cats?

Back 31

Struvites and oxalates!

Front 32

T or F:
Struvites in cats are usually sterile.

Back 32

True (they're metabolic stones)

Front 33

What is the age/sex distribution for stones in cats?

Back 33

<2yo males/<5yo females get struvites
>7yo males and >11yo females get oxalates

Front 34

Kidney stones in kitties are commonly which type?

Back 34

Oxalate

Front 35

How do you get rid of struvites in cats?

Back 35

Surgery
Hydropropulsion (females)
Diet dissolution (need pH 6.1-6.5)

Front 36

Which cat breeds are predisposed to oxalates?

Back 36

Himalayan, Persians, Ragdoll, Burmese

Front 37

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 prevent feline oxalates
d) oxalates form in acidic urine

Back 37

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)

Front 38

How are oxalates treated/prevented in cats?

Back 38

Surgery only!
Correct hyper calcemia
Keep urine pH between 7 and 7.5
use appropriate diet

Front 39

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

Back 39

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)

Front 40

When is crystalluria treated?

Back 40

When xanthine, cystine, or ammonium urate crystals are found

Front 41

What is the ONLY thing that makes a difference in idiopathic feline (interstitial) cystitis?

Back 41

Increased water consumption (wet food)
Amitriptyline (pain control, bladder/urethra relax, anxiolytic) may increase interval between crises

Front 42

What effect does sympathetic tone have on the urinary system?

Back 42

Detrusor relaxation (filling)
Internal sphincter contraction

Front 43

What effect does parasympathetic tone have on the urinary system?

Back 43

Detrusor contraction
Overrides sympathetic tone

Front 44

What innervates the external urinary sphincter?

Back 44

Pudendal nerve

Front 45

T or F:
Normally, ALL urine is voided with micturation.

Back 45

True!

Front 46

What is going on if an animal only leaks with a full bladder?

Back 46

Paradoxical (obstructive) incontinence; full bladder forces urine around a stone

Front 47

What is going on if an animal stops suddenly while urinating?

Back 47

sphincter "timing" problem
Obstruction

Front 48

Where is the lesion in an animal with a difficult to express bladder with no attempts to void?

Back 48

Brain stem to L7

Front 49

What are the signs of an UMN bladder?

Back 49

No attempt to void
No voiding
Large amount of residual urine
Difficult to express

Front 50

Where is the lesion in an animal with an easy to express bladder, no attempts to void, residual urine, and possible incontinence?

Back 50

Sacral lesion (LMN)

Front 51

Where is the lesion in an animal with normal voiding but with leakage during stress, coughing, and is easy to express?

Back 51

ONLY in pudendal nerve (no control over external sphincter);
More commonly urethral sphincter mechanism incompetence

Front 52

What are the 3 scenarios of incontinence?

Back 52

Normal voiding + incontinence
Unfruitful voiding attempts
Don't even try to void

Front 53

What are the main causes of normal voiding+ incontinence?

Back 53

Sphincter by-pass
Sphincter incompetence

Front 54

Causes of sphincter incompetence

Back 54

USMI
UTI
Pudendal lesion

Front 55

What is the common signalment for urethral sphincter mechanism incompetence?

Back 55

middle-aged spayed females

Front 56

How is urethral sphincter mechanism incompetence diagnosed?

Back 56

Clinical signs and history; rule-out UTIs!!!

Front 57

How is urethral sphincter mechanism incompetence treated?

Back 57

Phenylpropanolamine
Diethylstilbestrol
Imipramine
(maybe surgery w/collagen or hydraulic occluder)

Front 58

What is the #1 and #2 reason for incontinence in young dogs? Spayed female dogs?

Back 58

Young (ectopic ureters and UTI)
Spayed female (UTI and urethral sphincter mechanism incompetence)

Front 59

What is the most common cause for urge incontinence (normal voiding with increased frequency)?

Back 59

UTI

Front 60

If urination starts then stops suddenly, what should you suspect?

Back 60

Obstruction!
stones, prostatitis, urethritis, or neoplasia
(maybe reflex dyssynergia)

Front 61

If you see an animal with constant leakage and an empty bladder, what should you suspect?

Back 61

Anatomical defect (ectopic ureters & etc)

Front 62

How should an animal with an overdistended bladder be treated? What is a possible sequel to overdistention?

Back 62

EMERGENCY!!! Unblock w/o manual expression (indwelling catheter for 7 days);
Rupture and separation of tight junctions (loss of coordinated contraction)

Front 63

What are the two main causes of detrusor arreflexia?

Back 63

Normal or increased sphincter tone (UMN bladder)
Decreased sphincter tone (LMN lesion)