Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
61 Cards in this Set
- Front
- Back
|
Definition of urinary incontinence
|
Lack of voluntary control over the passage of urine
|
|
|
Name the 3 nerves involved in the control of micturition
|
Hypogastric
Pelvic Pudendal |
|
|
Beta receptors are found in the ________
Alpha receptors are found in the _________ |
Beta receptors are found in the urinary bladder
Alpha receptors are found in the smooth muscle of the urethra (internal urethral sphincter) |
|
|
The internal urethral sphincter is innervated by the ______ (NS) via the ______ nerve which releases ______ (neurotransmitter) onto ____ receptors of the urinary bladder to ____ (relax/contract) and the _____ receptors of the IUS to ____ (relax/contract)
|
The internal urethral sphincter is innervated by the SNS via the HYPOGASTRIC nerve which releases NOREPINEPHRINE onto BETA receptors of the urinary bladder to RELAX and the ALPHA receptors of the IUS to CONTRACT
|
|
|
Where does SNS innervation start (spinal cord segments) and where does it branch?
|
L1-L4
Branches at the caudal mesenteric ganglion |
|
|
The bladder smooth muscle is innervated by the ______ (NS) via the ______ nerve which releases ______ (neurotransmitter) onto ____ receptors of the urinary bladder to ____ (relax/contract) and allow __________
|
The bladder smooth muscle is innervated by the PS via the PELVIC nerve which releases ACh onto MUSCARINIC receptors of the urinary bladder to CONTRACT and allow VOIDING
|
|
|
Where in the SC does the Pelvic nerve originate?
|
S1-S3
|
|
|
The external urethral sphincted is innervated by the ______ (NS) via the ______ nerve which releases _____ (neurotransmitter) onto ____ receptors and allows _____ (relaxation/contraction)
|
The external urethral sphincter is innervated by the SOMATIC NS via the PUDENDAL nerve which releases ACh onto NICOTINIC receptors and allows CONTRACTION
|
|
|
Where does the Pudendal Nerve originate?
|
Caudal to S3
|
|
|
What determines the onset of urination?
|
Forebrain
specifically Barrington's nucleus in the pontine micturition center |
|
|
4 classifications of urinary incontinence
|
1. Anatomic abnormalities
2. Decreased urethral tone 3. Detrusor hyperreflexia 4. Increased urethral tone (overflow bladder) |
|
|
4 anatomic abnormalities
|
1. ectopic ureters
2. pelvic bladders 3. ureterocoeles 4. bladder and urethral hypoplasia |
|
|
Ectopic ureters
-common age of presentation? -more females or more males? -3 common breeds -how to dx? -what else do you need to evaluate? |
-usually present <1 year of age
-more common in females -Huskies, Labs, Goldens -dx with cystoscopy or contrast CT -need to evaluate upper urinary tract (i.e. US) |
|
|
Causes of decreased urethral closure pressures?
|
-USMI
-LMN bladder -injury to hypogastric nerve from IVDD, LS disease, Discospondylitis, malformations (Manx cats) |
|
|
Common signalment for USMI
|
middle-aged to older spayed females
|
|
|
4 treatments for USMI
|
alpha adrenergic agonists
estrogen compounds GnRH Collagen |
|
|
3 alpha adrenergic agonists?
|
PPA
Psuedoephedrine Ephedrine |
|
|
Side effects of PPA
What should be monitored? |
panting
decreased appetite aggression hypertension tachycardia Monitor HR and BP |
|
|
How do estrogens work to treat USMI
|
-increase receptor affinity for norepinephrine (increase alpha receptor sensitivity)
|
|
|
2 types of estrogens available in the US
-what should be monitored |
-diethylstilbesterol
-premarin Monitor CBC for any count decreases |
|
|
MoA of GnRH analogues?
|
Administration downregulates GnRH receptors in the pituitary which suppresses FSH and LH
FSH and LH receptors in the urethra and bladder may cause incontinence, so decreasing activation may help tx incontinence |
|
|
What are the two main categories of increased urethral tone? (overflow bladder)
|
-mechanical obstruction (neoplasia, stones, strictures, proliferative urethritis)
-Neurological obstruction (UMN bladder, or Reflex dyssynergia) |
|
|
What is Reflex dyssnergia and what is the common signalment?
|
Incoordinated PS and SNS causing bladder contraction at the same time the urethral sphincter contracts so urine cannot be voided
Common signalment: middle-aged to older male, large-giant breeds |
|
|
What is the major goal of treating increased urethral tone
|
to keep the bladder small and residual urine volume low so the bladder does not become atonic
|
|
|
What class of drugs are used to increase urethral tone?
What class of drugs are used to treat an atonic bladder? |
urethral tone:
alpha antagonists atonic bladder: parasympathomimetics |
|
|
What are examples of alpha antagonists?
Side effects? |
phenoxybenzamine, prazosin
weakness, lethargy, hypotension |
|
|
Example of a parasympathomimetic?
Side effects? |
bethanechol
side effect: SLUDS |
|
|
When is a parasympathomimetic contraindicated and what should you do first?
|
do not use if urethral obstruction is present (place catheter or put on alpha antagonists prior)
|
|
|
What are the 3 theories involved in stone formation?
|
1) increase mineral content of urine increases relative supersaturation for that mineral
2) promoter present in urine potentiates stone formation 3) in the absence of inhibitors (i.e. citrate), stones are more likely to form |
|
|
What is a matrix?
|
substances incorporated into the stone lattice as it forms
includes proteins, cell debris, foreign bodies, drug residues |
|
|
What is a stable solution
|
A solution with a low saturation such that crystals will not form/existing stones may dissolve
|
|
|
What is a metastable solution?
|
A solution with a higher supersaturation than a stable soution; crystal growth and aggregation will occur, heterogeneous nucleation may occur, but inhibitors will impede or prevent crystallization
|
|
|
What is an unstable solution?
|
nucleation will occur
inhibitors are not generally effective |
|
|
What is homogeneous nucleation?
|
spontaneous, sustained nucleation that occurs in highly supersaturated (unstable) solution in the absence of preformed organic or crystalline material
|
|
|
List 4 radiodense stones
|
Struvite
Calcium oxalate Silica Calcium Phosphate |
|
|
What two types of crystals suggest a metabolic issue the animal should be worked up for?
|
urates and cystine stones
|
|
|
Name two stones that are not radiodense
|
cystine
purine |
|
|
Name 5 methods for stone removal
|
Dissolution
Voiding urohydropropulsion Basket retrieval YAG laser lithotripsy Cystotomy |
|
|
How do you dx non-radiodense stones?
|
contrast studies or US
|
|
|
Name 3 stones that can possibly be dissolved
Name 1 stone form that cannot be dissolved |
Struvite, possibly urate and cystine
CaOx stones cannot be dissolved |
|
|
What 2 diagnostics should be performed after stone removal?
|
radiographs to make sure none are left!
Send in stone for analysis |
|
|
What is the most common stone in dogs?
|
Calcium oxalate
|
|
|
What is the most common stone in cats?
|
50% Ca Ox
50% struvite |
|
|
Most common upper urinary tract stone in cats?
|
Ca Oxalate
|
|
|
What types of dogs (breed and signalment) are more predisposed to CaOx?
|
mini breeds: min pins, maltese, Bichone, Lhasas, Chihuahuas
more commonly middle aged males |
|
|
What disease do Keeshounds get that predisposes them to CaOx stones?
|
primary hyperparathyroidism increases serum Ca++
|
|
|
Why has the prevalence of CaOx stones increased in cats?
|
Diet shift from a more basic pH to a more acidic pH to dissolve struvite stones (pH <6.7)...bone acts as a buffer to the increased acid so get increased urinary Ca++ excretion
|
|
|
List intrinsic factors to consider with a dog with Ca Ox stones
|
-evaluate serum Ca++ (if hypercalcemic, need to fix that!)
-any concurrent disorders? -fasted triglycerides? (matrix may contain lipids/fats; schnauzers predisposed to hyperlipidemia; important for diet choice) |
|
|
What are the two most important components of a diet for preventing CaOx stone?
|
moisture (at least 85%)
sodium (stimualtes thirst; don't use if concurrent CHF, renal failure, hypertension) |
|
|
What are USGs that are consistent with an increased moisture intake?
|
<1.025 in dogs
<1.030 in cats |
|
|
What two ions in low levels are risk factors for CaOx stones?
why? |
Phosphate and Mg
-both are soluble Ca++ chelators -decreased Phos stimulates Vitamin D activity |
|
|
What is the best diagnostic for idiopathic detrusor hyperreflexia?
|
cystometrogram
|
|
|
What drugs are used to treat idiopahic detrusor hyperreflexia?
side effects? |
-anticholinergics (detrol)
-side effects include urine retention, constipation -tricyclic antidepressants (have anticholinergic side effects) |
|
|
What drugs can be used for recurrent CaOx stone formation?
|
K citrate (citrate forms soluble salt with Ca++)
hydrochlorothiazide (increases Ca++ reabsorption in tubule) |
|
|
What kind of management can be used for struvite prevention in cats?
|
water (want USG < 1.030)
ad lib feeding to prevent fluctuations in urine pH Rx diets |
|
|
What pH does the urine have to be under to prevent struvite ppt?
|
6.7
|
|
|
What is the pathway of purine metabolism in normal dogs?
What is the defect in Dalmatians/JRT/English Bulldogs? |
Purine --> hypoxanthine --> xanthine (via XO) --> uric acid (via XO)
uric acid taken to liver and converted to allantoin via uricase Dalmatians et. al have a defect in the hepatocytes such that they can't bring uric acid into the hepatocyte |
|
|
What is allopurinol? How is it used?
|
Allopurinol is a competitive inhibitor of xanthine oxidase, so less uric acid is formed
need to use it in conjunction with a purine restricted diet |
|
|
Breeds predisposed to cystine?
|
Newfoundlands, Dachshunds, Bullmastiff, Pitbulls, Welsh Corgi, English Bulldog
|
|
|
3 urease-producing bacteria?
|
Staphylococcus, Klebsiella, Proteus
|
|
|
How many cfu/ml for
-cysto -male catheter sample -female dog catheter sample |
cysto: >1000 cfu/ml
male cath: >10,000 cfu/ml female dog cath: >100,000 cfu/ml |
