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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?
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palpate vagina and vestible
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What are key ways to localize a problem to the upper urinary tract?
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-Body weight change
- fever or hypothermia - PU/PD -vomiting |
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What are key ways to localize a problem to the lower urinary tract?
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-discharges
-dysuria, stranguria, pollakiuria -incontinence (most often due to LUT) |
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What will a CBC with leukocytosis point to if there are urinary problems?
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lepto, pyelonephritis, prostatitis, rupture
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What will a CBC with thrombocytopenia point to if there are urinary problems?
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lepto, DIC
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Azotemia is an increase in BUN, creatine and P. When there is renal failure, what is damaged?
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nephrons
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Azotemia is an increase in BUN, creatine and P. When there is prerenal azotemia, what does this mean?
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-decreased perfusion or increased production (eating blood or bleeding inside)
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What does it mean where there is high BUN and normal creatine?
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GI bleeding
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Azotemia is an increase in BUN, creatine and P. When there is post-renal azotemia, what is the cause?
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obstruction or disruption
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What will the SG be if there is renal failure?
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1.008-1.012
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What endocrine abnormalities can affect USG?
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1 - hypoadrenocortism (collecting duct)
2 - hyperadrenocortisms (antagonists to V2 vasopresin) 3 - ketoacidosis, DM 4 - hyperthyroidism |
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What are "other" diseases that affect the USG?
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1 - hypercalcemia (antagonists to vasopresin)
2 - hepatic disease (PSS and severe hepatitis) 3 - pyometra (antagonists to V2 vasopressin) 4 - urinary obstruction |
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What % of nephrons must be damaged to be:
1 - isothenuric 2 - azotemic |
1 - 66%
2 - 75% |
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What is the best estimator of GFR?
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creatinine
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When can you get false positives on protein dip stick?
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alkaline urine
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What does protein in the urine mean?
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1 - lower urinary tract problem (infection, inflammation, infection)
2 - renal disorder 3 - excess serum protein |
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What is an ABNORMAL amount of protein in the urine?
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> or equal to 2 + in <1.035
-check UPC |
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What are the steps to determining the cause of protein in the urine?
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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 |
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What are causes of preglomerular proteinuria?
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-Bence Jones proteins (myeloma)
-hemoglobin (hemolysis) -myoglobin -fever seizures -extreme exercise |
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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 |
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What is a normal UPS in a dog and cat?
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dog = <.5
cat = <.2 |
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What is a granular cast a sign of?
a waxy cast? |
necrosis of infection of the kidney
acute kidney failure |
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Where are the majority of obstructions?
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lower urinary tract
-if complete, cause uremia in 24-48 hours |
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What are common anatomic causes of obstruction?
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mucus plugs, urolithiasis, neoplasia (TCC, protstate)
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What are the most common signs of obstruction of the lower urinary tract?
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stranguria, pollakiuria, +/-hematuria, DISTENDED bladder
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What are clinical signs of upper urinary tract obstruction?
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ulilateral, occult, enlarged kidney (hydronephrosis), pain on palpation of kidney or retroperitoneal space
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What are the causes of disruption?
What is the most common cause? |
rupture (most common)
avulsion necrosis -trauma = motor vehicle accidents, fights, improper cath. |
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What are the two main causes of obstruction?
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functional or anatomic
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WHERE are the majority of distruptions?
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the lower urinary tract (mostly bladder)
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How do you treat disruptions from trauma?
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treat for shock --> rehydrate and get ECG
- diagnostics - urine drainage |
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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 |
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How do you tell if there is uroabdomen?
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if fluid azostick is > serum azostick
- if fluid creatine/K: serum creatine/K ratio is >2:1 |
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If there is a obstruction in a cat, what should you try first to remove it?
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urethral massage
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What is the first step with trying to remove a urethral obstruction?
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-advance catheter to obstruction and flush with NaCl and lube
-may need indwelling if uremic or obstruction remains in UT |
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How do you remove stones in the urethra if you can't get the cath to go in?
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retrograde urohydropulsion
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When would you likely perform a urethrostomy?
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1 - when can't relieve
2 - when likely to reobstruct |
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What must you watch out for when performing post obstructive diuresis?
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hypokalemia
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Although primary renal neoplasia is rare, what is the most common?
what is the prognosis? |
adenocarcinoma - usually occult
-unilateral renomegaly 3-4 months |
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What is the most common type of renal neoplasia?
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secondary neoplasia - lymphoma
-more common in cats and is bilateral |
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Is upper or lower neoplasia more common in the urinary tract?
is it primary or secondary? |
lower
almost exclusively primary neoplasia --> TTC |
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What sex and breeds are predisposed to LUT neoplasia with TCC?
What environements? |
females
scotties - 18 xmore common industrial |
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How often is the urethra involved with TCC?
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15%
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What are CS of TCC?
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hematuria, stranguria, pollakiuria - LUT signs
recurrent UTIs can also cause these signs -palpation -sometimes see dystrophic mineralization |
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Why is the veterinary bladder tumor antigen test bad?
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specificity is low - 78%
therefore 22% get false positive -hematuria causes these |
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What always works for identification of a TCC??
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traumatic catheterization
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What drug is used to treat TCC in the bladder?
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piroxicam
-COX inhibitor and causes shrinkage 30% of time |
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What disease do cats get that dogs don't?
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idiopathic cystitis (54%) --> lower urinary tract signs
AKA interstitial cystitis |
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Cats with lower urinary tract disease get idiopathic cystitis 54%? What are the other problems they get and in what percentage?
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-urolithiasis (21%)
-urethral plugs (22%) -UTI (<2%) n-eoplasia (0.3%) |
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What are possible pathogenesis for feline interstitial cystitis?
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1 - viral infection --> calicivirus, synchitial virus
2 - GAG def. 3 - neurogenic inflammation 4 - abnormal stress response |
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What are predisposing factors to a cat getting feline interstitial cystitis?
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fat, lazy, indoor, neutered cats on dry food
-multi-cat household |
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What does a UA normally look like in a cat with interstitial cystitis and LUT signs?
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hematuria only
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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?
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-can't urinate
-signs persist for more than 10 days -reoccurance (in 30-70%) |
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What is the most important factor when treating feline idiopathic cystitis?
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client communication
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When you bring a cat back in for idiopathic feline cystitis, what diagnostics do you preform?
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-imaging (plain and contrast) to make sure no stones or infection
-CBC/Chem -urine culture - FeLV/FIV |
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What general method do you use to help reduce stress in cats with idiopathic cystitis?
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Multimodal Environmental Modifications (MEMO)
-goal is to reduce stress with food, litter, environmental enrichment, anti-depressant/tranquilizer |
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What anti-depressants might you try in cats with idiopathic cystitis?
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amitriptyline (anti-histamine effect)
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What ways might you try in cats to decrease urethral contractility with idiopathic cystitis?
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phenoxybenzamine
prazosin valium |
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What are the most common causes of male cat urethral obstruction?
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1 - urethral plugs
2 - urolitiasis 3 - obstructive idiopathic cystitis (urethral spasm, blood clots) 4 - neoplasia 5 - blood clots |
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What is the minnisota olive-tipped catheter for?
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Unobstructing MALE Cats
-safest in the cat and for unobstructing only |
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What is the Tom Cat (polypropylene) catheter used for?
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Draining only
-stiff and end is blunt so it could tear urethra |
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When should you leave a cath in after unabstructing a male cat?
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1 - patient azotemic or hyperkalemic
2 - obstructing object still in the cat 3- bladder atonic 4- bladder/urethra perforation 5 - no overnight care available |
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What bacteria are common with urinary tract infections?
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Staph, Proteus, E. coli, Enterococcus
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What two things help bacteria from adhering to the bladder?
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IgA and GAG
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What are the 3 key factors of an uncomplicated UTI?
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-one organism
-no impaired host defenses or renal/protatic involvement -easy to treat |
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What animals are automatically considered to have complicated UTIs?
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cats and adult male dogs
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What type of deep infections are considered to have a complicated UTI?
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-pyelonephritis
-prostatitis |
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What type of diseases that impair the host defenses are classified as complicated UTIs?
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-cushings
-DM -CRF -micturition disorders -immunosuppression |
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What type of other abnormalities that impair the host defenses are classified as complicated UTIs?
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-uroliths
-foreign bodies -bacterial resistance |
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What type of anatomic abnormalities that impair the host defenses are classified as complicated UTIs?
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-urinary fistulas
-ureteral ectopia -urinary diversion Sx -neoplasia -obstruction -hypoplastic vulva |
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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 |
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Does lack of bacteruria rule out a UTI?
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no - verify by culture and smear
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What is best for determining bacterial susceptibility for a UTI?
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serial dilution is best
-determination of a MIC -choose S and avoid R |
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Do you need to culture all cases of UTI?
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no - esp. if first time or infrequent LUT sings in a dog without complicating factors
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What are 1st line antimicrobials for UTIs?
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amoxicillin, TMS, tetracyclines
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What are 2nd line antimicrobials for UTIs?
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-fluroquinolones (Baytril)
-1st generation cephalosporins -amoxicillin and clauvulonic acid (clavamox) |
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What are 3rd line antimicrobials for UTIs?
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-2nd and 3rd generation cephalosporins, imipenem, aminoglycosides
-most expensive and most likely to be toxic and inject able |
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How long are most UTI drugs given?
-What is the exception? |
TID
BID for TMPS and fluroquinolones 1/day for aminoglycosides |
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What is the duration of therapy for uncomplicated UTIs?
Complicated? |
10-14 days
4-6 weeks or 2 weeks PAST a complicating factor |
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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 |
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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 |
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What are CS to bacterial urethrocystitis?
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-stranguria
-dysuria -pollakiuria |
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Why might the pH be high in a UA?
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urease producing bacteria (Staph and Proteus)
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What does a polypoid cyst look like?
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grape like structures (TCC)
- caused by recurrent and chronic UTIs |
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What type of cystitis is common with DM?
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emphysematis cystitis
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What is the etiology of bacterial pyelonephritis?
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ascending urinary, hematogenous, or spread from adjacent infection
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How do you diagnose bacterial pyelonephritis?
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-culture of renal tissue or renal pelvic urine
-azotemia, neutrophilia -diagnostic imaging (US) -- hyperechoic cortex with anechoic fluid in the center CS of UTI |
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What is the treatment for acute and chronic bacterial pyelonephritis?
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acute - broad spectrum parenteral antimicrobials with ampicillin and enrofloxacin until systemic signs resolve then as for complicated UTI
chronci - as for complicated UTI |
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What are CS of urolithiasis?
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same as for the lower UT
-hematuria, stranguria, pollakiuria -uremia is urethral obstruction |
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What are struvite stone made of?
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magnesium, ammonia, and Phos
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Do males are females more often get struvite stones?
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females because almost always induced by infection (UTI)
-min. schnauzer, bichon, cocker |
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What causes stone formation with struvite stones?
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pH
-bacteria produce urease (by proteus and E. coli) and ammonium can bind to P more easily |
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What does a struvite stone look like and what is the ph of the uirne?
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radioopaque, round, smooth
neutral to alkaline crystals are coffin shaped UTI with Stap of proteus |
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How do you dissolve a struvite stone?
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feed s/d-low protein, acidifying, high Na
-antibiotics - clavamox -montly rads and UA (+/- cultures) |
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How long does it take to dissolve a struvite stone?
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1/5-3.0 months
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Will urethral struvite stones dissolve?
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no
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What is the most common urolith in the cat?
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struvite (48%)
-they are sterile in the cat so most don't need antibiotics |
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HOw do you prevent struvite?
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- do UA often to detect infection early (3-6 months)
-may need reduced protein and Mg -increase water intake |
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How do Ca oxalate look in the bladder?
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-sharp and irregular, opaque
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What are known causes of calcium ocalate in dogs?
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-hyperPT
-hyperAC -becoming more common due to breed popularity (min schnauzers) and acidifiying diets |
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What should you evaluate a dog for if they have calcium oxalate stones?
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-hypercalcemia
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Can you dissolve Ca oxalate stones?
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no
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What is the recurrence rate of Ca ocalate stones?
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40% in 3 years
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What SG do you want to keep the urine at to avoid ca oxalate?
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SG<1.020 and pH of 6.5-7.5
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What are the most common uroliths in dogs and cats?
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CaOx and MAP
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What percentage of animals with ammonium urate stones are males?
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>97%
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Why are dalmations prone to ammonium urate stones?
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purine handling is abnormal
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Other than being a dalmations, what other conditions predispose an animal to getting ammonium urate stones?
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-portovascular anomalies (PSS, MVD)
-urease produciing bacteria -breed - english bulldogs, min schnauzers, shih tzu, yorki |
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What is the pH of urine in animals with ammonium urate stones?
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acid to neutral
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What must you use in order to see ammonium urate stones?
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contrast rads
-they are smooth |
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How do you dissolve ammonium urate crystals and what is the success rate?
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hills u/d - to make more alkaline urine
-protein restricted diet -allopurinol blocks conversion of purines to uric acid -30-40% success rate |
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What are prevention diets, esp. for dalmations, to prevent ammonium urate crystals?
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low protien, low purine diets
-hills u/d or Hills k/d -pH>7 -low dose of allopurinol |
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What stones are most common with neprholiths and ureteroliths?
young or old? |
Ca OX
old |