12. Examination of the urinary system Flashcards
what is the parts of the urinary system?
1. Upper urinary tract = examination of the kidneys 2. Lower urinary tract – Bladder – Urethra – Prostate (male dogs)
What are some specific signs in advanced cases?
- Halitosis (foetor ex ore) → uremic breath
- Uremic ulcers
- Abnormal palpation of the kidneys
What are some signs we look for in the physical examination?
• Poor body condition • Dehydration • Anaemia • Periodontal, oral diseases - Gingivitis, tooth tartar, halitosis, ulcers • Palpation of the kidneys - Small, firm kidneys - Normal findings - Enlarged kidneys
Are both kidneys palpable in the cat?
yes
Are both kidneys palpable in the dog?
only the left one
Description of the palpatory findings of abdominal organs:
Location, size, shape, relation to their neighborhood,
painfulness, surface, consistency, structure, (symmetry)
What can be the cause of enlarged kidneys?
- renal diseases
- kidney tumors
- hydronephrosis
- polycystic kidney disease (PKD)
- perinephric pseudocyst (cats)
- viral infections (cats)
- PSS (dogs)
What can be the cause of smaller kidneys?
- renal fibrosis
- renal dysplasia
What can be some causes of painful kidneys?
- acute nephritis
- kidney stones
- tumor
- pyelonephritis
What do we check in glomerular function?
- GFR
2. Urinary protein
How do you check the GFR?
• Urea, creatinine • SDMA • Clearance techniques Endogenous (creatinine) – Exogenous (creatinine, inulin, iohexol, isotopes)
How do you check the urinary protein?
Dipstick sulpho-salicylic acid test Urine protein/creatinine ration (UPC) microalbuminuria? sediment !!!
Dips stick is
unreliable !!!
what are the laboratory evaluation methods of tubular function?
• Specific gravity
- Hypo-1007
- Iso-(1008-1012),
- Hyperstenuric: dogs above1030, cats above 1035
- Cats often able to concentrate urine despite having kidney disease
• Glycosuria, mild proteinuria, urine sediment (casts, tubular cells)
Diagnosing kidney disease:
4 important steps:
- Fasted, well hydrated animals (rehydrated if needed) repeated samples:
Urea, Creatinine, SDMA
2. Urinalysis (2-3x) – Specific gravity (refractometry) – Presence of proteinuria - Measure UPC (unless a hyperstenuric urine dipstick negative) – Urine sediment
- Ultrasonography
- Cytology, biopsy in selected cases
Problems related to micturition (urination), urine quality, incontinence =
- Dysuria
- Stranguria
- Hematuria
- Pollakiuria
- Incontinence
- Periuria
What are the first steps in case of lower urinary tract problems?
• Urinary bladder size, bladder tone, compressibility of the bladder.
• Urethral patency? (Catheterization in case of suspected obstruction)
+ complete physical exam
• Other diseases, systemic signs?
• PU/PD ?
• dehydration?
How do you examine the urinary bladder?
- inspection
- abdominal palpation
Description of the palpatory findings of the urinary bladder:
location, size = degree of distension, shape, painfulness, surface, (wall thickness, bladder content)
Abnormal findings of the urinary bladder:
• Dilation -Acute (urethral obstruction) overdistended, turgid, firm urinary bladder that cannot be expressed • Chronic (innervation problem) flaccid • Pain - cystitis, stones • Abnormal surface– tumors • Thickened wall - cystitis, tumor
Additional examination of the lower urinary tract:
- Rectal examination (to palpate the prostate in male dogs)
- Catheterization (in case of suspected urethral obstruction)
- Diagnostic imaging (US, Radiography)
- Urinalysis (always needed!!!)
what are the purpose of the different types of radiography?
Plain film: stone in the urethra?, in the ureters?
– Non-obstructive urethral stones may be missed during catherization
Contrast exams:
– to visualize the ureters (excretory urography)
– to detects urethral pathologies(retrograde)
– If no access to ultrasound
How do you examine the female urethra?
- vaginal examination
- inspection (opening of the urethra)
- palpation
- catheterization
How do you examine the male urethra?
Rectal examination (dogs)
- palpation (pelvic part) examination of the perineum
- inspection (perineal part)
- palpation
Examination of the prepuce and penis
- inspection (penile part and opening of the urethra)
- palpation (penile part and opening of the urethra)
- catheterisation
How do you examine the prostate?
• Palpation (abdominal, rectal-digital)
– size, shape, symmetry, consistency, pain
• Imaging methods (X-ray, US)
• Urinalysis
• Examination of prostatic fluid (prostatic massage)
– Examination of semen
• Cytology, biopsy
