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Y4 SA - urinary & endocrine disease > Approach to haematuria & dysuria > Flashcards

Approach to haematuria & dysuria Flashcards

1
Q

What is haematuria?

A
  • blood in the urine
  • red urine
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2
Q

What is haemoglobinuria?

A
  • haemoglobin in the urine
  • red urine
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3
Q

What is myoglobinuria?

A
  • myoglobin in the urine
  • brown/orange urine
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4
Q

What is bilirubinura?

A
  • bilirubin in the urine
  • yellow/orange urine
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5
Q

What is dysuria?

A
  • difficulty/pain urinating
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6
Q

What is incontinence?

A
  • inability to control urination
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7
Q

What is stranguria?

A
  • straining to urinate
  • usually small volumes being produced
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8
Q

What is pollakiuruia?

A
  • frequent, abnormal urination
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9
Q

What is oliguria?

A
  • minimal urine production
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10
Q

What is anuria?

A
  • no urine production
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11
Q

What dz in males can manifest as urinary dz but isn’t?

A
  • prostate issues
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12
Q

What dz in females can manifest as urinary dz but isn’t?

A
  • uterine dz
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13
Q

Why are females more prone to UTIs than males?

A
  • due to a shorter, wider urethra (some bacteria from skin, faecal contamination, etc can make it’s way up the urinary tract)
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14
Q

What does gross urinalysis tell us?-

A
  • colour (blood/myoglobin/concentration)
  • smell
    – glucose = sweet
    – bacteria = strong smell
    – ketones = DKA?
    – metallic = bleeding
  • turbidity (increase in solutes, casts, cells, mucus)
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15
Q

How can urine dipstick help differentiate between haematuria and haemoglobinuria?

A
  • dots = supportive of blood
  • homogenous change = supportive of haemoglobin/myoglobin
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16
Q

How can a sediment exam differentiate between haematuria and haemoglobinuria?

A
  • spin the sample down so supernatant is on top and sediment on the bottom
  • RBCs will precipitate and settle on the bottom -> presence of them on cytology
  • haemoglobin/myoglobin won’t precipitate and no presence of RBCs on cytology
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17
Q

Haemaglobinuria vs myoglobinuria

A

Blood sample & centrifuge
- plasma likely to be red with haemoglobinuria
- plasma likely to be clear with myogloinaemia
– test for AST & CK

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18
Q

Causes of haemoglobinurea

A
  • haemoglobinaemia, caused by haemolysis
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19
Q

Causes of myoglobinuria

A

myoglobinaemia caused by:
- Severe muscle damage
– AST/CK, History, exam.
– Physical causes: trauma/burns/strenuous
exercise/prolonged immobility
– Non-physical causes: hypoxic/ischaemic/metabolic disturbances/infectious

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20
Q

Haematuria - where could the blood have come from?

A
  • anywhere in the uro tract (kidney, ureter, bladder, urethra)
  • depending on sample technique
    – cystocentesis
    – repro tract: prostate, penis, uterus, vagina
    – external/mucocutaneous e.g. penile sheath, vulva
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21
Q

Haematuria - why might something be bleeding?

A
  • damage to blood vessels or abnormal blood vessels
    – trauma
    – urolithiasis
    – UTI
    – inflammation
    – neoplasia
  • abnormal haemostasis
    – coagulopathy
  • idiopathic
    – idiopathic renal haematuria
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22
Q

Diagnosing trauma causing haematuria

A
  • History and exam
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23
Q

Diagnosing urolithiasis causing haematuria

A
  • Urine sediment exam,
    ultrasound, radiography (contrast)
24
Q

Diagnosing UTI causing haematuria

A
  • Urine sample – cytology and C+S
  • Ultrasound
25
Q

Diagnosing inflammation causing haematuria

A
  • History, urinalysis, imaging to rule out other causes
26
Q

Diagnosing neoplasia causing haematuria

A
  • CBC – chronic anaemia (due to chronic bleeding)
  • Ultrasound and radiography
  • endoscopy and biopsy
27
Q

Diagnosing coagulopathy causing haematuria

A
  • CBC; platelet count and PT, aPTT, TEG
28
Q

Diagnosing idiopathic causes of haematuria

A
  • rule out everything else
  • CBC for anaemia
  • ureteroscopy
29
Q

Idiopathic Renal Haematuria - prevalence, signalment

A
  • Uncommon
  • Typically large breed, young dogs
  • Unilateral in 75% of cases
  • Caused by vascular anomalies in some humans
30
Q

Idiopathic Renal Haematuria - CS & diagnostic findings

A
  • Haematuria; potentially passing clots, or seeing them in the bladder via ultrasound
  • Can lead to:
    – Anaemia; Renal pain; Ureteral pain and/or ureteral obstruction; UTI’s
31
Q

Idiopathic Renal Haematuria - tx

A
  • ACEi (for proteinuria) and ARBs
  • Potentially interventional radiography – sclerotherapy
32
Q

Dysuria: What do we see clinically?

A
  • History or a video of the animal urinating is useful, both stranguria or pollakiuria may have pain as a component, but stranguria is prolonged, painful straining and owners may report ‘a drop at a time’ or tenesmus
33
Q

Ddx for dysuria

A
  • anything that stimulates pain or inflammation
  • aka similar to haematuria
34
Q

How is dysuria different to haematuria?

A
  • Dysuria is due to lower urinary tract disease – whereas discoloured urine can be from anywhere on the urinary (or repro) tract
35
Q

What is urge incontinence?

A
  • Very similar to pollakiuria – involuntary bladder contractions voiding small amounts of urine regularly (sometimes referred to as an ‘overactive bladder’).
  • Involuntary bladder contractions – neuromuscular and anatomical disease should also be considered
  • Anatomical dz for urge incontinence - e.g. enlarged prostate pushing on bladder, bladder will keep firing off as being squeezed.
36
Q

RTA / trauma: haematuria, dysuria or both?

A
  • mainly haematuria
  • but can get neurological damage and/or pain that contributes to dysuria
37
Q

UTI: haematuria, dysuria or both?

A
  • both due to the inflammation caused
38
Q

Fulminant hepatic failure: haematuria, dysuria or both?

A
  • clotting factors made in the liver so this could cause a coagulopathy which could lead to haematuria
  • could get dysuria secondary as blood in the urine can increase chance of getting a UTI, causing dysuria
39
Q

Warfarin toxicity: haematuria, dysuria or both?

A
  • haematuria as thins blood
  • but same as fulminant hepatic failure in terms of increased risk of UTI -> dysuria
40
Q

Urolthelial carcinoma (transitional cell carcinoma): haematuria, dysuria or both?

A
  • both
41
Q

Idiopathic renal haemturia: haematuria, dysuria or both?

A
  • haematuria
  • but clots can attract infection so can get both
42
Q

Urethral sphincter mechanism incompetence (USMI): haematuria, dysuria or both?

A
  • dysuria
43
Q

Ectopic ureter: haematuria, dysuria or both?

A
  • dysuria most likely
44
Q

Differentials for dysuria

A
  • Inflammatory
  • Infectious
  • Obstructive
  • Neuromuscular
  • FIC (can become obstructive)
  • Drugs
  • Anatomical
  • Iatrogenic
  • Idiopathic
45
Q

Inflammatory differentials for dysuria

A
  • Cystitis – polypoid or pyogranulomatous
  • Granulomatous urethritis
  • Follicular vaginitis*
46
Q

Infectious cause of dysuria

A
  • Bacterial: E.coli*
47
Q

Obstructive differentials for dysuria

A
  • Urethral Stricture
  • Urolithiasis*
  • Urethral plug
  • Perineal hernia, post-spay granuloma/ stump pyometra
  • Prostatic disease* (Stranguria)
    – Prostatitis
    – Prostatic abscess
  • Neoplasia
    – TCC, Prostatic adenocarcinoma, urethral leiomyoma
48
Q

Neuromuscular differentials for dysuria

A

(Urge incontinence)
- Upper motor neuron bladder
- Detrusor Atony (overflow incontinence)
- Urethral sphincter mechanism
incontinence*

49
Q

Drug cause of dysuria

A
  • cyclophosphamide
50
Q

Iatrogenic cause of dysuria

A
  • Irritation secondary to procedures
51
Q

Idiopathic cause of dysuria

A
  • Detrusor hyperspasticity (Urge Incontinence)
52
Q

Is the animal blocked or not?

A

Obstructive disease
- Failure of bladder to empty (neuromuscular)
– Detrusor atony –> overstretch and damage –> flaccid, easy to express
- UMN bladder (Thoraco-lumbar disease) –> urethral sphincter tone remains high preventing urination, difficult to express
- Inflammatory, infectious, iatrogenic can all have a big bladder

Small Bladder: non-obstructive disease
- Anatomical – e.g. ectopic ureters
- Neuromuscular – e.g. USMI
- Inflammatory, infectious, iatrogenic or idiopathic
- FIC

52
Q

Imaging: should we use CT? Specific use examples

A
  • if required in workup, yes

Specific use examples:
* Investigation/ characterization of a mass
* Assessment of tumour spread or surrounding
tissue involvement, metastasis
* Ectopic ureter
– Diagnosis
– Characterisation

53
Q

Further diagnostics

A
  • Ex lap
  • Endoscopy
54
Q

Ex lap - uses

A
  • Allows direct visualisation
    – Neoplasia
  • Allows for biopsy/sampling/curative surgery
  • Technical expertise for procedures otherwise major complications;
    – Bladder mass incisional biopsy –> uroabdomen
    – Bladder mass excisional biopsy –> curative
55
Q

Endoscopy - uses

A
  • Allows for direct visualisation (via a screen)
    – Ectopic ureters
    – Neoplasia
    – Idiopathic renal haematuria (identify the ureter)
  • Allows for biopsy/sampling
  • Reduced risk of trauma – but can perforate a fragile bladder
  • Technical expertise – specialist training to use and interpret

Y4 SA - urinary & endocrine disease (17 decks)

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