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Module 17 > Approach to Hematuria, Dysuria & Stranguira and Approach to & Management of LUT Disease > Flashcards

Approach to Hematuria, Dysuria & Stranguira and Approach to & Management of LUT Disease Flashcards

1
Q

what is hematuria

A

presence of blood or red blood cells in the urine

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2
Q

what is gross (macroscopic) hematuria

A

sufficient blood to be apparent to the naked eye

urine may appear brownish to red

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3
Q

what is occult (microscopic) hematuria

A

hematuria present but not visible to naked eye

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4
Q

what is pseudohematuria

A

red to brownish urine without intact red blood cells

can be due to hemoglobinuria, myoglobinuria or chemicals

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5
Q

how do you differentiate pseudohematuria from hematuria (2)

A

urine will be discoloured in both cases

  1. sediment exam
  2. centrifuge urine
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6
Q

how does sediment exam differentiate pseudohematuria from hematuria

A

PS: RBCs not visible

H: RBCs visible

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7
Q

how does centrifuge urine differentiate pseudohematuria from hematuria

A

PS: colour remains throughout sample

H: RBCs form a pellet at bottom of tube and urine becomes a more normal colour

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8
Q

how is hematuria investigated in history (5)

A
  1. bleeding noted from other sites?
  2. trauma?
  3. exposure to anticoagulant rodenticides?
  4. timing of occurence of blood?
  5. colour of blood?
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9
Q

how is hematuria investigated in clinical examination (6)

A
  1. other sites of hemorrhage?
  2. mucus membrane colour
  3. examine feces
  4. palpate kidneys
  5. palpate muscles
  6. digital rectal examination (dog)
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10
Q

what systemic diseases can cause hematuria

A

hemostatic defects

can be gross or microscopic

may occur intermittently

commonly signs of bleeding elsewhere

signs of LUT inflammation unlikely

look for evidence of platelet or coagulation problems

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11
Q

what renal/ureteral diseases can cause hematuria

A

neoplasia

calculi

trauma

infarction

cysts

glomerulonephritis

idiopathic renal hematuria

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12
Q

when would renal/ureteral hematuria occur

A

throughout urination

at end of voiding

or intermittently

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13
Q

when would signs of dysuria be present in renal/ureteral causes of hematuria

A

unlikely unless concurrent lower urinary tract disease

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14
Q

what can renal/ureteral hematuria lead to

A

hemoglobinuria

if urine dilute, RBCs can lyse and may see ghost RBCs

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15
Q

what are bladder/urethral causes of hematuria

A

bacterial infection

calculi

trauma

neoplasia

polyps

cyclophosphamide therapy

feline idiopathic cystitis

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16
Q

when would bladder/urethral hematuria occur

A

throughout urination

present at start of urination

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17
Q

are signs of LUT present in bladder/urethral hematuria

A

yes

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18
Q

what are genital tract causes of hematuria

A

prostatic disease

estrus

infection

neoplasia

trauma

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19
Q

when would genital tract hematuria be

A

at start at urination

throughout urination

unrelated to urination

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20
Q

would genital tract hematuria have signs of LUT

A

may or may not

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21
Q

what investigations might you do with hematuria

A

hematology

biochem

coagulation profile

full urinalysis including urine culture

imaging (utlrasound)

vaginoscopy

vaginal cytology

prostatic wash

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22
Q

what is dysuria

A

difficult and/or painful urination

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23
Q

what is stranguria

A

slow and painful urination

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24
Q

what is pollakiuria

A

abnormally freq passage of small volumes of urine

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25
what are two processes that can cause dysuria +/- stranguria
1. mucosal irritation or inflammation (cystitis) 2. narrowing or obstruction of the urethra or bladder neck
26
what are common causes of dysuria +/- stranguria in dogs
bacterial infections urinary calculi
27
what are common causes of dysuria +/- stranguria in cats
idiopathic cystitis (males/females) and urethral plugs (males only) both part of idiopathic feline lower urinary tract disease (iFLUTD)
28
what are bladder causes of dysuria +/- stranguria
1. cystitis (bacterial, secondary to stones, idiopathies) 2. neoplasia 3. bladder rupture
29
what are urethral causes of dysuria +/- stranguria (7)
1. calculi 2. plugs (cats) 3. stricture 4. bacterial urethritis 5. rupture 6. neoplasia 7. granulomatous urethritis
30
what are bladder & urethra causes of dysuria +/- stranguria
reflex dyssynergia
31
what are prostate causes of dysuria +/- stranguria (5)
1. benign hyperplasia 2. prostatits 3. abscess 4. cysts 5. neoplasia
32
what are penis, prepuce, vagina causes of dysuria +/- stranguria
neoplasia (rare presentation)
33
why is a good history key when investigating dysuria, stranguria
owners may not recognize dysuria for what it is --\> may think animal is constipated may think animal is incontinent because it passes small amounts of urine often, urine at unusual times, urine in inappropriate places
34
what are important history questions to ask the client with a dysuria patient (11)
1. is any urine being passed 2. how much urine 3. how often 4. is it painful 5. what is the urine stream like (stranguria) 6. is the urine discoloured (hematuria/cloudly) 7. where is it urinating 8. is the animal licking the penis/vulva 9. how long has it gone on 10. has this happened beofre 11. has there been any trauma
35
what should you do in a clinical exam for a dysuria pateint
abdominal palpation bladder palpation digital rectal palpation (bladder trigone, urethra, prostate) examination of perineum and external genitalia if possible watch the animal urinate and collect midstream sample
36
what would an obstruction or bladder rupture look like on biochem
post renal azotemia hyperkalemia metabolic acidosis
37
what should you look for in hematology when investigating hematuria
evidence of anemia thrombocytopenia/thrombocytosis causes of pseudohematuria
38
in cases with UTI what should you look for in hematology
look for leukocytosis (suggests pyelonephritis)
39
on US what should you examin the bladder for when investigating hematuria
uroliths, neoplasms, inflammation
40
on US what should you examine the prostate for when investigating hematuria
enlargement distortion cysts
41
on US what should you examin the kidney for when investigating hematuria
concurrent pyelonephritis
42
what other investigation could you do when investigating hematuria
1. prostatic wash 2. cytoscopy 3. bladder biopsy
43
what can urine retention be due to
1. obstruction 2. functional problem
44
what are functional causes of urine retention (3)
1. failure of relaxation of urethral sphincter (UMN lesion) 2. failure of detrusor muscle contraction (detrusor atony) 3. dyssynergia
45
what is urinary incontinence
involuntary leakage of urine through urethra
46
what are causes of urinary incontinence (2)
1. pressure in bladder \> urethra 2. anatomical abnormality bypassing urethral sphincter mechanism
47
what can cause the pressure in bladder to be \> urethra (2)
1. decreased detrusor compliance 2. decreased urethral tone
48
what can cause a decrease in urethral tone (5)
1. urethral sphincter mechanism incompetance 2. bladder/urethral neoplasia 3. UTIs 4. prostatic problems 5. ectopic ureters
49
what are important history questions when investigating urinary incontinence
is animal truly incontinent --\> identify or exlude polyuria, pollakiuria, periuria timing age at onset able to urinate normally pets awareness
50
what are diagnostic investigations for urinary incontinence
rectal and vaginal exam neurological exam manual bladder expression urinalysis and culture (inflammation, neoplasia, polyuria, infection)
51
when should you consider diagnostic imaging when investigating urinary incontinence (10)
1. under 1 year old 2. male 3. recent surgery 4. continuous urine leakage 5. leakage from anatomically abnormal site 6. recurring UTIs 7. vaginitis 8. hematuria 9. crystalluria 10. azotemia
52
what are bacteria that can cause ascending infections (6)
1. E coli 2. staphylococcus 3. streptococcus 4. proteus 5. enterococcus 6. klebsiella
53
what predisposes to urinary tract infections (3)
1. impaired freq of urination 2. incomplete bladder emptying 3. disruption of urethral anatomy
54
what is the prevelance of UTIs
more common in female dogs associated with prostatitis in male dogs rare in cats (treatment with antibiotics is not appropriate)
55
what are the signs of LUT infections (4)
1. urgency, hematuria, dysuria, pollakiuria, stranguria 2. urinary incontinence 3. urinary retention 4. bladder may be small and thickened
56
how would you diagnose UTIs
history and clinical signs of bladder inflammation urinalysis (including microscopy) imaging -- thickened bladder wall
57
what is a definitive diagnosis of UTI
positive urine culture
58
what is the definition of sporadic bacterial cystitis
sporadic bacterial infection of the urinary bladder with compatible LUT signs \<3 episodes of cystitis in prev 12 months
59
what is recurrent bacterial cystitis
animals that have had 3 or more episodes of clinical bacterial cystitis in prev 12 months OR 1 recurrece in prev 3 months may be relapsing, recurrent or persistent
60
what is asymptomatic bacteriuria
animals with bacteriuria in the absence of clinical signs
61
when would you culture the urine in a suspecting UTI
1. all animals with LUT signs 2. all animals with renal disease 3. animals with non-specific/vague signs 4. animals with active sediment 5. animals with diseases that predispose to UTIs
62
how would you treat sporadic bacterial cystitis
3-5 days treatment ideally based on culture and sensitivity
63
what antibiotics would you use for sporadic bacterial cystitis
cocci small paired rods in alkaline urine
64
what antibiotic would you use if there is rods in non-alkaline urine in sporadic bacterial cystitis
amoxicillin cephalexin TMPS
65
what antibiotics should you not use in sporadic bacterial cystitis
fluroquinolones, cefovecin unless necessary on culture results
66
how should you treat recurrent bacterial cystitis
may be associated with underlying cause so need to identify risk factors and comorbidities for long term success urine culture should always be performed try to determine if relapsing, persistent or re-infection
67
what is the difference between relapse and reinfection
68
what is the goal of treating recurrent bacterial cystitis
clinical cure with minimal risk of adverse effects
69
how would you treat recurrent bacterial cystitis
analgesia while waiting for culture and sensitivity short courses (3-5d) if its reinfection or may need 7-14d if relapse or persistent identify and control underlying caues
70
how should you treat subclinical bacteriuria
positive urine culture with no UTI symptoms usually don't treat
71
what are complications of UTIs (2)
1. polypoid cystitis 2. emyphsematous cystitis
72
what are polypoid cystitis
can occur to UTIs consider partial cystectomy
73
what is emphysematous cystitis
gas in lumen and wall of bladder glucose-fermenting bacteria (usually E. coli) treat cause of glucosuria
74
what are benign bladder masses
polypoid cystitis leiomyoma
75
what are malignant bladder masses (6)
1. transitional cell carcinomas 2. squamous cell carcinoma 3. leiomyosarcoma 4. rhabdomyosarcoma 5. prostatic neoplasia 6. metastatic neoplasia
76
what is the most common bladder tumour
transitional cell carcinoma
77
what breed of dogs are predisposed to transitional cell carcinomas
scottish terriers
78
what are the presenting signs of transitional cell carcinomas in the bladder (3)
1. signs of lower urinary tract inflammation 2. can cause urine retention 3. can cause urinary incontinence
79
how do you diagnose transitional cell carcinomas in the bladder (4)
1. thickening of bladder on US and mass lesions (trigone region) 2. urine sediment: neoplastic cells may be detected 3. cytoscopy: abnormal irregular proliferation from bladder wall 4. cytology or biopsy: for definitive diagnosis
80
how are transitional cell carcinomas in the bladder treated (3)
1. surgery: rarely possible due to tumour size and location 2. chemo: mitoxantrone/carboplatin 3. NSAIDs (piroxicam or meloxicam) (anti-neoplastic effects)

Module 17 (31 decks)

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