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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
Q

what are two processes that can cause dysuria +/- stranguria

A
  1. mucosal irritation or inflammation (cystitis)
  2. narrowing or obstruction of the urethra or bladder neck
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26
Q

what are common causes of dysuria +/- stranguria in dogs

A

bacterial infections

urinary calculi

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27
Q

what are common causes of dysuria +/- stranguria in cats

A

idiopathic cystitis (males/females) and urethral plugs (males only)

both part of idiopathic feline lower urinary tract disease (iFLUTD)

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28
Q

what are bladder causes of dysuria +/- stranguria

A
  1. cystitis (bacterial, secondary to stones, idiopathies)
  2. neoplasia
  3. bladder rupture
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29
Q

what are urethral causes of dysuria +/- stranguria (7)

A
  1. calculi
  2. plugs (cats)
  3. stricture
  4. bacterial urethritis
  5. rupture
  6. neoplasia
  7. granulomatous urethritis
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30
Q

what are bladder & urethra causes of dysuria +/- stranguria

A

reflex dyssynergia

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31
Q

what are prostate causes of dysuria +/- stranguria (5)

A
  1. benign hyperplasia
  2. prostatits
  3. abscess
  4. cysts
  5. neoplasia
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32
Q

what are penis, prepuce, vagina causes of dysuria +/- stranguria

A

neoplasia (rare presentation)

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33
Q

why is a good history key when investigating dysuria, stranguria

A

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
Q

what are important history questions to ask the client with a dysuria patient (11)

A
  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
Q

what should you do in a clinical exam for a dysuria pateint

A

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
Q

what would an obstruction or bladder rupture look like on biochem

A

post renal azotemia

hyperkalemia

metabolic acidosis

37
Q

what should you look for in hematology when investigating hematuria

A

evidence of anemia

thrombocytopenia/thrombocytosis

causes of pseudohematuria

38
Q

in cases with UTI what should you look for in hematology

A

look for leukocytosis (suggests pyelonephritis)

39
Q

on US what should you examin the bladder for when investigating hematuria

A

uroliths, neoplasms, inflammation

40
Q

on US what should you examine the prostate for when investigating hematuria

A

enlargement

distortion

cysts

41
Q

on US what should you examin the kidney for when investigating hematuria

A

concurrent pyelonephritis

42
Q

what other investigation could you do when investigating hematuria

A
  1. prostatic wash
  2. cytoscopy
  3. bladder biopsy
43
Q

what can urine retention be due to

A
  1. obstruction
  2. functional problem
44
Q

what are functional causes of urine retention (3)

A
  1. failure of relaxation of urethral sphincter (UMN lesion)
  2. failure of detrusor muscle contraction (detrusor atony)
  3. dyssynergia
45
Q

what is urinary incontinence

A

involuntary leakage of urine through urethra

46
Q

what are causes of urinary incontinence (2)

A
  1. pressure in bladder > urethra
  2. anatomical abnormality bypassing urethral sphincter mechanism
47
Q

what can cause the pressure in bladder to be > urethra (2)

A
  1. decreased detrusor compliance
  2. decreased urethral tone
48
Q

what can cause a decrease in urethral tone (5)

A
  1. urethral sphincter mechanism incompetance
  2. bladder/urethral neoplasia
  3. UTIs
  4. prostatic problems
  5. ectopic ureters
49
Q

what are important history questions when investigating urinary incontinence

A

is animal truly incontinent –> identify or exlude polyuria, pollakiuria, periuria

timing

age at onset

able to urinate normally

pets awareness

50
Q

what are diagnostic investigations for urinary incontinence

A

rectal and vaginal exam

neurological exam

manual bladder expression

urinalysis and culture (inflammation, neoplasia, polyuria, infection)

51
Q

when should you consider diagnostic imaging when investigating urinary incontinence (10)

A
  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
Q

what are bacteria that can cause ascending infections (6)

A
  1. E coli
  2. staphylococcus
  3. streptococcus
  4. proteus
  5. enterococcus
  6. klebsiella
53
Q

what predisposes to urinary tract infections (3)

A
  1. impaired freq of urination
  2. incomplete bladder emptying
  3. disruption of urethral anatomy
54
Q

what is the prevelance of UTIs

A

more common in female dogs

associated with prostatitis in male dogs

rare in cats (treatment with antibiotics is not appropriate)

55
Q

what are the signs of LUT infections (4)

A
  1. urgency, hematuria, dysuria, pollakiuria, stranguria
  2. urinary incontinence
  3. urinary retention
  4. bladder may be small and thickened
56
Q

how would you diagnose UTIs

A

history and clinical signs of bladder inflammation

urinalysis (including microscopy)

imaging – thickened bladder wall

57
Q

what is a definitive diagnosis of UTI

A

positive urine culture

58
Q

what is the definition of sporadic bacterial cystitis

A

sporadic bacterial infection of the urinary bladder with compatible LUT signs

<3 episodes of cystitis in prev 12 months

59
Q

what is recurrent bacterial cystitis

A

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
Q

what is asymptomatic bacteriuria

A

animals with bacteriuria in the absence of clinical signs

61
Q

when would you culture the urine in a suspecting UTI

A
  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
Q

how would you treat sporadic bacterial cystitis

A

3-5 days treatment

ideally based on culture and sensitivity

63
Q

what antibiotics would you use for sporadic bacterial cystitis

A

cocci

small paired rods in alkaline urine

64
Q

what antibiotic would you use if there is rods in non-alkaline urine in sporadic bacterial cystitis

A

amoxicillin

cephalexin

TMPS

65
Q

what antibiotics should you not use in sporadic bacterial cystitis

A

fluroquinolones, cefovecin unless necessary on culture results

66
Q

how should you treat recurrent bacterial cystitis

A

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
Q

what is the difference between relapse and reinfection

A
68
Q

what is the goal of treating recurrent bacterial cystitis

A

clinical cure with minimal risk of adverse effects

69
Q

how would you treat recurrent bacterial cystitis

A

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
Q

how should you treat subclinical bacteriuria

A

positive urine culture with no UTI symptoms

usually don’t treat

71
Q

what are complications of UTIs (2)

A
  1. polypoid cystitis
  2. emyphsematous cystitis
72
Q

what are polypoid cystitis

A

can occur to UTIs

consider partial cystectomy

73
Q

what is emphysematous cystitis

A

gas in lumen and wall of bladder

glucose-fermenting bacteria (usually E. coli)

treat cause of glucosuria

74
Q

what are benign bladder masses

A

polypoid cystitis

leiomyoma

75
Q

what are malignant bladder masses (6)

A
  1. transitional cell carcinomas
  2. squamous cell carcinoma
  3. leiomyosarcoma
  4. rhabdomyosarcoma
  5. prostatic neoplasia
  6. metastatic neoplasia
76
Q

what is the most common bladder tumour

A

transitional cell carcinoma

77
Q

what breed of dogs are predisposed to transitional cell carcinomas

A

scottish terriers

78
Q

what are the presenting signs of transitional cell carcinomas in the bladder (3)

A
  1. signs of lower urinary tract inflammation
  2. can cause urine retention
  3. can cause urinary incontinence
79
Q

how do you diagnose transitional cell carcinomas in the bladder (4)

A
  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
Q

how are transitional cell carcinomas in the bladder treated (3)

A
  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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