Approach to Urinary Tract & Liver Disease in Cows Flashcards
1
Q
what are the main differences between sa/equine and farm animal
A
rare
cattle dont live long enough to get CRF and not stressed enough to get FLUTD type disease
PUPD hard to assess
other signs vague
diagnostic relatively basic compared to other species
often underdiagnosed
2
Q
what are the clinical signs of urinary disease in cattle
A
- non specific: weight loss, diarrhea, abdominal pain
- specific: enlarged kidney on rectal,abnormal urine (pus, blood), stranguria, pollakiuria, crystals on prepuce
3
Q
which kidney can you palpate on rectal
A
left kidney
4
Q
what is the normal SG
A
1.015-1.035
5
Q
what is the normal pH of urine in cows
A
7-8 (more alkali than other species)
6
Q
are ketones in freshly calved dairy cows in the urine normal
A
yes
7
Q
what bacteria can cause pyelonephritis in carrier animals/bulls servicing
A
Corynebacterium renale (+, aerobe)
8
Q
how does pyelonephritis occur
A
hematogenous spread (bacterium common in dairy cows) or
ascending from uterus (bad calving, retained fetal membrane)
9
Q
what bacteriacancause pyelonephritis ascending from uterus
A
E. coli
T. pyogenes
staph
step
10
Q
what are the clinical signs of pyelonephritis (4)
A
- ill thrift
- intermittent pyrexia
- colic
- enlarged kidney on rectal
11
Q
what are the findings in urinalysis of pyelonephritis
A
leukocytes, hematuria, protein
12
Q
how is pyelonephritis treated
A
3 week course borad spectrum antibiotics that is excreted via urine (amoxicillin/clavulanic acid or trimethoprim/sulfamethoxazole)
or if have C+S can be more specific
13
Q
what antibiotic is not to be used in pyelonephritis
A
aminoglycosides (Penicillin Streptomycin) because it is nephrotoxic
14
Q
what reproductive disease can look like pyelonephritis
A
endometritis and metritis
15
Q
what is amyloidosis
A
chronic inflammation and repeated antigen exposure
antibody/antigen –> amyloid deposition –> proteinuria
16
Q
what are the clinical signs of amyloidosis (5)
A
- ill thrift
- frothy urine
- enlarged kidney
- diarrhea
- edema (low albumin)
17
Q
what are the urinalysis findings of amyloidosis
A
protein ++
low SG
no blood or WBC
18
Q
what are the biochem findings of amyloidosis
A
hypoalbuminemia
hyperglobinemia
19
Q
what is the treatment of amyloidosis
A
none
20
Q
what are the main ddx of amyloidosis
A
pyelonephritis (enlarged kidney) or heart disease (edema)
21
Q
when are urolithiasis mainly seen
A
young bulls/tups and goats
22
Q
what are urolithiasis associated with
A
high ca or conentration ration
or restricted water
high phosphates (calcium, mag, ammonium)
calcium carbonate
23
Q
what are the clinical signs of urolithiasis (3)
A
- cyrstals on preuptial hair
- colic
- swelling in ventrum = bladder/urethral rupture
24
Q
how do you treat a urethroliasis
A
- administer smooth muscle relaxant: ACP, xylazine, clenbuterol
- broad spectrum antibiotic for secondary cystitis and NSAID for pain
surgical treatment –> sigmoid flexure is common site for stone formation
25
what are the causes of cystitis
previous navel ill
ascending infection from metritis/endometritis
mainly E.coli
26
what are traumatic causes of dysuria/stranguria
1. ruptured bladder (difficult calving, urolithiasis)
2. ruptured urethra (urolithiasis)
3. penis hematoma
27
what are congenital malfmorations that can cause dysuria/stranguria (2)
1. persistent urachus (leak urine, scald)
2. hypospadia
28
what are ddx for red urine
BBBBPPCCLT
29
what ddx of red urine will have hemoglobinuria on urine dipstick
1. babesoisis
3. brassicas poisoning
4. bacillary hemoglobinuria
2. post paturient hemoglobinuria
5. copper poisoning
BBBPC
30
what causes babesia
hemotrophic parasite
babesia divergens
31
what are the clinical signs of babesia (4)
1. pipestem diarrhea
2. spring and autumn (needs tick to feed)
3. tick area
4. pyrexic
32
what causes post partuirent hemoglobinuria
low phosphorus
33
what are the clinical clues of post partuirent hemoglobinuria
adult dairy cow 2-4 weeks after calving (or 2y old)
rare
34
what are the clinical clues of brassicas poisoning
diet history of rape/kale type feeding only
35
what are the cuases of bacillary hemoglobinuria
clostridium hemolyticum
36
what are the clinical clues of bacillary hemoglobinuria
rare
certain parts of UK
death
37
what are the causes of copper poisoning
over supplementation
38
what are the clinical clues of copper poisoning
jaundiced (chronic)
death if acute but rare
39
what are the clinical signs of babesiosis (7)
1. dull
2. hemoglobinuria
3. fever
4. anemia
5. weight loss
6. death 1-3 weeks post infection
7. pipestem feces
40
how do you diagnose babesia (5)
1. history
2. clinical signs
3. stained blood smear
4. low HCT
5. PCR
41
how do you treat babesia
1. imidocarb (imizol) double dose for previous
long meat/milk wd
notifity
2. blood transfusion?
42
what are the clinical signs of post parturient hemaglobinuria
1. hemaglobinuria
2. anemia
3. down cow
43
how do you diagnose post parturient hemaglobinuria
biochem phosphorua (Ca/Mg)
44
how do you treat post parturient hemaglobinuria
phosphorus (Foston)
45
what are the clinical signs of brassicas poisoning
1. death
2. hemaglobinuria
3. anemia + associated signs
46
how do you treat brassicas poisoning
1. blood transfusion
2. supportive
47
what are the clinical signs of bacillary hemoglobinuria (4)
1. sudden death
2. hemaglobinuria
3. anemia
4. jaundice
48
how is bacillary hemoglobinuria treated
penicillin
49
how do you prevent bacillary hemoglobinuria
vaccination
50
what are the clinical signs of copper poisoning
1. acute = death
2. chronic = sick, jaundiced, anemia, hemoglobinuria
51
is copper poisoning more common in sheep or cattle
sheep
52
how do you diagnose copper poisoining
liver copper biopsy
53
how do you prevent copper poisoning
ensure deficient before supplement
54
what are the clinical signs of brassicas poisoning (6)
1. acute leukopenia
2. thrombocytopenia
3. hemorrhage
4. pyrexia
5. bladder tumour
6. hematuria
55
how do you treat brassicas poisoning
1. supportive
2. remove from bracken
56
if you are presented with a freshly calved down cow what ddx is mostly likely (hemoglobinuria vs hematuria)
post-parturient hemaglobinuria
57
if you are presented with a dead cow which ddx is most likely (hemaglobinuria vs hematuria)
bacillary hemoglobinuria (clostridium chauvei)
58
if you are presented with an old, hill cow which ddx is most likley ((hemaglobinuria vs hematuria)
bracken poisining/enzootic hematuria
59
if the cow is pyrexic which ddx is most likely (hemaglobinuria vs hematuria)
babesia
60
if you are presented with a cow straining which ddx is most likey (hemaglobinuria vs hematuria)
cystitis
61
what are the clinical signs of liver disease (14)
1. non specific
2. weight loss
3. lethargy
4. anoreixa
5. milk drop
6. diarrhea
7. ascites
8. edema
9. photosensitixation
10. epistaxis
11. encephalopathy
12. LDA
13. jaundice
14. enlarged liver behind last rib (rare)
62
which liver enzyme is liver specific for disease
GLDH
glutamate dehydrogenase
hepatocellular --\> quite specific
63
which liver enzyme is indicator of bile duct and cholestasis
GGT
gamma glutamyltransferase
NB normal high in neonate (colostrum)
64
where is alkaline phosphatase synthesized and what can it measure
liver and bone
measures cholestasis
65
in order for makred damage by what elevation do the liver enzymes need to be
10times reference range for marked damage
3 times for moderate
66
what are the biochem changes that might suggest liver disease (4)
1. albumin: low or not produced
2. urea: low, ammonia not being converted to urea
3. bilirubin: increased production (hemolysis), liver damage so can't process (hepatopathy), bile duct blocked so can't excrete (choleostasis)
4. bile acids
67
where do you palpate the liver
behind the last rib
68
where do you US scan the liver
9-11th IC space on the right side
69
where do you obtain a liver biopsy
10-11th IC space
line tuber coxae to shoulder
clip/scrub
local anesthetic
scapel skin
aim biopsy needle cranial and ventral to left shoulder (+/- US guide)
70
what causes liver abscesses (5)
1. bacteremia
2. navel ill
3. acidosis
4. endocarditis
5. pyelonephritis
71
would you expect liver enzymes to be elevated with liver abscesses
not too bad because parenchyma in between is fine and the abscesses are walled off
72
what bacteria are involved in liver abscesses
Trueperella pyogenes (+)
fusobacterium necrophorum (-)
73
how do umbilical infections lead to liver abscesses
through the umbilical vein which leads to the liver
74
how does acidosis cause liver abscesses and how this can lead to vena cava thrombosis (6)
1. acidosis in rumen changes gut flora = ruminitis
2. bacteria leak into portal circulation = liver abscess (often near vena cava)
3. emboli from liver abscess are released into circulation
4. emboli get trapped in lungs = suppurative bronchopneumonia
5. emboli in pulmonary blood vessels cause blood vessels to burst = aneurism
6. epistaxis
75
how do you treat liver abscess
supportive
none
76
how do you prevent liver abscesses
avoid acidosis and prompt treatment of infections that could lead to bacteriam
77
how does photosensitization occur
photodynamic agent in skin, reacts with UV light, damages skin membranes
78
what is type I photosensitization
eat a photodynamic poisonous plant
ex. st johns wart, some drugs
79
what is type II photosensitization and what breeds are susceptible
congenital disease where photodynamic agent not processed
*bovine congenital erythropoietic protoporphyria*
can present with neurological signs
young animal
limousin and blonde D'acquataine
80
what is type III photosensitization
liver damage from disease or poison so photodynamic agents not processed
many liver diseases to consider
biochem for liver enzymes are key here
81
what is type IV photosensitization
idiopathic
82
what are the clinical signs of photosensitization (5)
1. unpigmented skin
2. hairless skin (extremities)
3. crusting
4. inflammation
5. infection
83
how is photosensitization diagnosed
history of ingestion of plant
liver enzymes (raised in type III)
response to treatment
type II measure porphyrin in blood -- difficult
84
how do you treat photosensitization
inside to remove from UV light and possible poison
treat primary liver disease if type III
antibiotics for secondary infections
85
how common is jaundice
rare
use first principles from SA
treat underlying condition
supportive care
86
what are pre hepatic causes of jaundice
hemolysis (increased production of bilirubin)
ex. toxins (copper), blood borne parasites (babesia)
87
how do you diagnose pre hepatic jaundice
HCT (low)
urobilinogen ++
hemoglobinuria
88
what are hepatic causes of jaundice
unable to process bilirubin
fatty liver, liver fluke (acute), liver abscess, hepatitis, neoplasia
89
what are post hepatic causes of jaundice
unable to excrete bilirubin
bile duct tumour, liver fluke (chronic)
90
how do you diagnose hepatic jaundice
liver enzymes high (GLDH)
low albumin
US scan of liver
91
how do you diagnose post hepatic jaundice
high liver GGT
US scan of bile ducts
92
what are the clinical signs of hepatoencephalopathy (5)
1. ataxia
2. dull
3. slow circling
4. head pressing
5. collapse
93
what are ddx for ill thrift in the adult cow (15)
1. amyloidosis
2. BVD PI
3. chronic fluke
4. chronic pneumonia
5. chronic LDA
6. dental disease/oral trauma
7. fatty liver
8. general peritonitis
9. Johne's
10. liver abscess
11. lumpy jaw
12. neoplasia
13. under nutrition
14. pyelonephritis
15. wooden tongue
94
what are ddx that do not cause ill thrift (4)
1. Parasitic gastroenteritis
2. mastitis
3. metritis
4. endometritis
