Chapter 64 - Dx techniques and principles or urinary surgery Flashcards
What are the most common presenting complaints for horses with urinary tract disease?
Weight loss, decreased performance, and abnormal urination.
Which clinical signs may indicate urinary tract disease?
Stranguria, pigmenturia, pyuria, incontinence, fever, and anorexia.
What is the significance of polydipsia in horses?
t may indicate renal disease, pituitary dysfunction, or diabetes.
How can an owner differentiate between pollakiuria and polyuria?
Pollakiuria is frequent urination, while polyuria is increased urine volume often with increased thirst.
What does a dropped penis in male horses typically indicate?
It often indicates obstructive urethrolithiasis.
What histWhat conditions can cause myoglobinuria in horses?regarding changes in urination?
Changes in frequency, posturing, and appearance of urine should be noted.
What might intermittent urine dribbling from the vulva suggest in younger horses?
It may indicate unilateral ectopic ureter.
What conditions can cause myoglobinuria in horses?
wxercise-associated rhabdomyolysis, crush injuries, and Clostridial myonecrosis.
Which medications can cause urine discoloration?
Rifampin, phenothiazines, nitazoxanide, and doxycycline.
What does hematuria at the beginning of urination suggest?
Lesions in the distal urethra.
What might persistent urine scalding indicate?
Incontinence in horses.
How should owners be questioned about water intake?
Quantify daily water consumption and note any changes.
What are common causes of hemoglobinuria in horses?
Infectious diseases, toxins, and immune-mediated hemolysis.
What does a “fishy” odor in a horse’s mouth indicate?
It may suggest chronic renal failure.
What is the primary rule out for hematuria after exercise?
Cystolithiasis.
What can indicate a renal mass during physical examination?
Altered abdominal conformation or gait abnormalities.
What might a mass on external genitalia suggest?
Possible lower urinary tract disease.
What might a mass on external genitalia suggest?
Possible lower urinary tract disease.
What symptoms may accompany pyelonephritis in horses?
Intermittent fevers, lethargy, and decreased appetite.
What should be assessed during an examination for incontinence?
Whether the horse shows awareness of bladder distension.
What is a common complication of anesthesia related to myoglobinuria?
Crush injury.
What environmental conditions can affect water intake?
Temperature, humidity, and level of activity.
What are signs of severe renal disease in horses?
Anemia, lethargy, and decreased body condition.
What does the presence of excessive dental tartar indicate?
It may be associated with chronic renal failure.
What condition is associated with hematuria and frequent urination in mares?
Cystitis.
What clinical sign might suggest the presence of urinary tract neoplasia?
Hematuria or abnormal urination patterns.
What should be monitored to assess for polyuria in horses?
Urine output, typically 0.5 to 1 mL/kg/hour.
What indicates that a horse is experiencing obstructive urethrolithiasis?
“Renal colic” presentation with a dropped penis.
What are potential causes of urinary tract infections in horses?
Urolithiasis or poor hygiene.
What might indicate a need for further neurological examination in a horse?
Signs of incontinence or abnormal gait.
What could cause pigmenturia aside from hematuria?
Myoglobinuria or drug-induced discoloration.
What factors can lead to increased urinary sediment?
Urinary tract infection or renal disease.
What might indicate a recent muscle injury or exercise in a horse?
Presence of myoglobin in urine.
What could blood in urine at the end of micturition suggest?
Hemorrhage from the proximal urethra or bladder neck.
What should be done if urine appears discolored upon bedding?
Investigate potential causes of pigmenturia or hematuria.
What can be inferred from a horse that exhibits excessive urination during exercise?
Possible renal disease or increased water intake due to exertion.
What is a common cause of recurrent colic in horses with urinary issues?
Urolithiasis may present as abdominal pain.
What clinical sign is often observed in mares with a history of dystocia?
Potential urinary incontinence.
What clinical findings are associated with severe renal disease?
Ventral edema and a strong urine odor.
What diagnostic tool is essential for understanding a horse’s water consumption?
Monitoring daily water intake over multiple days.
hat type of clinical signs might a horse with urolithiasis present?
Stranguria, abnormal micturition posture, and colic-like symptoms.
What is the typical range for normal daily water intake in a 500-kg horse?
22.5 to 27.5 liters per day.
Which infectious disease can lead to hemoglobinuria in horses?
Equine infectious anemia.
What is the relationship between urine scalding and incontinence in mares?
Urine scalding often results from the prolonged contact of urine with the skin due to incontinence.
What would a horse’s appetite changes suggest in the context of renal disease?
It may indicate renal dysfunction or chronic renal failure.
What should be evaluated to differentiate between normal and abnormal urination patterns?
Frequency, volume, and appearance of urine during micturition.
Which laboratory findings are important in assessing renal disease?
Changes in blood urea nitrogen (BUN) and creatinine levels.
what type of urinary appearance might suggest myoglobinuria?
Dark red or brown urine following strenuous exercise.
What does hematuria at the end of urination often indicate?
Hemorrhage from the proximal urethra or bladder neck.
What can be a sign of chronic pain related to urinary issues in horses?
Intermittent signs of colic or behavioral changes.
How might a horse with a renal mass present differently than one with urinary tract infection?
A renal mass may show altered abdominal conformation, while UTI might have more obvious signs of discomfort during urination.
What should be assessed if a horse shows signs of urinary urgency?
Possible urinary tract infection or bladder distension.
What is a common cause of exercise-induced pigmenturia?
Rhabdomyolysis.
what can the presence of oral ulcers indicate in a horse with urinary issues?
Possible chronic renal failure or systemic disease.
How does a horse with incontinence often position itself?
It may show signs of restlessness or attempts to posture without voiding.
What does prolonged posturing to urinate suggest?
Possible obstructive urolithiasis or urinary tract irritation.
What indicates that a horse’s bladder might be distended?
the horse appears restless or shows abdominal muscle use to relieve pressure.
Which non-infectious factors can contribute to hematuria?
Trauma, exercise-associated bladder mucosal trauma, or neoplasia.
What type of urine appearance can suggest a urinary tract infection?
Cloudy urine with excessive sediment.
What should be done if pigmenturia is suspected?
Differentiate between myoglobinuria, hemoglobinuria, and normal pigment changes.
What does it mean if a horse has both hematuria and signs of colic?
Possible underlying urinary tract obstruction or irritation.
What type of bacteria might cause a urinary tract infection in horses?
Commonly, Escherichia coli or other gram-negative bacteria.
How can one differentiate between normal urination and incontinence?
Incontinence is characterized by involuntary urine passage without posturing.
What dietary changes could influence a horse’s urinary health?
Increased protein intake may lead to higher nitrogen waste and potential renal strain.
What does a sudden change in urine color post-exercise often indicate?
Potential myoglobinuria from muscle damage.
What is a common condition associated with excessive thirst and urination in older horses?
Pituitary pars intermedia dysfunction (PPID).
What should be investigated if a horse displays signs of repeated colic?
Possible urinary tract issues such as urolithiasis.
What are potential complications of untreated urolithiasis in horses?
Urinary obstruction, bladder rupture, and systemic infection.
What should be included in the management plan for horses with urinary tract disorders?
Hydration assessment, dietary modifications, and monitoring of urine output.
What initial examination should be performed on male horses suspected of urinary tract disease?
External examination of the urethra below the anus while lifting the tail.
What findings might suggest a diagnosis of verminous nephritis?
Signs of hematuria along with a history of strongyle infections.
What systemic signs can be associated with chronic renal failure?
Ventral edema, poor coat quality, and lethargy.
What indicates urethral obstruction during a rectal examination?
Moderate-to-severe distention of the urethra.
Why is symmetry of the perineum important in rectal examinations?
Deformities may indicate proximal urethral rents.
How is the urethral sphincter described in relation to the mare’s anatomy?
It feels similar to the cervix of a mare but is located more caudally.
What features of the bladder should be assessed during palpation?
Size, wall thickness, and presence of cystic calculi or sediment.
What is dysuria and how does it affect bladder palpation?
It often results in a small bladder that may be entirely within the pelvic canal.
How can a cystolith be palpated effectively during a rectal exam?
The hand should be inserted wrist-deep to avoid missing it beneath the forearm.
What condition is indicated by an atonic bladder in horses?
Sabulous urolithiasis, which is the accumulation of urine sediment.
What aspect of the bladder’s anatomy is important for proper examination?
The apex should be freely movable within the abdomen.
What should be palpated to differentiate sabulous urolithiasis from cystoliths?
The size of the bladder and the indentability of the sediment with pressure.
What abnormality might occur if the bladder apex adheres to the umbilicus?
A tubular bladder that cannot be freely manipulated.
What is an osteochondroma and how can it affect the urinary bladder?
A bone tumor that can cause tears in the bladder and hematuria if it exceeds 20 mm in height.
What findings may suggest acute renal failure during kidney palpation?
Enlarged or painful left kidney.
How might chronic renal failure affect kidney palpation findings?
The kidney may appear smaller, irregularly shaped, and firmer.
What is azotemia and how is it identified in serum chemistry?
Increased BUN and creatinine levels indicating decreased renal function.
What are the three potential origins of azotemia?
Prerenal, intrinsic renal disease, and postrenal obstruction.
How is prerenal failure characterized in relation to BUN and Cr levels?
Reversible increases associated with renal hypoperfusion.
What is the significance of measuring glomerular filtration rate (GFR)?
It helps assess the severity of renal function impairment.
What are two indicators of acute kidney injury (AKI)?
A rise in creatinine of 0.3 mg/dL or a 50% increase from baseline.
How does NSAID administration affect renal blood flow?
It can diminish the protective vasodilatory response, increasing the risk of renal damage.
What are the typical laboratory findings in horses with chronic kidney disease (CKD)?
Azotemia, hypercalcemia, and hypophosphatemia.
How can BUN and creatinine ratios assist in dietary assessment?
Ratios above 15:1 suggest excessive protein intake.
What difference in electrolyte levels is noted between prerenal and intrinsic renal failure?
Electrolyte concentrations remain normal in prerenal failure, but are abnormal in intrinsic renal failure.
What changes in potassium levels can occur with acute kidney injury (AKI)?
Potassium levels can be low, normal, or increased, with significant hyperkalemia in severe cases.
What is the impact of urea accumulation in renal failure?
Urea is a uremic toxin that contributes to tissue dysfunction at elevated levels.
Why is creatinine considered a reliable marker of renal function?
Its levels rise when glomerular filtration decreases, with minimal tubular reabsorption.
How does muscle mass relate to creatinine production?
About 1% of muscle creatine is converted to creatinine daily.
Figure 64-2. Asymmetry of the perineum in two geldings with proximal urethral rents causing hematuria immediately after urination. (A) Note widening of the perineum. (B) Note an indentation of the perineum.
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Figure 64-3. Relationship between glomerular filtration rate (GFR) and serum creatinine (Cr) concentration. When renal function is normal, a large decrease in GFR results in a minor increase in Cr (arrow 1). In contrast, when renal function is decreased, as with chronic kidney disease, a much smaller decrease in GFR results in a similar increase in Cr (arrow 2).
Figure 64-4. A urine collection device for use in male horses and ponies.
Figure 64-5. Transabdominal ultrasonographic images of the left kidney (deep to spleen) of two horses with acute kidney injury resulting in acute renal failure. (A) Enlarged left kidney (23.3 cm in length).
(B) Renal cortex is more echogenic than normal.
Figure 64-6. Transabdominal ultrasonographic images of the left kidney of two horses with chronic kidney disease. (A) Left kidney of a yearling with chronic interstitial nephritis that developed 11 months following treatment with an aminoglycoside antibiotic and flunixin meglumine for a leg wound. Note the generalized increase in echogenicity of the renal parenchyma in comparison to the spleen. (B) Left kidney of the same yearling with the probe directed in a different plane, revealing a large nephrolith adjacent to the renal pelvis. (C) Left kidney of a stallion with an obstructive ureterolith causing hydronephrosis; note the small nephrolith in the center of the image producing an acoustic shadow. (D) Left kidney of the same stallion imaged in a plane rotated 90° revealing hydronephrosis consequent to obstructive disease. (E) Left kidney of the same stallion following relief of ureteral obstruction by electrohydraulic lithotripsy. Note that the kidney is small and the renal parenchyma has a diffuse increase in echogenicity because of renal fibrosis. (
Figure 64-7. Ultrasonographic images of the left (A) and right (C) kidneys and cross-sectional gross pathology of the left (B) and right (D) kidneys of a 19-year-old Arabian mare with chronic renal failure consequent to polycystic kidney disease. (
Figure 64-9. Endoscopic images of an abnormal ureteral opening (A) and a nephrolith in the renal pelvis (B) of a stallion with chronic kidney disease.
Figure 64-10. Nuclear scintigraphic dorsal image (cranial at top and caudal at bottom) of the kidneys of a horse with chronic hematuria arising from the left kidney. The study revealed considerably less radiopharmaceutical uptake and elimination by the left kidney and provided support to the theory that nephrectomy of the left kidney would not result in a substantial loss of remaining renal function. LT, Left; RT, right.
Figure 64-11. Contrast-enhanced computed tomographic images of the kidneys (excretory urography) of a normal Miniature horse. (A) The transverse plane image shows nearly homogeneous uptake of the contrast agent in both kidneys. (B) The reconstructed dorsal plane image provides even greater detail of the intrarenal distribution of the contrast agent within the right kidney (left side of image).
