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Clinical techniques Flashcards

1
Q

What are the 2 broad types of radiography used in urology?

A

Plain (survey)

Contrast

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2
Q

What are the benefits of a contrast radiograph over a plain?

A

Gives more detail

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3
Q

What are the key points in radiography in urology?

A
  • Need to radiograph whole abdomen
  • Usually in VD (everything spreads)
  • Starve 24 hous (faeces/urine obsscure view)
  • GA or sedation
  • Positioning, centring and collimation important
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4
Q

What is the correct positioning, centring and collimation to take a radiograph of the abdomen?

A
  • VD, avoiding axial rotation using cradle for example
  • centre on caudal border of last rib
  • collimate to greater trochanter, spine and skin edges
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5
Q

What is meant by positive contrast agents? Give examples

A
  • Appear more radiopaque than surrounding body tissues

- High atomic number e.g. barium or iodine

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6
Q

What is meant by negative contrast agents? Give examples

A
  • Appear more radiolucent than surrounding body tissues

- Gases e.g. air or CO2

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7
Q

What types of radiography can be used to visualise the urethra?

A
  • Plain
  • Retrograde ureothrography - contrast (males)
  • Retrograde vaginourethrography - contrast (females)
  • Plain will only show if abnormal
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8
Q

List the types of contrast radiography that are used in urology

A
  • Intravenous urography (IVU)
  • Retrograde vaginourethrogram
  • Retrograde cystogram
  • Retrograde urethrogram
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9
Q

What are the benefits of an intravenous urography?

A
  • Provides anatomical and functional info about kidneys

- Specific information obtained at each stage of IVU

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10
Q

What are some of the contraindications for an IVU?

A
  • Dehydration/hypovolaemia

- Severe renal failure/anuria

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11
Q

What are the 2 techniques used for IVU?

A
  • High concentration/low volume (inject bolus into peripheral vein)
  • Low concentration/high volume (contrast given in IV drip)
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12
Q

Describe the technique for a retrograde vaginourethrogram

A
  • Foley catheter or urinary catheter plus clamp
  • Inject diluted iodine contrast media (careful to avoid vaginal rupture)
  • Lateral views most helpful, VD maybe for some abnormalities
  • Contrast into vagina via catheter, flows inot urethra
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13
Q

Describe the techniue for a retrograde cystogram

A
  • Survey films lateral and VD
  • Catheterise, empty, flush bladder
  • Inject contrast medium until bladder just turgid (2 day old party balloon)
  • Negative, positive or double contrast
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14
Q

What are the benefits and indications for use of negative contrast radiography?

A
  • Cheap, readily available
  • Useful to identify bladder, show position and wall thickness
  • Poor mucosal detail, may miss small tears
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15
Q

What is the indication for use of positive contrast radiography?

A
  • Suspected bladder rupture

- Expensive, need a lot

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16
Q

What is a double contrast cystogram and what are the benefits?

A
  • Uses negative and positive contrast agents
  • Excellent detail
  • Useful contrast to see radiolucent calculi for example
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17
Q

Describe the technique for a retrograde urethrogram

A
  • Catheterise urethra (widest possible)
  • Position tip distal to area under investigation
  • Clamp sheath tightly around catheter
  • Inject diluted water soluble contrast medium
  • Mix with gel, keeps distension of urethra long enough to take radiograph
  • Exposure immediately after end of injection
  • Lateral most helpful
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18
Q

What imaging modalities can be used in urology?

A
  • Radiography
  • Ultrasonography
  • CT
  • Endoscopy
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19
Q

What views of the kidney can be achieved with ultrasonography?

A
  • Sagittal
  • Transverse
  • Frontal (dorsal)
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20
Q

Describe the ultrasonographic appearance of the renal cortex

A
  • evenly granular
  • Hypoechoic (occasionally isoechoic) to the liver in dogs
  • Often more echogenic in cats
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21
Q

Describe the ultrasonographic appearance of the renal medulla

A
  • Hypoechoic to cortex
  • Look for good “cortico-medullary” definition
  • Should be able to distinguish the cortex and medulla
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22
Q

Describe the ultrasonographic appearance of the renal pelvis

A
  • Echogenic peripelvic fat (hyperechoic)
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23
Q

What are the 3 layers of the bladder visible on ultrasonography?

A
  • Inner mucosal interface
  • Muscle layer
  • Outer serosal layer
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24
Q

What is the echogenicity of the inner mucosal interface of the bladder?

A

Hyperechoic

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25
Q

What is the echogenicity of the muscle layer of the bladder?

A

Hypoechoic

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26
Q

What is the echogenicity of the outer serosal layer of the bladder?

A

Hyperechoic

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27
Q

What ultrasonographically identifiable changes will occur in the a bladder with cystitis?

A

Lots of variation in thickness of the bladder wall

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28
Q

What are some of the disadvantages of radiogaphy in urology?

A
  • In VD get superimposition of spine and prepuce (bladder harder to see)
  • ureters and urethra not visible on plain radiograph
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29
Q

What are some of the advantages of ultrasonography in urology?

A
  • Simple, safe, cheap, avoids risks of ionising radiation

- Best imaging technique for kidneys and bladder

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30
Q

What are the “phases” of intravenous urography?

A
  • Angiogram phase
  • Nephrogram phase
  • Pyelogram phase
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31
Q

Describe the angiogram phase of intravenous urography

A
  • Immediately after introduction of contrast
  • All contrast in blood vessles
  • Very quick, easily missed
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32
Q

Describe the nephrogram phase of intravenous urography

A
  • Rapid filtration by glomeruli into renal tubules
  • Parenchyma of kidney visible
  • May still see contrast in blood vessles
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33
Q

Describe the pyelogram phase of intravenous urography

A
  • hrough tubules intro renal pelvis, down to ureter
  • See cortex and medulla, into renal diverticuli and pelvis
  • Small well defined diverticuli may be seen
  • Ureters visible
  • On lateral can see ureters into bladder and most of ureters
34
Q

What types of endoscopic examination can be used for the lower urinary tract?

A
  • Urethroscopy (urethra)
  • Cystoscopy (bladder)
  • Transurethral cystoscopy
  • Prepubic percutaneous cystoscopy
35
Q

How is a prepubic percutaneous cystoscopy carried out?

A

Puncture through skin using trochars

36
Q

List the equipment needed for endoscopy of the lower urinary tract

A
  • Rigid or semi-rigid endoscope with sheath (bitches and some cats)
  • Flexible endoscopes (male dogs/cats)
  • Camera and light source
  • Fluid irrigation
  • Instrumentation
  • Baskets (sometimes used to collect bladder or urethral stones)
37
Q

Describe the normal endoscopic appearance of the bladder

A
  • Thin wall when distended
  • Can see blood vessels easily
  • Translucent wall
38
Q

Describe what may be seen on endoscopy if there is cystitis

A
  • Opaque, matte appearance suggesting inflammation

- Thickening and inflammation (rubor) visible

39
Q

List the methods for obtaining urine samples in small animals

A
  • Micturition
  • Cystocentesis
  • Catheterisation
  • ## Midstream Sample Urine (MSSU) - naturally voided or manual expression
40
Q

What is the main aim when taking a urine sample?

A

To obtain a urine sample with in vitro characteristics similar to the original urine (in vivo)

41
Q

What are the advantages of MSSU?

A
  • Easy
  • Can be left to the owner if dog voids naturally
  • Non-traumatic
  • Use of modified litter tray with glass beads can be used for initial screening of cats
42
Q

What are the disadvantages of MSSU?

A
  • Cats often fussy about litter
  • Risk of damage to mucosa in manual expression
  • Need to avoid residue at end of urination (bacteriology)
  • Risk of haematuria and bladder rupture with manual expression
  • Variable volume
  • Risk of faecal contamination
  • Need decent volume in urine in bladder, too little and get sediment
  • Blocked urethra -> ruptured bladder
43
Q

What are the advantages of cystocentesis?

A
  • Quick, no need to wait for spontaneous urination
  • Aseptic collection with no urethral contamination
  • Easy to perform when bladder moderately distended and patient restrained
  • Lower risk of iatrogenic haematuria
  • Also to decompress severely distended bladder
44
Q

What are the disadvantages of cystocentesis?

A
  • Experience required
  • Need adequate volume of urine in bladder
  • Iatrogenic micro/macroscopic haemorrhage possible
  • Contraindicated if bladder severely diseased or clotting problems
45
Q

What are the advantages of urethral catheterisation?

A
  • No need to wait for spontaneous micturition
  • Relatively free of risk of bacterial contamination
  • Ample sample volume
46
Q

What are the disadvantages of urethral catheterisation?

A
  • Some experience needed
  • May need speculum/light source for bitch
  • Risk of iatrogenic infection, haematuria +/- mucosal damage
  • Cost of equipment and disposable catheter
47
Q

Outline the technique for obtaining a Midstream Sample of Urine (MSSU)

A
  • Naturally voided or manual
  • Manual compress bladder to induce micturition reflex
  • Direct compression towards neck of bladder
  • Increase pressure to stimulate urination, not squeezing urine out
  • Maintain continuous moderate pressure
  • Avoid excessive or vigorous intermittent pressure
48
Q

Describe the technique for urethral catheterisation in the bitch

A
  • Keep catheter in sterile sleeve
  • Either direct visualisation of urethral opening with speculum and light source into vulva
  • or digital palpation: ventral to vagina palpate urethral hillock, insert catheter ventral to finger
49
Q

Describe the technique for urethral catheterisation in the queen

A
  • Blind insertion
  • Get body as straight as possible
  • Cat in sternal, hindlegs to side, parallel
  • Advance catheter along ventral vaginal wall along midline, should slip into urethra
50
Q

Outline the technique of cystocentesis in the dog

A
  • Through abdominal wall into bladder
  • Palpate bladder, push against pubis to avoid piercing other organs
  • Insert needle into middle of bladder as bladder emptying may cause needle to slip out
  • Insert at oblique (45deg) angle
51
Q

What is included in a full urinalysis?

A
  • Macroscopic examination (colour etc)
  • Microscopic examination
  • Chemical examination (dipstick, USG)
  • Microbiological examination by culture
52
Q

What should the findings of a normal macroscopic urinalysis be?

A
  • Colour: light yellow/amber
  • Odour: should not be offensive
  • Transparency/turbidity: transparent but concentrated and end flow samples more likely to be turbid (sediment)
53
Q

What is involved in a routine urine chemistry?

A
  • Urine specific gravity
  • pH
  • Dipstick tests
54
Q

What are the disadvantages of dipstick tests for animals?

A
  • Do not give exact figures

- Are made for humans so are not 100% accurate for animals

55
Q

Which results on a dipstick should be ignored?

A
  • SG
  • Urobilinogen
  • Nitrite
  • Leucocytes
  • Care with pH
  • Care with bilirubin
56
Q

What is looked for in microscopic examination of urine sediment?

A
  • Crystalluria
  • Renal tubular casts
  • Epithelial cells
  • Blood cells
  • Bacteria
  • Concentrate debris in urine using centrifuge
  • Stain sediment, view under LM, often need high power
57
Q

What is pH assessment of urine useful for?

A
  • Important in management of urolithiasis

- Meters more precise method of measurement

58
Q

What are the advantages of taking a urine sample in the early morning or after fasting?

A
  • Most concentrated sample, useful for evaluating concentrating capacity
  • Gives highest yield of cells, casts and bacteria
59
Q

What are the disadvantages of taking a urine sample in the early morning or after fasting?

A
  • Glucosuria may be less obvious than in post-prandial samples
  • Cells may be altered due to prolonged exposures to variations in pH and osmolarity
60
Q

What are the advantages of taking a recently formed urine sample?

A
  • Cells more easily recognisable on microscopy

- Fastidious bacteria which are inhibited by urine may be easier to detect

61
Q

What are the disadvantages of taking a recently formed urine sample?

A
  • Sample more dilute as has drunk recently so concentrating ability more difficult to assess
  • More dilute sample amy cause lysis of cells
62
Q

What are the methods of urine storage and what is their function?

A
  • Plain sample (no additive)
  • Boric acid (preserved, usually micro analysis)
  • Formaldehyde (preserve cells for cytology)
63
Q

How should a urine sample be stored?

A
  • Preferably analyse withiin hour of collection

- Refrigerate and warm to room temp before analysis if longer

64
Q

What are the indications for urinalysis?

A
  • Signs of renal disease, lower urinary tract disease, many medical problems (esp with multi-systemic signs)
  • Part of geriatric or pre-anaesthetic screen
65
Q

Why might crystalluria be seen in a sample?

A
  • Precipitate out when urine saturated with dissolved minerals
  • Do not indicate presence of or predisposition to form urinary calculi
  • May get without disease
  • Prolonged or cold storage
  • Some are normal
66
Q

What are renal tubular casts?

A

Proteinaceous plugs of dense, mesh-like mucoprotein +/- cells accumulated in distal portion of the renal tubule

67
Q

What is the importance of renal tubular casts in urinalysis?

A
  • Low number (<2/HP field) can be normal
    Increased number relates to tubular disease
  • Try to identify associated cells e.g. epithelial, WBC, RBC
68
Q

What is the importance of epithelial cells in urinalysis?

A
  • Routinely see small number (<2/HP field)

- can be used to identify location of disease if increased number

69
Q

What epithelial cells may be seen on urinalysis and where do they originate?

A
  • Renal tubular cells
  • Transitional cells: renal pelvis, ureter, bladder, proximal 2/3 urethra
  • Squamous cells: distal to urethra
70
Q

Explain the importance of bacterioa in urinalysis

A
  • Absence does not rule out UTI

- May be present for reasons other than UTI e.g. contamination or overgrowth in stored sample

71
Q

What may cause glucose presence on urinalysis?

A
  • Glucose contamination (e.g. jam jar contamination)

- Glucose present: diabetes mellitus, very stressed cat, renal damage in some renal disease

72
Q

What may bilirubin on urinalysis indicate?

A
  • Liver disease or haemolysis
73
Q

What may ketones on urinalysis indicate?

A
  • Ketosis in cattle
  • Pregnancy toxaemia in sheep
  • Starvation
  • Diabetes mellitus
74
Q

What may urobilinogen on urinalysis indicate?

A
  • Trace is normal

- Positive can mean haemolytic disease or liver disease

75
Q

What may leucocytes on uriarlysis indicate?

A

Urinary tract inflammation or infection

76
Q

Why may struvite crystals be found in urine? Describe their appearace and components

A

Occasionally seen in normal cold, concentrated, alkaline urine

  • 3 to 8 sided prisms, coffin lids
  • Magnesium ammonium phosphate
77
Q

Why might calcium oxalate crystals be found in urine? Describe their appearance

A
  • Acidic or neutral urine
  • Small numbers normal in dogs and horses
  • Large number indicate ethylene glycol toxicosis
  • Dihydrate = small squares with X
  • Monohydrate: long rectangular or dumbbel shaped
78
Q

In what urine are calcium carbonate crystals normal? Describe their appearance

A

Rabbit and horse

Round or granular

79
Q

Why might cystine crystals be seen in urine? Describe their appearance

A

Genetic defect in renal handling of cystine

- Flat colourless hexagons

80
Q

Why might suphonamide crystals be seen in urine? Describe their appearance

A
  • Animals being treated with sulphonamide

- Needle shaped dark crystals

URI (15 decks)

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