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Small (Chloe) > Endocrine/metabolic snd urinary > Flashcards

Endocrine/metabolic snd urinary Flashcards

1
Q

What biochemistry markers can affect calcium values?

A

Low albumin - lowers calcium
Elevated phosphate increased complexed fraction of calcium.

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2
Q

The results of FGF-23, decreased calcitriol and reduced calcium absorption:

A

Increased PTH
Mineralisation in soft tissues including kidney and gastric mucosa

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3
Q

What are the causes of hypercalcaemia in dogs?

A

Increased PTH activity
Activity of PTH-like substances
Increased vitamin D activity
Osteolysis
Others - hypoadrenocorticism, raisin toxin, idiopathic

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4
Q

Can hypoadrenocorticism cause high or low calcium levels?

A

Normally mild hypercalcaemia - total calcium

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5
Q

What specific marker is excellent indicator of dietary sufficiency and excess?

A

25 hydroxy-vitamin D

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6
Q

What marker is implicated in the pathogenesis of renal secondary hyperPTH if low?

A

1, 25 dihydroxy-vitamin D

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7
Q

What are the general steps to treating hypercalcaemia?

A

Determine urgency by Ca x P
Fluids, diuresis
Glucocorticoids
Bisphosphonates

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8
Q

What is the short term therapy for hypocalcaemia?

A

IV calcium and monitor for bradycardia

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9
Q

What are the aims for long term therapy of hypocalcaemia

A

Aim for subclinical or low/normal hypocalcaemia
Oral calcium supplement if diet insufficient
Vitamin D to promote calcium uptake

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10
Q

What are the clinical signs of diabetic ketoacidosis (DKA)?

A

Inappetence/nausea/vomiting
Reduced mentation
Hypoperfusion and dehydration
Death

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11
Q

What is the summarised pathophysiology of diabetes ketoacidosis?

A

Reduced insulin causes a metabolic deficit of glucose. This causes the body to metabolise fatty acids into ketones instead, causing metabolic acidosis.

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12
Q

What findings usually accompany diabetes ketoacidosis?

A

Anaemia and left shift neutrophilia
Elevated ALP and ALT
Electrolyte derangements
Bacteriuria

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13
Q

What are the general steps to treating diabetes ketoacidosis?

A

Hartmann’s IVFT
Potassium supplement - monitor
Then achieve normoglycaemia

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14
Q

What is the prognosis for diabetes ketoacidosis?

A

Good - 70% however risk of relapse

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15
Q

What is hyperglycaemic hyperosmolar syndrome?

A

Similar to DKA but with a small amount of insulin and glucagon resistance. Reduces lipolysis so ketones aren’t elevated.

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16
Q

What is key with the treatment of hyperglycaemic hyperosmolar syndrome?

A

Fluid therapies are key however do it slowly to prevent risk of seizures, coma and death. Aim to restore normoglycaemia over 24-48 hours.

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17
Q

Are cases of hyperadrenocorticism more likely to be pituitary or adrenal dependant?

A

80-90% are pituitary dependant

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18
Q

What are the presenting signs of hyperadrenocorticism?

A

Middle aged - old female dogs
PU/PD, polyphagia
Muscle wasting and weakness
Skin thinning, calcinosis, pigmentation, bruising
Symmetrical alopecia, reproductive dysfunction.

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19
Q

What are the key diagnostics for hyperadrenocorticism?

A

Low dose dexamethasone or ACTH stim test
Haematology and biochemistry
Urinalysis

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20
Q

What does the low-dose dexamethasone test aim to show?

A

Resistance of abnormal pituitary-adrenal axis to suppression by dexamethasone.

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21
Q

What does the ACTH stim test measure?

A

Measure of adrenocortical reserves

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22
Q

When should urine be collected to measure urinary cortisol/creatinine levels?

A

One or more morning samples at home in a non-stressed environment

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23
Q

What are the advantages of the low-dose dexamethasone test?

A

Highly sensitive and may differentiate as well as diagnose

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24
Q

What are the disadvantages of the low-dose dexamethasone test?

A

Long test (8hrs), poor specificity, non appropriate if a history of exogenous steroids.

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25
Q

What are the advantages of the ACTH stim test?

A

Short (1hr), more specific, used to monitor trilostane

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26
Q

What are the disadvantages of the ACTH stim test?

A

Less sensitive, cannot provide differentiation

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27
Q

What are the advantages of the urinary cortisol/creatinine test?

A

Inexpensive, convenient for owner, highly sensitive

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28
Q

What are the disadvantages of the urinary cortisol/creatinine test?

A

Very poor specificity

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29
Q

What medical treatments are there for hyperadrenocorticism?

A

Trilostane (licenced), mitotane, selegilne

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30
Q

What are the clinical signs and findings for phaeochromocytoma?

A

Pu/PD, panting, weakness, weight loss, hypertension, poor appetite
Adrenal mass, hyperglycaemia

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31
Q

What values of urine indicate polyuria?

A

> 50ml/kg/day of urine

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32
Q

What values of water intake indicate polydipsia?

A

> 100ml/kg/day (dogs), >50ml/kg/day (cats)

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33
Q

When should urine be collected to measure urine cortisol/creatinine?

A

One or more sample in the morning at home in a non-stressful environment.

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34
Q

What are the advantages of the low dose dexamethasone test?

A

Highly sensitive, may differentiate as well as diagnose

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35
Q

What are the disadvantages of the low dose dexamethasone test?

A

Long test (8 hours)
Poor specificity

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36
Q

What are the advantages of the ACTH stimulation test?

A

Short test (1 hour)
More specific than LDDST
More confidence in positive result

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37
Q

What are the disadvantages of the ACTH stimulation test?

A

Less sensitive than LDDST
Cannot provide differentiation

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38
Q

What are the advantages of the urinary cortisol creatine test?

A

Inexpensive
Convenient for owner
Highly sensitive

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39
Q

What are the disadvantages of the urinary cortisol creatinine test?

A

Very poor specificity

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40
Q

What treatment is available for hyperadrenocorticism?

A

Trilostane (licenced), mitotane, selegiline
Adrenalectomy or hypophysectomy

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41
Q

What disease can be confused with Cushing’s?

A

Phaeochromocytoma

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42
Q

What are the clinical signs and findings of phaeochromocytoma?

A

PU/PD
Panting
Weight loss/poor appetite
Hypertension/ tachycardia
Adrenal mass
Hyperglycaemia

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43
Q

What values prove polyuria?

A

> 50ml/kg/day of urine

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44
Q

What values prove polydipsia?

A

> 100ml/kg/day intake (dogs)
50ml/kg/day (cats)

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45
Q

What can cause primary polydipsia?

A

Neoplasia, changes in osmolarity, endocrine disease, compensating other losses
Salt toxicity, exercise, high environmental temperature

46
Q

What are some causes of primary polyuria?

A

Osmotic diuresis, medullary solute washout, Interstitial tonicity reduction, increased GFR

47
Q

What is azotaemia?

A

Elevated urea and creatinine

48
Q

What are the four phases of intrinsic acute kidney injuries?

A
  1. Asymptomatic phase of initial insult
  2. Hypoxia and inflammatory responses
  3. Increased or decreased urine output
  4. Recovery phase
49
Q

What clinical signs can be seen with intrinsic acute kidney injury?

A

Signs associated with fluid loss
Concurrent illness, renal pain +/- palpable enlargement
Uremic halitosis, oral ulceration, jaundice

50
Q

What are the results of leptospirosis infection?

A

Renal and hepatic damage
Dyspnoea
DIC

51
Q

What is the most important treatment in an AKI

A

Fluid therapy - Hartmann’s

52
Q

What treatment considerations are required for AKIs?

A

Suspected UTI - amoxiclav/doxycycline
Metabolic acidosis - Hartmann’s
Tachyarrhythmias - ECG and lidocaine
Hyperkalaemia - Glucose, insulin, bicarb
Hypertension - amlodipine
Nutrition - feeding tube

53
Q

What are some causes of a blocked bladder?

A

Stone, stricture, inflammatory debris, UMN bladder, spasmodic

54
Q

What can be found on the clinical exam of a blocked bladder?

A

Enlarged, pain, non-expressible

55
Q

What is the common signalment for a blocked bladder?

A

Male animals - cats
Pugs, dalmations

56
Q

What is the initial treatment for a blocked bladder?

A

Pain relief - methadone

57
Q

What are the biggest worries with a blocked bladder?

A

Potassium causing bradycardia
Acidosis
Post-renal azotaemia/AKI

58
Q

What medications should be used to sedate and place a catheter in an AKI?

A

Midazolam or diluted alfaxalone (1:4)

59
Q

What are the three types of urinary catheter?

A

Jackson Tomcat
Slippery Sam
KatKath

60
Q

What are the common presenting of chronic kidney disease?

A

PU/PD, pallor, anorexia, v+d, weight loss, mucosal ulcers, dehydration, uraemic breath

61
Q

What co-morbidities can be associated with chronic kidney disease?

A

hyperthyroidism, heart disease, cystitis, diabetes
Previous AKI
Nephrotoxic drugs

62
Q

What is an uraemic crisis?

A

Build up of urea and other toxins usually excreted in the kidneys to intolerable levels.

63
Q

How do you treat chronic kidney disease?

A

IVFT
Treat nausea/GI ulceration
Antiemetics
Nutritional support

64
Q

What is pyelonephritis?

A

Bacterial infection of the renal pelvis and parenchyma

65
Q

What is polycystic kidney disease?

A

Fluid filled cysts present from birth in the kidney and possibly other organs

66
Q

What is haematuria?

A

Red blood cells in urine

67
Q

What is dysuria?

A

Difficulty or pain during urination

68
Q

What can red urine indicate?

A

Blood and haemoglobin

69
Q

What can orange urine indicate?

A

Strong urine
Bilirubin

70
Q

What can brown urine indicate?

A

Myoglobin
Methaemoglobin
Copper toxicosis
Poo

71
Q

What is the diagnostic approach to red or brown urine?

A
  1. Dipstick
  2. Sediment exam
  3. Haemoglobin/myoglobin
72
Q

What is the diagnostic approach to orange urine?

A
  1. USG >1040
  2. Urine dipstick
  3. Blood biochemistry
73
Q

What are the causes of myoglobinaemia?

A

Physical: Trauma, burns, strenuous exercise, prolonged immobility
Non-physical: Hypoxia, ischaemic, metabolic disturbances, infectious

74
Q

What is stranguria?

A

Prolonged, painful straining

75
Q

What is urge incontinence?

A

Involuntary bladder contractions voiding small amounts of urine regularly

76
Q

What causes a big bladder?

A

Obstructive disease - detrusor atony, UMN, inflammatory, infectious, iatrogenic

77
Q

What causes a small bladder?

A

Non-obstructive disease - anatomical, neuromuscular, inflammatory, infectious iatrogenic, idiopathic, FIC

78
Q

What are the complications of urinary tract surgery?

A

Renal pain, haemorrhage, retroperitoneal and peritoneal urine leakage, UTI, compromise of renal function

79
Q

How does the sympathetic nervous system affect the urinary tract?

A

Positive stimulus causes urethral smooth muscle contraction and inhibition of detrusor muscle allowing passive filling of the bladder

80
Q

How does the somatic nervous system affect the urinary tract?

A

Stimulates urethral striated muscle contraction

81
Q

How does the parasympathetic nervous system affect the urinary tract?

A

Stimulate detrusor muscle contraction and urethral sphincter muscles relax.

82
Q

What are the two broad categories of urinary incontinence?

A

Neurogenic and non-neurogenic

83
Q

What does USMI stand for?

A

Urethral sphincter mechanism incompetence

84
Q

How does urethral sphincter mechanism incontinence normally present?

A

Intermittent voluntary leaking of urine when the dog is relaxed or excited. Can occur with ectopic ureters.

85
Q

What is the most common signalment of ureter sphincter mechanism incontinence?

A

Female, spayed, older, large breed and overweight

86
Q

How do you manage ureteral sphincter mechanism incontinence?

A

Sympathomimetic agents
Phenylpropanolamine, propalin and urolin
Oestrogens

87
Q

How does detrusor instability present?

A

Overactive bladder presenting as pollakiuria. Underlying cystitis - urge incontinence

88
Q

How do patients with urinary retention present?

A

Stranguria or dysuria and unsuccessful attempts to void urine

89
Q

What are the two causes of urinary retention?

A

Detrusor muscle isn’t working well or bladder is contracting against high outflow pressure

90
Q

What are some examples of lower motor neurone disorders involving the urinary tract?

A

Cauda-equina syndrome
Sacroiliac luxation
IVDD
Sacrococcygeal trauma
Neoplasia

91
Q

What treatment/care should be undertake to manage lower motor neurone disorders?

A

Bethanechol (parasympathomimetic)
Manual bladder expression 3-4x a day
Cleaning
Monitor for UTI

92
Q

How does the bladder typically present with upper motor neurone disorders?

A

Large, firm and difficult/impossible to empty

93
Q

What is idiopathic reflex dyssynergia?

A

Loss of coordination between the detrusor muscle contracting and the relaxation of the urethra causing a spurting urine flow.

94
Q

What does idiopathic reflex dyssynergia result in?

A

Bladder not emptying properly, overstretched bladder

95
Q

What are struvite crystals composed of?

A

Magnesium ammonium phosphate (MAP)

96
Q

What are struvite crystals normally associated with?

A

UTIs caused by urease producing bacteria

97
Q

What are the risks for calcium oxalate crystals?

A

Acidifying diets, oral calcium supplements given outside of mealtimes, excessive dietary protein, formation of concentrated urine

98
Q

What are urate crystals composed of?

A

Uric acid, sodium urate or ammonium urate

99
Q

What breeds are pre-disposed to urate crystals?

A

Dalmatian and Black Russian terries

100
Q

What are urate crystals commonly associated with?

A

Porto-systemic shunts

101
Q

What signalment is related to cysteine crystals?

A

Intact male dogs

102
Q

What are the risk factors for calcium phosphate crystal formation?

A

Excessive dietary calcium, primary hyperparathyroidism, UTI

103
Q

What are the risk factors for xanthine crystals?

A

Genetic predisposition, acid urine, highly concentrated urine, urine retention, allopurinol treatment

104
Q

Which urinary crystals are radiopaque?

A

Calcium oxalate, struvite, calcium phosphate

105
Q

Which urinary crystals are radiolucent?

A

Xanthine

106
Q

Which urinary crystals vary in opacity on radiographs?

A

Urate and cysteine

107
Q

Which urinary crystals have a high rate of recurrence?

A

Calcium oxalate

108
Q

What is the most common malignant renal tumour?

A

Renal carcinoma

109
Q

What signalment is common with nephroblastoma?

A

Young male dogs less than <1year of age

110
Q

What are the clinical signs of renal neoplasia?

A

Haematuria, dysuria, Stranguria and pollakiuria
Abdominal pain, palpable, enlarged kidney
Thickened bladder, cord-like urethra

111
Q

What breed is predisposed to cystic transitional cell tumours?

A

Scottish terriers

Small (Chloe) (11 decks)

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