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CVNT2 > Equine Urinary Tract > Flashcards

Equine Urinary Tract Flashcards

1
Q

what does pollakuria mean?

A

increased frequency of urination

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2
Q

what does dysuria mean?

A

painful urination

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3
Q

what does stranguria mean?

A

painful, frequent urination of small volumes

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4
Q

what does oliguria mean?

A

low urinary output

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5
Q

what does anuria mean?

A

absence of urination

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6
Q

which urinary tract disorders are horses prone to?

A 
PUPD 
pigmenturia 
renal disease 
neoplasia 
urolithiasis 
UTIs 
developmental disorders
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7
Q

what are the most common problems that owners state in a horse with a urinary disorder?

A

abnormal urination

weight loss

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8
Q

what is considered polydipsia for a horse?

A

more than 100ml/kg/day

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9
Q

how should you perform a clinical examination of a horse presenting with urinary issues?

A

standard clinical exam

rectal exam

penis exam under sedation (a2 agonist and butorphanol PLUS ACP to encourage protrusion of penis)

pass urinary catheter if suspected obstruction

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10
Q

what blood tests can be performed to assess for urinary disease?

A

haematology - leukocytosis, anaemia (chronic disease/renal failure)

urea/creatinine (azotemia)

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11
Q

when will creatinine levels in the blood increase?

A

not until >75% nephrons non-functional - little use in evaluation of early/minor changes

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12
Q

what is the relationship between urea/creatinine and kidney function?

A

once elevated, doubling urea/creatinine = 50% decline in remaining function

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13
Q

how is urine caught for urinalysis?

A

usually caught midstream (container on a stick) or obtained by catheterisation

most horses will urinate when placed in a freshly bedded stable

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14
Q

can cystocentesis be performed in horses?

A

no

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15
Q

what urinalysis can be performed?

A

USG

biochemistry (reagent strip analysis)

sediment analysis (casts)

if pigmenturia, note timing and duration of passage of discoloured urine

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16
Q

what is USG? how do you measure it?

A

an estimate of urine concentration

measured with a refractometer

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17
Q

what is the term given for urine that is more dilute than serum?

A

hyposthenuria - low USG (<1.008)

kidney unable to concentrate urine normally

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18
Q

what is the term given for urine with a similar osmolality to serum?

A

isosthenuria (1.008-1.014)

kidneys cannot form urine with a higher or a lower specific gravity than that of protein-free plasma

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19
Q

what is the term given to urine that is more concentrated than serum?

A

hypersthenuria (>1.014)

unusually high specific gravity and concentration of solutes, resulting usually from loss or deprivation of water

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20
Q

what is the normal concentration of equine urine?

A

adults hypersthenuric

foals hyposthenuric

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21
Q

how/why is ultrasonography performed?

A

transrectally/transabdominally

looking for uroliths in kidneys/bladder

checking size and architecture of kidneys

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22
Q

what is cystoscopy useful for?

A

very useful for investigation of abnormal urination

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23
Q

what can be examined under cystoscopy?

A

urethra and bladder

watch urine coming from ureters (may identify a unilateral renal problem)

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24
Q

why might you perform a water deprivation test?

A

assessment of PUPD - tests for diabetes insipidus/psychogenic polydipsia

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25
Q

what is psychogenic polydipsia?

A

excessive fluid intake in the absence of physiological stimuli to drink

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26
Q

what parameters should be checked before a water deprivation test?

A

urea, creatinine and USG

do not proceed if increased (azotemic) or USG>1.008

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27
Q

when should a water deprivation test be stopped?

A

when 24 hours reached

when USG rises to >1.020

if azotemic
if any clinical signs of dehydration

if loss of 5% BW

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28
Q

how is a modified water deprivation test carried out?

A

water restricted to 4% BW per day and given in small amounts

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29
Q

why might a horse have myoglobin or haemoglobin in the urine?

A

myoglobin - myopathy

haemoglobin - haemolysis

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30
Q

why might a horse have haematuria throughout urination?

A

haemorrhage in kidneys/ureters/bladder

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31
Q

why might a horse have haematuria at the beginning of urination?

A

bleeding from distal urethra

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32
Q

why might a horse have haematuria at the end of urination?

A

bleeding from proximal urethra

33
Q

what are the possible causes of PUPD?

A

renal failure

diabetes mellitus

pituitary pars intermedia dysfunction (PPID)

primary/psychogenic polydipsia

central/nephrogenic diabetes insipidus

34
Q

what further tests can be done in horses with PUPD?

A

look for renal failure - isosthenuria and azotemia

investigate for PPID in older horses

water deprivation test to differentiate between diabetes insipidus and primary polydipsia

35
Q

what is acute renal failure?

A

a clinical syndrome associated with abrupt reduction in glomerular filtration

36
Q

what does acute renal injury lead to?

A

failure of kidneys to excrete nitrogenous wastes, causing azotemia –> uraemic syndrome

disturbances in fluid/electrolyte/acid-base homeostasis

37
Q

how does acute renal injury result from pre-renal failure?

A

decreased renal perfusion without associated cell injury

conditions causing decreased cardiac output / increased renal vascular resistance
e.g. dehydration, diarrhoea, endotoxaemia, septic shock, +/-use of NSAIDs in these cases

38
Q

how does acute renal injury result from intrarenal failure?

A

ischaemic or toxic damage to the tubules

tubular obstruction (e.g. from casts)

acute glomerulonephritis

tubulointerstitial inflammation

39
Q

how does acute renal injury result from post-renal failure?

A

obstruction or disruption of urinary outflow tract (e.g. uroliths)

40
Q

what are the clinical signs of acute renal failure?

A

lethargy
inappetence
dehydration

signs of the primary problem e.g. colic
vague and non-specific signs

41
Q

how is ARF diagnosed?

A

oliguria

azotemia

USG

casts in urine - show damage

rule in/out prerenal and postrenal causes, if not is intrarenal

if intra-renal, US, biopsy

42
Q

how is ARF treated?

A

reverse underlying cause

correct fluid and electrolyte imbalances

dopamine infusion to improve renal blood flow

diuretics to increase urine production

stop aminoglycosides where possible (if not, monitor serum concentrations)

43
Q

what are the nursing considerations for ARF?

A

fluid therapy

monitor urine output and signs of oedema, digital pulses

encourage appetite - variety of feeds, in-hand grazing

monitor for complications e.g. laminitis, thrombophlebitis, swelling/heat at catheter sites

44
Q

what is the prognosis for ARF?

A

depends on underlying cause, duration, response to treatment, and development of complications

can live long-term but usually polyuric - must always have access to water

45
Q

what are the possible causes of chronic renal failure (CRF)?

A 
glomerulonephritis (most common) 
immune-mediated 
ischaemia 
toxic insults 
infection
46
Q

what are the clinical signs of CRF?

A 
lethargy (anaemia) 
anorexia 
weight loss (common)
PUPD 
dental tartar 
azotemia and inability to concentrate urine

signs present late in disease course

47
Q

what are the nursing considerations for CRF?

A

fluid therapy to rule out ARF - monitor urine output and signs of oedema

access to water always

encourage eating

diet - reduce protein (avoid alfalfa)

48
Q

what is the most common sign of UTI in horses?

A

dysuria

49
Q

are UTIs common in horses?

A

no - usually secondary to another issue (e.g, urolithiasis)

50
Q

how can you diagnose a UTI?

A

mid-stream urine sample for bacteriology

investigate for underlying causes

51
Q

what types of neoplasia are common in horses?

A

penile - usually squamous cell carcinoma (older geldings)

can have melanoma, sarcoid, papilloma

52
Q

what are the signs of penile squamous cell carcinoma?

A

no signs early on

malodourous/swollen sheath

haematuria if distal urethra involved

obstruction is uncommon unless tumours are large

53
Q

how is penile SC treated?

A

local excision and penile resection

penile resection plus urethrostomy

54
Q

what is the prognosis for penile SCC?

A

high rate of recurrence but slow metastasis (inguinal lymph nodes)

55
Q

which horses are more likely to develop uroliths?

A

male adults (mean age 10)

shorter, wider urethra makes it easier for mares to pass small caliculi

56
Q

what is the most common site for uroliths to form?

A

bladder

57
Q

what is the least common site for uroliths to form?

A

urethra

58
Q

what are the 2 types of uroliths?

A

type 1 - most common, yellow and spiculated, easily fragment

type 2 - grey and smooth

59
Q

what are all uroliths made of in horses?

A

calcium carbonate

60
Q

what is a sabulous urolithiasis?

A

accumulation of urine sediment in the ventral bladder

61
Q

what are cystic caliculi?

A

bladder stones

62
Q

what are the signs of cystic caliculi?

A 
dysuria 
haematuria 
stranguria 
incontinence 
signs especially at/after exercise
63
Q

how are cystic caliculi diagnosed?

A

rectal exam, endoscopy of bladder, US (must empty the bladder)

64
Q

how are cystic caliculi treated?

A

laparotomy and cystotomy

65
Q

why can’t cystic caliculi be dissolved?

A

horses have alkaline urine due to diet - difficult to alter diet to make urine acidic enough to dissolve stones

66
Q

which horses usually suffer from cystic caliculi?

A

usually males

67
Q

what are urethral caliculi?

A

usually small cystoliths that have passed into the urethra

68
Q

what are the signs of urethral caliculi?

A

dysuria

colic, post-renal ARF and risk of rupture if blocked

69
Q

how are urethral caliculi treated?

A

perineal urethrotomy

70
Q

how can recurrence of urolithiasis be avoided?

A

avoid predisposing factors
no supplementary electrolytes
no alfalfa/lucerne
check for UTI

71
Q

what are the signs of urinary incontinence in horses?

A

similar signs to urolithiasis, which is more common, so more beneficial to check for uroliths

72
Q

what can cause urinary incontinence?

A

upper motor neuron diseases (equine herpes virus, myeloencephalitis)
lower motor neuron diseases
myogenic disorders

sabulous urolithiasis

73
Q

what are the nursing considerations for urolithiasis/urinary incontinence?

A

cleaning of the perineum/hindlimbs

protection from urine scalding

management of urinary catheter

monitoring urine output and quality

74
Q

which developmental urinary diseases can affect foals?

A

patent urachus

ruptured bladder

75
Q

what is patent urachus?

A

developmental malformation

congenital patent urachus - failure to close at birth means urine passes out of umbilicus

76
Q

how is patent urachus treated?

A

prophylactic antibiotics, usually closes with time

some may require surgical resection

77
Q

when does bladder rupture occur in foals?

A

occurs during parturition, usually in males

78
Q

what does a bladder rupture result in?

A

electrolyte imbalance (hyperkalaemia)

urine accumulation free in the abdomen

79
Q

how is bladder rupture treated?

A

fluid support then surgery to correct

CVNT2 (47 decks)

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