exam 2 Flashcards
Upper urinary tract
the ureters and kidneys
lower urinary tract
the batter, urethra, and prostate
Cystitis
urinary bladder inflammation, the most common form of UTI, primarily bacterial causes
more common in dogs than cats
ascending infections is wayyyyy more common than descending infection
Cause: opportunistics that overcome normal host defenses
Natural defenses against urinary tract infections
1) Urethral length (males longer, harder to establish an infection)
2) Sphincters
3) Urine flow flushes out bacteria
4) Healthy urine has an osmolarity and urea concentration that is difficult for bacteria to establish
5) Location innate immunity of urothelium- glucosaminoglycans and antimicrobial peptides
Uncomplicated infectious cystitis
sporadic urinary tract infections that are common in dogs and humans, presumptive diagnosis is reasonable if there are no predisposing causes and an animals has had less than 3 times in a year
Complicated infectious cystitis
frequent urinary tract infections that are a cause of predisposing causes
1) normal micturition interference (obstruction, upper motor neuron injury to detrusor, etc)
2) anatomic defects (ectopic ureter- embryonic origin, juvenille vulvar conformation, urachal diverticula, etc.
3) urothelium changes (traumatic catherization, neoplasia of urothelium, urolithiasis)
4) Metabolic/Immunological causes (Chronic Kidney disease- dilute urine, diabetes mellitus, corticosteroids, hyperadrenocortism, congenital immunodeficiency- IgA or SCID)
5) Decreased kidney function
What kind of bacteria is typically manifested in urinary tract infections
facultative anaerobes
The majority of infectious agents that cause UTI in small animals include
Gram - enteric organisms (fac anaerobes)
1) E. coli
2) Proteus spp.
3) Enterobacter spp
4) Klebsiella spp
Gram + cocci (fac anaerobes)
1) Coagulase positive Staphylococcus sp. (S. pseudointermedius, S. aureus)
2) Enterococcus spp.
What are some less common causes of UTI in small animals
Corynebacterium urealyticum (fac anaerobe gram + rod)
Non enteric gram - rods (Pseudomonas aeruginosa)
Mollicutes- Mycoplasma spp and ureaplasma spp
Fungal (typically C. albicans)
What is the main pathogen that causes UTIs in large animals
Corynebacterium renale
Corynebacterium renale
a facultative gram + rod that is a part of the normal urogenical flora and causes ascending UTI infections in cattle, sheep, and goats
often reach the kidney (pyelonephritis) and cause balanoposthitis (pizzle rot)
have pili that attach to the urothelium
Urease role
Produced by Staphylococcus spp, Proteus sp, enterobacter, and corynebacterium renale
converts urea to ammonia which raises urine pH and forms struvite crystals and causes a predisposition to urolithiasis (stones)
What UTI pathogens produce urease and predispose the animal to urolithiasis?
Staphylococcus spp.
Proteus spp.
Enterobacter spp.
Corynbacterium Renale/urealyticum
What single pathogen is the most common cause of UTI in humans and dogs?
UPEC (uropathogenic E.coli) that is a type of ExPEC
UPEC
Uropathogenic E. Coli that is the cause of most UTIs in dogs and humans have P-fimbrae- pili that attach to the urothelium and alpha-hemolysin, siderophores for iron uptake
Is the presence of bacteriuria an indication to treat the animal?
NO, dont treat aniamls that dont have urinary signs (straining, increased frequency, and discomfort)
the simple presence of bacteriuria is not an indication to treat and infection
What drugs go to the urine and are helpful to treat UTIs?
Penicillin (Amoxicillin)
Cephalosporins (Cephalexin)
Fluoroquinolones (Enrofloxacin)
Trimethoprim- Sulfamethoxazole
Tetracyclines (Doxycycline)
Aminoglycosides (Amikacin)
Nitrofurantoin
How should you diagnose UTIs?
Collect using cystocentesis, catherization, or midstream voided and do an aerobic culture as most are facultative anaerobes
use quantitative plating that measures the number of colony forming units per mL of urine (varies on collection technique- midstream gives the most organisms and cystocentesis gives the least amount
(guidelines for contamination, suspicious, and significant infection
In-clinic cultures
small incubator with standard plate media and commercial kits for UTI culture, most are gram + and show up overnight
How do you prevent against UTIs?
-Address anatomic defect (vulvoplasty)
-Control primary metabolic diseases (diabetes mellitus)
-good catheter management
-Pulse dosing (not really helpful)
Methenamine- used to prevent recurrence after treatment, hydrolyzed to formaldehyde only in acidic urine, not effective in urease + bacteria, no efficacy studies in animals
Cranberry’s role in UTI treatment
Theoretically might prevent some infections caused by UPEC, prevents p-fimbriae attachment to the urothelia, works in humans well to reduce the incidence of infection
Empirical therapy for UTI
Therapy for a UTI that is on the basis of clinical diagnosis (signs and abnormal urinalysis)
NO CULTURE
Reasonable if it is the first time with clinical signs but not optimal for recurrent cases
Drug choice: Beta lactam drug (amoxicillin or amoxicillin/Cluvulanic acid, or cephalexin)
Targeted therapy for UTI
Basis of significant culture result and antimicrobial susceptibility testing
typically used for 2nd, 3rd, 4th, 5th, etc presentation
or in suspect hospital acquired infections (onset of greater than 48 hours in the hospital
Pyelonephritis
an ascending infection (can be sequelae to cystitis)
-Dogs and cats are common
challenging to diagnose
-Ultrasound (dilated renal pelvis)
-Elevated blood urea nitrogen (BUN) and creatinine
-flank pain on palpation
-+/- fever, +/- leukocystis
can lead to bacteremia and sepsis
How should you treat pyelonephritis
antimicrobial agents with high tissue penetration is best: fluoroquinolones, Trimethoprim Sulfa
Prostatitis (dogs)
a disease that can occur in both intact and neutered males
cysts occur in intact males (14% males) approx half of cysts become infected
Acute: fever, depression/lethargy, anorexia, +/- urethral discharge
Chronic: infection is often silent and you should diagnose baced of infertility and recurrent UTI or hematuria, only enlarged if concurrent benign hyperplasia
What is the most common causative agent of prostatitis?
the same as UTI, E coli is the most common overall
How should you treat prostatitis in dogs?
-Surgical approach in cases of abscesses (drainage and omentalization)
Use antimicorbial drugs (only a few options bc acidic acini pf prostatic acini and you can only use lipophilic/weakbases (Enrofloxacin, Trimethoprim-Sulfamethoxazole, Clindamycin, Chloramphrenicol)
Describe the pathway of milk to ejection
1)Alvelous with myoepithelia and capillaries with tight junctions
2) Interlobular ducts
3) Intralobular ducts
4) Lactiferous ducts
5) Gland Cistern (where it is help)
6) Annular ring
7) Teat cistern
8) Sphincter muscle (sm. that allows milk leltdown)
9) Streak canal (Papillary canal)
Are mammary glands in quarters connected?
NO there is 1 mammary gland per quarter and there is no physical connection to the other quarters
What is the milk vein?
Subcutaneous abdominal vein (milk vein)
What ligaments support the mammary gland
Median suspensory ligament, lateral suspensory ligament, and intermammary groove
Defense mechanisms of the mammary gland?
Physical factors (Keratin plug, stratified squamous epithelium)
Cellular factors (WB: neutrophils, macrophages, lymphocytes) and epthelial cells
Innate Immunity: lactoferin- bind iron to prevent iron depended bacteria from binding, cytokines, complement, acute phase proteins
acquired immunity: immunoglobulins, T lymphocytes
Mastitis pathogenesis
compromised defense mechanisms (teat milking, post milking, and immune suppression
lead to inflammation of the mammary gland
teat end exposure and invasion, pathogens multiply in the milk leading to an inflammatory response and induced signs
What SCC indicates an animal is uninfected with mastitis?
SCC less than 100,000 cells/mL
What SCC indicates an animal has mastitis (subclinical or clinical) or early lactaction (colostrum)
SCC of more than 200,000 cells/mL
What is the target of bulk tank SCC
SCC of less than 250,000 cells/mL
What is the US legal limit of SCC in milk?
SCC of 750,000 cells/mL