examination of the urinary system Flashcards
what is the structure of the examination of the urinary tract
history physical examination ancillary diagnostic aids laboratory tests special procedures
history and distant examination
what do we look for?
Abnormal, painful urination Abnormal frequency of urination Abnormal color or consistency of urine Abnormal amount of urine Abnormal amount of water intake Colic signs Weight loss Decreased appetite
ancillary diagnostic aids
- Rectal palpation
- Endoscopy
- Radiography
- Scintigraphy
what laboratory tests can we use
- Haematology
- Serum biochemistry
- Urinalysis
what special procedures can we do
- Uretral cathetrisation
- Water deprivation test
- Antidiuretc hormone challenge test
- Quantitative measurement of renal function
- Renal biopsy
what are the methods of the physical examination
inspection
palpation - external and rectal
precussion to detect pain
what is the sequence of the physical examination
kidney
ureter
urinary bladder
urethra
how can we examine the kidney
inspection, external palpation and percussion, rectal palpation
is palpation and percussion of the kidney useful ?
Provides minimal or zero information
Deeper and stronger palpation and percussion of the renal region probably detects back pain
Renal dullness does not exist – percussion does not make sense
what information can we get from rectal palpation of the kidney
Only a part of the left kidney is palpable – caudal third or caudal half of the kidney
Provides information about the shape, size, consistency and painfulness of the caudal third/half of the organ
how do we examine the ureters
Cannot be examined by physical methods in healthy horses
rectal palpation: plpable when the wall is thickened and/ or the lumen is distended
physical examination of the urinary bladder
Cannot be examined by physical methods in adults or larger foals
Full bladder might be palpable in the caudoventral part of the abdomen of neonatal foals
rectal palpation of the urinary bladder
At the bottom or entrance of the pelvis
Spherical or oval, non-painful, smooth, undulant structure
Size depends on the amount of urine, full bladder is hand- or football-sized in adult horses
what should we check when performing a rectal palpation of the urinary bladder
position, shape, size, surface, wall thickness, painfulness, content, structures within the lumen (urolith, tumor)
examination of the urethra of the mare
Short and relatively large in diameter
Orifice is 10-15 cm from the vulva
- Inspection is possible by a vaginal speculum (ventral midline of the vaginal vestibule)
Urethra and its orifice are palpable by fingers – 1-2 fingers can be placed into the urethra an palpate
examination of the urethra in the stallion and gelding
Inspection and palpation
- Orifice can be examined during urination and mating, under sedation (alpha2 agonist + small dose of acepromazine, butorphanol can also be added)
- Do not try to pull penis out without sedation
- Short section can be examined at perineum (e.g. swelling in urolithiasis) – not frequent
what should we check during the examination of the urethra
Mucous membranes around the urethral orifice (color, surface, abnormalities)
Discharge from the urethra
Mucocutaneous junction in stallions and geldings
how can we make a horse pee
Horses do not often urinate during clinical examination
Take them for a short walk
Some horses urinate if they are put on fresh bedding
what do we observe when the horse pees
posture
Behavior during urination (e.g. signs of difficult or painfull urination)
Way of voiding (e.g. stream or dribbling)
Amount of released urine
what is the normal peeing position?
- Mare: hind limbs are in base wide stance, placed slightly cranially, tail is elevated, rump is bent down
- Stallion and gelding: hind limbs are in base wide stance, placed slightly caudally, tail is elevated, penis is released
- Abdominal muscles are used in both genders, they often groan
what is the normol amount of released urine
- Frequency of urination: 4-7 times a day
- Amount of urine: approx.. 10-30 ml/kg dail – depends on temperature and feed
what is Pollakiuria
abnormally frequent passage of urine
- normal amount of urine is passed in multiple, smaller portions
- polyuria: formation and elimination of abnormally large amount of urine – usually both frequency and quantity per urination are increased often seen together with polydipsia
what is oliguria
reduced urine output
- reduced frequency, but normal amount of urine per urination
- reduced frequency and reduced amount per urination
anuria
lack of urination, no passage of urine
- renal: cessation of urine production by the kidneys (e.g. acute renal failure)
- postrenal: voiding is blocked (e.g. bladder rupture bladder paralysis, urethral stone)
urinary tenesmus
excessive straining during urination
- persistent and/or frequent voiding stance
- unsuccessful voiding
dysuria
painful or difficult urination
- voiding small amount of urine frequently and with difficulty
urinary incontinence
lack of voluntary control over urination
- horses do not stand in normal posture, abdominal muscles are not used
- urine may dribble continuously, or small amounts are released intermittently
ultrasonography of the kidney
- There is an organ between the kidney and abd wall – spleen
Image quality of left kidey is usually not so good
Pelvis – most echogenic - no organ between kidney and abd wall
Can measure thickness of cortex
ultrasonography of uroliths
- transrectal ultrasosnography of left kidney – etter resolution than the transabd ultrasonography
Visible bright hyperechogenic nephrolith - bladder – many uroliths
what can we use endoscopy for
put it in the pee hole and examine the inside of the urethra and bladder
how can we use x rays to examine the urinary tract?
use contrast to see if there is a blocjkage or leakage
excretory urography
how does scintigraphy work
Not so frequently used, it has to be given a special intravenous medication which is labelled by gamma radiation substance, we use a gamma camera to detect the gamma radiation of the substance, image on right there is much more uptake in part of the kidney
what can we discover about the urinary tract with haematology
Mild anemia may be presented in chronic kidney disease caused by decreased erythropoietin production
what parameters do we check with biocemistry
Urea
Creatinine
Urea:creatinine ratio
Electrolytes – extremely frequent in acute and chronic kidney diseases
what can the different results of creatinine:urea ratio tell us
- differentiation between acute and chronic kidney problem
- in chronic cases it is in most of the cases above 10
- in acute cases it is normally below 10
what does the urinalasys concist of?|
Physical exam Reagent strip analysis Sediment examination Enzymuria Fractional clearance of electrolytes Bacterial culture Clarity Specific gravity
what do we look at during physical examination of the urine
color, odor, clarity, viscosity, specific gravity
what enzymes can be present in the urine if we find enzymuria
GGT, ALP, LDH
how should the clarity of the urine be like
usually turbid (CaCO3 and mucus) – if it is clear this can be a sign of polyuria
what can specific gravity tell us
- <1008 g/L (hyposthenuria)
- 1008-1014 g/L (isosthenuria)
- > 1014 g/L (hypersthenuria)
- Normal urine: >1020-1025 g/L
what samples do we need for a fractional clearance of electrolytes test
Information about popular function
You need a blood sample – mesaure from serum
Get a urine sample as well
what is the equation for fractional clearance of electrolytes
Scr/Ucr x Ux/Sx x 100 = % fractional clearance
- U= urine
- S= serum
- X [electrolyte]
- CR [creatinine]
what values should the electrolytes have
Na 0.03-0.5% K 15-70% Cl 0.2-1.7% Ca <7% PO4 <0.5% Mg <15
