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Equine medicine > examination of the urinary system > Flashcards

examination of the urinary system Flashcards

1
Q

what is the structure of the examination of the urinary tract

A 
history
physical examination
ancillary diagnostic aids
laboratory tests
special procedures
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2
Q

history and distant examination

what do we look for?

A 
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
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3
Q

ancillary diagnostic aids

A
  • Rectal palpation
  • Endoscopy
  • Radiography
  • Scintigraphy
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4
Q

what laboratory tests can we use

A
  • Haematology
  • Serum biochemistry
  • Urinalysis
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5
Q

what special procedures can we do

A
  • Uretral cathetrisation
  • Water deprivation test
  • Antidiuretc hormone challenge test
  • Quantitative measurement of renal function
  • Renal biopsy
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6
Q

what are the methods of the physical examination

A

inspection
palpation - external and rectal
precussion to detect pain

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7
Q

what is the sequence of the physical examination

A

kidney
ureter
urinary bladder
urethra

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8
Q

how can we examine the kidney

A

inspection, external palpation and percussion, rectal palpation

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9
Q

is palpation and percussion of the kidney useful ?

A

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

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10
Q

what information can we get from rectal palpation of the kidney

A

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

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11
Q

how do we examine the ureters

A

Cannot be examined by physical methods in healthy horses

rectal palpation: plpable when the wall is thickened and/ or the lumen is distended

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12
Q

physical examination of the urinary bladder

A

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

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13
Q

rectal palpation of the urinary bladder

A

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

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14
Q

what should we check when performing a rectal palpation of the urinary bladder

A

position, shape, size, surface, wall thickness, painfulness, content, structures within the lumen (urolith, tumor)

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15
Q

examination of the urethra of the mare

A

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

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16
Q

examination of the urethra in the stallion and gelding

A

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
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17
Q

what should we check during the examination of the urethra

A

Mucous membranes around the urethral orifice (color, surface, abnormalities)
Discharge from the urethra
Mucocutaneous junction in stallions and geldings

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18
Q

how can we make a horse pee

A

Horses do not often urinate during clinical examination
Take them for a short walk
Some horses urinate if they are put on fresh bedding

19
Q

what do we observe when the horse pees

A

posture
Behavior during urination (e.g. signs of difficult or painfull urination)
Way of voiding (e.g. stream or dribbling)
Amount of released urine

20
Q

what is the normal peeing position?

A
  • 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
21
Q

what is the normol amount of released urine

A
  • Frequency of urination: 4-7 times a day

- Amount of urine: approx.. 10-30 ml/kg dail – depends on temperature and feed

22
Q

what is Pollakiuria

A

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
23
Q

what is oliguria

A

reduced urine output

  • reduced frequency, but normal amount of urine per urination
  • reduced frequency and reduced amount per urination
24
Q

anuria

A

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)
25
Q

urinary tenesmus

A

excessive straining during urination

  • persistent and/or frequent voiding stance
  • unsuccessful voiding
26
Q

dysuria

A

painful or difficult urination

- voiding small amount of urine frequently and with difficulty

27
Q

urinary incontinence

A

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
28
Q

ultrasonography of the kidney

A
  1. There is an organ between the kidney and abd wall – spleen
    Image quality of left kidey is usually not so good
    Pelvis – most echogenic
  2. no organ between kidney and abd wall
    Can measure thickness of cortex
29
Q

ultrasonography of uroliths

A
  1. transrectal ultrasosnography of left kidney – etter resolution than the transabd ultrasonography
    Visible bright hyperechogenic nephrolith
  2. bladder – many uroliths
30
Q

what can we use endoscopy for

A

put it in the pee hole and examine the inside of the urethra and bladder

31
Q

how can we use x rays to examine the urinary tract?

A

use contrast to see if there is a blocjkage or leakage

excretory urography

32
Q

how does scintigraphy work

A

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

33
Q

what can we discover about the urinary tract with haematology

A

Mild anemia may be presented in chronic kidney disease caused by decreased erythropoietin production

34
Q

what parameters do we check with biocemistry

A

Urea
Creatinine
Urea:creatinine ratio
Electrolytes – extremely frequent in acute and chronic kidney diseases

35
Q

what can the different results of creatinine:urea ratio tell us

A
  • 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
36
Q

what does the urinalasys concist of?|

A 
Physical exam 
Reagent strip analysis 
Sediment examination
Enzymuria
Fractional clearance of electrolytes
Bacterial culture
Clarity
Specific gravity
37
Q

what do we look at during physical examination of the urine

A

color, odor, clarity, viscosity, specific gravity

38
Q

what enzymes can be present in the urine if we find enzymuria

A

GGT, ALP, LDH

39
Q

how should the clarity of the urine be like

A

usually turbid (CaCO3 and mucus) – if it is clear this can be a sign of polyuria

40
Q

what can specific gravity tell us

A
  • <1008 g/L (hyposthenuria)
  • 1008-1014 g/L (isosthenuria)
  • > 1014 g/L (hypersthenuria)
  • Normal urine: >1020-1025 g/L
41
Q

what samples do we need for a fractional clearance of electrolytes test

A

Information about popular function
You need a blood sample – mesaure from serum
Get a urine sample as well

42
Q

what is the equation for fractional clearance of electrolytes

A

Scr/Ucr x Ux/Sx x 100 = % fractional clearance

  • U= urine
  • S= serum
  • X [electrolyte]
  • CR [creatinine]
43
Q

what values should the electrolytes have

A 
Na	0.03-0.5%
K	15-70%
Cl	0.2-1.7%
Ca	<7%
PO4	<0.5%
Mg	<15

Equine medicine (17 decks)

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