Hematuria, Pollakiuria, Stranguria Flashcards
__ is small frequent urination and __ is when its hurts to urinate and both are associated with __
Pollkiuria, stranguria, Hematuria
If you spin down a Hematuria sample what will it look like?
Blood separates out to bottom of test tube
Lower urinary tract common differentials
Bacterial UTI
Urocystoliths/urethroliths
Urinary tract neoplasia
Sporadic bacterial cystitis
Uncomplicated or simple
No structural/fxn abnormalities
Normal host defenses
Fewer than 3 episodes in last 12 mths
Recurrent bacterial cystitis
Complicated UTI
3 or more episodes in last 12 mths
Relapsing or persistent infection
Reinfection
Sporadic bacterial cystitis is common in __ and is less common in __
Dogs
cats (typically get idiopathic cystitis or urolithiasis)
Diagnosis of sporadic bacterial cystitis
Urinalysis: turbid with 50wbc/hpf
Bacti culture: preferred but can empirically treat without a culture
Specimens should be collected by __ for aerobic bacterial urine culture
Cysto - AUS guidance can be helpful and id abnormalities of the bladder
UTI’s in younger and older populations what should you evaluate?
Potential comorbities
How do we treat sporadic bacterial cystitis?
- Antimicrobials
- Analgesics
Typically lasts for 3-5 days
__ is the first choice for empirical treatment of sporadic bacterial cystitis
Amoxicillin
When 1st line treatment of sporadic bacterial cystitis doesn’t work, what antimicrobials should you use?
Nitrofurantoin, fluoroquinolone and 3rd generation cephalosporins
- avoid if possible because of antimicrobial resistance
Diagnosis of recurrent bacterial cystitis
- Urine culture by cysto
- Ultrasound, rads or contrast studies
- Biopsies of bladder may revels deep seated infections
Treatment of recurrent bacterial cystitis
- may treat with analgesics solely while waiting for culture results
- reinfection may only need 3-5 days of antibiotics
- relapsing/persistent infections may need longer courses (7-14 days)
If abdominal radiographs reveal a stone was is the treatment plan?
Depends on the type of stone - will likely recommend surgery but can also attempt to dissolve the stone
Needs a longer course of antibiotics (2wk)
Pyelonephritis (upper urinary tract infx) is suspected to be due to:
- positive aerobic Bacti urine culture
- fever, lethargy, and/or pu/pd
- renal pain
- azotemia, cylindruria and peripheral neutrophilia
- renal pelvic dilation and/or blunting of the renal papilla on ultrasound
Treatment of pyelonephritis
Treatment should be initiated immediately while waiting for culture and susceptibility
- fluoroquinolones or Cefpodoxime are reasonable first choices
10-14 days of treatment
What should you look for in every intact male dog diagnosed with bacteriuria or bacterial cystitis?
Underlying bacterial prostatitis
Dx of bacterial prostatitis
Full exam with rectal palpation of prostate and urinalysis
- AUS eval of prostate
- discordance between urine and prostatic fluid culture results can occur
Treatment of bacterial prostatitis
- drain prostatic abscesses
- fluoroquinolones while awaiting culture and susceptibility treating
- blood-prostate barrier reduces penetration of many drugs
- 4 weeks of treatment for acute prostatitis
- castration
How should you follow up bacterial prostatitis?
Monitor the prostatic size by AUS +/- rectal palpation
- culture of prostatic fluid or urine can be performed during therapy but not recommended
T/F: you should not treat or culture the majority of subclinical bacteriuria
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What are common differentials of cats with Lower urinary tract infections?
Idiopathic cystitis
Behavioral
Urocystoliths/urethroliths
Mucus plugs
Bacterial UTIs
__ is the most common cause of chronic lower urinary tract signs in cats
Feline idiopathic cystitis
Treatment of FIC
- Goal is to reduce activation of the central stress response system
- multimodal environmental modification (focuses on environmental enrichment)
need to communicate well with owners
MEMO
- Cats in general
- FIC
- Effective resource management (food and water management, litter space, etc.)
- Reduced perceived threats and reduce interact conflict
Diets for FIC
Hills urinary care c/d
- changing the cats diet may just stress the cat out more
What would be a good feeding management practice for cats prone to FIC?
Food puzzles and quiet locations
Feliway
Combination of synthetic feline pheromone and marketed to exert a calming effect on cats
List physical manifestations of feline idiopathic cystitis and what they lead to
- mucosal edema
- vascular leakage
- mucosal ulceration and hemorrhage
- intramural inflammation
leads to urgent, frequent, painful and bloody urination
Central Stress Response System with FIC
natural variations in activation of neural, endocrine, and immune responses
- varied physiologic and behavioral abnormalities
T/F: most cats with FIC resolve clinical signs in a few days without treatment
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