Incontinence & Pollakiuria Flashcards
Small amounts - frequently
Pollakiuria
Straining to urinate
Stranguria
Difficult urination
Dysuria
If total obstruction is occuring, clinical signs of ____ may also be present
Uremia
high BUN and Creatinine
Differentials for UTI - Dogs; most common to least
- infectious - BACTERIAL
- Stone
- Neoplasia
Differentials for UTI - Cats; most common to least
- Sterile - Idiopathic
- Infectious
- Stone
- Neoplasia
Differentials for pollakiuria/stranguria/dysuria
- UTI
- Neurological (reflex dyssynergia, spinal cord dz)
- Behavioral
- Extraluminal obstruction (prostatic dz, fractured pelvis, etc)
If affected dogs are intact, you should ask the O about ______ hx and ______ serological status
Breeding history and Brucella canis
In cats, determine whether the _____ and _____ serostatus are known. Why?
FeLV and FIV
Immunodeficiency with either virus can lead to secondary bacterial infections
What are you testing when doing a tail lift?
Cauda equina
What are you testing when examining for anal wink? How do you elicit an anal wink?
Local pudendal n
Females: pressure on vulva
Males: bulbospongiosus area
What are you assessing during a rectal exam?
- Anal tone
- Urethra
- Prostate
- Width of pelvic canal - previous fractures
- Pain in lumbosacral area (apply pressure dorsally)
The two most common vaginal anomalies are?
- 360 degree vaginal strictures
- usually not a problem if cranial to urethral papilla - dorsoventral bands
- when palpating it seems like there are two vaginas
What diagnostic should ALL animals with UTI have?
UA! by cysto is best
What kind of culture is best?
Aerobic!
99% of bacteria found are aerobic - waste of money to do Anaerobic
Should you do a Mycoplasma culture?
No - suuuuper rare, not worth the money
Can you treat animals with 1st time UTIs empirically?
It is recommended sometimes
Gold standard would be to culture on 1st UTI so you could compare if UTI reoccurs
If the same bug was cultured on both initial and subsequent visit, what most likely happened?
- Wrong Abx choice
- Incomplete therapy - O
- Nidus of infection
If a different bug was cultured on the 2nd visit, what do you think?
UTIs will likely continue to occur - conformational problem?
Should we offer rads to Os of all animals with clinical signs of UTI? Why or why not?
Yes! ALWAYS have calculi on your list
Should we offer US to Os of all animals with clinical signs of UTI? Why or why not?
Yes! They are sometimes superior to rads in that they can detect radiolucent calculi, as well as intraluminal dz like urachal diverticulum and neoplasia
What does FLUTD stand for?
Feline Lower Urinary Tract Disease syndrome
What is the major cause of FLUTD (current theory)? Whats the best treatment?
Stress!
Canned food and stress relief
*Add in pain meds if needed
If the urine pH is low ___ calculi are most likely
Ca Oxalate
If the urine pH is high ____ calculi are most likely
Struvite
What breed are Ca Oxalate calculi common?
Schnauzers (and cats on acidifying diets)
______ calculi cannot be medically dissolved, but alkalinizing diet can slow growth
Ca Oxalate
____ calculi are almost always assoc’d with PSS in dogs and cats (exclusion of dalmations and english bulldogs)
Urate Calculi
2 year-old MI dog, presents with hematuria (w/o pyuria). On rectal exam you note the prostate is bilaterally enlarged, smooth, and non-painful. Dx? Tx?
Dx: Benign prostatic hyperplasia
Tx: Neuter or Anti-androgens
On rectal exam, prostate is of normal size, but extremely painful, and pt is clinically ill. Dx? Tx?
Dx: Acute bacterial prostatitis
Tx: Neuter and ABx
On rectal exam, prostate is bilaterally enlarged, irregular, and non-painful? Dx? Tx?
Dx: chronic bacterial prostatitis
Tx: neuter and Abx
On rectal exam, prostate is unilaterally enlarged, fluid-filled, painful, and pt is clinically ill. Dx? Tx?
Dx: Prostatic abscess
Tx: Drain, neuter, and Abx
Middle-age, MN dog. On rectal exam, prostate is unilaterally or bilaterally enlarged, very firm, loss of septum, fixed, and pt has stranguria
Dx: Prostatic neoplasia
Tx: Piroxicam
On cytology of prepuce you find lots of cornified epithelial cells. What kind of tumor is this? what causes these? Tx?
Squamous metaplasia
These occur secondary to estrogen:
- Sertoli cell tumor
- Exogenous estrogen administered for incontinence
Tx: remove estrogen source
Male dog presents with intra-abdominal mass, normal urine. On radiographs is looks like there are two bladders. Dx? Tx?
Dx: Periprostatic cyst
Tx: Surgically excise and neuter
How can you dx Benign Hyperlasia of the prostate?
- Rads
- UA
- Ejaculate cytology
- Biopsy (definitive)
Should you treat prostatitis with Beta-Lactams? What about Aminoglycosides?
NOOOO! They don’t cross the BTB (beta-lactams)
Only give aminoglycosides if the patient is dying
What are 3 classes of Abx used to treat Gram-negative Prostatitis?
- Potentiated sulfas
- Quinolones
- Chloramphenicol
What are 3 classes of Abx used to treat Gram-positive Prostatitis?
- Erythromycin
- Clindamycin
- Azithromycin
____ is the #1` type of Prostatic Neoplasia
Adenocarcinoma
How does incontinence happen? Explain it in terms of cmH20
Urethral tone weakens with spay (lack of hormones) –> dog goes to bed with an empty bladder (urethral tone > bladder pressure) –> bladder fills overnight and the bladder pressure becomes greater than the urethral tone –> urine begins leaking and dog finally wakes up in puddle of urine
Name 5 major Rule-Outs for UI Workup
- R/O infection
- R/O stones/masses
- R/O PU/PD
- R/O prostate diseases
- R/O ectopic ureters
Causes of sphincter incompetence? Drug used to tx Sphincter Incompetence?
Causes:
Infection, partial obstruction, hormonal
DES! Diethylstilbesterol
- can also use PPA
What are some benefits to using estrogen for treating sphincter incompetence?
Cheap, easy for client (give every 3-14 days), minimal toxicity
So oral estrogen (DES) is okay to give to dogs; is it okay to give injectable estrogens?
NO! its contraindicated in dogs
What drug would you give to tx Sphincter Hypertonicity?
Phenoxybenzamine (e.g. Prazosin)
Prazosin is an alpha-2 antagonist –> relaxes the urethral sphincter
What drug would you give to treat Destrusor Hyperactivity ?
Propantheline
its a parasympatholytic
What drug would you give to treat Destrusor Atony?
Bethanecol or Cisapride
- parasympathomimetic
What is ectopic ureter? Which sex is more prone?
Opening of the ureters anywhere other than the normal area of trigone of bladder
Females more likely to get than males
Drug choice for uncomplicated UTI
Amoxicillin, trimethoprim-sulfonamide
Drug choice for complicated UTI
Guided by culture and susceptibility testing, but consider amoxicillin or trimethoprim-sulfonamide initially
Drug choice for subclinical bacteriuria
Antimicrobial therapy not recommended unless high risk for ascending infection. If so, tx as per complicated UTI (culture and sensitivity)
Drug choice for pyelonephritis
Start with a fluoroquinolone, with a re-assessment based on culture and susceptibility testing
Ca Oxalate, Struvite, and Silicate are Radio-____
Radio-dense
Urate and Cystine are Radio-____
Radio-lucent
“I Cant C U”
Ca oxalate and Silicate can be treated ____
Sx
Struvite, Urate, and Cystine can be treated _____
Med
All but Struvite are treated with diets that are _____
Alkalinizing
Only struvite is treated acidically
Which calculi is common among Dalmations and dogs with PSS?
Urate!
Predispositions for _____ calculi: Schnauzers, chronic acidification, hypercalcemia
Ca Oxalate
What does infection do to pH?
Increases pH
Top 3 R/O for a radiodense stone, bacterial UTI?
- Struvite
- Ca Oxalate
- Urate
What drug is drug of choice for Lepto?
Doxy!
Abortion, stillbirth, failure to conceive, bacteremia, genital tract inflammation…. what should you be thinking?
Brucellosis!
CBC and Chem abnormalities of pt with Brucellosis
CBC:
neutrophilic leukocytosis, monocytosis
Chem:
hyperglobulinemia, polyclonal gammopathy, proteinuria
Brucella diagnosis:
Trust a _____, confirm a _____
Trust a NEGATIVE, confirm a POSITIVE
*Make sure you confirm positives –> animal may be euthanized
How do we treat Brucellosis
Discuss zoonotic risk - may euthanize
If tx is chosen:
- carefully! spay or neuter if intact
- Quinolone, PO, SID 14 days
- Doxy, PO, SID for 14 days
- repeat until seronegative
