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Urology > LA urology (Reuss) > Flashcards

LA urology (Reuss) Flashcards

1
Q

History

A
  • Duration
  • relation to other events
    • exercise
    • parturition
  • number animals affected
  • Non specific signs
    • weight loss
    • colic
    • decreased performance
  • Diet
  • Medications
  • Water intake: 40-60 ml/kg/day
  • Urine output: 5-20 ml/kg/day
    • amount
    • pattern
    • character
    • groaning/grunting
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2
Q

Abnormal micturation

  • Stranguria
  • Dysuria
  • Pollakiuria
  • Polyuria
  • Oliguria
  • Anuria
A
  • Stranguria: straining to urinate
  • Dysuria: pain on urination
  • Pollakiuria: inc frequency urination
  • Polyuria: inc total volume urination
  • Oliguria: dec total volume of urination
  • Anuria: passing no urine
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3
Q

Oral exam

A
  • Excessive tartar
    • kidney dz
  • Ulcers
  • Bad breath
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4
Q

External genitalia

A
  • urethral fossa
    • squam
    • stones
  • Vulva
    • crystals
    • evidence of bleedings
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5
Q

Transrectal palpation

Horse

Cow

Small Ruminant

A
  • Horse
    • Left kidney
    • Bladder
    • Ureters -bad news
    • Urethra
  • Cattle
    • Left kidney
      • Lobulated
      • almost on midline
    • Ureters
    • Bladder
    • Urethra
  • Small ruminant
    • digital
    • transabdominal
    • perineal urethra (urethral pulse if stone)
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6
Q

Ruminant urine collection

A
  • Females: urethral diverticulum
    • stroke vulva
  • Males: NOT POSSIBLE to catheterize
    • sigmoid flexure
    • urethral diverticulum
    • stroke preputial hairs
  • small ruminants
    • suffocate them…lol
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7
Q

Lab evals we do

A
  • CBC
  • CHEM
  • UA
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8
Q

CBC

Anemia

A
  • Cause of renal disease
    • hemolysis => pigment nephropathy
    • acute blood loss => vasomotor nephropathy
  • Effect of renal disease
    • Anemia of chronic disease
    • Decreased erythropoietin production
    • Decreased life span of RBCs
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9
Q

Hematology

  • Chronic infection or inflammation
  • Glomerulonephritis
A
  • Chronic infection or inflammation
    • Neutrophilia
    • Hyperfibrinogemia
    • Inc globulins / total protein
  • Glomerulonephritis
    • hypoalbuminemia
    • panhypoproteinemia = almost always GI DZ
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10
Q

Serum biochem

Creatinine

A
  • waste product from muscle
  • Freely filtered
  • filtration rate = excretion rate
  • increases once 75% nephrons damaged
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11
Q

Serum biochem

BUN

A
  • LA patients can secrete in sweat
  • LA patients can recycle
  • Can use urea to inc medullary hyperotonicity
    • retain water
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12
Q

GFR measurements

A
  • Creatinine clearance
  • Iohexol Clearance
  • Nuclear scintigraphy
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13
Q

Serum electrolytes

Acute Kidney Injury

A
  • dec Na, Cl
  • inc K, Mg
  • dec Ca, inc P
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14
Q

Serum electrolytes

Chronic kidney dz

Horses

A
  • inc Ca, dec P
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15
Q

Urinalysis

A
  • Color
    • horses should have cloudy urine
    • ruminants should not be cloudy
  • Red urine:
    • blood, hemoglobin
  • Brown urine:
    • myoglobin
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16
Q

UA

Hematuria

Hemoglobinuria

Myoglobinuria

A
  • Hematuria
    • erythrocytes settle out
  • Hemoglobinuria
    • urine and serum discolored
  • Myoglobinuria
    • urine stays discolored
    • serum clear

*urine dipsticks can’t tell the difference

17
Q

urine pH

A
  • herbivores have alkaline urine
  • exceptions:
    • high protein diet
    • anorexia
    • neonate
18
Q

USG

A
  • Estimates solute concentration
    • weight of solution relative to equal volume of distilled water
  • Use refractometer
    • dipstick not accurate (I think)
  • Can be falsly increased if lots of protein or glucose
    • use osmolality (# particles/kg water)
19
Q

Hyposthenuria

Isosthenuria

Hypersthenuria

A
  • Hyposthenuria
    • USG < 1.008
    • normal in suckling foals
  • Isosthenuria
    • USG 1.008 - 1.014
    • tubule disease
    • high producing dairy cows N: 1.007 - 1.015
  • Hypersthenuria
    • USG > 1.014
    • N: 1.015-1.035
    • Dehydration: > 1.025

*Sedation will falsly lower USG

20
Q

Fractional clearances

A
  • Reflection of tubular disease
    • Urine (electrolyte) % Plasma (x) * P (Cr) % U (Cr) * 100 = % FC
  • Na clearance most useful
    • should be less than 1
    • should be close to 0 in dehydrated horses
  • Altered by IV fluids, furosemide, exercise
21
Q

Urine GGT

A
  • Biliary and pancreatic tubular GGT production not filtered by kidney
  • Proximal tubular brush border enzyme
    • early indicator of proximal tubule damage
    • increases quickly with aminoglycoside tox
    • only released during active destruction
22
Q

Liver dz without tubular dz and GGT

A

no GGT in urine

23
Q

Tubular dz without liver dz and GGT

A

tubular dz will mean GGT in urine, not liver dz

24
Q

Urine GGT will go up before

A

Creatinine

25
Q

Ratios used to get rid of

A

dilutional effect

26
Q

Urine GGT/Creatinine Ratio

A
  • (UGGT)/(UCr) * 100
    • normal < 25 IU/g
    • 25-100 IU/g ???
    • > 100 IU/g are clinically relevant
    • Follow trends
27
Q

Proteinuria

Normal kidney

Proteinuria

A
  • Normal kidney
    • glomerulus excludes albumin, globulin
    • proximal tubules reabsorb low-molecular weight proteins
  • Proteinuria
    • kidney
      • more pronounced with glomerular disease
    • Exudative processes in ureters, bladder, urethra
    • vulvar contamination
28
Q

Proteinuria

False positives

A
  • False positives
    • alkaline pH causes trace protein on dipstick
      • overcomes citrate buffer
    • Hemoglobin
  • Sulfosalicylic acid precipitation (SSA)
  • Urine protein: creatinine = 1.0:1
29
Q

Glucosuria

A
  • Reabsorbed in proximal tubule
  • Renal threshold = 150 mg/dl
30
Q

Glucosuria + normoglycemia =

A

proximal tubular damage

31
Q

Glucosuria + hyperglycemia =

A

systemic disease

32
Q

Sediment

Casts

Crystals

A
  • Casts
    • dissolve quickly in alkaline urine (LOOK W/IN 1/2-1hr)
    • indicates tubular damage
  • Crystals (hard to interpret, all can be normal)
    • calcium carbonate, phosphate, oxalate
    • struvite
33
Q

Sediment

WBC

RBC

A
  • WBC > 10/hpf = pyuria
    • infection, inflammation
    • +/- Bacteria
  • RBC > 5/hpf = hematuria
    • inflammation, infection, neoplasia, exercise
34
Q

Ultrasound

Kidneys

A
  • Transabdominally
  • Transrectally
  • Assess size, density, structure
  • Cortex should be more echogenic than medulla
  • Pelvis echogenecity varies
35
Q

Renal biopsy

A
  • complications
    • hemorrhage
    • bowel penetration
  • not done often
    • doesn’t give etiology, just confirms end stage kidney dz
36
Q

cystoscopy

A
  • ureteral openings
  • cystoliths
37
Q

Abdominal Radiographs

A
  • Retrograde cystogram
  • Excretory pyelography

*suspect bladder rupture

38
Q

Nuclear scintigraphy

A

assess renal perfusion

Urology (15 decks)

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