Large Animal Flashcards
how to acquire urine on a female ruminant
stroke vulva
how to acquire urine from a small ruminant
occlude nares
things to look for on a CBC of a large animal
anemia –> hemolysis or acute blood loss will cause nephropathy
chronic inflammation or infection –> neutrophilia, hyperfibrinogenemia, increased globulins
glomerulonephritis –> hypoalbuminemia, panhypoproteinemia
things to look for on chemistry of a large animal
- creatinine
- BUN is a waste of time in large animals bc they can get rid of it in other ways
- azotemia
- serum electrolytes in AKI will have decreased Ca and increased P
what is unique about the chemistry lab evaluation in horses with CKD?
they will have increased Ca and decreased P –> this is the opposite of all other animals
how do you evaluate a UA for hematuria?
spin the urine. if you get a pellet or RBCs at the bottom, its hematuria. if not - its either hemoglobinuria or myoglobinuria.
though if its myoglobinuria, the color of the urine will be brown
when evaluating for hemoglobinuria
the urine and serum will be discolored
when evaluating for myoglobinuria
the urine will be discolored but the serum will be clear
what are the levels of isosthenuria and what is it indicative of?
1.008 - 1.014
tubular disease
what test can you run to evaluate a large animal for tubular disease? and how does it work?
fractional clearance.
take urine and serum sample at the same time and test Crt and electrolyte (usually Na).
- Na clearance helps differentiate from pre-renal and renal azotemia
- can be altered by fluids, furosemide, and exercise
what is a way to get rid of the dilutional effect when collecting urine?
take the urine GGT/Crt ratio: Uggt / Ucrt x 100%
this way you don’t have to collect the entire sample of urine.
what is GGT?
GGT is a big protein that cannot cross the glomerulus. so if its in the urine, it got there bc it was released by the proximal tubular brush border indicating tubular damage.
if you get trace protein on a dipstick from a large animal indicating proteinuria, should you panic?
no! because large animals normally have alkaline urine which causes false positives on dipsticks.
to avoid this, look at the pH before looking at trace protein!
when evaluating sediment of a urine sample in large animals, what do casts indicate? what is important to remember about casts?
tubular damage
they dissolve quickly so look at them within 30min!
if you see crystals in urine sediment evaluation in large animal should you get excited?
nope, it just means the urine is supersaturated.
if you see excess WBCs on a urine sediment evaluation in large animal, what does it indicate? what should you do?
if you see excess 10/hpf WBC, its an indication of infection or inflammation.
look for bacteria. if you don’t see any, it DOES NOT mean you can rule out a UTI
once a horse is on fluids, how fast should you see a reduction in azotemia?
> 50% within 24 hours
horses: what is intrinsic renal azotemia?
acute kidney injury. its a syndrome in which there is an abrupt decrease in GFR
horses: what two things cause AKI? which one is most common?
acute tubular necrosis (ATN) and acute glomerulonephritis
ATN is most common
horses: what things cause ATN? how?
- ischemia - “vasomotor nephropathy” - not perfusing kidneys
- aminoglycoside toxicity - inhibits phospholipase and causes vasoconstriction
- NSAIDs - decreases renal blood flow causing medullary crest necrosis because medulla is not well perfused
- pigment nephropathy - causes vasoconstriction, casts and heme particles
- leptospira - should jump to top of ddx if hx of uveitis, AKI and infertility on farm
horses: how is lepto diagnosed and treated?
dx: urine PCR
tx: amoxicillin, penicillin, ceftiofur
what two drugs are nephrotoxic and may cause aminoglycoside toxicity? what can aminoglycoside toxicity cause?
gentamicin > amikacin
aminoglycoside toxicity may cause ATN (acute tubular necrosis)
what antigen causes acute glomerulonephritis in horses? what does acute glomerulonephritis cause?
streptococcus equi (strangles) and EIA
causes ATN
horses: what are the clincal signs of AKI? what will you see on chemistry? on UA?
- often non-specific like poor appetite and dull
- oliguric
horses: what clinical sign will tell you its post-renal azotemia
if a horse continues to be oliguric 6 - 12 hours after initiation of fluid therapy
horses: how do you treat AKI?
- correct fluid volume deficits
- monitor edema
- tx for hyperK
- give diuretics if they still will not urinate after fluids started
horses: how do you treat hyperK?
- give fluids without K like 0.9% NaCl, plasmalyte or LRS
- give 5% dextrose - stimultes endogenous insulin which drives K back into cells
- give Ca gluconate - restores RMP of cardiac cells
- Na bicarb - DO NOT give at the same time as Ca gluconate, they will precipitate out
- insulin
horses: what diuretics are indicated if you give fluids and they still wont urinate?
- furosemide (lasix) - loop diuretic
- Mannitol - increases GFR but also O2 demand
- dopamine - increases GFR but also causes hypertension so its basically never used.
horses: what is the most common cause of acquired CKD in horses?
tubulointerstitial disease
what are the 3 most important signs of CKD in horses?
dental tartar 10:1 = CKD
increased Ca decreased P
what are some common signs of CKD in horses?
uremia
chronic weight loss
horses: what are the most important differences between AKI and CKD in horses?
AKI =
BUN: Crt 10:1
HyperCa, HypoP
horses: what are common post-renal issues in horses?
uroperitoneum and urolithiasis
horses: what is uroperitoneum most common in? how is it diagnosed?
colts»_space;> fillies
diagnosed via ab tap: if peritoneal Crt > 2x serum = confirms uroperitoneum
what lab abnormalities will you have with uroperitoneum?
azotemia - BUN and Crt leak from urine back into blood
decreased NaCl
super increased K
horses: what are the clinical signs of a cystolith vs a nephrolith or ureterolith?
cystolith
horses: how are uroliths diagnosed in horses?
cystoscopy
horses: what does hematuria mean if its
throughout =
beginning =
end =
throughout = kidneys, bladder beginning = distal urethra end = proximal urethra
what two things can cause renal hematuria/
- adenocarcinoma
2. idiopathic renal hematuria
horses: what is idiopathic renal hematuria? in which breed do we see it the most?
sudden onset of life threatening hematuria
> 50% Arabians
horses: what is the most common way to get urethra hematuria?
summer sores - habronema lesions at the end of the urethra that lead to bleeding
horses: when we see urethral tears in geldings, what is it thought to be caused from? how do you treat it?
thought that it relates to all the muscle in hindquarters resulting in “blowout” of corpus spongiosum into urethra
tx: by leaving it alone bc it will heal on its own. can also do:
a urethostomy - relieves pressure
buccal mucosal graft - rare
horses: what do we need to remember about bacterial cystitis?
its rare in horses but occurs most often in mares
and is treated with TMS. TMS is great bc its cheap and concentrates in the urine so its a great 1st line abx
horses: what is the 411 on pyelonephritis?
- secondary to ectopic ureters
- commonly occurs with bacteremia
- CS: systemic illness + dysuria + hematuria
- Tx: abx, nephrectomy
horses: what 3 things cause urinary incontinence?
upper motor neuron disease
lower motor neuron disease
myogenic bladder
horses: what is the big deal about upper motor neuron disease?
it will cause urinary incontinence but the big deal is its caused from a spinal cord lesion and they wont be able to stand!!
horses: whats the 411 on lower motor neuron disease?
- it causes urinary incontinence
- CS: continuous dribbling, cauda equina syndrome (no anal tone, perineal analgesia, hindlimb weakness, etc.)
- etiology: if they have fever + dribbling urine = EHV-1 myeloencephalitis!!
horses: what does myogenic bladder cause?
sabulous cystitis - it stretches out the detrussor
how do you treat myogenic bladder?
- culture urine
- treat cystitis
- lavage bladder
- stimulate emptying with bethanechol
horses: how do you stimulate bladder emptying?
bethanechol
horses: if a horse has PU/PD what is their urine output and water intake levels?
> 50 ml/kg/day urine output = PU
>100 ml/kg/day water intake = PD
horses: what are some causes of PU/PD in horses?
- diabetes inspidus
- cushings - pituitary pars intermedia dysfunction
- renal failure - sepsis
ruminants: what are the 6 causes of AKI?
- acute tubular necrosis
- hemoglobinuria
- myoglobinuria
- oak poisoning
- pigweed toxicity
- leptospira
ruminants: what is the most common cause of ATN? vasomotor
nephropathy = septic mastitis
ruminants: what are some of the most common causes of hemoglobinuria?
- post-parturition = low P
- Cu toxicity in sheep
- bacillary hemoglobinuria
- water intoxication
- salt poisoning
- Se deficiency = Fl is Se deficient
ruminants: what are some causes of myoglobinuria?
white muscle disease (vit E, Se deficient)
cassia occidentalis (wild coffee)
ruminants: what is so impt about oak poisoning?
oak poisoning is specific to cattle in the Spring and Fall
CS: melena, azotemia, proteinuria and glucosuria
tx: supportive
sheep and goats are ok bc they have tanninase in their rumen
ruminants: what is impt about pigweed toxicity?
- affects cattle and swine
- CS: weakness, tremors, ataxia, azotemia, proteinuria, Increased K
- 75 - 100% mortality once signs appear
ruminants: what is the 411 on leptospira?
- affects young animals exposed to stagnant water
- CS: fever, abortion, mastitis, meningitis
- Dx: urine PCR
- Tx: tetracycline, penicillin, ampicillin
ruminants: clinical signs of AKI - regardless of etiology
oliguria poluria anorexia diarrhea, bloat muscle weakness epistaxis ammonia breath
ruminants: what is the clin path of ruminants with AKI? how is it treated?
azotemia
decreased NaCl
decreased Ca, increased P
isosthenuria
tx - fluids
ruminants: how does amyloidosis occur and what does it lead to?
inflammatory disease –> serum Amyloid A –> deposits in kidney, GI –> disrupts glomerulus or GI –> PLN or PLE
ruminants: what causes pyelonephritis? what are the CS?
cornebacterium renale (cattle specific) - contagious, causes herd outbreaks!
CS: colic, arched back, fever, decreased milk yield, blood/pus/crystals on vulva
ruminants: how do you treat pyelonephritis?
gram + = penicillin
gram - = ceftiofur
for > 3 weeks!
quarantine affected animals - report drug used and adhere to withdrawal times
ruminants: in what kind of animals do we see urolithiasis and why?
young, castrated males like pet goats and feedlot cattle
its a disease of management- from being fed a high concentrate, pelleted diet
ruminants: why does crystallization occur?
from decreased water consumption and a basic pH
ruminants: what type of stone is most common in small ruminants? why?
struvites (Mg ammonium Phosphate)
- they occur in alkaline pH
- pelleted diets due to Ca:P
ruminants: what are the most common sites of obstruction?
small rumiannts = urethral process
cattle = sigmoid flexure
ruminants: what is the clin path of a ruminant with a urethral obstruction?
azotemia hemoconcentration decreased NaCl increased K, increased Mg, increased P ab tap: peritoneal Crt: serum Crt > 2:1
ruminants: how do you treat urethral obstructions?
- medical: correct fluid, walpoles’ solution
- amputate urethral process
- surgical options: perineal/ischial urethrostomy (salvage procedure for feedlot cattle) , tube cystotomy (best option for breeding animals)
ruminants: how do you prevent urethral obstructions?
Ca:P > 2:1
Mg
ruminants: what is the 411 on enzootic hematuria? what does chronic ingestion cause? what does acute toxicity cause?
- caused by bracken fern
- chronic ingestion causes hematuria and bladder neoplasms
- acute toxicity causes bone marrow suppression
ruminants: what is ulcerative posthitis and vulvitis? what is it caused by? what are the clinical signs? how is it treated?
“pizzle rot” !
- caused by cornebacterium renale. it proliferates with a high protein diet, hydrolyzes urea to ammonia and causes ulcers. its contagious!
- CS: moist ulcers on external genitalia, dysuria, weight loss, vocalization
- Tx: isolate those affected, decrease protein, give systemic and topical abx like penicillin and oxytet powder
how to acquire urine froma male ruminant
brush hairs on prepuce
