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A - Medicine Urology > Lec 5-7 > Flashcards

Lec 5-7 Flashcards

1
Q

What is periuria?

A

Inappropriate urination

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2
Q

If you find crystals in a urine sample, does that mean that there are uroliths present?

A

No
They are microscopic structures which on their own don’t form signs
-After collection urine cools down and struvite crystrals form

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3
Q

What are some factors that can predispose to urolith formation?

A

Highly concentrated urine
Urine retained for sufficient time
Favourable pH
Nidus/nidi for nucleation/crystallisation
Decreased concentration of crystallisation inhibitors

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4
Q

What percentage of uroliths are found in the kidneys of dogs and cats?

A

Less than 5%

Most are in the LUT, ureters, bladder, urethra

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5
Q

What are the 2 most common types of uroliths?

A

Struvite
Calcium oxalate
-Both radiopaque

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6
Q

What is one explanation for why oxalate uroliths are more common now?

A

Increased use of urine-acidifying diets

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7
Q

After detecting a urolith in an animal, what should you do with it?

A

Stone analysis

-Optimal management of the case

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8
Q

What are struvite uroliths made up of?

A

Magnesium ammonium phosphate

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9
Q

Are struvite uroliths seen in infected or uninfected animals?

A

Both

  • Cats usually uninfected
  • Dogs usually infected
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10
Q

What are most feline urethral plugs made up of?

A

Struvite

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11
Q

How do straphylococci and proteus lead to struvite urolith formation?

A

They produce urease

  • Leads to alkaline urine
  • Increased phosphate and ammonia
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12
Q

What 2 breeds may have a genetic predisposition to developing struvite urolithiasis?

A

Cocker Spaniels

Miniature Schnauzers

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13
Q

If you find a urolith that is over 1cm, what is it most likely to be?

A

Struvite

-Smooth, blunt-edged, faceted, pyramidal

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14
Q

How do you treat a struvite urolith?

A

If infected

  • Remove stones surgically
  • Treat the UTI
  • Monitor for recurrence

If uninfected

  • Remove stones surgically
  • Culture stones
  • Maintain on hills c/d food or equivalent
  • Monitor for recurrence
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15
Q

If instead of removing stones surgically you are instead dissolving them, how long would the animal need to be on antibiotics for?

A

Entire duration of dissolving can take 2 weeks to 7 months

-Bacteria would have been embedded as the stone grew, so will be slowly released

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16
Q

What are 4 contributing factors to developing calcium oxalate uroliths?

A

Increased urinary calcium
Increased urinary oxalate
Decreased urinary citrate
Acidic urine - Under pH 6.5

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17
Q

What patients are you more likely to find calcium oxalate uroliths?

A

Male dogs
Old
Schnauzers, Miniature poodles and other small breeds

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18
Q

Describe treatment principles for calcium oxalate uroliths?

A 
Surgical removal and analysis 
-Decrease probability of recurrence by
Consider feeding Hills u/d 
Avoiding excessively salty foods
\+/- oral potassium citrate
\+/- thiazide diuretic
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19
Q

What does giving oral potassium citrate decrease the probability of calcium oxalate uroliths forming?

A

Slightly alkalinises

Chelates calcium

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20
Q

How do urate uroliths form?

A

Form readily in acidic urine
Uric acid is derived from purine catabolism and dietary nucleic acid
-Usually uric acid is converted to allantoin

21
Q

What breed is predisposed to urate uroliths and why?

A

Dalmatians - 60% of all cases
They produce less allantoin - defect inhepatic transport of uric acid
-Therefore stays as less soluble form of uric acid

22
Q

What type of urolith is a dog with liver failure most likely to get?

A

Urate

-Increased excretion of ammonium urate

23
Q

Describe the treatment principles of urate uroliths?

A 
Remove and analyse stones
Diagnose and treat PSS if present 
Treat any UTI 
Hills u/d
Allopurinol 
-Xanthine oxidase inhibitor
24
Q

What animals are more likely to get silicate uroliths?

A

High dietary intake of silicates
-Corn gluten and soybean husks
Male GSD
Acidic urine

25
Q

What breeds are predisposed to cystine uroliths?

A

3-6 year old male Dachshunds

Basset hounds, Bulldogs, Yorkies, Setters, Chihuahuas

26
Q

What predisposes a dog to getting cystine uroliths?

A

Inherited defect of renal proximal tubular cystine reabsorption
Form more readily in acidic urine

27
Q

Describe treatment principles for cystine uroliths?

A

Hills u/d food
Oral potasium citrate - alkalinises urine
If they get recurrence go on one of these lifelong-
*MPG - reduces cystine in urine
*D-penicillamine - forms disulphide bond to form soluble product - nauseous side effects

28
Q

Describe what is meant by calcium oxalate uroliths causing ‘big kidney, little kidney’ syndrome

A 
Starts as kidney stone
Travels and gets stuck in one ureter
Causes pain and increased pressure
Eventually the kidney dies
-Little kidney 
-Other kidney unaffected so big kidney 
-However since only one is affected the creatinine doesn't go up
29
Q

Why is FLUTD a common term that is used?

A

Because up to 80% of cats with these signs don’t have a detectable cause - idiopathic

30
Q

What 3 things can cause a predisposition of a cat developing FLUTD?

A 
Highly concentrated urine
-Feed wet food
Infrequent voiding
-Stress
And low secretion of GAG's
-Less of a protective layer
31
Q

How do you treat idiopathic sterile cystitis?

A 
After a thorough workup eliminating other causes
-Optimal treatment unknown
Increase water intake - canned food
Multiple clean litter trays
Reduce stress, provide toys, play
Pheromone sprays
32
Q

What is the first thing you do to a patient presented with urethral obstruction?

A

Give IV fluids

33
Q

Where does potassium and sodium usually sit in the cells?

A

Potassium - Intracellular

Sodium - Extracellular

34
Q

Describe the pathogenesis of urethral obstruction?

A 
Can't excrete
Increased potassium is what will kill it first 
Also dehydrated 
Anaerobic shock causes lactic acid 
This increases H+
Goes into the cells
Pushes out positive ions
Potassium is dominate ion pushed out
Goes from intracellular to extracellular
35
Q

Describe a treatment strategy for a urethral obstruction?

A

Give IV fluids
Give calcium at the rate for eclampsia to protect the heart
-Affects the depolarisiiton and repolarisation - Bradycardia
Then give glucose
Increases insulin and pushes potassium back into cells

36
Q

What can the shape of the bladder tell you about a problem?

A

If it is spherical - acute

If it is a spear - chronic

37
Q

What are some examples of pseudo-incontinence?

A

Puppy excitement
Submissive behaivour
Left indoors too long

38
Q

What are some examples for owners mistaking a disorder for urinary incontinence?

A

Vulvar discharge
Pollakiuria
Diarrhoea

39
Q

What can you use to treat bladder atony?

A 
-Contract the detrusor
Bethanechol (cholinergic)
-Relax the sphincter
Phenoxybenzamine (alpha blocker)
Diazepam (Skeletal muscle relaxant)
40
Q

What can you use to treat reflex dyssynergia?

A 
Relax the sphincter
-Phenoxybenzamine (alpha blocker)
-Prazosin (Alpha blocker)
-Diazepam (Skeletal muscle relaxant 
Contract the detrusor
-Bethanechol (cholinergic)
41
Q

What do you need to remember when using phenoxybenzamine?

A

It is an alpha blocker

Can cause fainting

42
Q

What can you use to treat urethral sphincter mechanism incompetence?

A 
Alpha-adrenergic agonists
-Phenylpropanolamine
-Ephedrine
Hormones
-Oestriol
-Diethylstilbestrol
-Testosterone
43
Q

What can you use to treat dextrusor hyperexcitability?

A 
Treat underlying cause
Anticholinergics
-Oxybutinin
-Imipramine
-Amitriptyline
44
Q

What are some clinical signs of a prostate disease?

A 
Penile discharge at times other than urination
Haematuria / dysuria
Tenesmus / obstripation
'Ribbon' faeces
Stiff gait - Painful
\+/- urethral obstruction 
\+/- fever, sepsis
45
Q

What is the most common cause of a painful prostate?

A

Bacterial prostitis

46
Q

What is the most common cause of an enlarged non-painful prostate?

A

Benign prostatic hyperplasia

47
Q

On radiograph how big should the prostate be?

A

Under 50% width of pelvic inlet on VD

Under 70% pubic-sacral height on lateral

48
Q

On radoigraph what does a mineralised prostate have a strong correlation with?

A

Neoplasia - Carcinoma

49
Q

If you want to get a sample of the prostate for evaluation, how should you try and do it and why?

A

Transurethrally first

-If it is neoplasia then you will seed the needle track back through the skin

A - Medicine Urology (5 decks)

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