Lec 5-7 Flashcards by Sam Lumby

What is periuria?

Inappropriate urination

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

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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What are some factors that can predispose to urolith formation?

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

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

Less than 5%

Most are in the LUT, ureters, bladder, urethra

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What are the 2 most common types of uroliths?

Struvite
Calcium oxalate
-Both radiopaque

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

Increased use of urine-acidifying diets

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

Stone analysis

-Optimal management of the case

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What are struvite uroliths made up of?

Magnesium ammonium phosphate

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Are struvite uroliths seen in infected or uninfected animals?

Both

Cats usually uninfected
Dogs usually infected

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What are most feline urethral plugs made up of?

Struvite

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How do straphylococci and proteus lead to struvite urolith formation?

They produce urease

Leads to alkaline urine
Increased phosphate and ammonia

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

Cocker Spaniels

Miniature Schnauzers

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

Struvite

-Smooth, blunt-edged, faceted, pyramidal

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How do you treat a struvite urolith?

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

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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What are 4 contributing factors to developing calcium oxalate uroliths?

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

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

Male dogs
Old
Schnauzers, Miniature poodles and other small breeds

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Describe treatment principles for calcium oxalate uroliths?

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

Slightly alkalinises

Chelates calcium

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How do urate uroliths form?

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

What breed is predisposed to urate uroliths and why?

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

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

Urate

-Increased excretion of ammonium urate

Describe the treatment principles of urate uroliths?

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

What animals are more likely to get silicate uroliths?

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

What breeds are predisposed to cystine uroliths?

3-6 year old male Dachshunds | Basset hounds, Bulldogs, Yorkies, Setters, Chihuahuas

What predisposes a dog to getting cystine uroliths?

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

Describe treatment principles for cystine uroliths?

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

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

``` 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 ```

Why is FLUTD a common term that is used?

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

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

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

How do you treat idiopathic sterile cystitis?

``` 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 ```

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

Give IV fluids

Where does potassium and sodium usually sit in the cells?

Potassium - Intracellular | Sodium - Extracellular

Describe the pathogenesis of urethral obstruction?

``` 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 ```

Describe a treatment strategy for a urethral obstruction?

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

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

If it is spherical - acute | If it is a spear - chronic

What are some examples of pseudo-incontinence?

Puppy excitement Submissive behaivour Left indoors too long

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

Vulvar discharge Pollakiuria Diarrhoea

What can you use to treat bladder atony?

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

What can you use to treat reflex dyssynergia?

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

What do you need to remember when using phenoxybenzamine?

It is an alpha blocker | Can cause fainting

What can you use to treat urethral sphincter mechanism incompetence?

``` Alpha-adrenergic agonists -Phenylpropanolamine -Ephedrine Hormones -Oestriol -Diethylstilbestrol -Testosterone ```

What can you use to treat dextrusor hyperexcitability?

``` Treat underlying cause Anticholinergics -Oxybutinin -Imipramine -Amitriptyline ```

What are some clinical signs of a prostate disease?

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

What is the most common cause of a painful prostate?

Bacterial prostitis

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

Benign prostatic hyperplasia

On radiograph how big should the prostate be?

Under 50% width of pelvic inlet on VD | Under 70% pubic-sacral height on lateral

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

Neoplasia - Carcinoma

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

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