Lecture 8

Question 1

Describe uroperitoneum

Answer 1

Can come from bladder, urethra (perineal and preputial edema), uracha (subQ edema around umbilicus), or ureteral

Colts more common than fillies; can happen from birth trauma, sepsis, or congenital abnormality

Rare in adults

Question 2

Clinical signs of uroperitoneum

Answer 2

Abdominal distention, colic, increased RR

Stranguria, pollakiuria

Lethargy, depression, anorexia

Question 3

How to diagnose uroperitoneum

Answer 3

US
Methylene blue, fluorescin (inject through catheter then do ab tap)
Contrast rads
Post renal azotemia
Low Na, Cl
Increased K
Ab tab with creatinine being 2x serum creatinine!!

Question 4

Describe electrolyte movements with uroperitoneum

Answer 4

BUN, creatinine, and K go from peritoneum to blood

Sodium and Cl go from blood to peritoneum

Question 5

Treatment for uroperitoneum

Answer 5

IV fluids- correct high K
Abx
Ab drainage
Surgical correction

Question 6

Describe urolithiasis

Answer 6

Usually in geldings with mean age 10yr

More likely in bladder > urethrolith > nephrolith > ureterolith

Nucleation cause by decreased water intake, UTI, NSAIDs, urine stasis. Then leads to crystallization (high pH and CaCO3)

Question 7

Most common uroliths

Answer 7

Calcium carbonate

Calcium phosphate

Question 8

Clinical signs of urolithiasis

Answer 8

Cystoliths- hematuria post exercise, stranguria, incontinence, recurrent colic

Nephrolith or ureterolith- silent until bilateral obstructive disease and CKD

Question 9

Diagnosis of urolithiasis

Answer 9

Rectal palpation
US
Cystoscopy- useful for stone in ureter

Question 10

Treatment for urolithiasis

Answer 10

Mares- remove via urethra (crush, lithotripsy, manual removal, +/- sphincterotomy)

Males- surgery

Question 11

Post surgical treatment of urolithiasis

Answer 11

Bladder lavage
Anti inflammatories and abx
Encourage water consumption
Eliminate legumes
Lower DCAD to lower urine pH

Question 12

DDX for renal hematuria

Answer 12

Adenocarcinoma- weight loss, hematuria, colic, if unilateral then no azotemia, treat with nephrectomy

Idiopathic renal hematuria- sudden onset and life threatening hematuria; rule out adenocarcinoma and coagulopathy; treat with supportive care (transfusion, meds to promotes hemostasis), nephrectomy, dexamethasone

Question 13

Bladder hematuria ddx

Answer 13

Cystolith
Neoplasia
Blister beetle toxicity (cantharidin)

Question 14

Diagnosis and treatment of blister beetle toxicity

Answer 14

Low Ca, low Mg, azotemia
GI contents or urine
ID beetle in hay

Treat with supportive care, charcoal/biosponge

Question 15

Urethral/external genitalia hematuria ddx

Answer 15

Neoplasia- sarcoid, SCC

Habronemiasis

Urethral tear (level of ischial arch; bright red blood at end of urination, no pollakiuria or dysuria); diagnose with endoscopy; treat with benign neglect, corpus spongiosum incision, buccal mucosal graft

Question 16

Urinary incontinence DDX

Answer 16

Upper motor neuron (increased urethral resistance, pollakiuria, sporadic dribbling)

Lower motor neuron (relaxed bladder, continuous dribbling, cauda equina syndrome

Myogenic bladder (idiopathic or secondary obstruction; weight of sediment stretchs detrusor muscle

Sabulous cystitis can happen after myogenic bladder since bladder can’t void completely

Bacterial cystitis

Pyelonephritis

Ectopic ureter

Question 17

PU/PD ddx

Answer 17

Psychogenic drinker
Neurogenic or nephrogenic DI
PPID
Renal failure (increased tubular flow, medullary washout, impaired response to vasopressin)
Sepsis
Alpha 2 agonists