Logical Approach Uriniary Tract Dz Flashcards
What is normal urine output
- dogs 15-45ml/kg/day
- less than water intake ~1ml/kg/hour (20ml/kg/day) d/t insensible losses
Define oliguria and anuria
Oliguria less than normal output
Anuria no urine
Define dysuria and stranguria
Dysuria : difficult
Stranguria : slow and painful
Define pollakiuria
Frequent small amounts of urine (cf. excessive amount s of urine)
- pollakiuria indicates LUT
- polyuria indicates kidneys/endocrine
Define periuria
Inappropriate urination (wrong time and place, due to dysuria, nocturia or behavioural problems)
CS related to urinary tract dz
- abdo distension
- collapse
- halitosis
- depression
- vomiting
- suspected constipation
- post trauma
> Clin path - azotaemia
- hyperkalaemia
- hyperohosphataemia
- polycythaemia
- proteinuria
- others
Hx points
- main concern
- General Hx as well as specific urogenital
- problem (duration, severity, course, response to Tx)
- WHAT IS NORMAL?? (Has animal always drunk excessively)
What should be specifically felt on PE?
- kidneys, bladder in cats
- sometimes bladder and kidney in dogs
> don’t squash obstructed bladder! - rectal +- vaginal exam
- external genitalia
- NEURO (anal and perineal reflexes, tail and hindlimb function)
Signs localising to upper urinary tract?
- PUPD
- abnormal kidney palp
- depression.
- lethargy
- halitosis
- oral ulceration
Signs localising to lower urinary tract
- dysuria, pollakiuria
- urinary incontinence
- abnormal palp bladder or urethra
- abnormalities external genital
Signs associated with either upper or lower?
Oliguria/anuria
Haematuria
Common causes of urinary tract signs UPPER?
- acute kidney injury (ARF)
- CKD
- glomerulonephritis
- neoplasia
- pyelonephritis
- developmental abnormalities
- nephro/ureterolithiasis
Common cause urinary tract dz LOWER?
- cystitis
- urolithiasis
- Neoplasia
- urethral obstruction
- trauma
- FLUTD
- functional abnormalities
- developmental abnormalities
Further investigations appropriate for urinary dz?
> Clin path - blood - urine - calculus analysis - aspirate/biopsy > imaging - plain/contrast rads - ultrasound - CT /MRI > others - endoscopy - urodynamics - nuclear scintigraphy - DNA tests
Blood work
- routine haem biochemical
- emergency panel (electrolytes, urea creatinine, PCV TS, blood gas)
- abdo fluid analysis
What tests can be done on urine?
- SG
- dipstick
- sediment analysis
- culture sensitivity
How can urine be collected?
- free catch / catherter / cystocentesis
- first morning / random / post prandial
Pros and cons of free catch
- no iatrogenic Haematuria like others
- not good for culture
- can put vet bed in litter tray and collect sample from underneath
When is catheter collection useful?
If catheter placed for other reasons (otherwise cysto would be easier)
Important consideration when catheterising?
- length of catheter (you can push it in too far and tie a knot!!!!)
Considerations for cystocentesis
- not in thrombocytopenia
- not if bladder tumour present (can seed)
Imaging useful for urinary tract
> rads - radiodense calculus - bony change - contrast - thoracic for mets > ultrasound - fluid v soft tissue - bladder wall thickness - uretobladder emptying - not good for intapelvic, anything gassy, calculi, bony change > CT/MRI - expensive > cytology/biopsy - very important - ultrasound guidance > urendoscopy - therapeutic too - expensive > scintigraphy - rare but very useful for quantitative measurement of GFR kidney > urodynamics - Instill fluid and check resistance > DNA tests - feline polycysti kidney dz - familial/juvenile nephropathy - canine hyperuricouria (excessive excretion of urate)
Define polyuria
Greater than Normal urine output
