Lower Urinary Tract Disease Flashcards
What are the 5 most common signs of LUTD?
- stranguria - straining to urinate
- periuria - urinating outside the litter box
- hematuria
- pollakiuria - frequent, small volume urination
- incontinence
At what points if hematuria microscopic and macroscopic?
MICRO = > 5-15 RBCs/hpf
MACRO = red urine seen by owners
What do the abnormal colors of pigmenturia indicate?
- RED = erythrocytes, hemoglobin, myoglobin
- RED-BROWN = erythrocytes, hemoglobin, myoglobin, methemoglobin
- BROWN to BLACK = methemoglobin
- YELLOW-ORANGE = bilirubin
- YELLOW-GREEN/BROWN = bilirubin or bilverdin
What are the 4 most common causes of LUTD?
- infection
- urolithiasis (w/o infection)
- inflammation - polyploid cystitis, urethral proliferation
- neoplasia - TCC near trigone
What urinary tract infections affect the upper and lower tracts?
UPPER - pyelonephritis, ureteritis
LOWER - cystitis, urethritis, prostatitis
What is active sediment on UA?
pyuria, hematuria bacteriuria
- something is happening on UA
What are 5 causes of pyuria?
- UTI
- urinary tract inflammation
- contamination from prepuce or vagina/vestibule
- genital tract inflammation
- inflamed neoplasia
(not always infection!)
What is a complicated UTI?
presence of comorbidities or complicating factors that make UTIs more common or harder to clear
- anatomy: hooded/juvenile vuvla
- defects in host defense mechanisms
- other diseases
What is subclinical bacteriuria/UTI?
lack of LUT signs with the presence of bacteriuria +/- pyuria
- likely not needed to be treated
What is a recurrent UTI?
relapses of same species/strain that caused the UTI in the first place
- tx cleared the infection, but stopped working once finished
What is a persistent UTI?
recurrence of infection that never cleared with different species/strains than the prior UTI
What is the most common cause of UTIs? What is a rare other cause?
bacterial
fungal in immunosuppressed patients
What is the gold standard diagnosis for UTIs?
quantitative urine culture and sensitivity
What are some local host defenses that inhibit bacterial colonization of the urinary bladder and kidneys?
- normal urine volume and voiding frequency
- small residual urine volume
- urethral high-pressure zone, contraction, peristalsis, and length
- vesicoureteral junction
- ureteral contraction and peristalsis
- antibody and mucoprotein production
- non-pathogenic flora colonization
- hyperosmolality
- high urea concentration
- acidic pH
What are the most common G- and G+ causes of UTIs? How does cranberry extract affect their infection?
G- = E. coli, Proteus, Klebsiella, Pseudomonas, Enterobacter
G+ = Staph, Strep, Enterococcus (may or may not be pathogenic
decreases bacterial attachment
What is the pathophysiology of UTIs?
combination of defects in host defense mechanisms and virulence factors of microorganisms
What are some comorbidities associated with UTIs?
- endocrinopathy
- kidney disease
- obesity
- abnormal vulvar conformation
- congenital abnormalities of the urogenital tract: ectopic ureter, mesonephric duct
- prostatic disease
- bladder tumor
- polypoid cystitis
- urolithiasis
- immunosuppressive therapy
- rectal fistula
- urinary incontinence/retention
In what gender are UTIs most common? Why?
FEMALES - closeness of anus to vulva
How are UTIs diagnosed?
- clinical signs
- urine collection and assessment (macro and micro)
- quantitative bacterial urine culture
What is the significance of collection methods for UA and urine cultures?
MIDSTREAM VOIDING = < 10^5 contamination expected, making it not discriminatory in dogs, and a count > 10^5 diagnostic in cats
CATHETER = < 10^3 contamination in males and any number in females, making > 10^4 in male dogs and >10^3 in male cat diagnostic
CYSTOCENTESIS = < 10^3 contamination, making >10^3 diagnostic
What is the preferred method of collecting urine for UA and urine cultures? When is it contraindicated?
cystocentesis
TCC or coagulopathies
In what 4 situations are UTIs treated?
- symptomatic - if patient has no signs and normal kidney function, treatment can cause resistance
- pyelonephritis
- urolithiasis
- zoonosis - patients and clients with similar flora
How are first-time, uncomplicated UTIs treated? Rechecked?
first-line Amoxicillin or TMS (simple, not as broad-spectrum) for 7-10 days up to 14 days when complicated or pyelonephritis
- none: depending on patient and client; patient actively got better with treatment
- UA 5-7 days after cessation of antibiotics to avoid false negatives and observe possible relapse
How are complicated UTIs treated? Rechecked?
antibiotics based on culture and sensitivity for 14-28 days
urine culture 5-7 days after cessation of antibiotics
What are 6 possible reasons for relapse following bacterial cystitis treatment?
- use of ineffective drugs or duration of therapy
- failure of owner to administer prescribed dose at proper intervals
- GI disease or concurrent oral intake of food/drugs resulting in decreased drug absorption
- impaired action of drugs due to decreased bacterial multiplication or sequestration in an inaccessible site (prostate)
- mixed bacterial infections
- durg resistance
What are 2 possible reasons for reinfection following bacterial cystitis treatment?
- failure to recognize and eliminate predisposing causes
- iatrogenic reinfection caused by catheterization
