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Small Animal Medicine > Lower Urinary Tract Disease > Flashcards

Lower Urinary Tract Disease Flashcards

1
Q

What are the 5 most common signs of LUTD?

A
  1. stranguria - straining to urinate
  2. periuria - urinating outside the litter box
  3. hematuria
  4. pollakiuria - frequent, small volume urination
  5. incontinence
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2
Q

At what points if hematuria microscopic and macroscopic?

A

MICRO = > 5-15 RBCs/hpf

MACRO = red urine seen by owners

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3
Q

What do the abnormal colors of pigmenturia indicate?

A
  • RED = erythrocytes, hemoglobin, myoglobin
  • RED-BROWN = erythrocytes, hemoglobin, myoglobin, methemoglobin
  • BROWN to BLACK = methemoglobin
  • YELLOW-ORANGE = bilirubin
  • YELLOW-GREEN/BROWN = bilirubin or bilverdin
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4
Q

What are the 4 most common causes of LUTD?

A
  1. infection
  2. urolithiasis (w/o infection)
  3. inflammation - polyploid cystitis, urethral proliferation
  4. neoplasia - TCC near trigone
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5
Q

What urinary tract infections affect the upper and lower tracts?

A

UPPER - pyelonephritis, ureteritis

LOWER - cystitis, urethritis, prostatitis

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6
Q

What is active sediment on UA?

A

pyuria, hematuria bacteriuria

  • something is happening on UA
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7
Q

What are 5 causes of pyuria?

A
  1. UTI
  2. urinary tract inflammation
  3. contamination from prepuce or vagina/vestibule
  4. genital tract inflammation
  5. inflamed neoplasia

(not always infection!)

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8
Q

What is a complicated UTI?

A

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
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9
Q

What is subclinical bacteriuria/UTI?

A

lack of LUT signs with the presence of bacteriuria +/- pyuria

  • likely not needed to be treated
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10
Q

What is a recurrent UTI?

A

relapses of same species/strain that caused the UTI in the first place

  • tx cleared the infection, but stopped working once finished
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11
Q

What is a persistent UTI?

A

recurrence of infection that never cleared with different species/strains than the prior UTI

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12
Q

What is the most common cause of UTIs? What is a rare other cause?

A

bacterial

fungal in immunosuppressed patients

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13
Q

What is the gold standard diagnosis for UTIs?

A

quantitative urine culture and sensitivity

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14
Q

What are some local host defenses that inhibit bacterial colonization of the urinary bladder and kidneys?

A
  • 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
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15
Q

What are the most common G- and G+ causes of UTIs? How does cranberry extract affect their infection?

A

G- = E. coli, Proteus, Klebsiella, Pseudomonas, Enterobacter

G+ = Staph, Strep, Enterococcus (may or may not be pathogenic

decreases bacterial attachment

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16
Q

What is the pathophysiology of UTIs?

A

combination of defects in host defense mechanisms and virulence factors of microorganisms

17
Q

What are some comorbidities associated with UTIs?

A
  • 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
18
Q

In what gender are UTIs most common? Why?

A

FEMALES - closeness of anus to vulva

19
Q

How are UTIs diagnosed?

A
  • clinical signs
  • urine collection and assessment (macro and micro)
  • quantitative bacterial urine culture
20
Q

What is the significance of collection methods for UA and urine cultures?

A

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

21
Q

What is the preferred method of collecting urine for UA and urine cultures? When is it contraindicated?

A

cystocentesis

TCC or coagulopathies

22
Q

In what 4 situations are UTIs treated?

A
  1. symptomatic - if patient has no signs and normal kidney function, treatment can cause resistance
  2. pyelonephritis
  3. urolithiasis
  4. zoonosis - patients and clients with similar flora
23
Q

How are first-time, uncomplicated UTIs treated? Rechecked?

A

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
24
Q

How are complicated UTIs treated? Rechecked?

A

antibiotics based on culture and sensitivity for 14-28 days

urine culture 5-7 days after cessation of antibiotics

25
Q

What are 6 possible reasons for relapse following bacterial cystitis treatment?

A
  1. use of ineffective drugs or duration of therapy
  2. failure of owner to administer prescribed dose at proper intervals
  3. GI disease or concurrent oral intake of food/drugs resulting in decreased drug absorption
  4. impaired action of drugs due to decreased bacterial multiplication or sequestration in an inaccessible site (prostate)
  5. mixed bacterial infections
  6. durg resistance
26
Q

What are 2 possible reasons for reinfection following bacterial cystitis treatment?

A
  1. failure to recognize and eliminate predisposing causes
  2. iatrogenic reinfection caused by catheterization

Small Animal Medicine (52 decks)

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