lower urinary tract disease Flashcards
1
Q
acute renal failure define
A
charachterised by sudden onset of haemodynamic, filtration and excretory failure of the kidneys
2
Q
define acute kidney injury
A
abrupt decline in kidney function
3
Q
acute renal failure prognnsis
A
maybe reversible if caught early
4
Q
high GFR and changes to creatinine
A
big changes to GFR will not affect a low creatinine much
5
Q
low GFR and creatinine changes
A
small changes in a low GFR will cause big changes to creatinine
6
Q
define oliguria
A
anything less than 1ml/kg/hr
7
Q
when will oliguria be normal
A
hypovolaemia
8
Q
prerenal azotemia urine specific gravity
A
- cat - over 1.035
- dog - over 1.030
9
Q
renal azotemia urine specific gravity
A
- cat - under 1.035
- dog - under 1.030
10
Q
prerenal azotemia urine sodium conc
A
under 10mmol/L
11
Q
renal azotemia urine sodium conc
A
over 20mmol/L
12
Q
prerenal azotemia response to fluid therapy
A
dramatic
13
Q
renal azotemia response to fluid therapy
A
minimal
14
Q
chronic kidney failure history (3)
A
- chronic weight loss
- reduced appetite
- PU/PD
15
Q
kidney palpation/visualisation acute renal failure
A
swollen painful kidneys
16
Q
kidney palpation/visualisation chronic kidney failure
A
small fibrotic kidneys
17
Q
tx pyelonephritis
A
- antibiotics based on culture for 4-6 weeks
- cultures a week after starting and ending treatment
18
Q
diagnose leptospirosis
A
- demonstrate high antibody titre in serovar
- demonstrate a rising titre over a few weeks
19
Q
stage 1 chronic kidney disease (4)
A
- plasma creatinine - dogs below 125mmol/L - cats below 140mmol/L
- non-azotemic
- normal or near normal GFR
- some other renal abnormality
20
Q
stage 2 chronic kidney disease (3)
A
- plasma creatinine - dogs 125-180mmol/L - cats 140-250mmol/L
- non-azotemic to mild azotemic
- clinical signs absent or limited to PU/PD
21
Q
stage 3 chronic kidney disease (4)
A
- plasma creatinine - dogs 181-440mmol/L - cats 250-440mmol/L
- mild-moderate azotemia
- PU/PD
- external clinical signs like vomiting may be present
22
Q
stage 4 chronic kidney disease (3)
A
- plasma creatinine - dogs and cats over 440mmol/L
- PU/PD
- external clinical signs like vomiting
23
Q
6 intrinsic renal disease causes
A
- infectious
- metabolic
- neoplastic
- congenital
- other
- unidentified
24
Q
congenital cause of cat intrinsic renal disease
A
polycystic kidney disease
25
define obstructive uropathy
- big kidney little kidney syndrome
| - little kidney blocked first. clinical signs show when big kidney is blocked
26
management of renal secondary hyperparathyroidism
- dietary phosphate restriction
| - intestinal phosphate binding drugs
27
ACE inhibitors and glomerular hypertension and hyperfiltration
- preferentially dilate efferent arterioles
- reduce glomerular capillary pressure
- reduce glomerular capillary permeability to protein
- reduced proteinuria and development of glomerulosclerosis
28
risk with erythropoietin treatment
antibodies may develop against foreign protein and this could be cross reactive to the endogenous protein
29
blindness and chronic kidney disease
chronic kidney disease causes hypertension which causes retinal detachment, retinal haemorrhage and hyphema
30
what parts of the urinary tract are sterila
- kidneys
- ureter
- bladder
- proximal urethra
31
most common bacteria in urinary infection
E.coli
32
bacteria need to stick to urothelium
P or S fimbriae
33
how to culture urine
- 2ul of urine on blood agar and MacConkeys
| - incubate aerobically for 18 hours at 37*C
34
urinary tract infections seen most in (2)
- older cats
| - bitches
35
define microburia
microbes in urine
36
define bacturia
bacteria in urine
37
define funguria
fungi in urine
38
define pyuria
white blood cells in the urine
39
what kind of culture need to diagnose urinary tract infection
- quantitative
| - collection by cystocentesis
40
3 drugs commonly used in urinary tract infections
- ampicillin
- potentiated moxicillin
- cefalexin
41
how do crystals form in urine
urine is supersaturated causing nucleation to start and crystal growth
42
where cystoliths found
bladder
43
4 clinical signs cyctoliths
- dysuria
- polakiuria
- haematuria
- inappropriate urination
44
urethroliths cause (6)
- abdominal discomfort
- poor or absent urine stream
- licking genital area
- obstruction
- post renal azotemia
- enlarged painful bladder
45
to find composition of bladder do (2)
- quantitative analysis
| - x-ray diffraction
46
medical management of uroliths (4)
- increase water intake to dilute crystal concentration
- diet therapy
- drug therapy
- change urine pH
47
how to uropulsion (7)
- anaesthetise
- fill bladder with saline
- position urethra vertical
- agitate bladder
- leave stones to settle
- initiate voiding with brisk urine flow
- antibiotics
48
struvate stones are made of (2)
- magnesium ammonium phosphate
| - triple phosphate
49
why dogs get struvate stones
urinary tract infections
50
steps in formation strvate stones
urease producing bacteria cleave urea into ammonium and bicarbonate so making urine alkaline
51
appearance of struvate stones
bog and faceted
52
complications dissolving struvate stones
bacteria in them will be released with every layer dissolved therefore need antibiotics
53
what species calcium oxalate stones common in
male older cats
54
where calcium oxalate stones are found
upper urinary tract
55
medical dissolution calcium oxalate stones
not possible
56
ammonium urate stones are seen in
- dalmatians
| - animals with hepatic dysfunction
57
why dalmations predisposed to ammonium urate stone formation
dont have uricase which converts uric acid to ammonium
58
prevention ammonium urate stone formation (2)
- low protein diet
| - allopurinol which blocks x-oxidase which turns xanthine into uric acid
59
cystine stones why form
renal tubular defect resulting in excess urine cystine which isn't very soluble
60
calcium phosphate stones are associated with
primary hyperparathyroidism
61
most common urolith in rabbits and horses and why
calcium carbonate
| as they have a high calcium concentration in urine
62
define cystotomy
opening bladder to remove stones
63
cystotomy how to (7)
- place urinary catheter attached to extension set
- open caudal midline ventral celiotomy and empty bladder
- pack of abdomen
- ventral midline cystotomy
- remove calculi
- flush up urethra until all are removed
- close using monocryl avoiding entering bladder lumen
64
define feline lower urinary tract disease (FLUTD)
clinical presentation that can be due to lots of causes
65
6 clinical signs FLUTD
- haematuria
- strganguria
- pollakiuria
- dysuria
- licking penis or prepuce
- vocalisation or hiding
66
young cats common cause FLUTD
idiopathic
67
5 things predispose cats to urinary tract infections
- diabetes mellitus
- chronic kindey disease
- hyperthyroidism
- urolithiasis
- bladder tumours
68
feline lower urinary tract disease young cats present
65% idiopathic
| - episodic and resolves in 3-7 days unless there is a urethral obstruction
69
4 theories as to cause of idiopathic FLUTD
- infectious
- crystralluria
- vesicourachal diverticulum
- interstitial cystitis
70
infectious agent theory idiopathic FLUTD
- never successfully found bacteria etc
| - viruses have been isolated in urethral plugs
71
crystalluria theory iFLUTD
- disproved
- struvite crystals have been seen in presenting cats as well as healthy cats, and have been found to help in plug formation but need inflammation +/- urethral spasm
72
vesicourachal diverticula theory iFLUTD
- disproved
- vesicourachal diverticula are microscopic outpoachings of the bladder observed in iFLUTD but they leave a few days later after resolution
73
3 proposed mechanisms interstitial cystitis
- neurogenic inflammation
- deficient GAG layer
- sympathetic overactivity
74
5 tx iFLUTD
- feed canned food
- increase water intake
- reduce stress
- synthetic GAGs
- amitrptyline
75
5 diagnose procedures young cat with first FLUTD
- rule out obstruction
- rule out behavioural change/identify stress triggers
- urinalysis
- educate owner
- tx
76
3 steps young cat with recurent FLUTD
- go through as if it was first case
- imaging to rule out urolithiasis
- try GAGs
77
if getting desperate and can't find cause recurrent FLUTD young cat (5)
- go through as if first and recurrent case
- consult behaviourist
- oral analgesics
- maybe retry imaging
- be honest and open
78
functional urethral obstruction also known as
reflex dysynergia
79
define reflex dysynergia
- rare condition seen mainly in dogs
| - dysfunction with urethral relaxation not occurring as not receiving sense to urinate
80
3 clinical signs reflex dysynergia
- dysuria
- pass small spurts urine
- large residual volume
81
managment reflex dysynergia
medical
82
how obstructive uropathy causes azotemia (4)
- increase pressure in bowman's space
- GFR falls
- decreased renal blood flow
- protein enters filtrate
83
bladder enlargment due to overdistension can cause (4)
- ischaemia
- oedema
- haemorrhage
- mucosal sloughing
84
obstruction and progression times
- 48 hours - CNS depression, vomiting and decreased food and water intake
- 72 hours - death
85
treatment obstruction (3)
- IV fluids to dilute potassium
- calcium gluconate
- relieve obstruction
86
cystocentesis dog with obstruction urinary
- avoid as can cause septic peritonitis
| - if have to do then empty bladder completly
87
post unblocking urinary obstruction care
- keep up with ins and outs using IV fluids
| - may get hypokalaemia so supplement
88
define retrograde hydropulsion
pushing calculi from urethra back into bladder
89
how to retrograde hydropulsion (3)
- get a person to block urethra with a finger through the anus
- fill urethra with saline while blocking distal urethra
- get person to let go and pressure of fluid should push stones into bladder
90
define cystotomy tube
tube placed across the body wall and into bladder to drain into a bag
91
define urethrostomy
permanent surgical opening into the urethra to divert urine flow
