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Metabolism and excretion > Lower UT diseases > Flashcards

Lower UT diseases Flashcards

1
Q

Give four reasons why females are more predisposed to lower UTI than males

A
  1. Shorter, wider urethra that opens into non-sterile vagina
  2. Urethral opening much closer to anus than males
  3. Possible trauma incurred during parturition, mating
  4. Hormonal fluctuations of oestrus can alter the environment in the vagina and urethra
    - less glycosaminoglycan production when oestrogen is high
    - more alkaline urine during oestrus, which is preferred by bacteria
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2
Q

Give two reasons why males are more predisposed to urethral obstruction by calculi

A
  1. Longer, narrower urethra - more likely to get stuck

2. External structures that can hinder stone passage - prostate, os penis etc

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3
Q

Why is ectopic ureter reported 20X more in bitches than male dogs?

A

Because the ectopic termination into a distal site of the urinary tract causes uncontrolled leak of urine (incontinence). In males, the distal urethral sphincter prevents this, so ectopic ureter may never be discovered

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4
Q

Where does an ectopic ureter usually empty in a bitch?

A

Vagina or urethra

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5
Q

What is the urachus?

A

The tube-like communication between the allantoic cavity and bladder in the developing foetus

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6
Q

What are three potential congenital abnormalities of the urachus and their potential consequences?

A
  1. Failure to close = leakage of urine to the peritoneum or outside world can predispose to infection of bladder or liver
  2. Rupture may cause uroperitoneum
  3. Partial closure can cause urachal cyst formation between urachus and umbilicus
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7
Q

What is the technical name for a bladder diverticulum caused by remaining urachal tissue?

A

Vesicourachal diverticulum

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8
Q

What are two potential causes of bladder diverticuli other then persistant urachal tissue?

A

Obstruction to urine outflow

Weak patch in bladder wall musculature > balooning

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9
Q

What are three potential consequences of duplicate bladder?

A

Dysuria
Urinary incontinence
Abdominal distension

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10
Q

What is the name of the condition where the urethral groove fails to close to form the penile urethra?

A

Hypospadias

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11
Q

What is the most common developmental anomaly of the urethra?

A

Urethro-rectal fistula

Or vagino-rectal fistula

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12
Q

Under what circumstances might hydroureter occur without a distal obstruction?

A

Peritonitis - SNS activity inhibits ureteral peristalsis, causing urine buildup and hydroureter

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13
Q

What is bladder eversion? Which surface of the bladder is facing out?

A

It is invagination of the bladder through the urethra

The mucosal surface is facing out

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14
Q

What is bladder prolapse?

A

Bladder herniates through a tear in the vagina. Its serosal surface faces the outside.

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15
Q

Other than bladder eversion and prolapse, what can prolonged straining (e.g parturition) cause in female animals?

A

Uterine prolapse, vaginal prolapse

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16
Q

What are two possible mechanisms for bladder atony?

A
  1. Neural injury that blocks tonic PNS stimulation via the sacral plexus e.g intervertebral disc prolapse
  2. Prolonged urine outflow obstruction causing long term bladder dilation e.g calculi, prostatic hyperplasia, neoplasia
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17
Q

How does bladder hypertrophy occur? What is a good presumptive test at post mortem exam?

A

Chronic PARTIAL obstruction of urine outflow

Try to stretch at PME - if can stretch, unlikely hypertrophic

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18
Q

In the event of a complete block to urine passage, which anatomic structure determines whether or not the bladder is likely to rupture?

A

The vesicoureteral valves in the bladder trigone

19
Q

If the valves remain closed what is the likely outcome?

A

Increase in pressure in bladder > compression of mural veins > venous congestion > venous infarction of wall > rupture

20
Q

If the valves open what is the likely outcome?

A

Distension and atony of bladder, hydroureter and hydronephrosis - longer time frame

21
Q

What factors other than urine supersaturation might predispose to urolith formation?

A

Retention of urine, allowing it to concentrate
Bladder diverticuli preventing full evacuation
Favorable pH e.g acidic for calcium oxalate and urate, alkaline for struvite
Decreased concentration of crystal inhibitors e.g glycosaminoglycans, citrates

22
Q

What might lead to supersaturation of urine with solute?

A
  1. Abnormal metabolism e.g purine metabolism in Dalmations increasing saturation of urine with uric acid
  2. High dietary solute intake e.g high mineral content pasture
  3. Decreased water intake causing concentrated urine
23
Q

What is the usual nature of the obstruction in FLUTD? What does it cause?

A

Gritty, rubbery plug of protein, cell debris and struvite crystals especially in urethra of male cats

Causes oliguria, dysuria, stranguria and haematuria

24
Q

Name 5 of the usual defences of the lower urinary tract to infection

A
  1. Voiding of urine
  2. Acidity of urine especially carnivores
  3. Factors that inhibit bacterial attachment including Tamm Horsfall mucoprotein, surface glycosaminoglycans
  4. Sloughing of mucosal epithelial cells that have adherent bacteria
  5. Urinary oligosaccharides may detach adherent bacteria
25
Q

What are 5 factors that predispose to lower UTI?

A
  1. Incontinence > constant wetting of perineum
  2. Glucosuria or proteinuria > bacterial substrate
  3. Disruption/overgrowth of vaginal or distal urethral flora e.g following antibiotic therapy
  4. Incomplete urine voiding or urine stasis
  5. Urinary catheter
  6. Impaired immune defense e.g Cushings, corticosteriod use
26
Q

What are three bacterial species that are only pathogenic when in the lower urinary tract?

A

Corynebacterium renale
C. pilosum
C. cystitidis

27
Q

What are two features of bacteria that enhance their pathogenicity in the urinary tract?

A
  1. Having of fimbriae which mediate attachment

2. Having urease which splits urea to ammonia and can make the surrounding environment more alkaline promoting survival

28
Q

Name one iatrogenic cause of cystitis

A

The chemotherapeutic drug cyclophosphamide causes sterile, haemorrhagic cystitis
Can get TCC with prolonged therapy

29
Q

Five descriptors of the lesions of cystitis?

A 
Catarrhal (serous exudate on surface)
Fibrinopurulent
Haemorrhagic
Necrotising
Ulcerative
30
Q

What causes emphysematous cystitis?

A

Production of CO2 by glucose-fermenting bacteria in the wall of the bladder

E.g secondary cystitis in diabetes mellitus

31
Q

What is chronic follicular cystitis? Which species?

A

Cystitis characterised by multifocal 1-4mm cream-white nodules in the bladder mucosa, which correspond to aggregates (follicles) of lymphocytes in the superficial submucosa. Dogs.

If nodules are red - “chronic active”

32
Q

What is chronic polyploid cystitis? Which species?

A

Bladder mucosa thrown into folds corresponding to submucosal fibrous tissue infiltrated by mononuclear leukocytes. Nodules may be sessile or pedunculated. Biopsy required to discriminate from tumour. All species.

33
Q

What is a von Brunn’s nest?

A

A downgrowth of hyperplastic bladder epithelium into the submucosa, in response to chronic irritation. Typically undergo glandular metaplasia and produce mucous, or become cystic

34
Q

Are primary or secondary tumours more common in the bladder? Why - what are two predisposing factors.

A

Primary
Because:
- chronic irritation due to cystitis or infection can predispose
- mucosa is exposed to carcinogenic substances concentrated in the urine

35
Q

What are two examples of urinary carcinogens?

A

Cyclophosphamide metabolites, tryptophan metabolites

36
Q

What is the usual location and behaviour of a TCC?

A

Usually located at the trigone of the bladder - may grow into lumen (papillomatous, polyploid) or into the wall (sessile)
50% metastasise

37
Q

What is enzootic haematuria?

A

A syndrome of persistent haematuria and anemia in cattle (+ occasionally sheep) associated with haemorrhagic cystitis and bleeding tumours of the lower UT. Due to chronic ingestion of bracken fern or mulga rock fern + oncogenic bovine papillomavirus infection.

38
Q

What are the scientific names for bracken fern? What is its toxin called?

A

Pteridium aquilinum
Pteridium esculentum
Ptaquiloside

39
Q

What is the scientific name for mulga rock fern?

A

Cheilanthes sieben

40
Q

What is the initial effect of ptaquiloside consumption on the body?

A

Causes bone marrow suppression and subsequent thrombocytopaenia > small or large haemorrhages in the mucosa of the lower UT, causing microscopic haematuria

41
Q

What happens if ptaquiloside is ingested long term?

A

Dilation of submucosal capillaries in lower UT, chronic cystitis and hyperplasia +/- metaplasia of cystic mucosa - leading to tumour development

42
Q

If an animal with enzootic haematuria has macroscopic haematuria, how far along is the cancer?

A

Most likely has ulcerated, bleeding tumours that are bleeding into the lumen of the bladder

43
Q

Is there a single tumour type typical of ptaquiloside toxicity?

A

No - may even be multiple types in same specimen including papillomas, fibromas, haemangiomas, haemangiosarcomas and transitional cell carcinomas

Metabolism and excretion (9 decks)

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