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RUSVM Small Animal Medicine II 2017 > Nephrology and Urology > Flashcards

Nephrology and Urology Flashcards

1
Q

Azotemia

A

Abnormal increase in the concentration of non-protein nitrogenous wastes in blood

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2
Q

Causes of Pre-Renal Azotemia

A 
Dehydration
Hypoadrenocorticism
Cardiac disease
Shock 
Hypovolemia
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3
Q

Causes of Renal Azotemia

A 
Parenchymal disease
infections 
cysts
inflammation 
neoplasia
toxins
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4
Q

Causes of Post-Renal Azotemia

A

Blockage

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5
Q

Renal Failure

A

When the kidneys are no longer able to maintain regulatory function, excretory Function, and endocrine Function

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6
Q

When does Renal failure occur?

A

When greater than 75% of the nephron population is non-functional

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7
Q

Characteristics clinical findings associated with Uremia

A

Hypoalbuminemia
Azotemia
Hypercholesterolemia
Peripheral edema

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8
Q

What the indirect methods for measuring Glomerular function?

A

Serum urea levels
Serum creatinine levels
Cystatin C
SDMA

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9
Q

What are the accurate techniques for measuring Glomerular function?

A

Clearance of radioisotopes with renal scintigraphy

Iohexal/inulin/creatinine clearance tests

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10
Q

What percentage of nephrons have to be destroyed before GRF is decreased?

A

66%

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11
Q

What is the gold standard for measuring Glomerular function?

A

Renal scintigraphy

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12
Q

What can cause an increase in urea?

A

GIT bleeding
Intravascular hemolysis
high protein diets

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13
Q

What causes the production of Creatinine?

A

breakdown of creatine in muscle

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14
Q

When do you get a decrease in creatinine?

A

Reduced muscle mass

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15
Q

What are the limitations of Creatinine?

A

Does not discriminate between causes of azotemia, Acute vs. chronic renal failure, or Reversible or irreversible renal failure

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16
Q

Cystatin C

A

small polypeptide protease inhibitor produced by all cells with a nucleus that is freely filtered by the glomeruli and does not undergo tubular secretion

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17
Q

SDMA

A

methylated form of the amino acid arginine which is produced in every cell and released into the body’s circulation during protein degradation and excreted exclusively by the kidneys

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18
Q

What is the best method for Urine collection?

A

Cystocentesis

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19
Q

What are the useful tests on the Urine dipstick?

A 
Protein 
pH
blood
glucose
ketones
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20
Q

What is the gold standard of urine concentration?

A

Osmolality

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21
Q

What test measures concentration of urine relative to plasma?

A

Urine Specific gravity

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22
Q

What is the range of urine specific gravity for hyposthenuria?

A

1.000-1.007

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23
Q

What is the range of urine specific gravity for Isosthenuria?

A

1.008-1.012

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24
Q

What is the range of urine specific gravity for Hypersthenuria?

A

Greater than 1.012

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25
What is the range of urine specific gravity for minimally concentrated?
1.013-1.030
26
What is the range of urine specific gravity for Inadequately concentrated?
1.013-1.022
27
What is the range of urine specific gravity for adequately concentrated urine in dogs?
greater than 1.030
28
What is the range of urine specific gravity for adequately concentrated urine in cats?
greater than 1.035
29
What are the DDx for a urine specific gravity of 1.005?
Diabetes Insipidus | Psychogenic Polydipsia
30
What is a test you can perform for an animal with low concentrating urine?
Partial Water Deprivation Test
31
Fractional excretion of electrolytes
The fraction of electrolyte clearance relative to creatinine clearance
32
What crystals are found in Lhaasa Apsos?
Calcium dihydroxylate
33
What crystals are found in bull dogs?
Cysteine crystals
34
What crystals are created due to Ethylene Glycol?
Calcium monohydrate
35
What crystals are seen in dalmations or with hepatic shunts?
Ammonium biurate
36
What are common crystals seen in cats?
Struvites
37
What causes a false positive on Urine protein creatinine ratio?
Lower Urinary Tract Disease
38
Urine protein creatinine ratio
comparison of protein to creatinine
39
What is the most common bacterial cause of UTI?
E. coli
40
Gross macroscopic hematuria
Sufficient blood to be apparent to the naked eye | Urine is brownish to red
41
Occult microscopic hematuria
Hematuria not present to the naked eye
42
Pseudohematuria
Red to brownish urine without intact red blood cells
43
What are the causes of pseudohematuria?
Hemoglobinuria | myoglobinuria or chemicals
44
What causes systemic hematuria?
Hemostatic defects
45
What causes Renal Hematuria?
``` Neoplasia Calculi Trauma Infarction Cysts Glomerulonephritis infection ```
46
What causes Bladder, Ureter, and Urehral Hematuria?
``` Bacterial infection calculi trauma neoplasia polyps cyclophosphamide Feline idiopathic cystitis ```
47
What causes Genital tract Hematuria?
``` Prostatic disease estrus infection neoplasia trauma ```
48
What are the clinical manifestations of kidney disease?
``` PU/PD Anorexia GI signs weight loss pale MM Lethargy Blindness Distended Abdomen ```
49
Name some Renal Toxins
``` Lilies Ethylene Glycol Aminoglycosides Grapes Raisins ```
50
Pollakiuria
Frequent Urination
51
Stranguria
Straining to urinate
52
Dysuria
Inappropriate urination
53
How much urine is produced per hour?
1-2ml/kg/hr
54
What are primary causes of enlarged kidneys due to neoplasia?
Renal adenocarcinoma Renal lymphoma Renal sarcoma Nephroblastoma
55
Why does Renal Carcinoma cause Polycythemia?
overproduction of erythropoietin by the tumor or due to renal hypoxia
56
What is the treatment for Renal carcinoma?
Nephrectomy
57
What is the prognosis for an animal with Renal Carcinoma?
16 months with treatment
58
What renal neoplasia is common in cats?
Renal Lymphoma
59
How do you treat Renal lymphoma?
Multi-agent chemotherapy (COP or CHOP)
60
What is the prognosis for Renal lymphoma?
60% have remission
61
What are non-neoplastic causes of renomegaly?
``` Acute nephrosis Acute pyelonephritis FIP Leptospirosis Amyloidosis Hydronephrosis Polycystic kidney disease Portosystemic shunts ```
62
Acute Kidney injury
Encompasses mild damage that does not cause azotemia to severe damage associated with complete anuria
63
Acute renal failure
Decreased GFR leading to retention of nitrogenous wastes
64
What is the criteria for Acute Kidney Injury?
``` R - Risk I - Injury F - Failure L - Loss E - End-stage kidney disease ```
65
IRIS
Intenational renal interest society
66
Grade 1 AKI
Blood creatinine less than 1.6 mg/dl
67
Grade 2 AKI
Blood Creatinine 1.7-2.5mg/dl
68
Grade 3 AKI
Blood Creatinine 2.6-5.0mg/dl
69
Grade 4 AKI
Blood creatinine 5.1-10mg/dl
70
Grade 5 AKI
Blood creatinine greater than 10mg/dl
71
What are the pre-renal causes of AKI?
``` Hypoxia Ischemia Dehydration hypovolemia hypotension decreased effective circulatory volume anesthesia hypoadrenocorticism Trauma surgery shock heatstroke Hypoalbuminemia hypoperfusion ```
72
What are the renal causes of AKI?
``` Prolonged renal hypoperfusion Prolonged obstruction Excessive vasoconstriction Thrombosis Transfusion rxns Infectious causes Neoplasia Immune mediated causes Secondary to systemic disease NSAIDs Ethylene glycol Aminoglycosides ```
73
Post renal causes of AKI
Urine leakage or obstruction
74
What are the four phases of acute renal failure?
Initial Extension Maintenance Recovery
75
Initial phase of Acute renal failure
decrease in urine output or increase in creatinine without clinical signs
76
Extension phase of Acute Renal Failure
Continued hypoxia and inflammation Proximal tubule and loop of henle susceptible to toxic and ischemic damage Compromised Sodium:Potassium pump Increased cytosolic calcium Loss of brush border or apical and basal cell surfaces
77
Maintenance phase of Acute Renal Failure
1-3 weeks duration Urine output is increased or decreased Urine = ultrafiltrate
78
Recovery phase of Acute Renal Failure
Heralded by polyuria | Extreme Sodium loss
79
What are the risk factors for Renal tubular necrosis/injury?
``` Dehydration Hypovolemia Anesthesia Hypoxia Systemic inflammatory syndrome ```
80
How do you manage the risk factors for Renal tubular necrosis/injury?
Aggressively treat shock Treat dehydration Avoid nephrotoxic drugs
81
What are the Renoprotective drugs?
Calcium channel bloackers Selective DA-2 receptor drugs Selective DA-1 receptor agonists Erythropoeitin analogues
82
What is normal urine production per hour?
1-2ml/kg/hr
83
What is abnormal urine production per hour?
less than 0.5ml/kg/hr
84
Diagnosis of AKI/ARF
``` Identify a predisposing cause Reduced urine output Casts - RTE cell casts Azotemia Renal tubular biomarkers: GGT: Creat NAG:Creat ```
85
Treatment of ARF
Maintaining fluid balance | Correct hypotension
86
What drugs are use in the treatment for ARF?
Mannitol Furosemide Dopamine Fenoldopam
87
What is the correct shock dose for dogs?
60-90ml/kg/hr
88
What is the correct shock dose for cats?
45ml/kg/hr
89
What is the amount of insensible fluid loss?
22ml/kg/day
90
What is the amount of Maintenance fluids for a dog?
60ml/kg/day
91
What fluids would you use with for treatment of ARF?
Crystalloids 0. 9% NaCl 0. 45% NaCl + dextrose
92
What are the fluid requirements for ARF?
Dehydration Insensible losses Ongoing losses Sensible losses
93
Oliguria
less than 0.5ml/kg/hr urine producton
94
How do you treat Oliguria?
Mannitol Furosemide Dopamine Calcium Channel blockers
95
Mannitol
Osmotic diuretic that increases circulatory volume and decreases cell swelling
96
Furosemide
Loop diuretic the increases urine production without increasing GFR
97
What does Fenoldopam do?
increased urine output
98
What is the benefit of Dopamine?
a pressor when ARF is secondary to cardiac output failure or severe hypotensive
99
What drug is used in the standard of care for Leptospirosis?
Calcium Channel blockers
100
What do Calcium channel blockers do?
Prevent calcium moving intracellularly
101
What is the definitive treatment of ARF?
Extracorporeal renal replacement therapy/ dialysis | Peritoneal dialysis
102
What are the indications for Dialysis?
FLuid overload with pulmonary edema Hyperkalemia Progressive azotemia Acute toxicity
103
What is the complication of Peritoneal dialysis?
Dialysis disequilibrium syndrome | Blockage of the peritoneal drain by the omentum
104
What is the treatment for Ethylene glycol?
4-methylpyrazole
105
What is the treatment for NSAIDs?
Misoprostal
106
What is the treatment for Leptospirosis?
Penicillin and doxycycline
107
What is the treatment for Pyelonephritis?
Culture | Fluoroquinolones or TMS
108
What is the treatment for Aminoglycoside toxicity?
Ticarcilin IV
109
What is the treatment for TMS toxicity?
Urinary alkalinization
110
What is the treatment for Hyperkalemia?
Insulin Dextrose infusion Calcium gluconate Correct metabolic acidosis
111
What is the treatment for Acidosis?
Sodium Bicarbonate IV
112
What is the treatment for Hypocalcemia?
Calcium gluconate
113
What is the treatment for Hypercalcemia?
Furosemide/glucocorticoids Calcitonin Biphosphonates
114
What is the treatment for Hyperphosphatemia?
Aluminum hydroxide/carbonate
115
What is the treatment for Hypertension?
Amlodipine and hydralazine
116
What is the treatment for Gastrointestinal problems associated with ARF?
Prokinetics: Ondansetron, Metoclopramide Antiemetics: Metoclopramide, maropitant Omeprazole, pantoprazole, famotidine, ranitidine
117
What is chronic kidney disease?
Loss of functional renal tissue due to prolonged process | Usually progressive and irreversible
118
What are the degenerative causes of CKD?
Chronic interstitial nephritis | Renal infarcts
119
What are the developmental causes of CKD?
Familial renal dysplasia | PKD
120
What is a metabolic cause of CKD?
Hypercalcemia
121
What is the neoplastic cause of CKD?
Renal carcinoma | Renal lymphoma
122
What is an infectious cause of CKD?
Pyelonephritis Lyme nephropathy Leptospirosis
123
What is an iatrogenic cause of CKD?
Vitamin D supplementation | Nephrotoxic durgs
124
What is an immune mediated cause of CKD?
Immune-complex mediated glomerulonephritis
125
What are the effects of Hyperphosphatemia?
Drives renal secondary hyperparathyroidism | Causes progression of disease
126
What causes Hypokalemia in CKD?
Reduced intake | Increased renal potassium loss
127
What causes anemia in association with CKD?
Erythropoietin deficiency Decreased life span of RBC Effect of PTH on bone marrow and RBCs
128
What causes renal injury in CKD?
Proteinuria
129
What is the treatment for Proteinuria associated with CKD?
ACE inhibitors | ARB (telmisartan)
130
What are the aims of Treatment and Management of CKD?
Treat underlying cause Improve clinical signs/quality of life Slow the progression
131
What causes Vomiting and nausea associated with CKD?
Uremic gastritis Hypergastinemia Stimulation of the CTZ by uremic toxin
132
What are the appetite stimulants used for the treatment of CKD?
Cyproheptadine in cats | Mirtazapine in dogs and cats
133
How do you treat Hyperphosphatemia associated with CKD?
Dietary phosphate restriction | Intestinal phosphate binders
134
When would you begin a cat on a Renal Diet?
IRIS stage 2
135
When would you begin a dog on a Renal Diet?
IRIS stage 3
136
How would you treat Hypokalemia associated with CKD?
Supplement IV | Oral potassium supplements
137
How would you treat non-regenerative anemia associated with CKD?
Erythropoietin therapy | rHuEPO or Darbopoietin
138
What is the Hypertension therapy for cats?
Amlodipine
139
What is the Hypertension therapy for dogs?
ACE inhibitors
140
How do ACE inhibitors work?
inhibit conversion of angiotensin I to angiotensin II | Reduce glomerular capillary pressure and glomerular size
141
Telmisartan
Angiotensin receptor blocker
142
Management of acute on chronic disease
identify and treat underlying cause | IV fluids
143
What is considered a non-proteinuric UP/C value in dogs?
less than 0.2
144
What is considered a non-proteinuric UP/C value in cats?
less than 0.2
145
What is considered a borderline proteinuric UP/C value in dogs?
0.2 to 0.5
146
What is considered a borderline proteinuric UP/C value in cats?
0.2 to 0.4
147
What is considered a proteinuric UP/C value in dogs?
greater than 0.5
148
What is considered a proteinuric UP/C value in cats?
greater than 0.4
149
What is a physiologic cause of proteinuria?
Strenuous exercise seizures fever stress
150
What is the pre-renal cause of proteinuria?
Abnormal concentrations of protein been presented to the kidneys
151
What is the renal cause of proteinuria?
Defective renal function or inflammation of renal tissue
152
What is the post-renal cause of proteinuria?
Inflammation in the ureter, bladder, urethra or prostate
153
What causes a false positive of Proteinuria on the urine dipstick?
Alkaline urine | Contamination
154
What causes a false negative of proteinuria on the urine dipstick?
Acid urine | Bence-jones proteinuria
155
What causes proteinuria in association with glomerular disease?
Defective renal function: Glomerular pathology or tubular pathology Inflammation of renal parenchyma: Pyelonephritis or acute tubular necrosis
156
What is a renal cause of Proteinuria?
Increased Glomerular permeability | decreased tubular protein reabsorption
157
Protein losing nephropathy
condition causing severe proteinuria due to primary glomerular disease
158
Glomerulonephritis
condition where immune-complexes are deposited in the glomeruli
159
What is the cause of glomerulonephritis?
Familial nephropathy basement membrane: X-linked hereditary PLN of Samoyeds or Alport syndrome of English Cocker Spaniels Immune-complex glomerulonephritis Non immune complex GN Amyloid deposits in glomeruli
160
What are the infectious causes of Glomerulonephritis?
Borreliosis Dirofilariosis Ehrlichiosis Leishmaniosis
161
What is the cause of Hypercoagulability of Glomerulonephritis?
``` Mild thrombocytosis Increased platelet adhesion and aggregation Loss of antithrombin Altered fibrinolysis Increase in large clotting factors ```
162
How do you measure hypercoagulability?
Thromboelastography
163
How do you indirectly measure hypercoagulability?
Increased/decreased number of platelets Decreased antithrombin Increased fibrin Increased d-dimers
164
Nephrotic syndrome
Kidney disease characterized by edema and loss of protein from the plasma into the urine due to increased glomerular permeability
165
How do you diagnose Glomerulonephritis?
Kidney biopsy Light microscopy Transmission electron microscopy Immunofluorescent antibody assessment
166
What are the findings associated with Nephrotic Syndrome?
Proteinuria Hypoalbuminemia Ascites/Edema Hypercholesterolemia
167
What is the treatment for Glomerulonephritis?
Immunosuppressive therapy
168
What drug should not be used alone for the treatment of Glomerulonephritis?
Glucocorticoids
169
What is the first choice of treatment for Glomerulonephritis?
Mycophenolate
170
If Mycophenolate does not work for Glomerulonephritis then what do you add?
Cyclosporine Chlorambucil Azathioprine Cyclophosphamide
171
How do you treat Protein Losing Nephropathy?
treat proteinuria with ACE inhibitors, ARB, and Renal diets | treat hypercoagulability with aspirin or clopidogrel
172
What is the most significant cause of renal disease and acute uremia?
Ureteral obstruction from calcium oxalate
173
What is the clinical sign that cats with Acute unilateral ureteral obstruction present with?
Acute Abdominal pain | hematuria
174
What is the clinical signs for Acute bilateral ureteral obstruction in cats?
bilaterally enlarged and painful kidneys Azotemia oliguria/anuria
175
"Big Kidney Little Kidney" Syndrome
cats with past unilateral ureteral obstruction that causes the kidney to progress to fibrotic end stage. the contralateral hypertrophied kidney becomes acutely obstructed by a ureterolith causing further enlargement
176
Bilateral Chronic Kidney Disease with Concomitant Ureteral Obstruction
Chronic kidney disease secondary to fibrotic changes from previous obstruction predisposes to intrinsic kidney disease and a sudden obstruction causes decompensation of the tenuous residual kidney function
177
What do you see on ultrasound with ureteral obstruction?
hydronephrosis and dilation of the proximal ureter
178
What is the advanced imaging used for diagnosis of ureteral obstruction?
Antegrade pyelography | Computed tomography
179
Antegrade pyelography
guided pyelocentesis and antegrade injection of positive contract media into the renal pelvis and ureter to delineate the size and patency of the ureter
180
What is the medical management for ureteral obstruction?
Stabilize uremia mannitol Ureteral relaxants - Prazosin and amitryptilline Pain management
181
What is an excellent choice of management for ureteral obstruction in dogs?
Lithotripsy
182
What is the standard of car for ureteral obstruction?
Ureteral stents through cystoscopy or Surgically
183
Subcutaneous ureteral bypass system
indwelling bypass using a combination locking loop nephrotomy/cystotomy tube
184
How do you stabilize a cat with ureteral obstruction?
``` Heat Fluids ECG Emergency panel Cystocenetesis ```
185
What is treatment for hyperkalemia in an obstructed cat?
Calcium gluconate IV insulin Bicarbonate Shock fluids
186
How do you relieve the obstruction of a cat?
``` Retrograde Penile massage/rectal massage of urethra Anesthesia and positioning Cystocentesis Penis extrusion Catheterization ```
187
What is the ongoing management for a blocked cat?
Indwelling U-cath placement Monitor urine production/urine sediment Analgesia Anti-spasmotics
188
What is the treatment for a blocked cat with an owner that cannot afford treatment?
Euthanasia or Repeated cystocentesis and anti spasmotics
189
Anti-spasmotics
Prazosin/Phenoxybenzamine | Pheromones for stress
190
What is a clinical finding associated with Urethral rupture?
Hyperkalemia Hyponatremia Acidosis
191
What is a consequence of Uretheral rupture?
Stricture | Urethrocutaneous fistula
192
What is the cause of Uroabdomen?
Trauma
193
How do you treat Uroabdomen?
Medical management and urinary catheterisation | Surgery once stable
194
What are non-obstructed lower urinary tract diseases?
``` Urinary tract infections Urolithiasis Feline lower urinary tract disease Prostatic disease Neoplasia ```
195
What are the clinical signs of urinary tract disease?
``` Dysuria Pollakiuria/periuria Stranguria Pigmenturia Incomplete voiding Urinary incontinence ```
196
What causes Dysuria/Stranguria/Pollakiuria?
Irritation of the bladder: bacterial, uroliths, or interstitial cystitis Neurological disease Secondary lower urinary tract disease Neoplasia
197
How do you diagnose Lower Urinary Tract disease?
``` Collect urine on free flow and cystocentesis Urinalysis urine culture urethral cytology Radiography Ultrasonography Cystoscopy Bladder biopsy Excretory contrast studies Urethral profilometry ```
198
Is Bilirubinemia normal in a dog?
Yes
199
Is Bilirubinemia normal in a cat?
No
200
What are the causes of Hematuria?
Renal Lower Urinary Tract Reproductive Systemic disease: Bleeding disorder, Hypertension, or Hyperviscosity
201
What is the number one cause for UTIs?
E. coli
202
What is the most common route of UTI?
Ascending
203
What are the drugs of choice for an uncomplicated UTI?
Amoxicillin Cephalosporins TMS
204
Uncomplicated UTI
the first time it presents with bacteria in the urine without stones in the bladder
205
What is classified as a Complicated UTI?
Relapse Reinfection Superbugs
206
Reinfection UTI
New/different organism | C and S positive greater than 7 days after last treatment course
207
Superinfection UTI
C and S positive at day 7 after starting antibiotics
208
Relapse
Same organism/strain, 7 days after last treatment course
209
What causes a Relapse?
Inappropriate drug choice Dose frequency duration
210
What causes Lower Urinary Tract Disease?
``` Anatomic urinary tract abnormalities Voiding abnormalities Upper urinary infection Endocrine diseases Prostate Uterine/Vaginal disease Immune compromise Iatrogenic diuresis ```
211
Urachal Diverticulum
cord from the bladder to the mother does ot disappear
212
Patent Urachas
cord from the bladder to the mother has an opening to the skin
213
What is the treatment for Recurrent UTI?
One daily bedtime administration 30-50% of original dose of Nitrofurantoin that is an urinary disinfectant
214
What are the alternative techniques for Recurrent UTI therapy?
Probiotics Polysulfated glycosaminoglycans Fosfomycin Cranberry extract
215
Therapy for Urolithiasis?
``` Diet Urohydropulsion Cystotomy with baskets Cystrotomy Lithotripsy ```
216
Retrograde Urohydropulsion
Hydropulsion of uroliths into the bladder
217
Struvite
Big Smooth Radiodense Magnesium Ammonium phosphate due to Urease producing bacteria when the urine pH is high In cats it is diet related
218
What breeds of dog get Struvites?
``` Mini Schnauzers Lhasa Apso Cocker Spaniel Shih tzu Bichon Frise ```
219
What is the treatment for Struvites?
Hills S/D diet that dilutes the acidic urine | Walthams S/O
220
Calcium Oxalate
Spiny radio-opaque small stones that are common in male dogs due to acidifying diets, obesity or Hypercalcemia
221
What kind of stone is associated with Ethylene glycol toxicity?
Calcium monohydrate
222
What is the treatment for calcium oxalate crystals?
Therapy for hypercalcemia | Surgical/lithotripsy/cystoscopy
223
How do you prevent Calcium Oxalate formation?
``` Hills U/D Walthams S/O Thiazide diuretics Potassium citrate Avoid Vitamins C and D ```
224
What is the crystal that looks like a "hairy apple"?
Ammonium biurate
225
What causes Ammonium Urate and Xatnthine formation?
Hepatic disease (PSS, cirrhosis) Genetic tubular defect Breeds: Dalmations, Black Russian Terrier) Decreased uptake of uric acid from hepatocytes to form allantoin
226
Ammonium Urate
Radiolucent crystal associated with lower urinary pH
227
What is the treatment for Ammonium Urate formation?
Diet - low protein and increased pH Xanthine oxidase inhibitors: Allopurinol Supportive care for hepatic dysfunction
228
What breeds are associated with Cystine Calculi?
Australian cattle dogs Newfoundlands Dachshunds Bulldogs
229
Cystine Calculi
Tubular carrier proteins fail to reabsorb cystine | Radio-opaque crystal
230
How do you treat Cystine crystals?
Alkalinize Urine | Low protein diet
231
Calcium phosphate uroliths
usually secondary to primary hyperparathyroidism
232
Silica Uroliths
Associated with plant sources, poor diets rich in rice and soybean husks, cheap diets devoid of proper protein
233
What are the potential causes of Feline Lower Urinary Tract Disease?
``` Bacterial Uroliths Neoplasia trauma anatomical behavioral Feline interstitial cystitis ```
234
What is the gold standard of diagnosis for Feline Interstitial cystitis?
Cystoscopy
235
What are the clinical signs of Feline Idiopathic Cystitis?
``` Hematuria Stranguria Pollakiuria Inappropriate urination Palpate a large firm bladder Inability to urinate ```
236
How do you diagnose Feline Idiopathic Cystitis?
Exclusion | Cystoscopy
237
Pudendal Nerve
somatic nerves to the external urethral sphincter causing the sphincter to be tight
238
Pelvic Nerve
parasympathetic nerve to the detrusor muscle that allows the animal to pee through contraction and received pain stimulations from the bladder
239
Hypogastric Nerve
Sympathetic nerve allows the detrusor muscle relax and the urethral sphincter to contract and store urine
240
What is the treatment for Feline Lower Urinary Tract Disease?
Reduce stress Multiple Litter boxes Plenty of Water sources Activity/playing
241
What is the preferred method of dislodging an obstruction in Feline Lower Urinary Tract Disease?
Catheterisation | IV fluids
242
What is the treatment of Feline Lower Urinary Tract Disease?
Wet food not dry Pheromones for stress Analgesics - opioids
243
What are some Vaginal Diseases?
``` Hemorrhage Vaginitis Hyperplasia Prolaspe Neoplasia Persistent Hymen ```
244
What is the main cause of Feline Lower Urinary Tract Disease?
Stress | Concurrent disease with stress
245
Persistent Hymen
Persistent sheet of tissue in the vagina
246
Juvenile vaginitis
seen in young females that will resolve in 6 weeks
247
What is the predisposing factor for vaginitis?
sunken vulva
248
Vaginal Hyperplasia/Prolapse
Hyperplasia of the vaginal wall that prolapses when the female comes into heat and will resolve after the dog goes out of heat
249
What are the neoplasias of the Female Genital tract?
Leiomyoma/Leiomyosarcoma | Transmissible Venereal Tumors
250
What are the prostatic diseases?
Benign Prostatic Hyperplasia Prostatic cysts Prostatitis Prostatic Neoplasia
251
What are the clinical signs of Prostatic Disease?
Difficult defecation | Tenesmus
252
What are the clinical signs of Acute Prostatitis?
the dog is very sick
253
What are the clinical signs of Chronic Prostatitis?
recurrent UTIs preputial discharge Non-painful prostate symmetrically enlarged prostate
254
Hoe do you diagnose Chronic Prostatitis?
UA for UTI | Ultrasound
255
What is the therapy for Benign Prostatic Hyperplasia?
Orchidectomy | Medical chemical castration
256
What is the therapy for Prostatic Cysts?
US drainage | Marsupialize
257
What is the therapy for Prostatitis?
Antimicrobials | Surgery - Orchidectomy
258
What is Finasteride used for?
converts testosteron to dihydrotestosterone to avoid castration
259
What antibiotics penetrate the Prostate well?
``` Fluoroquinolones Doxycycline Trimethoprim Rifampin Erythromycin ```
260
What antibiotics do not penetrate the prostate?
``` Nitrofurantoin sulfonamides vancomycin penicillins cephalosporins ```
261
What are the clinical signs of Prostatic Neoplasia?
Lameness Painful gait with pain in sacrum prostate palpable Palpable sublumbar LNs
262
Where would metastasis be located with Prostatic Neoplasia?
LN Vertebrae Lungs
263
What is the treatment for Prostatic Neoplasia?
Chemo - Mitoxantrone radiation stents
264
Mitoxantrone
Topoisomerase inhibitors disrupt DNS synthesis and repair
265
What are the Neoplasias in the Bladder or urethra?
``` Transitional Cell Carcinoma Muscle Neoplasms Squamous cell carcinoma adenocarcinoma fibrosarcoma hemangiosarcoma ```
266
How do you diagnose Bladder or Urethra Neoplasia?
``` Urine sediment Imaging Catheter suction samples for cytology Endoscopy Cytology Biopsy ```
267
What is the treatment for TCC of the bladder?
``` Piroxicam Surgery Chemotherapy - Mitoxantrone Photodynamic therapy Urine diversion - catheter ```
268
What causes Detrusor Atony?
caused by trauma or over distension causing disruption of the nerves
269
Where do you find the parasympathetic innervation to the bladder?
S1-3
270
Where do you find the sympathetic innervation to the bladder?
L1-4 in dogs | L2-5 in cats
271
Where do you find the somatic innervation to the bladder?
S1-3
272
What overrides the Pudendal nerve to increase urethral sphincter tone?
Cerebrum
273
What are the UMN bladder signs?
Detrusor areflexia with sphincter hyperreflexia Small bladder to large distended bladder Small volumes of urine Difficult to express
274
Where is the lesion located when there are UMN bladder signs?
Aboove sacral segment
275
What is the treatment for UMN bladder signs?
Baclofen
276
Baclofen
Antispasmodic causing muscle relaxant
277
What are the LMN bladder signs?
Detruspr areflexia and sphincter areflexia Large bladder Easily expressed Constantly leaks
278
Where is the location of the lesion when LMN bladder signs are seen?
Sacral spinal segment or pelvic segment
279
What is the treatment for LMN bladder signs?
Express bladder 3-4x/day | Bethanecol
280
Bethanecol
parasympathomimetic causing contraction of the bladder
281
Detrusor-sphincter reflex dyssynergia
with initiation of detrusor contraction the urethral sphincter spasms
282
What is the treatment for Detrusor-sphincter reflex dyssynergia?
Alpha-adrenergic blockers (Phenoxybenzamine)
283
In what species do you see Dysautoanomia?
Cats
284
What causes Detrusor Atony?
Overfill due to obstruction
285
How do you treat Detrusor Atony?
Manually express the bladder and keep the bladder small and hope the nerves grow back
286
Detrusor instability/detrusor hyperreflexia (Urge Incontinence)
Detrusor contraction during storage of urine or low compliance of the detrusor muscle which may be confirmed by cystometrography
287
What is the treatment for Detrusor instability/detrusor hyperreflexia (Urge Incontinence) ?
Anticholinergic - Oxybutynin imipramine or dicyclomine
288
Urinary incontinence
the involuntary escape of urine during the storage phase of the urinary cycle Intermittent or continuous dribbling of urine with a normal voiding episode Loss of voluntary control of urination and consequent leakage of urine
289
What is the cause of Urinary Incontinence?
Urinary Sphincter Mechanism Incompetence
290
What are the clinical signs of Urinary Sphincter Mechanism Incompetence?
Soiled perineal coat | Urine scald
291
How do you diagnose Urinary Sphincter Mechanism Incompetence
Urethral pressure profile
292
What is the pathophysiology of Urinary Sphincter Mechanism Incompetence?
Lack of estrogen decreases sensitivity of the smooth muscle receptors to sympathetic stimulation Spaying reduced urinary sphincter pressure
293
What is the Pressure transmission theory for Urinary Sphincter Mechanism Incompetence?
when urethral neck is not in the abdominal cavity it is not subjected to the same pressures as the intra-abdominal bladder, the bladder pressure exceed urethral pressure and the urine leaks
294
What is the Hammock theory for Urinary Sphincter Mechanism Incompetence?
the anatomic structures maintaining the position of the bladder and urethra are abnormal
295
What are the indications to perform a Urethral pressure profile?
Urinary Sphincter Mechanism Incompetence Detrusor instability Reflex dyssynergia Neurogenic abnormalities
296
What is the medical management for Urinary Sphincter Mechanism Incompetence
Estriol therapy + PPA
297
What are the side effects of Estriol?
increased mammary tumors
298
What are the surgical treatment for Urinary Sphincter Mechanism Incompetence?
``` Bovine Cross-Linked Collagen Implantation Colposuspension Urethropexy Transobturator Vaginal Tape inside out Static Hydraulic Urethral sphincter ```
299
What are the clinical signs of Ectopic Ureter?
Wet coat Inflamed perineum Excoriations
300
What is the treatment of choice for Ectopic Ureter?
Cystoscopic laser ablation
301
What are the most accurate diagnosis of Ectopic Ureter?
Excretory urogram CT | Cystoscopy
302
How long should you continue antibiotics for UTI associated with Ectopic Ureters?
6-8 weeks

RUSVM Small Animal Medicine II 2017 (4 decks)

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