Non-Obstructed LUTD Flashcards
What are the components of the lower urinary tract?
Bladder, urethra, prostate
What are the functions of the lower urinary tract?
Storage and voiding of urine
What are some clinical signs associated with LUTD?
Dysuria Pollakiuria/periuria Stranguria Pigmenturia Incomplete voiding Urinary incontinence
What are some causes of dys/strang/pollakiuria?
Irritation to the bladder, neurological disease, UTI, neoplasia
What are the basic diagnostics to perform when investigating LUTD?
Urinalysis with sedimentation/cytology and culture
What are additional diagnostics to perform when investigating LUTD?
Radiography/Ultrasound
Cystoscopy with or without biopsy
Excretory contrast studies
Urethra profilometry
What does dark yellow to orange urine indicate?
Excess bilirubin
What does red to port wine color urine indicatte?
Blood, hemoglobin, or myoglobin
What kind of dogs will produce more bilirubin normally?
Male dogs- sometimes enough to make crystals
Where can blood come from to end up in the urine?
Kidneys, lower urinary tract, reproductive tract, systemic disease
What kinds of systemic diseases may result in blood in the urine?
Bleeding disorders, hypertension, hyperviscosity
What is the incidence of UTIs in dogs?
Common- males predisposed
What is the incidence of UTIs in cats?
Less common although incidence increases with age and concurrent disease
What cell count in urine is diagnostic for a UTI?
> 5 WBC per HPF in cystocentesis sample
What are some normal host defenses against UTI?
Normal micturition, anatomy, mucosal defenses, urine properties, systemic immune system
What is the most common organism isolated from UTIs?
E.coli
What is the second most common organism isolated from UTIs?
Gram positive cocci
T/F: Most infections are caused by a single species
True (75%)
Which route is more common, ascending or descending infections?
Ascending
What kind of animals are more likely to get hematogenous UTIs?
FIV+ cats
If a dog presents with a hematogenously acquired UTI, what condition should you look for?
Bacterial endocarditis
What is the drug typically used when treating an uncomplicated UTI empirically?
Amoxicillin and cephalosporins for 10-14 days
What are complicated UTIs typically associated with?
Relapse, reinfections, or resistant organisms
Are cultures necessary in complicated UTIs?
Yes
What classifies a UTI as a reinfection or a superinfection?
When culture reveals a new or different/altered organism
When should a C/S be repeated in a typical UTI?
7 days after completion of treatment
What kind of infection should be suspected if an animal is C/S positive >7 days after the last treatment?
Reinfection
What kind of infection should be suspected if an animal is C/S positive at day 7 after STARTING antibiotics?
Superinfection
What classifies an infection as a relapse UTI?
The same organism or strain 7 days after the last treatment
What is typically the reason for a relapse infection?
Inappropriate drug use- dosage, frequency, or duration
What renal is often implicated with multiple relapsing UTIs?
Pyelonephritis
What are some things that can predispose an animal to a UTI?
- Anatomical abnormalities
- Voiding abnormalities
- Upper UTI
- Endocrine disease
- Repro disease/infection
- Immune compromise
- Iatrogenic diuresis
What should you look at if you have a recurrent UTI?
What is causing it and antimicrobial history
What can be done to determine cause of a recurrent UTI?
- Imaging
- Culture
- Underlying disease screening
- Finding a nidus
Why should antimicrobial history be reviewed in recurring UTI cases?
To make sure that the appropriate therapy was given and determine owner compliance
How long should recurrent UTIs be treated for?
at least 4-6weeks
When should prophylactic therapy be administered to a UTI case?
Once a recurrent infection has been eradicated as a last resort
What is the typical prophylactic therapy?
Once daily at night at 30-50% of original dose for 6mo
Choose a drug that has high urine concentration and few side effects
How long should animals be monitored after prophylactic therapy?
3 months after resolution with regular cultures
What are some alternative therapies in recurrent UTI cases?
Cranberry extract
Probiotics
Polysulfated glycosaminoglycans
Fosfomycin (resistant E. coli)
What fungus do we typically find in UTIs?
Candida
What kind of animals do we find fungal UTIs in?
Underlying disease
Diabetes or cushings most commonly