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3. Cat & Dog 2 > Oakley stones 1 > Flashcards

Oakley stones 1 Flashcards

1
Q

etiology of bladder stones

A
  • Several theories
  • Supersaturation of urine with minerals
  • Formation of crystals
  • Decrease inhibitors of crystalisation
  • Aggregation of crystals
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2
Q

simple vs mixed vs compounds stones

A

Simple stone
* No nidus or shell,
* ≥ 70% of one type of mineral
<><>
Mixed
* < 70% of one mineral
<><>
Compound
* Nidus or stone with ≥ 1 surrounding layers of different mineral composition

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3
Q

how common are different types of stones? what is most common, generally?

A
  • 85-91% : struvite & calcium oxalate
  • Calcium Oxalate 42-45%
    > 98% (Fe) and 50% (Dog) of upper calculi
  • Struvite 43-44%
  • Purine 5%
  • Calcium Phosphate 1%
  • Cystine 1 % (recently doubled)
  • Silicate <1%
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4
Q

Epidemiology of Canine Urolithiasis
most common types in female vs male dogs?

A

Female dogs : struvite uroliths
Male dogs : oxalate, cystine

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5
Q

Epidemiology of Canine Urolithiasis
more common stones in younger cats and dogs?

A

Younger dogs : Struvite > oxalate
Young cats: urate

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6
Q

what are the most common stone types in canada?

A
  1. calcium oxalate 49.5%
  2. struvite 35.5%
  3. urate 3.4%
  4. calcium phosphate 2%
  5. silicate
  6. cysteine
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7
Q

which type of stones tend to be found in kidneys, ureter, bladder?

A

Kidneys:
- calcium oxalate
- silicate?
<><>
Ureter
- silicate?
- dried solidified blood
<><>
bladder, lower system
- cysteine
- suture
- struvite
- urate
- xanthine

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8
Q

Major Complaints due to bladder stones

A
  • Pollakiuria
  • Stranguria
  • Hematuria
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9
Q

stones - what might we find on physical exam?

A
  • Stone may be felt at the bladder palpation
    • /- tense abdomen
  • Rectal examination: some stones palpable in urethra
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10
Q

bladder stone differentials

A
  • Urinary tract infection (UTI)
  • Urolithiasis
  • Cystitis
  • Tumor
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11
Q

abdominal radiographs for stones, pros and cons
- radiolucent stones
- other techniques that can help here?

A

Pros
* Can measure and count stones
* Can look at urethra
* Rule out kidney and ureteral stones
Cons
* Radiolucent Stones: urate and cystine
* (“I Can’t see yoU”)
* Less true with digital radiographs
<><><><>
* Contrast radiographs can help us
- ultrasound is better as we can see all stone types

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12
Q

abdominal ultrasound for uroliths pros and cons

A

pros
- all stones visible
<><>
cons
- Can not count or measure them
- Urethra not seen

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13
Q

What can help guesstimating the type of urolith?

A
  • Crystals
  • Urine pH
  • Shape
  • Breed
  • Underlying disease
  • UTI
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14
Q

urinalysis - what do we see with uroliths?

A
  • Hematuria and proteinuria common with stones
  • Bacteriuria and pyuria common with struvite and urate stones
  • Crystals?
  • pH?
  • Urine Specific Gravity (USG)?
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15
Q

Does the presence of crystals indicate the presence of stones?

A

NO

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16
Q

the presence of crystals in urine depends on what?
- how should we treat our sample to best see them?
- significance?

A

Depend on many factors
* In vivo: diet, infection
* In vitro: duration of urine storage, temperature, pH, contaminants
* Iatrogenic causes: Radiocontrast media, allopurinol
<><><><>
* Use fresh urine sample
* Avoid refrigeration
* Rarelly clinically significant

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17
Q

Types of Uroliths and Urine pH that they form in (acid vs alkaline)
- important consideration for this when trying to deduce type in clinic?

A

Acid pH (<7)
- cystine
- silicate
- acid uric
- calcium oxalate
<><><><>
Alkaline pH (>7)
- Struvite
- Calcium phosphate
- Ammonium urate
<><><><><><><><><>
pH at stone formation vs pH at visit

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18
Q

Cystine uroliths- Particularity in who?

A
  • Males(98%)
  • Except Newfoundland
    > Young/both genders
    > Nephroliths+++
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19
Q

cystine stone geography

A
  • 1-2% in NA
  • 8-26% in Europe
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20
Q

Silicate stones - predisposing causes in environment?

A
  • Soil
  • Soybean Hull
  • Rice hull
  • Corn gluten feed
  • Homeopathy
  • +++ Kenya
21
Q

Urate Stones and Genetics
- what breeds and why

A
  • dalmations (2/3), english bulldogs, black russian terriers
    <><><><>
    Dalmatians
  • Autosomal Recessive Gene
  • Missense mutation SLC2A9
  • Urate transporter
  • All dalmatians homozygous
  • 25% of males have stones
    <><><>
    Non-Dalmatians
  • Same mutation BUT no hepatic dysfunction
22
Q

Cystine Stones and Genetics
- what breeds and why?
- is there anything we can do to avoid issues?

A

Newfoundland, Landseer
- Autosomal Recessive Gene
- Missense mutation SLC3A1
<><><>
Labrador Retriever
- Different mutation of SLC3A1
<><><>
Australian Cattle dog, Border Collie, Mini Schnauzer
- Different mutation of SLC7A9
<><><><><><><>
BREED SPECIFIC MUTATION TEST Detects cystinuric AND asymptomatic carrier

23
Q

Cystine Stones and Genetics in Cats

A
  • Recent reports:
  • SLC3A1 mutation in 1 cat
  • SLC7A9 gene variants in 4 cats
24
Q

exam?
Androgen- dependent type III Cystinuria
- what is this condition?
- who gets it? when? signs?
- genes?

A
  • Detected later in life
  • Less severe clinically
  • ONLY MALES
  • Castration lower cystine excretion
  • No gene mutation identified
    <><>
    Preliminary test to identify dogs at risk of stone formation being evaluated….
25
Q

Predisposing Conditions for Stones dogs

A
  • hyperadrenocorticism
    > calcium oxalate
    <><>
  • hyperparathyroid
    > calcium oxalate, calcium phosphate
    <><>
  • portal anomaly
    > urate
    <><>
  • hematuria
    > dried solidified blood
    <><>
  • UTI
    > struvite
26
Q

what factors can lead to xanthene uroliths

A

Diet high in purine (meat based)
+
allopurinol

27
Q

what 5 of recurrent stones are suture induced

A

~ 9.5 % of recurrent stones are suture induced

28
Q

can weight affect urolith formation?

A

obesity is. apredisposing factor

29
Q

Struvite and Urinary Tract Infection
- what is the connection?

A
  • In dogs: struvite secondary to alkaline urine caused by Urease- producing bacteria
30
Q

Sterile Struvite - urine pH? infection?

A
  • Alkaline urine
  • No infection
31
Q

Likely Struvite if we see these 4 things:

A
  • female dog
  • UTI
  • struvite crystals
  • alkaline urine
32
Q

likely ammonium urate if we see these things

A
  • PSS
  • Dalmation or English Bulldog
33
Q

Likely Calcium Oxalate if we see these 3 things

A
  • acidic urine
  • schnauzer
  • male
34
Q

when should we treat uroliths? - depends on what?

A

Depends on
* Clinical signs > Only treat if clinical signs!
* Location of the stones
* Type of stones
* Presence of discomfort or obstruction requiring immediate removal

35
Q

treatment for kidney stones?

A
  • Do NOTHING
    > High morbidity and mortality rate with kidney surgery
  • Unless obstruction, or recurrent infection or pain
  • If obstruction
    > Dogs: ureteral stents
    > Cats: subcutaneous ureteral bypass
36
Q

options for treatment of uroliths

A

Medical
> dissolution
<><>
Removal
> surgery
> minimally invasive

37
Q

medical urolith dissolution
- goals
- efficacy

A

Goal
* ↓ concentration of calculogenic salts
* ↑ urine volume
<><>
Efficacy
* High for struvite in dogs and cats
* moderate for urate and cystine in dogs

38
Q

medical urolith dissolution disadvantages, contraindications

A

Disadvantages
* Owner compliance
* Cost of medical dissolution ≈ surgical treatment
* Low efficacy for nephro/ureteroliths
<><><>
Contra-indications
* Obstruction
* Large solitary urolith filling the bladder
* Comorbidities

39
Q

Treatment based on type of stone and location - reccomendations for:
* Bladder stones and likely struvite
* Bladder stones and likely NOT struvite
* Obstructive urethral stones

A
  • Bladder stones and likely struvite
    > Dissolution= 1st choice unless lots of
    pain
  • Bladder stones and likely NOT struvite
    > Removal of stones
  • Obstructive urethral stones
    > Urgent removal
40
Q

Does the size of the stone affect the success of medical dissolution?

A

B.No

41
Q

Treatment Plan for Struvite

A
  • Hill’s s/d (acidifying diet) or Royal Canin Urinary S/O
  • Small meals throughout the day (avoids alkaline tide)
  • Antibiotic treatment (amoxicillin or based on sensitivity)
  • Recheck after 2 w and then every 4 w
    > Radiographs : size of the stone
    > Urinalysis : pH, USG, crystals??
    > Urine culture
42
Q

Struvite Uroliths - hills urinary diet > how fast does it work? how does it work?
- how long should we continue with it?
- when is it not great?

A
  • Dissolved by Hill’s s/d in 8-10 weeks
    > Markedly restricted in P, Ca,
    Magnesium diet
    > High salt content → more acidic urine
  • Continue ≥ 1 month after calculi no longer visible on radiographs
  • Recheck urine culture 4 weeks after
  • Limitations of the diet
    > Not effective if UTI persists or if ureteroliths or nephroliths
43
Q

Contra- indications Medical Dissolution

A
  • Restricted protein content
    > Pregnant or lactating female, growing animals or after a surgery
  • High salt content
    > Congestive heart failure, hypertension or nephrotic syndrome
  • High fat content
    > Risk of pancreatitis in miniature schnauzers
44
Q

When can we stop antibiotics for a urolith?

A

The antibiotics should be continued throughout the course of the medical dissolution treatment
- this may change in the future

45
Q

When can we stop s/d diet in dogs?

A

C. 1 month after we can not see any stone on radiographs

46
Q

Is it necessary to maintain an acidifying diet life long to prevent struvite in dogs ?

A

No

47
Q

Is it necessary to maintain an acidifying diet life long to prevent struvite in cats?

A

YES (vs no for dogs)
> alkaline pH problem in cats, we don’t know why

48
Q

Prevention of Struvite Recurrence

A
  • Eradication /prevention of UTI
    > Based on the results of urine culture and sensitivity findings
  • Maintaining acidic urine in cats
    > Hill’s c/d = good maintenance diet
    <><>
    ↑ water consumption
  • Canned diet (>70% moisture)
  • Water fontain, flavoring water
  • Several bowls of water
  • Several meals per day
  • Late meal late
    <><>
    Maintain
  • USG < 1.020 in dogs
  • USG < 1.045 in cats
    <><>
  • Monitor urine pH and sediment- MAKE OWNER BUY A REFRACTOMETER
49
Q

Reevaluation of the Patient after urolith - when to recheck? what to do if no improvements after 2 months?

A
  • Recheck every 2 weeks: UA +/- Urine culture, rads or US
  • If no dissolution after 2 months
    > Owner compliance, persistent UTI, and urolith type?
    > Surgical removal should be considered

3. Cat & Dog 2 (50 decks)

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