Pu/Pd toolkit Flashcards

1
Q

BRIEF EXPLANATION OF PATHOPHYSIOLOGY OF PU/PD?

(PD = >100ml/kg/day (dog))

(PU = >50ml/kg/day)

A

Loss of functional nephrons → inability to concentrate urine → polyuria → polydipsia.

Found in CKD and less commonly in AKI.

  • *Polyuria due to inability to concentrate urine. Four main mechanisms:**
    1. Lack of ADH secretion
  1. Lack of response to ADH
  2. Osmotic diuresis (losing more water than conserving, water is being drawn into the tubules)
  3. Primary polydipsia (rare)
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2
Q

BRIEF EXPLANATION OF PATHOPHYSIOLGY OF Oliguria?

A

Oliguria

(reduced urine output: <0.5 mL urine/kg/hour)

Found most commonly in AKI:

Nephrons are damaged at different sites (glomerulus, tubular cell, intercellular junction, basement membrane) depending on etiology → acute decline in glomerular filtration rate → increased urea/creatinine, decrease in urine specific gravity → uraemic signs, oliguria (sometimes anuria or polyuria), fluid and electrolyte imbalances, acidosis

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3
Q

Briefly explain the pathophysiology of Straining (stranguria)?

A

Obstruction in the urinary tract which interferes with the flow of urine and causes irritation

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4
Q

Briefly explain the pathophysiology of Blood in urine (haematuria)?

A

Irritation to the mucosa of the urinary tract caused by obstruction, urolithiasis or bacterial infection (cystitis)

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5
Q

Briefly explain the pathophysiology of Reduced appetite or anorexia associated with PU/PD?

A

Due to uraemia = Polysystemic toxic syndrome resulting from severe azotemia due to decreased renal function. Azotemia is an increased concentration of non-protein nitrogenous compounds, eg urea and creatinine, in the blood.

Retention of waste products → toxemia (uraemia)→ catabolism of body tissues → anorexia

Can also be due to oral ulceration.

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6
Q
A
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7
Q

Briefly explain the pathophysiology of oral ulcers in PU/PD?

A

Result of uraemia

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8
Q

Briefly explain the pathophysiology of weight loss in PU/PD?

A

Sign of CKD

Uraemia causes a reduced appetite/anorexia, which leads to weight loss if persistent

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9
Q

Briefly explain the pathophysiology of Lethargy and weakness in PU/PD?

A

Associated with uraemia

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10
Q

Briefly explain the pathophysiology of Vomiting in PU/PD?

A

Associated with uraemia

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11
Q

Briefly explain the pathophysiology of Incontinence (urinating in the house/in their bed at night) in PU/PD?

A

Increased volume of urine in the bladder leads to increased urgency and incontinence

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12
Q

History – list specific questions you would ask the owner if you were suspicious of urinary tract disease?

A

How much is he drinking on a daily basis?

Are they urinating more/less often?

Have they started urinating in the house/in a different place to normal (cats in terms of litter trays)?

Are they obviously straining when they go to the toilet?

Noticed any blood in the urine?

What colour is the urine?

Are they licking at their genital area?

Any change in diet recently?

How is their appetite?

How are they in themselves? Lethargic/quiet?

How long have the signs been going on?

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13
Q

List common differentials for URT disease in the horse?

A

Renal neoplasia

CKD/renal failure

AKI (ischaemia, CRGV, thromboembolism, trauma)

Polycystic disease

Developmental abnormality

Glomerulonephritis

Renal tubular acidosis

Uroliths

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14
Q

List common differentials for URT disease in the cat?

A
  • Renal neoplasia
  • CKD/renal failure
  • AKI (ischaemia, CRGV, thromboembolism, trauma
  • Fanconi syndrome
  • Polycystic disease
  • Perinephric/perirenal pseudocyst
  • Developmental abnormality
  • Uroliths
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15
Q

List common differentials for URT disease in the dog?

A
  • Renal neoplasia
  • CKD/renal failure
  • AKI (ischaemia, CRGV, thromboembolism, trauma)
  • Fanconi syndrome
  • Polycystic disease
  • Pyelo/hydronephritis
  • Developmental abnormality
  • Uroliths
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16
Q

List common differentials for URT disease in the ruminant?

A
  • Renal neoplasia
  • AKI (ischaemia, CRGV, thromboembolism, trauma)
  • Pyelo/hydronephritis
  • Developmental abnormality
  • Uroliths
17
Q

List common differentials for Lower urinary tract disease in the cat?

A
  • FLUTD

If no abnormalities are identified consider a purely behavioral problem. However, if cat is currently asymptomatic repeat investigation when the cat is symptomatic.

Many cats which are believed to have a behavioral problem have a history of FLUTD in their past.

  • Urolithiasis
  • Cystitis
  • Neoplasia
  • Behavioral abnormalities resulting in urine marking Indoor marking.
  • Trauma.
  • Coagulopathy.
18
Q

List common differentials for Lower urinary tract disease in all other species?

A

Lower Urinary Tract Disease Ddx

  • Cystitis
  • Bladder diverticulum
  • Urolithiasis
  • Neoplasia: bladder, ureter
  • Lower urinary tract obstruction
  • Diabetes mellitus
  • Hyperadrenocorticism
  • Chemotherapeutic agents: (cyclophosphamide causes sterile hemorrhagic cystitis).
  • Urethral dysfunction, bladder dysfunction.
19
Q

List differentials for Hematuria?

A

Trauma: bladder rupture

Neoplasia: Ureter, Bladder, Urethra

Clotting disorders

Renal hemorrhage (idiopathic, renal neoplasia, trauma).

Prostatic disorders: benign hyperplasia and hypertrophy, abscessation ,cyst, neoplasia.

20
Q

List differentials for tenesmus?

A

Colon disease

(Peri-)anal or rectal disease: Perianal fistula, Anal sac impaction, Anal sacculitis, constipation or obstipation.

Prostate disease: (See above)