Special pathology - lower urinary tract Flashcards
hematuria
Blood in your urine
stranguria
slow, painful urination or straining to pass urine
pollakiuria
means frequent, abnormal urination during the day
Urolithiasis (syndrome):
familial, congenital, or
acquired pathophysiological factors
that, in combination, progressively increase the risk of
precipitation of excretory metabolites in urine to form stones
name the 5 most commmon uroliths found in dogs
struvite
calcium oxalate
urate
cystine
silica stones
most common type of uroliths in dogs
struvite
define lithotripsy
a treatment using ultrasound shock waves, by which a kidney stone or urolith is broken into small particles that can be passed out by the body
what breed of dog is most prone to urate stones?
dalmations
+ dogs with congenital portosystemic shunts
what type of diet is recommended for dogs wtih urate stones?
urine alkalinization via a low purine, low protein diet and specifically either wet food, watered kibble or added salt to encourage water intake for urine dilution
cystinuria
renal amino acid reabsorption defect of amino acid cystine
can form stones if cystine concentrations high
cystine cysteine difference
cysteine is an amino acid while cystine forms when two amino acids join together via a disulfide bond
so cystine is a dimer of cysteine
LUTS =
Lower urinary tract signs
periuria
urinating outside the litter-box and in unusual or inappropriate places
what is contrast urethrocystography
to determine the structure and possible disorders of the urinary bladder and the urethra
remains the method of choice to determine presence of rupture of the excretory pathway particularly in trauma cases
uses contrast that is administered either iv, or retrograde into teh bladder/urethra
Crystalluria is
the presence of crystals in urine
May be insensitive and unreliable because urine samples can crystalize with time.
Name 3 types of Radiopaque uroliths
Radiopaque:
calcium oxalate
calcium phosphate
silica
Name 1 type of moderately Radiopaque uroliths
struvite
Name 3 types of Radiolucent uroliths
radiolucent = transparent to X-rays. Radiolucent structures appear dark or black in xrays.
cystine
urate
xanthine
urolith composition prediction can be bcased on what 4 factors
survey radiography
breed
crystal identification on microscopy
urine pH
2nd most common type of canine urolith after struvite
calcium oxalate
most common 2 types of feline uroliths
struvite most common
2nd most common, calcium oxalate
so same as in dogs
Struvite stones composition
magnesium ammonium phosphate
The majority of struvite uroliths form as a consequence of
urinary tract infection (UTI) with bacteria that produce
urease.
Sterile struvite uroliths can be dissolved how?
with therapeutic foods through urine acidification
hypercalciuria could produce what type of uroliths?
Calcium Oxalate (CaOx)
What does it mean when struvite stones are described as sterile?
It means they form without a bacterial infection.
what are oxalates
a salt or ester of oxalic acid.
Oxalate is a natural product of metabolism in the body.
It should leave your body through your urine. If your oxalate levels are too high, the extra oxalate can combine with calcium to form kidney stones.
2 main causes of Urate Uroliths
- an inherited alteration of the urate transporter
(encoded by the SLC2A9 gene) - hepatic portovascular anomalies
hyperuricosuria is
excessive amounts of uric acid in the urine.
Uric acid is a product of the metabolic breakdown of purine nucleotides, and it is a normal component of urine.
How to minimize urate urolith recurrence (4-5)
decrease hyperuricosuria by
reducing purine intake
increasing urate solubility
in dogs with portovascular anomalies-complicated:
sufficient water and urine alkalization
how does allopurinol affect urate stones
Allopurinol is in a class of medications called xanthine oxidase inhibitors.
It works by reducing the production of uric acid in the body.
cystine stones caused by
rare inherited disease,
failure of renal tubular reabsorption of cystine
To minimize cystine urolith recurrence: (4)
to increase fluid consumption
limit animal protein intake
limit sodium intake
alkalinize urine
what is tiopronin
is a medication used to control the rate of cystine precipitation and excretion in the disease cystinuria
FLUTD
Feline lower urinary tract disease is an umbrella term that
describes the spectrum of disorders affecting the urinary
bladder or urethra in cats.
FIC
feline idiopathic cystitis
FIC is a diagnosis of exclusion
most common cause of FLUTD and lower urinary tract signs/LUTS
5 classic LUTS in cats
LUTS = Lower urinary tract signs
Pollakiuria
Stranguria
Periuria
Dysuria
Hematuria
anxiopathy is
pathology resulting from chronic activation of
the central threat response system (CTRS)
meaning a disease caused by overstimulation of the body’s stress response system.
such as in FIC - feline idopathic cystitis
What is a urine plug in cats?
Feline urethral plugs are a common cause for urethral obstruction in the male cat.
Typically, plugs contain mineral and organic matrix (e.g. inflammatory reactants, mucus, blood, sloughed tissue).
most common mineral composition of feline urinary plugs
struvite at 92%
obstructive FLUTD patient main points for care (3)
Stabilization -> ICU patients
Analgesia with opioids!
prevention of Urethral spasms
describe a Disorder of storage Disease of abnormal micturition
normal bladder pressure but inability to maintain adequate urethral tone
aquired disorders of urinary storage (3)
uretheral sphincter mechanism incompetence
lower motor neuron bladder
overactive bladder
Uretheral sphincter mechanism incompetence
Reduced muscle responsivness, tone and changes in the
periurethral tissues.
Typically problem of female dogs after spaying due to reduction in estrogen, increases in FSH and luteinizing
hormone.
The presence of urinary incontinence in an otherwise healthy neutered female dog that was previously continent is often adequate for presumptive diagnosis of
USMI and a trial of empirical therapy.
urethral sphincter mmmechanism incompetence
what is Lower motor neuron bladder
usually occurs secondary to spinal cord injury or disease
easily expressible bladder. requires intermittent catheterization or manual expression by the
owner.
treatment:
correction of the underlying lesion may lead to some
return to normal function
muscarinic agonist bethanechol
potential Reasons for The inability to completely empty the bladder during a normal void: (3)
result from either a functional or mechanical obstruction of
the outflow tract and urethra
an abnormality of the detrusor muscle, which would impair
the bladder’s contraction
Overflow incontinence can result from the lack of complete
emptying, often when the animal is at rest.
Detrusor Atony is
is bladder atony and is often associated with weakened
urethral tone.
Direct damage to the detrusor muscle can occur from
overdistension due to mechanical or functional outflow
obstruction.
Detrusor urethral dyssynergy is
abnormality in the reflex arc that normally allows the
urethral sphincter to relax at the initiation of urination.
Also called a Functional urethral obstruction.
give an example of a Functional urethral obstruction
Detrusor urethral dyssynergy
Clinical signs:
are similar to those of mechanical obstruction
Treatment of the hypertonic urethral sphincter such as in Detrusor urethral dyssynergy
alpha-adrenergic blockade with prazosin
alpha1-specific antagonist-effects on both the internal and
external urethral sphincter
Upper Motor Neuron Bladder is
a syndrome in which Spinal cord lesions cranial to the sacral segment cause difficulty in bladder emptying
e.g. often secondary to IVDD and associated paresis
After Treatment of the underlying lesion, partial or complete return to normal voiding function after days to weeks.
Until normal voiding resumes, the patients are managed:
with alpha-adrenergic blockade
manual expression or catheterization
