Topic 37 - Physical and additional examination of the urinary system. Abnormalities of urination. Flashcards
We have lower and upper urinary tract, what is part of the upper urinary tract?
kidneys
We have lower and upper urinary tract, what is part of the lower urinary tract?
Bladder
Urethra
Prostate (male dog)
Examination steps of the kidneys:
Anamnesis
Clinical exams: Physical + additional
Additional exams for kidneys:
are almost always needed because anamnesis and physical findings are generally nonspecific
Name some symptoms that are typically seen in kidney disease:
Oliguria, anuria
Anorexia
Apathy, weakness
Dehydration
Anaemia
CNS signs
Respiratory signs
GI signs: vomiting, diarrhoea
What is oliguria?
Less urine than 1 ml/kg/hour
What is polyuria?
More urine than 50ml/kr/day
Findings during physical exam, indicating kidney disease:
- Poor body condition
- Dehydration
- Anaemia
- Oral diseases: ulcers, gingivitis, halitosis
- Palpate kidneys!!
What is halitosis?
Uremic breath
Name some specific signs of kidney disease found in advanced cases:
- Halitosis
- Uremic ulcers
- Abnormal kidneys upon palpation
Which kidney(s) is palpable in dogs?
Only left!!
Which kidney(s) is palpable in cats?
Both
Parameters to describe the findings of the kidneys:
location
size
shape
relation to their neighborhood
painfulness
surface
consistency
structure
(symmetry)
Normal description of renal palpation in CAT:
Bean shape
Cherry like size
Surface is smooth
Not painful
Firm consistency
Slightly movable
Homogenic structure
Symmetric
Causes for enlarged kidney:
- renal disease
- Renal tumour
- Viral infections in cat
- ## polycystic kidney disease (PKD)
Causes for small kidneys:
Renal fibrosis
Renal dysplasia
Causes for pain upon palpation:
- acute nephritis
- kidney stones
- tumor
- pyelonephritis
Laboratory test to check the glomerular function:
GFR = Glomerular filtration rate
Urinary protein
What is the function of Glomeruli?
network of blood vessels that are the “cleaning units” of the kidney
How can we check the GFR?
Urea, Creatinine
SDMA = Symmetric dimethylarginine
How to check for proteinuria?
= High levels of protein
- Dipstick
- UPC: Urine protein/creatinine ration
- MAU: Microalbumin
ALWAYS check the sediment: matter on the bottom
How to check the tubular function?
- Specific gravity
- Refractometer: same scale in dog and cat
- Dip stick is unreliable
Name the abnormal findings we can have in specific gravity:
HYPOstenuric
ISOstenuric
HYPERstenuri
Normal specific gravity in dogs and cats:
Dog: 1013-1029
Cat: 1013-1034
HYPOstenuric values:
1007
ISOstenuric values:
Often found in dogs with CRF = Chronic Renal Failure
1008-1012
HYPERstenuric values:
Dog: Above 1030
Cat: Above 1035
Important steps to recieve a proper diagnosis:
- Fasted, well hydrated animals
- Urinalysis: specific gravity and protein
- US
(4. Cytology or biopsy - sometimes!!)
Name problems/causes related to urination:
- Dysuria = painful urination
- Stranguria = painful, SLOW urination
- Hematuria = blood in urine
- Pollakiuria = Frequent, abnormal urination
- Incontinence = cannot control the urination
- Periuria = Urination in places where they’re not supposed to
What are the first steps in examination of lower urinary tract problems?
- Urinary bladder size, tone and compressibility - Catheterization in case of suspected obstruction
- Complete physical exam, to check for other diseases
Examination method of urinary bladder:
Inspection
Palpation
Parameters to examine for the bladder:
Size
Shape
Painfulness
Surface
Location
Abnormal findings
(wall thickness + content)
Size of the bladder:
- empty
- moderately filled
- full
- dilated
Abnormal findings in the urinary bladder:
Dilation = Acute or chronic
Pain = cystitis, stones
Abnormal surface = tumour
Thickened wall = tumour, cystitis
Differentiate acute and chronic dilation of the urinary bladder:
Acute = overdistended, turgid, firm, urinary bladder that cannot be expressed
Chronic = flaccid
Additional examination of the lower urinary tract
- Rectal examination
- Catheterization
- Diagnostical imaging: contrast
- Urinanalysis (ALWAYS NEEDED)
Examination methods of male urethra:
Rectal examination: Palpation
Examination of the perineum: inspection, palpation
Examination of prepuce and penis: Inspection, catheterisation
Examination methods of female urethra:
Vaginal examination: inspection, palpation, catheterization
Examination methods of prostate in male dogs:
Palpation
X-ray, US
Urinalysis
Examination of prostatic fluid
Cytology, biopsy
