Urinary Emergencies

Question 1

What structures make up the lower urinary tract?

Answer 1

(Bladder, urethra, +/- caudal ureters)

Question 2

(T/F) If an animal has a urinary obstruction and a UTI, it is possible the UTI caused the obstruction.

Answer 2

(F, UTI is more likely to be a secondary issue)

Question 3

What are some common diseases that cause urinary obstruction?

Answer 3

(Idiopathic cystitis, urolithiasis, and lower urinary neoplasia)

Question 4

What are some common diseases that cause non-obstructive lower urinary disease?

Answer 4

(Idiopathic cystitis, urolithiasis, lower urinary neoplasia, and UTIs)

Question 5

UTIs are very uncommon in cats when compared to sterile cystitis unless…..

Answer 5

(They have a comorbidity)

Question 6

(T/F) Urinary obstructions are a life threatening emergency.

Answer 6

(T, they’ll die within a few days)

Question 7

Both obstructive and non-obstructive lower urinary tract diseases are associated with pollakiuria, stranguria, dysuria, inappropriate urination, hematuria, and/or pyuria; how can you use clinical signs to tell them apart?

Answer 7

(Obstructive urinary tract dzs are more likely to have systemic dz (and will get worse the longer the obstruction goes untreated); this finding is not expected with non-obstructive urinary tract dzs)

Question 8

When a patient is arriving for what you suspect is lower urinary tract disease based on the owner’s complaints, what is the first question you want to answer that will determine the order of your next steps?

Answer 8

(Whether the animal is obstructed or not)

Question 9

What is the most useful diagnostic test for a UTI?

Answer 9

(Urine culture, sample should be obtained via cystocentesis)

Question 10

What is the purpose of radiographs in a lower urinary tract dz case?

Answer 10

(To look for urolithiasis (radio opaque stones are the more common stones seen so that’s useful))

Question 11

What can you use ultrasound to look for in a lower urinary tract dz case?

Answer 11

(Look for radiolucent uroliths, masses, clots, free fluid, and dilated ureters or kidneys)

Question 12

Hypervolemia/hypovolemia (choose), hyperkalemia/hypokalemia (choose) and signs of shock (hypothermia, weak pulses, etc.) are common findings with obstructive urinary tract dz.

Answer 12

(Hypovolemia and hyperkalemia)

Question 13

Why is heart rate not a reliable marker for clinical status in potentially urinary obstruction patients?

Answer 13

(Bc hyperkalemia could be masking tachycardia)

Question 14

What procedures/treatments are involved in the stabilization of a patient with a urinary obstruction?

Answer 14

(IV catheter placement, fluid therapy, hyperkalemia therapy, pain management/sedation, and unblocking)

Question 15

Why is LRS better for the kidneys?

Answer 15

(It is balanced which means lower in chloride which can be not optimal for injured kidneys)

Question 16

What is the purpose of administering calcium gluconate to an urinary obstruction patient with hyperkalemia?

Answer 16

(Stabilize the electrical activity in the heart by restoring the difference between the resting and threshold potentials)

Question 17

(T/F) Calcium gluconate is used to lower the concentration of potassium in the blood of a hyperkalemic patient.

Answer 17

(F, calcium gluconate has no effect on potassium concentration)

Question 18

What are some drugs that can be administered to drive potassium into cells in hyperkalemic patients?

Answer 18

(Insulin and dextrose (dextrose can be used alone), bicarbonate, and methylxanthine bronchodilators (terbutaline, aminophylline, and albuterol))

Question 19

Besides driving potassium into cells, how else can you treat hyperkalemia in a urinary obstruction patient?

Answer 19

(Increase potassium excretion → unblock and give fluids)

Question 20

Why are opioids, benzodiazepines, and NMDA receptor antagonists some of the pain medications of choice for urinary obstruction patients?

Answer 20

(They are cardiovascular sparing drugs which is important for obstruction patients)

Question 21

(T/F) The unblocking procedure for urinary obstructions should be sterile.

Answer 21

(T)

Question 22

What is the normal output of urine in small animal patients?

Answer 22

(1-2 ml/kg/hr, usually obstruction patients have kidney injury so will be polyuric and will need to be monitored for that and return to normal and need to make sure matching losses with fluids)

Question 23

The ideal length of time to leave a u-cath in for inflammation cases is unknown but ideally it would be after what is attained?

Answer 23

(Normal urine output is attained)

Question 24

(T/F) It is incredibly rare, like close to 0%, for a male cat with idiopathic cystitis to have a concurrent UTI.

Answer 24

(T)

Question 25

(T/F) Idiopathic cystitis does not equal blocked.

Answer 25

(T)

Question 26

What is the treatment for feline idiopathic cystitis?

Answer 26

(Time (and providing comfort via pain meds, anti-anxiety meds))

Question 27

What types of stones should be considered in young, toy-breed dogs?

Answer 27

(Urate stones resulting from PSS)

Question 28

When is dissolution of stones not a viable option for treatment of urolithiasis?

Answer 28

(When an animal is blocked)

Question 29

What blood work values can be compared to abdominal effusion to aid in diagnosing a uroabdomen?

Answer 29

(Creatinine and/or potassium (if abdominal effusion potassium is 40% higher = uroabdomen, if abdominal effusion creatinine is 2x = uroabdomen))

Question 30

(T/F) BUN is not a marker that should be used for diagnosing a uroabdomen.

Answer 30

(T)

Question 31

What diagnostic tool will help you to determine if a bladder injury that is causing a uroabdomen can be managed medically versus needing surgery?

Answer 31

(Contrast radiography)

Question 32

(T/F) Azotemia is an elevated BUN and/or creatinine.

Answer 32

(T)

Question 33

What are the common causes of prerenal azotemia and how are you sure it is prerenal?

Answer 33

(Causes are dehydration and/or hypovolemia, urine should be concentrated appropriately)

Question 34

Pair the following patient descriptors with acute versus chronic azotemia: - Feeling sick with mild to moderate azotemia - Anemic - Good MCS - Small, irregular kidneys - Not anemic - Stable with moderate to severe azotemia - Painful and/or enlarged kidneys - Poor MCS

Answer 34

- Feeling sick with mild to moderate azotemia (Acute) - Anemic (Chronic) - Good MCS (Acute) - Small, irregular kidneys (Chronic) - Not anemic (Acute) - Stable with moderate to severe azotemia (Chronic) - Painful and/or enlarged kidneys (Acute) - Poor MCS (Chronic)

Question 35

You have a small urine sample from what you suspect is a patient with an acute kidney injury that can only be used for two of the following tests, which would you choose? - Culture - UPC - UA - USG

Answer 35

(Culture and USG, complete UA is great but USG and culture are top priority)

Question 36

(T/F) There is such a thing as too much fluids in an acute kidney injury case.

Answer 36

(T, bc the kidneys will have to get rid of the extra water you are giving the patient, that’s making them work overtime while already injured = further injury)

Question 37

If there is no underlying cause of an acute kidney injury, what is the treatment?

Answer 37

(Supportive care and time = maintain hydration but do not overhydrate, treat hypertension as/if it occurs, monitor urine output, manage pain and nausea with meds, and provide nutritional support)

Question 38

Providing maintenance fluids to an AKI patient that is anorexic/hyporexic may vary depending on what?

Answer 38

(The degree of polyuria or oliguria the patient has, more fluids are need for polyuria, less fluids are needed for oliguria)

Question 39

(T/F) In an AKI patient, though they may not have any PE changes that indicate dehydration, you can assume they are ~5% dehydrated.

Answer 39

(T → most patients that are presented for acute onset of azotemia have some degree of prerenal component)

Question 40

You have an AKI patient that is now showing signs of fluid overload but that is still only producing 0.5 ml of urine every 2 hours, is a diuretic an appropriate treatment for treatment of the fluid overload?

Answer 40

(Yes, diuretics in AKI patients may lead to worse outcomes if given to a patient that is NOT fluid overloaded, but they are an appropriate and advisable choice in a fluid overloaded patient who will not be able to urinate fast enough to fix it d/t oliguria)

Question 41

What are the two administration options for supplemental at home fluids in CKD patients?

Answer 41

(Subq fluids or esophagostomy tube)

Question 42

What are the pros and cons of at home subq fluids for tx of dehydration in CKD patients?

Answer 42

(Pros → easy, inexpensive initially; cons → excess salt (have to use an isotonic fluids for subq fluids), patient tolerance, and client abilities)

Question 43

What are the pros and cons of at home fluids given via an esophagostomy tube?

Answer 43

(Pros → more physiologic (no extra salt, can literally use tap water), can adm meds easier, improved patient tolerance, and ease of administration; cons → requires general anesthesia, increased up-front cost, potential complications (stoma infection, dislodgement of tube, esophageal stricture))

Question 44

Why are phosphorus binders included in treatment of CKD patients?

Answer 44

(Phosphorus clearing is dependent on GFR which is decreased with CKD, CKD patients will have high phosphorus and that contributes to nausea/discomfort and can worsen kidney function, phosphorus binders ameliorate that)

Question 45

(T/F) Dietary changes to a prescriptions renal diet should be recommended to every CKD patient and that change may slow progression of CKD and extend life-expectancy.

Answer 45

(T)