Urinary system Flashcards
1
Q
where are the kidneys located and how does the position of left and right vary?
A
retroperitoneal space
right more cranial
2
Q
how does IV urography work?
A
dye collects and highlights kidneys, then moves to ureters and bladder
3
Q
define nephron
A
functional unit of kidney
4
Q
what is the function of the glomerulus and how does this happen?
A
filtration of blood into glomerular filtrate due to high pressure capillary bed between 2 arteries
in healthy animals proteins stay in the blood
5
Q
what is the role of proximal convoluted tubule?
A
reabsorption of glucose, electrolyte control
6
Q
what does the loop of henle do?
A
water reabsorption
7
Q
what does the distal convoluted tubule do?
A
electrolyte and acid base regulation
8
Q
where does ADH act in the kidneys?
A
distal convoluted tubule
9
Q
what is the role of the collecting duct?
A
water reabsorption
10
Q
define polydipsia
A
excess water intake
11
Q
define glomerulonephritis
A
inflammation of glomeruli
12
Q
define renal insufficiency
A
measurable reduction in kidney function
13
Q
define renal disease
A
disease of the kidneys
14
Q
how are free catch urine samples carried out? state advantages and disadvantages
A
caught in container midflow
adv- non-invasive
disadv- not sterile so may show bacteria not actually in sample
15
Q
how are non-absorbable cat litter urine samples carried out? state advantages and disadvantages
A
collect after cat urinates as normal
adv- non-invasive, easy
disadv- non-sterile so may show bacteria not in sample
16
Q
how are catheterisation urine samples carried out? state advantages and disadvantages
A
anaesthetised unless male dog
adv- more sterile, can accurately measure volume
disadv- more invasive
17
Q
how are cystocentesis urine samples carried out? state advantages and disadvantages
A
needle inserted into bladder, blind or ultrasound guided
adv- sterile
disadv- invasive
18
Q
what is the first sign of most kidney disease?
A
inability to concentrate urine
19
Q
how is urine concentration measured?
A
USG with refractometer
20
Q
what are the normal cat and dog values of USG?
A
cat- 1.035-1.060
dog- 1.015-1.045
21
Q
define hypersthenuric USG and what values are seen for this?
A
appropriately concentrated urine
1.030
22
Q
what is meant by sub maximally concentrated urine and what USG values are seen for cats and dogs?
A
some urine concentration taking place
cats- 1.012-1.035
dogs- 1.012-1.030
23
Q
what is isosthenuric USG and what values are seen for this?
A
no modification of urine concentration
1.008-1.012
24
Q
define hyposthenuric USG and what values are seen for this?
A
active dilution of urine, more dilute than filtrate
<1.008
25
what parameters are shown on dipstick analysis of urine?
```
pH
glucose
ketones
protein
blood
WBC
```
26
what does microscopy of urine samples show?
crystals and casts in urine
27
what does cytology of urine show and what should be done after cytology?
cells and bacteria in urine
| culture of bacteria to identify
28
what is urea derived from?
protein breakdown
29
what is creatinine derived from?
breakdown of muscle creatinine
30
what is the purpose of blood tests relating to kidneys?
shows levels of urea and creatinine which shows function of kidneys as they are excreted by the kidneys
31
why do blood tests to look at kidney function need to be fasted?
protein in recent meal falsely elevates urea
32
define azotaemia
high urea +/- creatinine in blood
33
what does presence of azotaemia show?
reduced glomerular filtration of blood
34
what are the causes of azotaemia?
pre-renal- inadequate renal perfusion
renal- reduced functional mass of kidneys from underlying kidney disease
post-renal- lack of excretion of waste products due to obstruction or rupture
35
how can you determine cause of azotaemia?
pre-renal- concentrated urine as water preserved
renal- poorly concentrated urine
post-renal- imaging
36
what other findings aside from urea and creatinine can indicate kidney disease and what are they caused by?
hyperphosphataemia- reduced renal excretion
hypokalaemia- kidney disease
anaemia- erythropoietin synthesised by kidneys so less in disease
37
what can radiography show about the US?
shape and size of kidneys
ureters, urethra, bladder
stones
38
what can be seen on ultrasounds of the US?
parenchymal detail (kidneys and prostate)
bladder wall morphology
causes of post renal azotaemia
39
what can cytology and biopsy of US show?
renal lymphoma
glomerular disease
commonly used on prostate
40
what is cystoscopy used for?
visualise LUT for collecting biopsies
| laser lithotripsy of stones
41
define AKI
sudden onset kidney disease
42
what is the general cause of AKI and what are the effects of this?
sudden nephron damage
| high levels of toxins present causing rapid illness
43
why does CKI present less severe illness?
gradual increase of toxins allows compensation
44
define anuria
no urine production
45
define oliguria
very small amounts of urine produced
46
define polyuria
excess urine production
47
define ischemia
impaired blood oxygen supply
48
what types of injury are kidneys susceptible to and why?
toxic and ischemic injury
| highly metabolically active
49
what are causes of AKI?
toxic- NSAIDs, toxins
ischemia- hypoperfusion, hypovolaemia
infectious- leptospirosis, pyelonephritis
cutaneous and renal glomerular vasculopathy
50
define pyelonephritis
bacterial kidney infection
51
what are clinical findings of AKI?
```
acute kidney dysfunction
azotaemia, uraemia
general illness
anuria, oliguria
hyperkalaemia, cardiac arrhythmia
hyperperfusion or hypoperfusion
signs related to intoxicaton
```
52
define uraemia
clinical signs associated with azotaemia
53
how is AKI diagnosed?
history of short clinical illness
acute azotaemia with high phosphate and potassium
diagnosis of cause of azotaemia
urinalysis- concentration, casts, crystals, inflammatory cells, cultures`
54
what is initial treatment of AKI?
remove underlying cause- stop nephrotoxic drugs, treat for any ingestion of substances
supportive management- electrolytes, nutrition, analgesia
IVFT- crystalloids, correct hypovolaemia over 15 minutes, when euvolemic correct dehydration over 6 hours
55
what is ongoing treatment of AKI?
```
IVFT
treat hyperkalaemia- crystalloids for renal perfusion, calcium gluconate to stabilise heart, glucose to stimulate insulin release and glucose and potassium uptake to cells
treat cause
keep BP over 80mmHg minimum
appetite stimulants
analgesia
nutrition
```
56
what are complications associated with hyperkalaemia due to AKI?
cardiac arrhythmia or arrest
57
what is the prognosis for AKI for cats and dogs?
cats- 27-42%
dogs- 34-59%
up to 50% have CKD if survive
58
what are indications for euthanasia or dialysis for AKI cases?
persistent anuria, volume overload, unmanageable hyperkalaemia
59
define CKD
kidneys disease lasting over 3 months
60
what is the signalment of CKD?
cats
| older patients
61
what is the aim of management of CKD and why?
protecting nephrons remaining and managing clinical consequences
damage is irreversible and progressive
62
what are causes of CKD?
```
chronic interstitial nephritis
glomerulonephropathy
untreated infection
chronic obstructive disease
congenital
neoplasia
```
63
what findings tend to be in history of patients with CKD?
```
PUPD
weight loss
lethargy and weakness
inappetence
vomiting, diarrhoea, haematemesis, melaena
signs associated with hypertension
can be subtle or nonspecific
```
64
what does clinical exam show for patients with CKD?
```
low body muscle condition
dehydration
polyuric, very dilute urine
weakness
neck ventroflexion
uraemic ulcers
uraemic halitosis
hypertensive retinopathy
small irregular kidneys
```
65
what are the risks for organ damage associated with different systolic BP?
normotensive/<140- minimal
pre-hypertensive/140-159- low
hypertensive/160-179- moderate
severely hypertensive/>180- high
66
what organs are susceptible for damage due to high BP?
ocular
renal
cardiac
neurology
67
how is CKD diagnosed?
```
inappropriately concentrated urine with azotaemia (only when high level of GFR lost)
SDMA test to approximate GFR
anaemia
high phosphate, low potassium
hypertension
renal ultrasound
```
68
what is initial management of CKD?
stop nephrotoxic drugs
treat underlying cause
correct fluid balance
69
what is long term treatment for CKD?
renal diet
control hypertension, proteinuria, hyperphosphatemia, hypokalaemia
feed RER
monitor BW
avoid protein calorie malnutrition
phosphate binders every meal to prevent absorption as makes feel ill
potassium supplements
long term regular monitoring
70
what is prognosis for CKD?
cats- often years
dogs- poor if significant clinical signs
determined once reversible issues addressed
71
what is nephrotic syndrome?
complication of glomerular disease
72
what is meant by LUTD?
diseases of bladder, urethra and prostate
73
define cystitis
bladder inflammation
74
what are clinical signs of cystitis?
```
reflect LUT pathology, inflammation, similar signs regardless of aetiology
dysuria
stranguria
haematuria
pollakuria
periuria
vocalisation
licking prepuce
inappetance
lethargy
```
75
define dysuria
difficulty urinating
76
define stranguria
straining to urinate
77
define haematuria
blood in urine
78
define pollakuria
small frequent amounts of urine
79
define periuria
voiding in inappropriate places
80
what are causes of cystitis?
```
feline idiopathic cystitis
bacterial UTI
urolithiasis
neoplasia
drug induced
catheters
```
81
what is triage for cystitis?
find out clinical signs of LUTD
| are they able to pass urine as obstructions are emergency
82
define crystals
microscopic mineral precipitate
83
define crystaluria
crystals in urine
84
define uroliths
macroscopic urinary stone
85
what happens to fresh urine at room temperature if crystals are present?
crystals precipitate
86
what determines the type of crystal or urolith formed?
supersaturated compound
87
how do crystals and stones form?
high saturation of compounds is precipitation risk
| crystal growth and aggregation leads to uroliths
88
how can you try to prevent formation of crystals and stones?
encourage water intake as more dilute urine the less risk of formation
89
what are the treatment options for crystals?
as long as symptomatic no treatment needed as microscopic so wont cause damage
abnormal types may need investigating
90
when are uroliths treated?
if symptomatic
91
what are the types of symptomatic uroliths?
nephroliths/kidney stones- UUT
ureteroliths- UUT
urethroliths- LUT
crystoliths- LUT
92
what effects do nephroliths have?
```
abdominal pain
anorexia
lethargy
haematuria from irritation to pelvis lining
pyelonephritis
```
93
what effects do ureteroliths have?
ureteric obstruction
| post renal azotaemia
94
what affects do urethroliths have?
obstruction
| unproductive urination
95
what affects do crystoliths have?
pollakuria
stranguria
dysuria
haematuria
96
how are symptomatic uroliths treated?
dissolving with diet or medication
surgical removal
treat associated infections
97
how can you identify type of urolith?
radiolucency and opacity
crystals present
stone analysis only definite way
radiography if 2-3 mm or bigger
98
what is the management for preventing uroliths?
encourage water intake
USG- under 1.033 for cats and 1.020 for dogs
encourage voiding
avoid obesity
dissolution diets- neutral pH to prevent formation of stones, only short term then back to normal diet
99
what are nursing considerations for uroliths?
monitor for unproductive urination as re obstruction possible
maintain hydration and urination
catheter care
analgesia- opioids, NSAIDs when wont get blocked again
100
what are potential causes of feline idiopathic cystitis/FIC?
```
young to middle aged
overweight
indoor, litter tray user
multi animal household
nervous
dry diet
stressors present
sudden change in environment
hypofunctioning GAG layer
```
101
what is meant by the GAG layer of the bladder?
protective layer lining the bladder
102
what tests are done if suspect FIC to rule out other causes?
urinalysis- exclude UTI
radiographs- look for uroliths, masses, strictures
ultrasound- assess UUT
103
how do non-obstructive FIC cats present?
LUTD signs- pollakuria, stranguria, dysuria, haematuria
| able to void
104
how do obstructed FIC cats present?
urethral spasm or plug
unproductive urination
commonly recur
105
define urethral plug
accumulation of mucus, debris, organic matter due to inflammation in bladder lining
106
what is the consequence of obstructed UT?
back pressure on kidneys so cant filter blood- post renal azotaemia
hypokalaemia- bradydystrhythmia
pain
107
what is initial treatment for obstructed patient?
catheterise to relieve pressure
108
describe how to catheterise an obstructed patient
examine for stones, plugs, trauma
lubricate catheter
insert, can flush while doing this to aid process
suture in place
take urine sample for analysis
lavage bladder with warm 0.9% saline until clear to remove noxious secretions
109
what measures should be taken if placing indwelling catheter?
closed system, sterile handling
change bag daily, keep off floor
slack in system so no pulling
monitor UOP- hydration, electrolytes, infection
110
how do you calculate UOP?
weight of bag now- weight 4 hours ago= UOP over 4 hours
UOP over 4 hours/4= UOP over 1 hour
UOP over 1 hour/BW= UOP(ml/kg/hr)
111
what is management for FIC?
```
analgesia
remove stress
enough resources in house for number of cats
encourage water intake
urinary diet, wet food
avoid obesity
GAG supplements
```
112
define urinary incontinence
loss of normal voluntary control of micturition
113
what is the normal process of urination?
relaxation of urethral sphincter and contraction of bladder
114
what are the two types of neurogenic incontinence and how do these usually present?
upper motor neurone and lower motor neurone lesion
| overflow incontinence
115
how does upper motor neurone lesion incontinence present?
spastic bladder, high muscle tone
| hard to express
116
how does lower motor neurone lesion incontinence present?
flaccid bladder
| easy to express
117
what are the causes of non-neurogenic incontinence?
urethral sphincter mechanism incomplete/USMI
anatomical defects
urge incontinence
dyssynergia
118
why does USMI cause incontinence?
sphincter function fails so leak in recumbency as bladder neck no longer compressed by pelvis which prevents leakage
119
what are predispositions for USMI?
neutering
obesity
intrapelvic bladder
large dogs
120
how is USMI treated?
tightening sphincter
stimulating sphincter contraction with alpha adrenergics, alpha agonists, oestrogens
urethral cuff
surgical repositioning of bladder
121
why do anatomical defects cause incontinence?
ureter voids to urethra so no urine storage
122
what is the cause of urge incontinence?
inflammation causing sudden contraction
123
why does dyssynergia cause incontinence?
failure of bladder contraction to coordinate with urethral relaxation
124
how is neurogenic incontinence managed?
treat disease
| express bladder avoiding catheters where possible due to infection
125
how can anatomic cause of incontinence be treated?
laser to reposition bladder entry
| surgical re-implantation
126
what history should be taken for surgical diseases of UT?
```
continence
voiding urine, any abnormal times or location
ease of urination
volume, smell, appearance of urine
frequency of urination
drinking
neuter status
```
127
what initial investigations are done for surgical disease of UT?
bloods- leukocytes, anaemia, urea, creatinine
urinalysis
radiography- stones, abnormalities
ultrasound- stones, masses, lesions, inflammation
128
what are general considerations when performing surgery on UT?
antibiotics especially if UTI present
| minimise urine spilling with soaked lap pads
129
what equipment is required for surgery on UT?
```
fine instruments and suture material
abdominal retractors
retractors for bladder
catheters
cystotomy tubes
suction
spoons for stones
magnification
```
130
when is surgery for renal neoplasia contraindicated?
pulmonary metastasis
| bilateral neoplasia
131
what are clinical signs of renal neoplasia?
haematuria
palpable abdominal mass
other vague signs
132
what are common causes of renal trauma?
bite
| RTA
133
when would subcutaneous ureteral bypass be performed?
ureter blocked and cant dissolve medically
134
what is a subcutaneous ureteral bypass?
tube placed in kidney and connected to bladder via under skin to give new ureter
135
what causes renal stones?
similar to uroliths, supersaturation of minerals
136
what is the treatment for renal stones?
diet to dissolve
antibiotics
surgery
137
what surgery be used to treat renal stones and what is a disadvantage of this?
nephrotomy (incision thorugh kidney) with tourniquet around renal vessels to reduce blood to incisions
may reduce renal function
138
how are ureters treated when damaged during spaying?
remove the damaged kidney and ureter
| re implant ureter cutting off damaged part
139
define nephrectomy
removal of kidney
140
what are indications for nephrectomy?
```
renal neoplasia
renal trauma
chronic pyelonephritis
idiopathic haematuria
ureteral abnormalities
one normally functioning kidney
```
141
how is nephrectomy performed?
midline laparotomy
kidney isolated and freed from peritoneum
renal artery and vein ligated
ureter ligated and transected adjacent to baldder
142
what is ureteral ectopia?
ureters opening to urethra not bladder, usually bilateral
143
what is signalment for ureteral ectopia?
congenital abnormality in dogs, normally female
144
how is ureteral ectopia treated?
neoureterostomy with close observation post op for stranguira
145
how is neoureterostomy performed?
incision through bladder wall and ureteral mucosa to lumen of ectopic ureter close to its entry to bladder wall
ureteral and bladder mucosa sutured to make new stoma
146
what is presentation for bladder stones?
haematuria
frequency and urgency to urinate
complete obstruction
147
how are bladder stones treated?
struvite and urate- medically dissolved
cystotomy for all other uroliths or any obstructing or causing clinical signs
prescription diet to prevent recurrence
148
how does bladder neoplasia present?
elderly animals
haematuria
frequency and urgency to urinate
obstruction
149
what are treatment options for bladder neoplasia?
most malignant
if effect trigone cant remove
partial cystectomy can aid palliative care
150
what is the consequence of ruptured bladder?
uroabdomen
| post renal failure
151
how are bladder trauma treated?
IVFT to stabilise
| surgical repair
152
what are indications for cystotomy?
removal of bladder stones
153
how is cystotomy carried out?
caudal midline laparotomy
exteriorise and isolate bladder with swabs
incision in ventral midline of bladder
154
what equipment is needed for cystotomy?
urethral catheter
| volkmann spoon
155
what needs to be done following cystotomy for stone removal?
stones submitted for analysis of composition, culture and sensitivity
156
what are types of urethral disease?
```
urolithiasis
incontinence
FLUTD
trauma
neoplasia
```
157
what is the main consequence of urethral stones?
obstruction
158
how are urethral stones managed?
small pass unproblematically
relive obstructions
correct hypovolaemia, electrolyte imbalance, acid base balance
159
what are risk factors for USMI?
neutering
tail docking as affects spinal nerves
obesity
breeds- springers, mini poodles
160
how is USMI managed?
oestrogen or phenylpropanolamine to increase smooth muscle tone of sphincters
surgery if non responsive
161
what are the surgical options for USMI?
colposuspension
urethropexy
hydraulic artificial urethral sphincters
162
define urethropexy
support provided to urethra
163
what are risk factors for FLUTD?
```
middle aged
overweight
neutered
indoor cats
dry diet
secondary to bladder disease
```
164
how is FLUTD managed?
usually medically
| surgical if repeated episodes
165
what are surgical options for urethral neoplasia?
bypass urethra for palliation
| usually too advanced for excision and mets present
166
define urethrotomy
incision into urethra
167
what is urethrotomy used for?
stones that wont flush into bladder
168
define urethrostomy
creation of permanent new opening
169
what is urethrostomy used for?
last resort for recurrent obstruction, severe trauma or stricture
170
where are urethrostomies mainly performed?
scrotal- dogs
| perineal- cats
171
what are indications for tube cystotomy?
divert urine from urethral surgical sites
| palliation of obstructions due to neoplasia
172
how are tube cystotomies carried out?
purse string suture in bladder
foley or mushroom tip catheter through stab incision in middle of suture
suture tightened
catheter passed through incision in abdominal wall
cystopexy performed
catheter sutured to skin and kept in place for 7 days
173
what is post op care for urethral surgery?
prevent interference
monitor short term haematuria
observe dysuria if no catheter
analgesia
174
what are the effects of benign prostatic hyperplasia?
dyschezia or dysuria
175
define dyschezia
difficult or painful defecation
176
what is signalment for benign prostatic hyperplasia?
older entire males
177
how is benign prostatic hyperplasia treated?
medical- anti-androgens
| castration for definite treatment
178
define prostatitis
inflammation of the prostate gland
179
what are causes of prostatitis?
bacterial infection
| often with BPH
180
what are signs of prostatitis?
dysuria
pyrexia
purulent penile discharge
181
how is prostatitis managed?
antibiotics
anit-androgens
castration
182
what are indications for prostatic abscesses?
entire males
| usually with prostatitis
183
what are signs of prostatic abscesses?
male version of pyometra
dysuria
dyschezia
184
what is treatment for prostatic abscesses?
omentalisation following re-roofing and flushing of abscess to help healing
castration
rapid surgery and castration if burst with signs of sepsis
185
what are risks for prostatic neoplasia?
entire males
BPH
neoplasia
186
how is prostatic cysts treated?
de-roofing
omentalisation
castration
187
define catheterisation
inserting urinary catheter into urethra up to level of bladder
188
what are the two types of catheter?
temporary
| indwelling
189
why are catheters used?
```
urine sample
empty bladder to reduce contamination during surgery
contrast insertion for radiography
maintain urethral patency
unblocking urethra
monitoring UOP
diverting urine
preventing scalding
```
190
what are alternatives to catheterisation?
manual expression
free catch
cystocentesis
191
what are disadvantages of manual expression of urine?
can rupture bladder
not possible if tense
hard if overweight
not sterile
192
what are disadvantages of free catch urination?
time consuming
| non sterile
193
what are advantages of cystocentesis?
sterile
194
what are disadvantages of cystocentesis?
higher risk
| need to let animal void after
195
describe the features of portex catheters
rigid so traumatic
single use
side holes to allow drainage if end blocked but low pressure so hard to unblock
not designed for indwelling
196
describe the features of foley catheters
soft
inflatable balloon of sterile water to hold in place
preferred option for indwelling
too big for cats
multiple end ports for flushing, collection etc, externally large
197
describe features of jackson/tom cat catheters
good for unblocking
rigid
side holes make distal obstruction harder
not used indwelling as traumatic but can leave in short term
short so wont reach bladder
198
describe features of slippery sam catheters
open ended so good for unblocking
can be indwelling short term
atraumatic
risk hub detaching
199
describe how male dogs and cats are catheterised
restrain, may sedate
wash hands and put on sterile gloves and apron
expose penis from prepuce and prep with dilute iodine
lubricate catheter
can give lidocaine LA
insert until see urine
200
describe how to insert catheter in bitches and queens
```
sedate and place in sternal
clip and clean vulva
insert speculum in dogs to visualise urethral orifice, in cats use otoscope to visualise
feed into urethral orifice
insert until see urine
```
201
list equipment needed for catheterisation
```
catheter
dilute iodine
swabs
lubricant
containers for sample
closed system if needed
syringes
sterile gloves and apron
speculum
```
202
describe how to care for indwelling catheters
```
wash hands before and after
empty bag every 4 hours or as needed
measure UOP- hydration, kidney function
check for swelling or pain
check line
remove as soon as no longer needed
care for urine scalding
monitor for UTI
avoid patient interference
```
203
what are risks associated with catheterisation?
urethral rupture, trauma, inflammation, stricture
infection likely
obstruction of catheter by stones or kinks
204
what does cystotomy tube do?
urine from bladder to outside via abdominal wall
205
what does nephrostomy tube do?
urine from kidney to outside
206
what is normal UOP?
1-2ml/kg/hr
207
how do you calculate UOP?
(volume of urine/hours)/BW
208
how do you calculate expected normal UOP?
BW x normal UOP per hour x number or hours
209
how often should UOP be calculated in hospitalised patients?
every 4 hours
210
why do you need to measure UOP?
renal function information
211
what is the purpose of renal diets and what are their compositions?
minimise uremic episodes, prolong survival
| restricted protein, phosphorus, sodium, supplemented by omega 3, antioxidants
