Urinary system Flashcards
History and distant exam
Painful urination Abnormal frequency Abnormal colour Abnormal amount of urine Abnormal amount of water intake Colic Weight loss Decreased appetite
Physical exam
Inspection
Palpation- external and rectal- this is much more important
Percussion to detect pain, there will be no sound
Sequence of the physical exam
Kidneys
Ureter
Urinary bladder
Urethra
Rectal palpation of kidney
Only a part of the left kidney is palpable- shape, size, consistency and painfulness of caudal half
Right not palpable in adult horse
Rectal palpation of ureters
Only when the wall is thickened, lumen distended
Palpation of urinary bladder
Not by physical methods in adults or larger foals
Neonatal foals: full bladder may be palpable
Rectal palpation:
At bottom of pelvis
Spherical/oval, non-painful, smooth, undulating
Size: full= football sized
Check: position, shape, size, surface, wall thickness, pain, content e.g urolith or tumour
Urethra in the mare
short, wide diameter
Orifice is 10-15cm from the vulva
Inspection with vaginal speculum- ventral midline of the vestibule
Palpable with fingers
Urethra in the stallion and gelding
long and narrow
Inspection and palpation:
During urination and mating
Sedation: alpha2 agonist and ACP
Do not pull out penis without sedation first
Might be able to examine at the perineum- especially if there is swelling- urolithiasis
What is important to check when examining the urethra
Mucus membrane around urethral orifice
Discharge
Mucocutaneous junction in males
Urination in mares
Hind limbs wide base stance, placed slightly cranially
Tail elevated
Rump is bent down
Abd muscles used
Urination in stallions and geldings
Hind limbs wide base stance, slightly caudally
Tail elevated
Penis is released
Abd muscles used
Amount of urine
frequency: 4-7 times a day
amount: 10-30 ml/kg- depends on temp and feed
Abnormalities of urination: Pollakiuria
Very frequent passage of urine (normal amount)
Abnormalities of urination: Polyuria
Large amount
Both frequency and amount increase
Usually with polydypsia
Abnormalities of urination: Oliguria
Reduced urine output
Can be reduced freq with normal amount or
Reduced freq with reduced amount
Abnormalities of urination: Anuria
Lack of urination, no passage of urine
Renal: acute renal failure, when no urine prod
Postrenal: bladder rupture, paralysis, urethral stones
Abnormalities of urination: Urinary tenesmus
straining during urination
Abnormalities of urination: urinary incontinence
lack of voluntary control over urination
not standing in normal position and abd muscles are not being used
continuous dribble or small amounts are released continuously
Ancillary diagnostic methods
Rectal palpation (NB) Imaging modalities
What are the image modalities used
US- most often
Cystoscopy
Excretory urography- IV contrast material
Lab tests
Hematology
Serum biochem
Urinalysis
Hematology
Chronic kidney disease- decreased erythropoietin prod- anaemia
Serum biochem
Urea
Creatinine
Electrolytes
Urinalysis
- Phys: colour, odour, viscosity, SG
- Urine dipstick test
- Sediment exam
- Enzymuria: GGT, ALP, LDH
- Fractional clearance of electrolytes- tubular function, can use serum or urine
- Bacterial culture
- Clarity: usually turbid due to CaCO3 and mucus
- SG
SG
Measure with a refractometer
Hyposthenuria (<1008g/l) is normal in adult horse
Hyperstenuria (>1014 g/l) is normal in neonatal foals
Exam of the vulva and vagina
Check mucus membrane
Clean with chlorhexidine/ betadine soap
Use speculum and lubricant- upwards direction and turn 90 degrees
