Urinary system

Question 1

History and distant exam

Answer 1

Painful urination
Abnormal frequency
Abnormal colour 
Abnormal amount of urine
Abnormal amount of water intake 
Colic
Weight loss 
Decreased appetite

Question 2

Physical exam

Answer 2

Inspection
Palpation- external and rectal- this is much more important
Percussion to detect pain, there will be no sound

Question 3

Sequence of the physical exam

Answer 3

Kidneys
Ureter
Urinary bladder
Urethra

Question 4

Rectal palpation of kidney

Answer 4

Only a part of the left kidney is palpable- shape, size, consistency and painfulness of caudal half
Right not palpable in adult horse

Question 5

Rectal palpation of ureters

Answer 5

Only when the wall is thickened, lumen distended

Question 6

Palpation of urinary bladder

Answer 6

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

Question 7

Urethra in the mare

Answer 7

short, wide diameter
Orifice is 10-15cm from the vulva
Inspection with vaginal speculum- ventral midline of the vestibule
Palpable with fingers

Question 8

Urethra in the stallion and gelding

Answer 8

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

Question 9

What is important to check when examining the urethra

Answer 9

Mucus membrane around urethral orifice
Discharge
Mucocutaneous junction in males

Question 10

Urination in mares

Answer 10

Hind limbs wide base stance, placed slightly cranially
Tail elevated
Rump is bent down
Abd muscles used

Question 11

Urination in stallions and geldings

Answer 11

Hind limbs wide base stance, slightly caudally
Tail elevated
Penis is released
Abd muscles used

Question 12

Amount of urine

Answer 12

frequency: 4-7 times a day
amount: 10-30 ml/kg- depends on temp and feed

Question 13

Abnormalities of urination: Pollakiuria

Answer 13

Very frequent passage of urine (normal amount)

Question 14

Abnormalities of urination: Polyuria

Answer 14

Large amount
Both frequency and amount increase
Usually with polydypsia

Question 15

Abnormalities of urination: Oliguria

Answer 15

Reduced urine output
Can be reduced freq with normal amount or
Reduced freq with reduced amount

Question 16

Abnormalities of urination: Anuria

Answer 16

Lack of urination, no passage of urine
Renal: acute renal failure, when no urine prod
Postrenal: bladder rupture, paralysis, urethral stones

Question 17

Abnormalities of urination: Urinary tenesmus

Answer 17

straining during urination

Question 18

Abnormalities of urination: urinary incontinence

Answer 18

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

Question 19

Ancillary diagnostic methods

Answer 19

Rectal palpation (NB)
Imaging modalities

Question 20

What are the image modalities used

Answer 20

US- most often
Cystoscopy
Excretory urography- IV contrast material

Question 21

Lab tests

Answer 21

Hematology
Serum biochem
Urinalysis

Question 22

Hematology

Answer 22

Chronic kidney disease- decreased erythropoietin prod- anaemia

Question 23

Serum biochem

Answer 23

Urea
Creatinine
Electrolytes

Question 24

Urinalysis

Answer 24

1. Phys: colour, odour, viscosity, SG
2. Urine dipstick test
3. Sediment exam
4. Enzymuria: GGT, ALP, LDH
5. Fractional clearance of electrolytes- tubular function, can use serum or urine
6. Bacterial culture
7. Clarity: usually turbid due to CaCO3 and mucus
8. SG

Question 25

SG

Answer 25

Measure with a refractometer
Hyposthenuria (<1008g/l) is normal in adult horse
Hyperstenuria (>1014 g/l) is normal in neonatal foals

Question 26

Exam of the vulva and vagina

Answer 26

Check mucus membrane
Clean with chlorhexidine/ betadine soap
Use speculum and lubricant- upwards direction and turn 90 degrees