Urinary System and Opthalmic Diseases Flashcards
What are the functions of the Kidneys?
- produce urine: excretion
- maintain homeostasis: blood filtration, reabsorption, secretion; fluid balance regulation; acid-base balance regulation; hormone production
What is Feline Cystitis?
nonmalignant inflammatory condition that occurs frequently in cats
What is the cause of Feline Cystitis?
- cause is unknown
- multi factorial
- not caused by bacteria
What is the Signalment of Feline Cystitis?
- cats 2-6 yrs old
- occurs more in males than females
What are C/S of Feline Cystitis?
- pollakuria
- hematuria
- dysuria
- periuria (inappropriate urination)
How do you diagnose Feline Cystitis?
- urinalysis/culture: to rule out bacteria as cause
- radiographs: to rule out calculi. contrast studies may show thickened bladder wall
How do you treat Feline Cystitis?
- avoid unnecessary use of antibiotics
- change diet to produce dilute urine
- reduce stress from other cats, kids, etc: provide hiding places, pheromonotherapy
- behavior modification drugs: amitrypitilline, clomipramine
- glycosaminoglycan replacement: cosequin, adequan
What is Client Info for Feline Cystitis?
- disease is self limiting: resolution of c/s in 7-10 days
- may be reccuring problem
- no definitive cure
- reduce stress
What are the natural defense mechanisms of the Kidneys?
- frequent voiding of urine
- urethral and ureteral peristalsis
- glycosaminoglycans in the surface mucosal layer
- pH
- constituents of urine
What is the cause of Canine Bacterial Cystitis?
ascending bacteria up the urethra
What are the C/S of Canine Bacterial Cystitis?
- increased frequency of urination
- hematuria
- dysuria
- cloudy urine, abnormal color
- frequent licking of vaginal/urethral area
How do you diagnose Canine Bacterial Cystitis?
- urinalysis: increased WBC’s and bacteria
- urine culture and sensitivity: collect by cytocentesis
How do you treat Canine Bacterial Cystitis?
- antibiotics according to sensitivity: acute infections (10-14d), subsequent infections(4-6 weeks)
- avoid trauma to urinary tract during surgery
- indwelling catheters should be closed system
What is Client Info for Canine Bacterial Cystitis?
- can resolve without treatment
- give antibiotics as directed
- prostate may be source of recurring infections
- urine cultures should be repeated
What are the 2 most common types of urethral blockages?
- uroliths
- urethral plugs
What are Uroliths?
composed of minerals and a small amount of matrix
What are Urethral Plugs?
composed of small amount of minerals and large amount of matrix
What are the 3 different types of struvites that occur in cats?
- sterile urocystoliths
- infection-induced urocystolith
- matrix-struvite urethral plug
What are C/S of Feline Uroliths and Urethral Plugs?
- hematuria
- dysuria
- periuria
- anorexia, vomiting
- collapse, death
- non-specific signs: hiding, crying while urinating, frequent trips to litter box
How do you diagnose Feline Uroliths and Urethral Plugs?
- palpation of bladder: full and tight
- radiographs: double contrast study may be indicated
- ultrasound:locate position of urolith
- urolith analysis: necessary to determine type
- EKG: atrial standstill, bradycardia, hyperkalemia
What is the Medical Treatment (chronic, non obstructed) of Feline Uroliths and Urethral Plugs?
- dissolve struvite uroliths by acidifying urine and feeding diet low in Mg
- cystotomy to remove stones
- antibiotics according to culture/sensitivity
What is the Medical Treatment (obstructed) of Feline Uroliths and Urethral Plugs?
- this is a medical emergency!
- anesthetize (short acting)
- pass tom cat catheter and back flush
- sew catheter in place for 1-3 days, using closed system
What is the Medical Treatment (chronic obstructers) for Feline Uroliths and Urethral Plugs?
- perineal urethrostomy
- goal of surgery is to decrease the likelihood of life-threatening obstruction
What are C/S of Canine Urolithiasis?
- pollakiuria
- dysuria
- hematuria
How do you diagnose Canine Urolithiasis?
- urinalysis (crystalluria, hematuria, increased bacteria)
- radiographs (double contrast study if necessary)
How do you treat Canine Urolithiasis?
- change diet
- acidify urine (urinary acidifiers)
- increase urine output ( add salt to diet)
- antibiotics for bacterial infection
- surgical removal (calcium oxalate)
- stone analysis is vital for appropriate treatment
What is Client Info for Canine Urolithiasis?
- special diet may be required for life
- table scraps/treats should be limited
- long term antibiotics may be required
- uroliths may recur at any time
- always provide plenty of water
- allow plenty of bathroom time and frequency
Renal Failure is due to what?
- decreased blood flow
- damage to nephron and glomerular fitration declines resulting in azotemia
What are the 3 phases of Acute Renal Failure?
- induction
- maintenance
- recovery
What is Induction?
the time from the initial insult until decreased renal function is apparent (hours to days)
What is Maintenance?
the time period during which renal tubular damage occurs (weeks to months)
What is Recovery?
the time during which renal function improves, existing nephrons hypertrophy and compensate for those damaged and tubular repair occurs (when possible)
What are the causes of Acute Renal Failure?
- nephrotoxic drugs (aminoglycosides, chemotheraputic agents, antifungal meds, analgesics, anesthetics, toxins: antifreeze)
- infections(pyelonephritis)
- immune mediated diseases (glomerulonephritis)
- metabolic (hypercalcemia, addison’s)
What are C/S of Acute Renal Failure?
- kidneys are enlarged and painful on palpation
- signs of azotemia( anorexia, dehydrated, vomiting, diarrhea, weakness)
- fever
How do you diagnose Acute Renal Failure?
- urinalysis (urine sediment/casts, low sp. gravity)
- CBC (dehydration, increased PCV, acidosis)
- chem panel (increased BUN, creatinine, phosphorus, potassium
How do you treat Acute Renal Failure?
- relieve tubular obstruction
- discontinue toxic drugs
- iv fluids (start with normal saline)
- correct dehydration
- correct acid/base and electrolyte balance
What is Client Info for Acute Renal Failure?
- renal function may never return
- prognosis is guarded with older pets
- appropriate diet
- adequate water access
What is Chronic Renal Failure?
- common in older pets
- cats more than dogs
- irreversible and progressive decline in renal function
What is the Signalment for Chronic Renal Failure?
- dogs: older than 8
- cats: older than 10
What is the first function lost in Chronic Renal Failure?
ability to concentrate urine
What are other functions lost in Chronic Renal Failure?
- ability to cleanse blood
- azotemia starts at 75% nephron loss
What are C/S of Chronic Renal Failure?
- dull, lethargic, weak
- anorexia, wt. loss
- constipation
- PU/PD, cervical ventroflexion
- sudden blindness
How do you diagnose Chronic Renal Failure?
- acidosis
- anemia
- increased BUN, CREA
- hyperphosphatemia, hypokalemia
- proteinuria
How do you treat Chronic Renal Failure?
- fluids for dehydration
- potassium gluconate, calcium carbonate for electrolyte imbalances
- phosphorus binders
- sodium bicarbonate for pH adjustment
- hormones (epo)
- Vit. B supplements
What are causes of Urinary Incontience
- neurogenic: loss of normal neural function causing a paralyzed bladder
- ectopic uterus
- patent uracus
- endocrine imbalance (after spay)
What are C/S of Urinary Incontience?
- urine leakage while sleeping or exercising
- perianal area of pet is always wet
- concurrent UTI
How do you diagnose Urinary Incontinence?
- urinalysis
- xrays, cystography
- chem panel to r/o PU from endocrine disease
How do you treat Urinary Incontinence?
- surgical correction
- diethylstillbestrol (endocrine)
- phenylpropanolamine (loss of sphincter tone)
What is the Conjunctiva?
pink tissue that lines the inner surface of the eyelids and covers the front portion of the eyeball except for the cornea
What are causes of Conjunctivits?
- allergy
- anatomic (ectropion, entropion)
- bacterial infection (injury, decreased tear production, foreign body, respiratory disease)
What are causes of Conjunctivitis in cats?
- feline herpes virus
- calicivirus
- chlamydia psittaci bacteria
- mycoplasm
What are C/S of Conjunctivitis?
- redness
- chemosis (swelling of conjunctiva)
- ocular discharge (tears, mucus)
How do you diagnose Conjunctivits?
- rule out FB
- rule out dry eye: schirmer tear test
How do you treat Conjunctivitis?
topical antibiotic ointment
What is Client Info for Conjunctivitis?
- don’t allow dogs to ride with head out window
- keep medial canthus clean
- vaccinate kittens
- don’t touch eye with applicator
- discard unused meds
What is Epiphora?
excessive tearing
What are causes of Epiphora?
- overproduction of tears (ocular pain, irritation)
- faulty drainage by lacrimal system (blockage of duct, puncta, imperforate puncta, trauma)
What are C/S of Epiphora?
- watering of eye
- discoloration of hair
How do you diagnose Epiphora?
fluorescein dye test
How do you treat Epiphora?
- treat initial cause
- flush lacrimal duct
- surgically open imperforate puncta
- topical antibiotic ointment
- keep hair trimmed around eyes
What is Entropion?
eyelids that roll in against the cornea
What are causes of Entropion?
- congenital (large orbits w/deep set eyes, collies, great danes)
- poor ocular muscle development
- trauma
- secondary to painful corneal lesion, conjunctiva inflammation
What are C/S of Entropion?
- epiphora
- chemosis
- conjunctivitis
- pain
- corneal ulceration
- photophobia
How do you treat Entropion?
- surgical is TOC
- temp. mattress suture to evert eye (young animals)
- lateral canthoplasty
- hotz-celsus (remove elliptical piece of tissue from under eye)
What are causes of Ectropion?
- congenital
- bassets, bloodhounds, cocker spaniel, st. bernard
What are C/S of Ectropion?
- conjunctivitis
- ephiphora
- keratitis
- purulent discharge
How do you treat Ectropion?
- surgery to shorten eye lid
- other procedures
What causes Cherry Eye?
unknown
What is the Signalment for Cherry Eye?
bassets, beagle, boston terrier, cocker spaniel
What are C/S of Cherry Eye?
- young dogs (less than 2)
- epiphora
- usually no pain
How do you diagnose Cherry Eye?
to r/o tumor
How do you treat Cherry Eye?
- surgery to remove gland, not recommended
- suture back in place
What is Glaucoma?
increased intraocular pressure
What are causes of Glaucoma?
- inherited (c. spaniel, basset, chow)
- secondary(neoplasia, luxation of lens, hemorrhage, uvetitis)
What are C/S of Glaucoma?
- ocular pain
- episcleral injection
- corneal edema
- dilated pupil
- blind
How do you diagnose Glaucoma?
IOP >30mm Hg
How do you treat Acute Glaucoma?
- latanoprost
- dichlorphenamide
- surgical (cryosurgery or laser)
How do you treat Chronic Glaucoma?
enucleation to remove pain
What are the causes of Ulcerative Keratitis?
- trauma
- chemical burns
- foreign objects
- KCS (keratoconjunctivitis sicca)
- conformation abnormalities
- herpes virus (cats)
What are C/S of Ulcerative Keratitis?
- pain
- epiphora
- blepharospasm
- hyperemia of conjunctiva
How do you diagnose Ulcerative Keratitis?
fluorescein dye to cornea
How do you treat Ulcerative Keratitis?
- topical atropine ointment
- topical broad spectrum antibiotic ointment
- viral ointments or solutions
- surgery (eye lid flap, conjunctival flap)
- serum (autologous)
What is Desmetocele?
erosion to membrane
What is Client Info for Ulcerative Keratitis?
- most heal without treatment
- avoid using old meds
- cortisone will inhibit healing of ulcer
- don’t touch eye with applicator tip
What is Pannus?
superficial corneal vascularzation/scar tissue
What is the cause of Chronic Superficial Keratitis (Pannus)
- thought to be immune mediated (infiltration of cornea with lymphocytes, plasma cells)
- increased UV light/high altitudes increases incidience
What are C/S of Chronic Superficial Keratitis?
opaque lesions that begin at limbus and extend into cornea (milky, pink or tan)
What breeds are affected by Chronic Superficial Keratitis?
- german shepherds
- border collies
- greyhounds
- siberian husky
How do you diagnose Chronic Superficial Keratitis?
- to r/o KCS, corneal ulcers
- corneal scrapings
How do you treat Chronic Superficial Keratitis?
- corticosteroids when lifelong
- cyclosporine often lifelong
- antibiotic eye ointment
What is Client Info for Chronic Superficial Keratitis?
-no cure
-if Rx is stopped, disease will return and progress
high altitudes and increased sun predispose animals
What is the cause of KCS?
-lack of tear production
What are C/S of KCS?
- recurrent conjunctivitis, corneal ulcers, keratitis
- dull, dry, irregular cornea, conjunctiva
- tenacious, mucoid ocular discharge
- blepharospasm
- crusty nares
How do you diagnose KCS?
schirmer tear test
How do you treat KCS?
- tear stimulation (cyclosporine, pilocarpine)
- arttificial tears
What are causes of Cataracts?
- genetic
- secondary to:
- diabetes mellitus
- trauma
- lens luxation
- nutritional deficency
- uveitis
- hypocalcemia
- electrical shock
How do you treat Cataracts?
- surgical removal of lens
- treat underlying cause
What are C/S of Cataracts?
- progressive loss of vision
- opaque pupillary opening
How do you diagnose Cataracts?
opthalmascope
What is Progressive Retinal Atropy?
group of hereditary disorders causing loss of rods, cones and/or blood supply
What breeds are effected by PRA?
toy/minature poodle golden retriever irish setter cocker spaniel schnauzer collie samoay nor. elkhound
What are C/S of PRA?
- slow onset of blindness
- night vision goes first due to lack of rods
- loss of day vision (cones)
How do you diagnose PRA?
eye exam (gray, granular app. of retina, hyperreflective lens, muscular attenuation, optic nerve atropy)
How do you treat PRA?
none
What is Client Info for PRA?
inherited disease
blind animals adapt well
cats need balanced diet
What is Anterior Uveitits?
inflammation of uvea (ciliary body, iris, choroid)
What are causes of Anterior Uveitis?
- inflammation/infection
- neoplasia
- trauma
What are C/S of Uveitis?
- blepharospasm
- aqueous flare
- miosis of affected eye
- iridal swelling or congestion
- keratic precipitates
- ciliary flush in limbal region
- corneal edema
- hyphema
How do you treat Uveitis?
topical steroids topical anti inflammatory drugs systemic steroids atropine antibiotics
What are causes of Proptosed Globes?
- trauma
- conformation
- retrobulbar abscess or neoplasia
What are reasons you would save the eye in a Proptosed Globe?
- brachycephalic breed
- positive direct or consensual pupillary light response
- normal findings on posterior segment exam
- proptosed eye with vision on initial presentation
What are reasons you would remove the eye in Proptosed Globe?
- non brachycephalic breed
- cat breed
- hyphema
- no visible pupil
- facial fractures
- optic nerve damage and avulsion of 3 or more extraocular muscles
How do you treat a Proptosed Globe?
lubricate immediately reduce the globe into the socket ASAP enucleation if optic nerve is severed systemic and topical antibiotics steroids
