Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

CVNT 2 > Urinary system and theraputics > Flashcards

Urinary system and theraputics Flashcards

1
Q

azotemia definition

A

build up of nitrogenous waste in the body

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

pyelonephritis definition

A

inflammation of kidneys

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

renal insufficiency

A

poor function of kidneys

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

hypersthenuric definition

A

well concentrated urine
- >1.030 for dogs
- > 1.035 for cats

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

hyposthenuria definition

A

active dilution of urine
<1.008

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

isothenuria definition

A

no modification of urine concentration
- same osmolarity as plasma
- 1.008-1.012

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

types of urine collection

A
  • free catch
  • non-absorbable cat litter
  • catheterisation
  • cystocentesis (blind/ultrasound)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

urinalysis

A
  • USG
  • dipstix analysis
  • microscopy (crystals/casts)
    • some types crystals are normal
  • cytology
  • bacterial culture
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

blood testing

A
  • urea and creatinine
    • recent protein meal will give false increased urea (use fasted sample)
  • azotemia= increased urea and creatinine
    • indicates reduced glomerular filtration
  • anaemia
  • electrolytes- decreased K+ (contributes to inappetence)
  • hyperphosphataemia (reflects reduced renal excretion)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

pre-renal azotemia cause

A
  • inadequate renal perfusion
  • not filtering enough blood
  • hypovolaemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

renal azotemia cause

A
  • reduced functional mass of kidney due to underlying kidney disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

post-renal azotemia cause

A
  • kidneys functional but waste products not excreted
  • obstruction of urinary tract (ureter/urethra)
  • rupture of urinary tract
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

differentiating origin of azotemia

A

pre-renal- concentrated urine (trying to preserve as much water to compensate for hypovolaemia)
- renal- dilute urine (kidney not functioning well enough for water reabsorption)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

radiography

A
  • size and shape of kidneys
  • radiopaque stones
  • radiolucent stones with double contrast
  • evaluating ureteric course/insertion
  • evaluating urethral morphology
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

ultrasonography

A
  • for parenchymal detail (cellular)
  • bladder wall morphology
  • evaluating some causes of post-renal azotemia
    • uroabdomen/obstruction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

cytology/biopsy

A
  • uncommonly used for kidneys
  • commonly used for prostate
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

acute kidney injury

A
  • acute nephron damage/dysfunction
  • kidneys highly susceptible to toxic/ischaemic injury
  • severe AKI presents with anuria/oliguria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

intrinsic AKI

A
  • toxins (grapes, raisins)
  • ischaemic
    • infectious (leptospirosis- dogs, pyelonephritis)
    • cutaneous and renal glomerular vasculopathy (alabama rot)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

clinical findings of AKI

A
  • azotemia, uraemia
  • an/oliguria -> failure of K+ excretion
    • arrhythmias/arrest
  • +/- hyper/hypoperfusion- care with fluids if an/oliguria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

diagnosis of AKI

A
  • acute azotemia (increased urea, creatinine, phosphate)
    • increased K+ if anuric, decreased if polyuric
  • with dilute urine= excludes pre-renal
  • and no evidence of obstruction/rupture= excludes post-renal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

AKI diagnosis- urinalysis

A
  • often isosthenuric (dilute)
  • casts- indicate tubular injury
  • crystals- Ca oxalate monohydrate= ethylene glycol toxicity
  • inflammatory cells or positive culture= pyelonephritis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

crystals that are normal in dogs and cats

A

calcium oxalate dihydrate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

AKI management

A
  • remove underlying cause
    • known nephrotoxic drugs, gastric decontamination/adsorption
  • supportive- fluid balance, electrolytes, nutrition, nausea, analgesia
  • treat hyperkalaemia
    • calcium gluconate- stabilises heart for 20 mins
    • glucose- stimulates insulin release
    • insulin- stimulates uptake of glucose and K+
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

fluid therapy for AKI

A
  • crystalloids (hartmanns)
  • correct any hypovolaemia
    • 10ml/kg -dog, 5ml/kg cat over 10-15 mins
  • once euvolaemic- correct dehydration over 6hrs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

hyperkalaemia as complication of AKI

A
  • kidneys= major route of K+ excretion
  • hyperkalaemia= >6.5-7mmol/l
  • leads to arrhythmias/ arrest
  • ECG quicker than bloods to detect changes
    • wide QRS, spiked T, flat P wave
    • bradycardia, V-fib
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

nursing care for AKI patient

A
  • ensure euhydrated
  • ensure renal perfusion (systolic BP)
  • manage inappetence, nausea, pain
  • nutrition (oral, assisted)
    • liquid food needs calculating into fluid ‘ins’
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

prognosis of AKI

A
  • persistent anuria with vol overload and unmanageable hyperkalaemia= consider dialysis or euthanasia
  • 50% have CKD
  • survival 34-59% dogs, 27-42% cats
  • better prognosis if polyuric
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

CKD overview

A
  • most common in older cats
  • functional and/or structural disease of > 3 month duration
  • irreversible and progressive damage and dysfunction
    management:
  • protect remaining nephrons, supportive treatment to protect quality of life
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

aetiology of CKD (causes)

A
  • chronic interstitial nephritis (CIN)
    • end stage of many pathological processes
  • glomerulonephropathy
  • untreated infections (pyelonephritis, leptospirosis)
  • chronic obstructive disease (uroliths)
  • congenital (polycystic kidneys (cats) renal dysplasia (dogs))
  • neoplastic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

historical findings of CKD

A
  • signs may be subtle, tolerable due to slow onset of disease
  • PUPD
  • dehydrated due to polyuria
  • weight loss
  • lethargy, weakness
  • inappetence
  • vomiting +/- diarrhoea +/- heamatemesis/melaena
  • hypertension signs (blindness)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

clinical exam findings of CKD patient

A
  • catabolic state, reduced body condition
  • dehydrated
  • hypokalaemic, neck ventroflexion
  • mouth ulcers, halitosis (bad breath)
  • hypertensive retinopathy
  • small, irregular kidneys on palpation
  • rubber jaw
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

consequence of systemic hypertension

A

target organ damage
- ocular (hypertensive retinopathy)
- retinal oedema, haemorrhage
- can cause acute blindness
- renal
- cardiac
- neurological
epistaxis may also be complication

33
Q

normal BP

A

120-140mmHg
- sight hounds 10-20mmHg higher in hospital

34
Q

pre-hypertension range

A

140-159mmHg

35
Q

severe hypertension range

A

> 180mmHg
- high risk of future target organ damage

36
Q

diagnosis of CKD

A
  • dilute urine (not until 67% GFR loss)
  • with azotemia (increased urea, creatinine) not until 75% GFR loss
  • anaemia
  • increased phosphate, decreased K+
  • hypertension
  • imaging
  • symmetric dimethylarginine SDMA test- approximates glomerular filtration rate
37
Q

management of CKD

A

initially:
- stop any nephrotoxic drugs
- find and treat any underlying cause
- hypertension, UTI, ureteroliths
- correct and maintain fluid balance
ongoing:
- encourage oral water intake
- different water sources, wet food

38
Q

delaying progression of CKD

A
  • renal diet
  • control:
    • hypertension
    • proteinuria
    • hyperphosphataemia
    • hypokalaemia
39
Q

nutritional guidelines for renal patients

A
  • calculate and feed RER
  • weigh food in and out
  • monitor bodyweight/condition
  • avoid protein calorie malnutrition (ensure getting enough calories)
  • avoid aversions- introduce new diet at home
40
Q

renal diet

A
  • restricted protein, phosphorus, sodium
  • supplemented antioxidants, K+, soluble fibre
41
Q

additional management of CKD

A
  • phosphate binders to decrease levels of phosphate
  • potassium supplementation if hypokalaemic
  • amlodipine to reduce hypertension
42
Q

nephrotic syndrome

A
  • complication of glomerular disease
  • renal albumin loss
  • leads to hypoalbuminaemia
  • decreases oncotic pressure leading to effusions, oedema
    management:
  • reduce levels of protein within blood
  • omega 3 supplementation (protects kidneys
  • antiplatelet drugs due to increased risk of blood clots
43
Q

lower urinary tract disease

A

disease of bladder and urethra
+ prostate in males

44
Q

pollakiuria definition

A

increased frequency of urination

45
Q

periuria definition

A

voiding inappropriate places
- cats not voiding in litter tray due to association with pain

46
Q

cystitis definition

A

inflammation of bladder

47
Q

causes of cystitis

A
  • feline idiopathic cystitis
  • bacterial urinary tract infection (female dogs)
  • urolithiasis
  • neoplasia
  • drug induced
  • implants/indwelling catheters
48
Q

phone triage of LUT disease

A
  • clinical signs of LUT disease
  • are they still able to pass urine?
    • emergency
49
Q

urolith definition

A
  • urinary stone
  • macroscopic (can be seen by naked eye)
50
Q

crystal definition

A
  • microscopic
  • mineral precipitate
  • needs to be analysed in fresh, room temp urine
51
Q

crystalluria definition

A

crystals in urine
- crystals and uroliths can happen separately or together

52
Q

common urinary crystals and stones

A
  • struvite (normal as crystals)
  • calcium oxalate (normal as crystals)
  • urate
53
Q

crystal and urolith formation

A
  • urine is frequently saturated with compounds
  • increased saturation causes increased risk of precipitation
    • compound can no longer be held in solution (crystal formation)
  • further supersaturation can cause urolith formation
54
Q

treatment of urolithiasis

A
  • crystalluria is frequently normal and asymptomatic
  • uroliths are abnormal but may be asymptomatic
  • symptomatic uroliths need treating
55
Q

symptomatic upper urinary uroliths

A
  • nephroliths
    • cause abdominal pain leading to anorexia/inappetence + lethargy
  • ureteroliths
    • can cause ureteric obstruction
    • leading to post-renal azotemia
56
Q

symptomatic lower urinary uroliths

A
  • urethroliths- can cause obstruction
    • leads to stranguria
  • cystoliths- cystitis signs
    • pollakuria, stranguria, dysuria, haematuria
      uroliths may predispose animal to UTIs
57
Q

importance of urolith type

A
  • can change management
  • some can be dissolved through diet or medication
  • some need surgical removal
  • some are associated with infections
  • radiolucency can be used to guess type
  • crystals cannot predict stone type
58
Q

urolith radiographs

A
  • uroliths need to be >2-3mm to visualise
  • contrast/double contrast can be used for radiolucent stones
59
Q

general principles for urolith management

A

if urine is dilute, crystal/stone formation cannot occur
- encourage water intake (n+1 sources)
- wet diet preferably
- monitor USG (<1.030 (cats) <1.020 (dogs))
- encourage voiding
- avoid obesity

60
Q

dietary dissolution of stones

A
  • usually protein restricted
    • unsuitable for long term use, lactating animals or growing animals
  • some diets are suitable for more than one type of stone
61
Q

nursing considerations for urolithiasis

A
  • vigilance- monitor for unproductive urination (indicates obstruction)
  • maintain hydration, urine dilution/output
  • urinary catheter care and management
  • analgesia requirements (pain scoring)
62
Q

feline idiopathic cystitis- signalment

A
  • young to middle aged (2-7yrs)
  • overweight, inactive
  • indoor, litter tray users
  • multi-animal household
  • nervous disposition
  • dry diet
  • stressors in life (seasons, other animals, house move)
63
Q

cats susceptible to feline idiopathic cystitis

A
  • neuroendocrine modulation
    • adjusted sensory nerve function
    • abnormalities of CNS stress response
  • GAG layer of bladder hypofunction
    • typically protects bladder
      FIC affects susceptible cats in provocative environment
64
Q

diagnosing FIC

A

rule out other causes
- urinalysis (excludes UTI)
- radiographs (uroliths, masses)
- ultrasonography (abnormalities of UT)
- nothing found= FIC

65
Q

presentation of non-obstructed FIC

A
  • signs of LUTD
    • pollakiuria, stranguria, haematuria
  • still able to void
  • often self limiting (2-3 days)
  • may experience recurrent episodes
66
Q

presentation of obstructed FIC

A
  • urethral spasm or plug
  • unproductive attempts to urinate
  • emergency
  • more common in males (high recurrence rates)
    • > 40% experience recurrence within 6-12 months
67
Q

urinary catheter care

A
  • leave in place or remove?
  • closed, clean system
  • keep collecting bag off floor
  • wear gloves for handling
  • keep connections clean
  • change bag daily
  • tape tubing to tail to avoid pulling
  • avoid antibiotics
68
Q

post-catheterisation management

A
  • monitor urine output
  • monitor hydration/volaemic status
  • monitor electrolytes
    • post-obstruction diuresis will cause hypokalaemia
  • examine urine sediment/cytology daily for evidence of infection
69
Q

calculating UOP

A
  1. weight of bag now- weight of bag 4hrs ago
  2. UOP for last 4hrs/4= UOP for 1hr
  3. UOP for 1hr/patient weight= UOP (ml/kg/hr)
70
Q

medical management of FIC

A
  • analgesia (opioids= buprenorphine, NSAIDs)
  • avoid NSAIDs if azotemic
71
Q

environmental modifications for FIC patient

A
  • alleviate predisposing stressor
  • address negative cat-cat interactions
    • provide easy exit route from cat/places to hide
  • resource availability (n+1 for water + litter trays + beds)
  • use of feliway
72
Q

antispasmodics for obstructive FIC

A
  • used post-obstruction
    prazosin- smooth muscle relaxant
  • monitor BP due to risk of hypotension
73
Q

urinary incontinence definition

A
  • loss of normal, voluntary control of micturition
    normal control of urination:
  • sensory reflexes and conscious control
  • relaxation of urethral sphincter and bladder contraction
74
Q

neurogenic incontinence

A
  • upper motor neurone lesion (CNS)
    • spastic bladder, difficult to express
  • lower motor neurone lesion (PNS)
    • flaccid bladder, easy to express
75
Q

non-neurogenic incontinence

A
  • urethral sphincter mechanism incompetence
    • typically leak during recumbency
  • anatomical defects- ureter voids directly into urethra
    • frequent dribbling, risk of ascending infection
  • dyssynergia- failure of coordination of bladder contraction with urethral relaxation
76
Q

urethral sphincter mechanism incompetence (USMI)

A
  • common in larger breed, spayed bitches
  • leak during recumbency
  • multifactorial:
    • intra-pelvic bladder, obesity, neutering: increased collagen
77
Q

treatment of USMI

A
  • tighten sphincter
  • alpha agonists (trigger contraction of sphincter)
  • oestrogens (enhance agonists)
  • surgical repositioning of bladder
  • urethral cuffs
78
Q

management considerations of urinary incontinence

A
  • neurogenic
    • treat neurogenic disease, bladder expression
  • anatomic
    • repositioning of ureters

CVNT 2 (33 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions