Urinary Tract Diseases Flashcards
What is uroperitoneum? In what horses is it most common?
leakage of urine into the peritoneal space
colts > fillies
What is the most common cause of uroperitoneum in mares? What are 4 possible causes in foals?
trauma during parturition causes rupture to the bladder or urachus
- prolonged recumbency
- dummy foal bladder
- rupture secondary to cystitis in septicemic foals
- rupture of urachus due to umbilical abscesses
What are clinical signs of uroperitoneum in foals?
appears normal at birth, signs begin in 1-3 days:
- depression, anorexia
- tachycardia, shallow breathing
- abdominal distension (percussion wave)
- straining to urinate, dribbling
- intestinal ileus, dehydration
What 5 things are seen on biochemistry in cases of uroperitoneum?
- hyperkalemia*
- hyponatremia
- hypochloremia
- increased or normal BUN/creatinine
- metabolic acidosis
What is the most common sign on ultrasound of uroperitoneum? What should be checked for?
hypoechoic free abdominal fluid
umbilical remnants - urine can accumulate
What are 2 important aspects of peritoneal fluid from uroperitoneum?
- pale, yellow, copious, urine smell
- creatinine in fluid/serum > 2
What are 3 things seen on ECGs in cases of uroperitoneum? Why?
- broad QRS
- tall T wave
- bradycardia, arrhythmias (block)
increased potassium in serum
What is the first part of treatment of uroperitoneum? In what 3 ways is this done?
STABILIZE
- controlled abdominal drainage with teat cannula or 16F tube
- correct hyperkalemia
- check potassium every hour until < 5.5 mEq/L achieved
What are 2 options for correcting hyperkalemia in patients with uroperitoneum?
- 0.9% NaCl with 5-10% dextrose and calcium borogluconate
- sodium bicarbonate if acidotic with insulin/dextrose
After patients with uroperitoneum are stabilized, what is done?
surgery (not an emergency!)
- repair
- indwelling catheter
- antimicrobials, NSAIDs
- good prognosis!
In what horses are UTIs most common? What is the most common etiology?
mares > geldings, stallions
usually ascending infections due to defects, obstructions, catheters, or paralysis, which leads to urethral colonization and the bladder and kidneys
What are the 9 most common pathogens that cause UTIs?
- E. coli
- Proteus mirabilis
- Klebsiella spp.
- Enterobacter
- Streptococcus
- Pseudomonas aeruginosa
- Corynebacterium renale
- Candida
- rhinitis virus
What are the most common signs of UTIs in males? What are the 2 overall most common signs?
urethritis, hemospermia (stallion)
- CYSTITIS - pollakiuria, stranguria, hematuria, pyuria, scalding, crystals
- PYELONEPHRITIS - can go undetected, nephrolithiasis, CKD, hematuria, pyuria, fever, weight loss, anorexia, depression
What is seen on UA in cases of UTIs?
- > 10 WBC/hpf, bacteria
- quantitative urine culture >10000 CFU/mL
What are 4 important aspects to treating UTIs?
- correct primary cause
- antimicrobials ideally based on culture for >7 days, 4-6 weekds
- NSAIDs - Banamine
- phenazopyridine
What 5 antimicrobials are recommended for UTI treatment? Why?
- TMS
- Tetracycline
- Ceftiofur
- Ampicillin
- Pen/Gen
concentrate well in urine
Why is phenazopyridine used in UTI treatment? What side effect is common?
topical anesthetic that relieves burning, irritation, discomfort, and frequent urination
turns urine orange
What is the difference between sulfamethoxazole and sulfadiazine?
SM = inactive
SD = unchanged, greater concentrations in urine
What changes to lifestyle can be made to treat/prevent UTIs?
- pasture access
- diet supplementation with 50-75 g of loose salt
- warm water
What is the most common urolithiasis in horses? In what horses is it most common?
calcium carbonate
- older horses
- males > females - longer urethra that is less distensible
What is the most common site for urolithiasis?
bladder > urethra > kidney, ureter
often more than one stone!
What are 3 urinary factors that increase chances of developing urolithiasis? Diet factor?
- alkaline pH
- naturally high incidence of crystalluria, concentration of mucoproteins, and mineral content
- urine stasis
high mineral content
What are 3 additional factors that increase chances of developing urolithiasis?
- urinary retention and stasis
- decreased water intake
- bacterial infection
What are the 2 types of calcium carbonate stones in horses?
TYPE 1 - most common, spiculated, easier to break down manually
TYPE 2 less frequent, smooth, harder to break down
What is the most common sign of urolithiasis? What else is seen?
hematuria after exercise
- frequent, painful urination
- incontinence, dribbling
- colic
- tenesmus
- tail swishing, stamping hind feet
When is rectal palpation done to diagnose urolithiasis? Where is the bladder found? What is required for this diagnostic?
when the bladder is empty
very close to rectal inlet in front of the pelvic rim
- sedation, epidural
- buscopan: control of abdominal pain (colic)
What are the 2 most common diagnostics for urolithiasis?
- ultrasound of the entire urinary tract
- UA and quantitative culture (for treatment of secondary infection)
What 2 treatments are recommended for urolithiasis? What is done following this?
- manual breakdown - mare, small hands, sedation, epidural
- fragmentation by laser lithotripsy via endoscope
- culture and urolith analysis
- antibiotics for 7-10 days
- catheter
- NSAIDs
What 3 surgeries can be done in uroliths that are unable to be broken down?
- cystotomy
- perineal urethrotomy or urethrostomy
- urethral sphincterectomy
In what 4 ways can the diet be altered to prevent urolithiasis?
- balance mineral consumption
- change from legume to grass hay
- urinary acidification by ammonium chloride, ammonium sulfate, or ascorbic acid
- increase water consumption, can be induced by giving some salt
(recurrence common)
What is sabulous urolithiasis? What are 2 clinical signs?
large quantities of crystalloid sediment (calcium carbonate) that accumulate on the bladder floor, compromising its emptying —> incontinence
- urinary incontinence with scalding
- neurologic signs
How is sabulous urolithiasis diagnosed? What 3 treatments are recommended?
neurologic exam, rectal exam, endoscopy
- repeated bladder lavage
- encourage bladder emptying with bethanechol or phenazopyridine
- broad spectrum antimicrobials
What is seen on cytology in cases of hematuria?
> 5 RBC/hpf
What are some common causes of hematuria?
- urolithiasis
- UTI
- neoplasia
- exercised-induced (without cystoliths)
- proximal ureter tears
- idiopathic renal hematuria
- idiopathic cystitis
How can timing be used to localize the site of hematuria?
- throughout urination: kidneys, ureters, bladder
- beginning of urination: distal urethra
- end of urination: proximal urethra, bladder neck
What is the etiology of urethral tears? Where is this most common? Why is it difficult to diagnose?
high pressure in corpus spongiosum
proximal urethra at the level of the ischial arch
often heals into a fistula
How are urethral tears diagnosed? What doesn’t seem to help?
- history, clinical signs
- hematuria at the end of urination with urethral contractions
- endoscopy
antimicrobials
How are urethral tears treated?
temporary subischial perineal urethrotomy to relieve pressure
often no treatment is necessary - breeding rest for stallions is recommended
What is the etiology of idiopathic renal hematuria? What horses seem to be predisposed?
sudden onset of gross hematuria due to episodic hemorrhage from 1 or more kidneys (no other signs)
Arabians
How is idiopathic renal hematuria diagnosed? Treated? What is prognosis like?
exclude other causes of hematuria or clotting disorders + endoscopy, ultrasound
- supportive care: aminocaproic acid, formalin
- nephrectomy: bleeding will likely occur from other kidney
will bleed again and worsen over time - fatal bleeding is possible!
What are 3 congenital causes of urinary incontinence?
- patent urachus
- septic omphalitis/omphalophlebitis
- ectopic ureter
What are 5 neurologic causes of urinary incontinence?
- sacral or coccygeal trauma
- EHV-1, EPM, rabies
- EDM
- polyneuritis equi
- neoplasia
What are some iatrogenic, hormonal, and toxicological causes of urinary incontinence?
IATROGENIC - epidural alcohol, urethral sphincter damage
HORMONAL - estrogen-responsive
TOXIC - sudan grass, sorghum cystitis ataxia
What is the most common signs of urinary incontinence?
urine scalding of legs and perineum
(+ smell)
