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Clinical Urology > Urinary Tract Diseases of the Horse > Flashcards

Urinary Tract Diseases of the Horse Flashcards

1
Q

What crystals are normal to find in horse urine?

A

Calcium oxalate crystals

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2
Q

When do Calcium oxalate crystals become problematic in the horse?

A

When the crystals aggregate together into a urolith and cause abrasions to the bladder wall and subsequent cystitis
OR
When the uroliths pass into the urethra and cause partial or complete obstruction

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3
Q

What are the clinical signs associated with urolithiasis in horses?

A
  • Frequent urination
  • Passing of small volumes
  • Straining to urinate
  • Blood in the urine
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4
Q

How can urolithiasis be diagnosed in horses?

A
  • Ultrasound evaluation per rectum

- Endoscopy of the bladder

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5
Q

What is the treatment for urolithiasis in FEMALE horses?

A
  • Pass forceps into the bladder and break up the stones to allow for pieces to be manually removed or lavaged out
  • A cystotomy under general anesthesia may be necessary to remove extra large uroliths
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6
Q

What is the treatment for urolithiasis in MALE horses?

A
  • Pass a catheter to push the stones back into the bladder before lavaging it out
  • If a stone is stuck in the urethra, then a perineal urethrotomy or urethrostomy may be needed to remove it. Complications of this sx are stricture and fistula formation
  • Lithotripsy (U/S shockwaves) can be used to break up uroliths and facilitate removal
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7
Q

Where is the most common site of lodgement for a urolith in the male horse?

A

at the point of urethral narrowing behind the ischium

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8
Q

How can urolithiasis be prevented in horses?

A
  • Dilution of urine: increase water intake by increasing salt intake
  • Acification of urine: adding Vit C and potassium aspartate
  • Decreased minerals in diet: reduce grain and decrease calcium
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9
Q

What is the difference between a urethrostomy and a urethrotomy?

A

Urethrotomy: the surgical incision into the urethra and then allowed to close either through primary or secondary intention

Urethrostomy: the surgical incision into the urethra and then tacking of the mucosa to the skin to create a permanent urethra opening

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10
Q

What are the complications associated with both a urethrostomy and a urethrotomy?

A
  • Stricture formation: usually occurs 6m - 1 year after surgery
    This can be redone, but stricture formation is then even more likely after this
  • Fistula formation
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11
Q

What age is bladder rupture most commonly seen in horses?

A
  • Neonatal foals: more common in colts (believed to be due to narrower pelvis than filly’s)
  • Secondary to urolithiasis at any time
  • Mares post parturition (not always associated with dystocia)
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12
Q

What is the typical presentation of a foal with a ruptured bladder?

A
  • Clinically normal at birth
  • Then 1-5 days, clinical signs arise as uroabdomen develops and associated electrolyte imbalances: depressed, anorexic, abdominal distension, mild colic, dehydration
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13
Q

Where in the bladder is the most common site for tearing, in foals?

A
  • Small tear at the dorsal neck of the bladder
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14
Q

How can a ruptured bladder be diagnosed in foals?

A
  • Clinical signs and history
  • Blood analysis: hyperkalemia, low Na and Cl, metabolic acidosis, high serum creatinine

note: the hyperkalemia is what can kill the foal if left untreated as it can cause arrhythmias

  • Ultrasound
  • Abdominocentesis
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15
Q

What is the treatment and prognosis to a ruptured bladder in a foal?

A
  • Stabalize the foal with fluid therapy, correction of electrolyte imbalances, slow abdominal drain and glucose supplementation
  • evaluate for concurrent diseases: PAS (perinatal asphyxiation syndrome) or septicemia
  • midline laparatomy under GA

Prognosis: good to excellent

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16
Q

What is considered to be the most common malformation of the equine urinary tract?

A

Congenital patent urachus: due to increased tension on the cord or torsion can lead to dilatation and failure to close at birth

17
Q

What are the clinical signs associated with a patent urachus in a foal?

A
  • persistently moist umbilicus after birth
  • urine leaking from the umbilicus
  • signs of systemic disease (septicemia, joint ill and pneumonia)
18
Q

How can a patent urachus be diagnosed in a foal?

A
  • Clinical signs, exam and history

- Ultrasound

19
Q

What is the treatment for a patent urachus in a foal?

A

Dependent on whether there is infection or not:
- No Infection: navel dip with 0.5% chlorhexidine 2-4x a day
+/- systemic antibiotics with regular U/S to monitor changes

  • Infection: broad spectrum antibiotics, and if urine leakage continues after 7 days of medical therapy then surgical exploration and resection of the urachus and umbilical vessels may be needed
20
Q

What 2 diseases are most commonly found in the upper urinary tract of the horse?

A
  • Acute renal failure

- Chronic renal failure

21
Q

What 3 diseases are most commonly found in the lower urinary tract of the horse?

A
  • Cystitis/ Urethritis
  • Uroliths
  • Incontinence
22
Q

What are the causes of Acute renal failure in the horse?

A

Divided into Pre-renal, Renal and Post-renal causes

Pre-renal: Decreased perfusion
- Hypovolemia, hypotension, dehydration, sepsis/ endotoxemia, DIC and volume redistribution

Renal:

  • Toxins: exogenous toxins (aminoglycosides, NSAID’s, acorns, Cantharidin) or endogenous toxins (Myoglobin/ Hemoglobin and Endotoxin)
  • Nephritis: Bacterial or Immune mediated

Post-renal: Obstruction
- Urolithiasis, neoplasia, bladder paralysis

23
Q

What are the causes of Chronic renal failure in the horse?

A
  • Residual damage from untreated acute renal failure
  • Abscesses
  • Neoplasia
  • Infarct/ Haemorrhage
24
Q

What are the clinical signs associated with acute renal failure in the horse?

A

Non-specific usually

  • Depression
  • Fever
  • Anorexia
  • Early polyuria
  • Anuria
25
Q

What are the clinical signs associated with chronic renal failure in the horse?

A
  • Depression
  • Fever
  • Anorexia
  • Poor performance
  • Weight loss
  • PU/PD
  • Oral Lesions: dental tartar and ulcers
26
Q

What is the most common causes for cystitis in the horse?

A
  • Ascending infection
  • Secondary to catheter
  • Neurogenic dysfunction: due to trauma, Equine Herpes virus-1 and Sorghum toxicity
27
Q

What is the most common causes of Incontinence in the horse?

A
  • Congenital
  • Trauma: e.g. post-foaling
  • Neurogenic:
    • equine herpesvirus-1 myelitis, which affects the detrusor and sphincter function
    • cauda equina syndrome
    • intoxication
    • sacral + spinal trauma
    • equine protozoal myeloencephalitis
    • cervical stenotic myelopathy
    • equine degenerative myelopathy
28
Q

What are the clinical signs associated with Lower Urinary Tract diseases in the horse?

A
  • Dysuria
  • Stranguria
  • Pollakiuria
  • Hematuria
  • Incontinence
  • Prolapse
  • Colic
29
Q

How can Urinary Tract Disease be diagnosed in the horse?

A
  • Blood work:
    Acute renal failure: increased BUN and creatinine, increased K, and decreased Na and Cl
    Chronic renal failure: all of the above results in ARF + Decreased PCV + evidence of other disease
  • Urinalysis
  • Fractional Excretions: calculation of what the kidneys are doing with the elctrolytes
  • Ultrasound +/- Cystoscopy
30
Q

What results would you expect in a NORMAL urinalysis of the horse/ foal?

A

Normal urinalysis:

  • Straw coloured and cloudy
  • SG: 1.015 - 1.050 (foals may be dilute)
  • pH: alkaline >8.0 - 9.0(foals may be acidic)
  • WBC: none
  • RBC: none
  • Casts: none
  • Crystals: Calcium carbonate
31
Q

How can renal failure be treated in the horse?

A
  • Correct underlying disease
  • Fluid therapy: 2x maintenance if producing urine
  • Diuretics: if anuric
  • Low protein diet: reduce nitrogen content
  • Low Calcium diet: reduce calcium oxalate crystal formation
32
Q

What is the prognosis for acute and chronic renal failure?

A

Acute: reasonably good IF addressed early

Chronic: guarded to poor

33
Q

A rectal exam of an incontinent horse reveals the bladder to be small and turgid, what is this indicative of?

A
  • Upper Motor Neuron Dysfunction
34
Q

A rectal exam of an incontinent horse reveals the bladder to be large and flaccid, what is this indicative of?

A
  • Lower Motor Neuron Dysfunction
35
Q

A tumour is found at the neck of the bladder of a horse during Cystoscopy, what is the most likely diagnosis?

A

Transitional cell carcinoma

36
Q

What is the treatment protocol and prognosis for cystitis in the horse?

A

Ideally a culture and sensitivity is collected

  • Antibiotics: TMS
  • Anti-inflammatories: Flunixin meglumine or Ketoprofen

Prognosis: Good

37
Q

What is the treatment and prognosis for Incontinence in the horse?

A

Treatment:

  • sx if anatomic malformation (congenital)
  • treat underlying cause if neurogenic

Prognosis: depends on the cause

38
Q

What are the potential causes for PU/PD in the horse?

A
  • Renal Disease
  • Behavioural: psychogenic polydipsia. Stabled and bored horses will drink a lot
  • Diabetes insipidus: and associated with Equine Cushings Disease/ PPID
  • Diabetes mellitus: extremely rare
39
Q

What test can be done to rule out/in Behavioural PU/PD from other causes of PU/PD?

A

Water Deprivation Test:

1) Weigh Horse
2) Measure Urine S.G.
3) Remove water and repeat weight and S.G. at 12 and 24 hours
4) Stop when Urine S.G. > 1.025 = this indicates normal function
5) S.G. should be >1.045 by 24 hours

Caution: do NOT perform if the horse is dehydrated or azotemic!
Stop test if the horse becomes clinical dehydrated - this is abnormal!

Clinical Urology (8 decks)

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