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Module 17 > Urinary Tract Problems & PUPD in the Horse > Flashcards

Urinary Tract Problems & PUPD in the Horse Flashcards

1
Q

what is the water maintenance requirements in the horse

A

40-60 ml/kg bwt/day

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2
Q

what would a polydipsic horse be drinking a day

A

>100 ml/kg/day

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3
Q

what is a normal urine output

A

15-30 ml/kg bwt/day

15l for a 500kg horse

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4
Q

what are the ddx for PUPD (5)

A
  1. psychogenic PUPD
  2. secondary renal medullary washout
  3. endocrine: Cushing’s syndrome
  4. chronic renal failure
  5. diabetes insipidus (rare)
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5
Q

what are the causes of psychogenic PUPD

A

boredem/change of environment/feed

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6
Q

what is secondary renal medullary washout

A

inability to concentrate urine due to loss of sodium in renal medulla

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7
Q

how does cushing’s cause PUPD

A

direct inhibition of ADH

glucosuria

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8
Q

how does chronic renal failure lead to PUPD

A

increased water intake to maintain glomerular filtration rate

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9
Q

what are the types of diabetes insipidus

A

central vs nephrogenic

both very rare

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10
Q

what are the ways water is lost in equine

A

urine +/- 20%

feces +/- 75%

sweat

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11
Q

what is the normal colour of adult urine

A

pale yellow to brown

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12
Q

what is the normal colour of foal urine

A

pale yellow

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13
Q

what is the normal viscosity of adult urine

A

viscous (mucoid)

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14
Q

what is the normal viscosity of foal urine

A

watery

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15
Q

what is the normal transparency of adult urine

A

slightly turbid

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16
Q

what is the normal transparency of foal urine

A

translucent

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17
Q

what is the specific gravity of adult urine

A

1.006-1.050 (usually 1.020-1.050)

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18
Q

what would the specific gravity be if BUN elevated

A

>1.020 if BUN increased

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19
Q

what is the normal specific gravity of foal urine

A

1.001-1.027

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20
Q

what is the pH of adult urine

A

6.5-8.0

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21
Q

what is the pH of foal urine

A

6.0-7.0

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22
Q

what is the RBC/hpf in adult horse

A

<5 cells/hpf

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23
Q

what is the RBC/hpf in foal

A

none

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24
Q

what is the WBC/hpf in foal

A

0-3/hpf

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25
Q

what is the WBC/hpf in adult

A

<5cells/hpf

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26
Q

what are PUPD diseases in congenital/young horses (6)

A
  1. patent urachus may follow septicemia in neonates
  2. ectopic ureters – seen in fillies
  3. rectovaginal fistula
  4. rectourethral fistula
  5. polycystic kidneys
  6. renal agenesis
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27
Q

what are middle aged diseases that can cause PUPD (2)

A
  1. urolithiasis (more common in males)
  2. neoplasia
    - bladder neoplasia rare (SCC, transitional cell carcinoma)
    - externial genitalia (SCC, fibrosarcoma, melanomata)
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28
Q

what are the diet changes that may cause urinary diseases

A

important to establish any recent changes

change from pasture to stabling causes dramatic drop in water intake

is forage high in Ca? what supplements?

is water intake adequate?

presence of salt blocks?

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29
Q

what role does the environment play in urinary diseases (5)

A
  1. recent change of environment or use?
  2. any recent trauma? ortho/neuro damage
  3. more than one individual affected? (ex. EHV, equine protozoal myeloencephalitis)
  4. access to toxic plants (oak/acorns, exposure to alfatoxins)
  5. receiving NSAIDs?
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30
Q

what specific complaints from the owner might indicate renal involvement

A
  1. weight loss and PUPD
  2. lethargy or loss of athletic performance
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31
Q

what will the clinical exam entail (9)

A
  1. full exam
  2. collect blood sample prior to sedation
  3. detailed exam of external organs
  4. rectal palpation
  5. collection of sterile urine sample
  6. bladder/renal ultrasound
  7. bladder endoscopic exam
  8. peritoneal fluid collection
  9. neurological exam
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32
Q

what are clinical signs of urinary diseases (5)

A
  1. weight loss common
  2. can appear lame if external genital pain
  3. depression if azotemic: pre, post, or intrinsic renal failure
  4. fever: sheath infection, cystitis, urolithiasis or pyelnonephritis
  5. anemia: hematuria, CRF
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33
Q

what would the ddx of a mass on the sheath be (4)

A
  1. sarcoid (nodular, fibroblastic)
  2. SCC
  3. habronemiasis
  4. melanoma (cytobrush sample or biopsy)
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34
Q

what would the ddx of a mass on the perianal or perivulvular mass be (5)

A
  1. SCC
  2. abscess
  3. post service injury
  4. fibrosarcoma
  5. lymphoma (US + aspirate or biopsy)
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35
Q

how would you examine the penis

A

acepromazine 0.05 mg/kg IV/IM

most reliable for penile relaxation

xylazine 0.3-0.5 mg/kg IV

wait 5-10 mins

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36
Q

what are the components you can evaluate with the rectal exam (3)

A
  1. left kidney (right = retroperitoneal) (size, any associated pain)
  2. ureters
  3. bladder (size, tone, wall thickness, presence of calculi, is a cystolith palpable?)
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37
Q

what would this penile mass be

A

squamous cell carcinoma

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38
Q

what would this penile mass be

A

squamous cell carcinoma

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39
Q

what would this penile mass be

A

viral papilloma lesions

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40
Q

what would this penile mass be

A

melanoma

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41
Q

what would be a ddx for an adult male spraying urine, may be dysuria, swelling of urethral opening

A

urethral diverticular concretion (bean)

SCC

habronemiasis

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42
Q

how do you treat a urethral diverticular concretion

A

manual removal

sheath cleaning water based lube only

43
Q

what are the clinical signs of stranguria (2)

A
  1. scalding/urine staining of the dorsal hind legs in males

perineal scalding in mares

  1. swelling of sheath/distal penis (edema vs infection, purulent discharge from sheath or from vulva)
44
Q

how do you collect a urine sample

A

use sterile technique

minimal sedation to reduce changes in urine concentration and content

stallion catheter or mare catheter/foley

in the mare: external urethral orifice

45
Q

what is a catether useful for in mares

A
  1. submit cathetirzed sample for cytology and bacterial culture
  2. bladder lavage helpful in cases of sabulous urolithiasis –> reduce sediment, 5l hartman’s, indwelling foley catheters in bladder paralysis or LMN bladder
46
Q

can dipstick distinguish blood vs myoglobin vs hemoglobin in horses

A

no

cytology required

47
Q

what might be elevated if there is myoglobinuria

A

CK/AST

48
Q

what would be in the urine if there is lower urinary hemorrhage

A

whole rbcs

49
Q

what might be in the urine if there is renal damage

A

renal casts

50
Q

what could cause proteinuria (3)

A
  1. glomerular disease
  2. pyuria
  3. bacteriuria
51
Q

what could be ddx for glucosuria (4)

A
  1. elevated with stress
  2. alpha agonists
  3. cushing’s syndrome
  4. equine metabolic syndrome
52
Q

what crystalluria is normal in the horse (3)

A
  1. calcium carbonate
  2. calcium oxalate
  3. triple phosphate
53
Q

what does elevated urea/creatinine indicate

A

reflects reduced GFR

determine if elevations are due to pre-, post- or intrinsic renal failure

54
Q

what serum electrolyte changes would indicate post-renal obstruction

A

increased K+

Na+ decreased

Cl- decreased

55
Q

what is NAG

A

n-acetly-B-D-glucosaminidase

56
Q

what can NAG indicate

A

urinary increase in acute kidney injury

57
Q

what can lower albumin indicate

A

PLN uncommon in horses

58
Q

what can increased globulin indicate

A

increased if chronic inflammatory focus

59
Q

what can elevated WCC, fibrinogen, SAA concentration indicate

A

likely left shift neutrophilia, elevated fibrinogen and serum amyloid A in urolithiasis

60
Q

what can anemia indicate

A

decreased erythropoiesis

decreased RBC lifespan if chronic renal failure

61
Q

what other clinical pathologies seen in pre renal azotemia

A

signficant dehydration

endotoxemia

USG >1.030

62
Q

what other clinical pathologies seen in renal azotemia

A

often following prerenal causes

renal medullary necrosis

NSAID toxicity esp in hypovolemia

acute kidney injury (AKI) subsequent to dehydration, aminoglycoside use

63
Q

what other clinical pathologies seen in post renal azotemia

A

increased K+

decreased Na+

decreased Cl-

64
Q

what can endoscopic exam of the bladder assess (5)

A
  1. is there trauma?
  2. rule out cystoliths?
  3. visualize ureters
  4. are both producing urine?
  5. rule out neoplasia
65
Q

what are the clinical signs of urolithiasis (4)

A
  1. renal: may cause hematuria or pyelonephritis
  2. ureter: may cause ureteral rupture and uroperitoneum
  3. bladder: colic signs, dysuria, and hematuria post exercise
  4. urethra: acute colic, stranguria, bladder distention, penile swelling
66
Q

what are clinical signs of nephroliths

A
  1. colic
  2. hydronephrosis
  3. hematuria
67
Q

what are the clinical signs of cystic and urethral calculi (5)

A
  1. dysuria, stranguria
  2. hematuria after excerise
  3. frank blood at end of urination
  4. urine scalding
  5. similar signs to colic
68
Q

how do urolithiasis form

A

nidus required + supersaturation of urine following urine stasis

69
Q

what are the two types of urolithiasis (2)

A
  1. spiculated, yellow-brownish
  2. smooth, oval and white
70
Q

how would you diangose a urolithiasis (4)

A
  1. clinical signs
  2. rectal palpation
  3. catheterization
  4. endoscopy
71
Q

what is shown here

A

accoustic shadowing

urolithiasis

72
Q

how would you treat an uncomplicated primary bacterial cystitis

A

hydration: maintain flow of urine

irrigation of bladder

antimicrobial therapy: renal excretion

73
Q

what antimicrobials would you use to treat a primary bacterial cystitis

A
  1. trimethoprim-sulphadiazine
  2. penicillins (gentamicin, cephalosporins, ampicillin)

may need >2 week duration based on culture cytology and culture

74
Q

how would you remove a urolithiasis surgically

A

xylazine epidural

urethral sphincterotomy may be needed

lithotripsy

laparocystotomy commonest technique in males

75
Q

how do you treat a urethral calculi surgically

A

surgical emergency

distal urethral –> attempt to express manually

incision over median raphe under GA

ischial calculi require ischial urethrostomy

76
Q

how do you treat a urethral calculi (3)

A
  1. antibiotics
  2. urinary acidification: oral asorbic acid (1kg/horse/day), diet with low DCAB, restrict caclium intake
  3. water intake: maximize, addition of salt to diet
77
Q

how do you treat sabulous urolithiasis (4)

A
  1. freq lavage of bladder with sterile saline to remove sediment
  2. bethanechol to increase detrusor contraction
  3. phenoxybenzamine only if UMN sphincter involvement
  4. aim to promote diuresis: urinary acidifying diet, underlying neurological problem not treatable
78
Q

what are the clinical signs of bladder rupture (3)

A
  1. depression and inappetence
  2. pass small volumes of urine
  3. pendulous abdomen may develop
79
Q

what clinical pathology changes might be seen following a bladder rupture (5)

A
  1. azotemia
  2. hyperkalemia
  3. hyponatremia
  4. hypochloremia
  5. uroperitoneum: peritoneum creatinine > serum creatinine by factor of 2
80
Q

what can cause bladder ruptures

A

post partum mares and foals (male foals)

following severe necrotizing cytitis

81
Q

why is a cystoscopy useful in a bladder rupture

A

determine original cause of rupture and extent of tear to give prognosis

82
Q

how are bladder ruptures treated

A
  1. small tears: heal by secondary intention
  2. foals: surgery after correction of electrolyte imbalances (correct fluid therapy!)
83
Q

what are congenital causes of urinary incontinence (2)

A
  1. ectopic ureters
  2. hydroureters
84
Q

what are neurological causes of urinary incontinence (4)

A
  1. LMN damage may occur secondary to sabulous urolithiasis
  2. cauda equine damage
  3. infectious causes of cauda equina neuritis
  4. traumatic injury to spinal cord or brain causing LMN or UMN damage
85
Q

what are anatomical defects that can cause urinary incontinence (2)

A
  1. mares may have pooling of urine in the repro tract
  2. accumulation of urine within the sheath in males if unable to exteriorize the penis
86
Q

what are the sympathetic nerves that innervate the bladder

A

hypogastric nerves from the lumbar vertebrae

87
Q

what are the parasympathetic nerves that innervate the bladder

A

pelvic nerve from sacral vertebrae

88
Q

what does the sympathetic innervation in the bladder cause

A

detrusor relaxation, internal sphincter contraction

filling and continence

89
Q

what does the parasympathetic innervation in the bladder cause

A

detrusor contraction

emptying bladder

90
Q

what is the somatic innervation of the bladder

A

pudendal nerve from sacral vertebrae

91
Q

what is the somatic innervation of the bladder control

A

external sphincter

92
Q

what is cauda equine syndrome

A

meninges end at S2/S3 vertebral junction

caudal nerve roots extend further

cauda equine = nerve roots and SC located caudal to LS junction

sacrococcygeal nerve roots (pudendal, caudal rectal, pelvic and coccygeal peripheral nerves, part of sciatic and gluteal nm)

damage to this region may occur in isolation or be part of multifocal problem

93
Q

what are the signs of cauda equine and the ddx (8)

A
  1. traumatic damage
  2. neuritis of the cauda equina (polyneuritis equi)
  3. EHV-1 myeloencephalitis
  4. sorghum-sudan grass toxicity
  5. equine protozoal myeloencephalitis
  6. sacrococcygeal vertebral osteomyelitis
  7. rabies
  8. neoplasia
94
Q

what might cause equine LMN incontinence

A

may be linked to cauda equina neuritis

primary or secondary sabulous urolithiasis (sediment crystalliuria, recurrent discomfort and infection)

95
Q

what are the signs of LMN incontinence

A

incomplete bladder emptying

overflow of small quantities urine from large flaccid bladder

96
Q

what would LMN neurological incontinence affect

A

detrusor and urethral sphincter atony

urinary retention and overflow incontinence

large, atonic bladder easy to express

97
Q

where would a UMN neurological deficit be that causes incontinence

A

lesion in suprasacral or brain stem

98
Q

where would a LMN deficit be that would cause neurological incontinence

A

lesion in sacral, pelvic or pudendal nerves

99
Q

what would a UMN neurological incontinence look like

A

urethral sphincter tone exaggerated and loss of coordination micturition

urinary retention and overflow incontinence

large, firm bladder difficult to express

100
Q

what is renal tubular acidosis

A

alkaline urine and systemic acidosis

inability to excrete H+ ions in the distal convoluted tubule (Type 1)

or

fail to resorb bicarbonate ions from proximal convoluted tubule (type 2)

101
Q

what are the clinical pathologies of renal tubular acidosis

A

hypercholermia

low potassium

metabolic acidosis

102
Q

what are the clinical signs of renal tubular acidosis (4)

A
  1. depression, weakness and ataxia
  2. loss of condition
  3. tachypnea and tachycardia
  4. primary and secondary forms
103
Q

how is renal tubular acidosis treated

A

bicarbonate deficit = bwt x 0.6 x base deficit (mmol)

correct bicarbonate deficit

longterm oral supplementation based on blood gases and response to treatment

Module 17 (31 decks)

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