Urogenital tract Flashcards
Urogenital tract
Upper UGT- kidneys and ureters
Lower UGT- bladder and urethra
The upper urogenital tract is always sterile and introduction of bacteria can cause significant disease
Conditions affecting the UGT are common
Conditions may be what for urogenital tract disease
Congenital
Acquired
Degenerative
Reproductive tract
Less emphasis on this in small animal medicine– most animals are spayed/neutered
Prostate and testicles in male dogs
Uterus in females
Acute renal failure
Damage to the kidneys occurs over hours to days
Acute renal failure can be caused by
Anything that decreases renal perfusion- shock, dehydration, hypotension
Anything that causes direct harm to the kidneys - trauma, infection, toxins
pathological changes with acute renal failure
Damage to nephron unit
Loss of filtration
Ultimately,
Build-up of toxins
Uremia
Acidosis
Dehydration
Eventually the kidneys shut- down causing anuria (no urine production)
Is ARF an emergency and why
ARF is an emergency
ARF is potentially fatal depending on the cause and amount of damage that has already occurred
History with ARF
Drugs: NSAIDs, aminoglycoside antibiotics
Toxins: Anti-freeze, lilies
Risk of infection, recent dehydration, hypotension (including during a GA)
Treatment with ARF
Remove toxins
Treat infection if present
FLUIDS
Flush kidneys of toxins
Restore renal blood flow
Restore hydration
Balance losses (input MUST equal output)
Twice daily weight check
Balance input and output
Watch for fluid overload (altered distribution and risk of anuria)
Prognosis with ARF
Depends on underlying cause–poor to guarded
The kidneys have a poor regenerative capacity
Healthy kidney will compensate
Lily toxicosis is and only affects what
Cats
Renal toxin
All parts of the plant are toxic
1 leaf can be fatal to a cat
How fast is lily toxicosis
2-6 hours – toxicity starts
12-18 h – kidney damage occurs
3-7 days – death from ARF
Treatment and response with lily toxicosis
Always treat as emergency
Induce vomiting (<4h since ingestion)
Start emergency detoxification
IV fluids
Detoxification with activated charcoal
Renal support
Ethylene glycol (antifreeze) toxicity is caused by and common in
Tastes sweet
Increased risk if it is the only available liquid in the Winter
Dogs, cats, (cattle)
When is ethylene glycol toxicity going to happen
Dogs: <1 tsp/kg
Cats: ¼ tsp/kg
Effects of ethylene glycol toxicity
Alcohol toxicity (immediate)
Vomiting, PUPD
Acidosis, dehydration (3h)
Calcium oxalate crystal formation causing acute kidney damage (12 h)
Is ethylene glycol toxicity an emergency
EMERGENCY: rapidly fatal from ARF
Treatment of ethylene glycol toxicity
If ingestion has occurred within the past 2 hours
Induce vomiting
Activated charcoal
IV fluids
Antidote- IV vodka
Chronic renal failure is common in
Age-related
Cats >10y; Dogs >8y
Progression of CRF
IRIS STAGING SYSTEM
Stage 1– renal insufficiency
Stage 2– start prevention
Stage 3 – clinical signs related to water loss and urea
Stage 4– end stage, requires hospitalization
Complications with CRF
Dehydration
Acidosis
Ulcerative lesions–mouth, GIT
Hypertension→retinal detachment→sudden onset of blindness
ANEMIA
Loss of EPO production
EPO is the hormone that stimulates RBC production in the bone marrow
Hypercalcemia
Proteinuria
Hyperphosphatemia and hypokalemia
Treatment of CRF
Will eventually die–this is a progressive disease
Supportive care only
Fluids
Low protein diet→decreased uremia
GI protectants, antiemetics…
Other….
Prognosis of CRF
Death in
Cats 1-5y
Dogs 6mo–2 y
Tech notes with CRF
Animals with CRF are at a higher risk of adverse reactions for most drugs including general anesthesia
Many drugs are contra-indicated
GA decreases blood flow to kidneys
Kidneys already at risk
Assume most geriatrics have some degree of CKD
Urethral sphincter mechanism incompetence (USMI) is and common in
(Estrogen-Dependent Urinary Incontinence)
(Hormone-Responsive Urinary Incontinence)
Incontinence– Lack of control of micturition
Older large breed females…….. that have been spayed
Problem = decreased estrogen
Diagnosis by exclusion
Lack of urethral sphincter tone
Treatment for USMI is and for how long
Treatment is for life
Supplement with diethylstilbestrol (DES) or phenylpropanolamine (PPA)
DES: initially once daily for 5 days then decrease to minimal effective dose (often every 7 days)
Can suppress the bone marrow -aplastic anemia (erythropenia, possible thrombocytopenia and leukopenia)
Annual blood work is recommended
PPA: sympathomimetic- increases sympathetic tone
Treatment of USMI
Stilbestrol (diethylstilbestrol)- is often the treatment of choice for spayed, mature, female, dogs
Initially once a day for 5 days and then usually only once a week so good compliance
Estrogen can potentially suppress the bone marrow causing estrogen induced aplastic anaemia (manifested with low platelet counts, petechiation and ecchymotic lesions, bruising, very low RBC count, and even low WBC count)
Annual blood work is required
Phenylpropanolamine- another commonly used treatment option
Available in liquid or tablet form
Needs to be administered every 12 hours in most cases
Can be used in males or immature dogs
Can be used as a combination therapy with DES in poorly responsive cases
Monitoring of blood work recommended
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Inappropriate elimination for cats
Bad news for cats
Over 100 000 cats enter shelter every year
50% of cats in shelter are euthanized
Most common reason for relinquishing a cat to a shelter is inappropriate elimination
Reasons for inappropriate elimination
Aversion to
Litterbox
Type of litter
Location of the litterbox
Substrate preference
Separation anxiety
Medical management, litter box makeover and environmental enrichment are all importanti in improving the issue
Most commonly more then one is the cause
UTI is
Bacteria most common
Ascending from exterior
Skin or feces; distal urethra
More common in females than males
Males usually have an underlying pathology
Risk factors for UTI
Sphincter incontinence
UGT abnormalities
Indweling u-catheter
Crystalluria/ urolithiasis
Decreased frequency of urination
Diabetes mellitus
Prostate /uterine infection
Estrus
Presenting signs with UTI
Inappropriate urination
Stranguria, pollakiuria
Hematuria, cloudy urine, licking ant prepuce or vulva
Sometimes will have no observable signs until systemic disease is present
Diagnosis of UTI
Gold standard for diagnosis is urinalysis on urine collected by aseptic technique (cystocentesis)
Ask owners to not let the animal urinate for a couple hours prior to the appointment
In-clinic microscopy
Culture and sensitivity- if recurrent infections or the animal is not responding to therapy
Treatment results for UTI
Resolution
Recurrent
Resistant
If untreated, can lead to pyelonephritis
Pyometra is
INTACT female dogs and cats
Bacterial infection of the uterus
What causes pyometra
Estrus
Decreased immune responsiveness
Relaxation of the cervix
Mucosal hypertrophy
E.coli > other
open pyometra is
Draining
Less risk of rupture
Easier to diagnose
Better prognosis
Closed pyometra is
May not see outward signs
Risk of necrosis/rupture causing bacteremia
Poor prognosis if not caught early
Surgical treatment of pyometra
Ovariohysterectomy
Treatment of choice for open and closed pyometra
A higher risk surgery than healthy dog spay
Significant risk of uterine rupture with closed pyometra
Medical management of pyometra
Open pyometra ONLY
>50% recurrence rate with subsequent heat cycle if the animal is not bred
Prostaglandins and antibiotics
Crystalluria means
crystals in urine
Urolithiasis means
stones in urine
Pahtology of crystalluria and uroliathiasis
Rub on bladder mucosa → inflammation
Embeds in bladder mucosa → inflammation
Obstruction of ureters or urethra
Damage to kidney if renolith or ureterolith is present can male it difficult to resolve UTIs
Diagnosis and treatment of crystalluria and urolithiasis
Imaging
Not all types of stones will show up on radiographs
Ultrasonography
Surgery - cystotomy
Dissolution diet
Analysing the stones/crystals is part of the diagnosis
Types of stones determines course of treatment and long term prevention plan
Prevention of crystalluria and urolathiasis
Must do for life
>70% recurrence rate
Prescription diet
Increased water intake
Increase frequency and volume of urination
Urine pH
Types of crystals/stones
Struvite- triple phosphate; Mg-ammonium phosphate
Ca-oxalate
Ammonium urate
Struvite is caused by and how to treat
Primary UTI
Treat infection
Dissolvable
Ca-oxalate is caused by and can they dissolve
Genetics (lack of nephrocalcin); diet high in Ca/VitD
Diet and breeding
Can’t dissolve
Ammonium urate is caused by and can they dissolve
Genetics (Dalmations); liver shunt
Diet and breeding
Can’t dissolve
Presentation of FLUTD
Indoor, male cats
Recognize these clinical signs
Straining in litter box
Vocalizing while urinating
Lack of urine production
Licking at prepuce/penis
Inappropriate urination (dribbling, leaking) in a male cat
When is FLUTD an emergency
If blocked over 24 hours
Uremia
Acidosis
Dehydration
Hyperkalemia- which leads to bradycardia
Can also cause urethral stricture
Will lead to an increased risk of recurrent obstructions or permanent blockage
Obstructive FLUTD can be caused by
Stones
Crystals (struvite or calcium oxalate)
Mucus plugs
Physical blockage of the urethra; can be unblocked
Catheterization
Idiopathic cystitis is and caused by
Triggered by stress
Males, indoor, overweight
Inflammation of the bladder- without an obvious cause
Swelling blocks urethra
Clinical signs of idiopathic cystitis
Pollakiuria
Stranguria
Hematuria
Vocalizing in the litterbox
Idiopathic cystitis treatment
Anti-inflammatories?
Omega 3 fatty acids?
Anti Anxiety medications?
Adequan?
Environmental enrichment
Minimize stress
