Brainscape's Knowledge GenomeTM

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


See full index

Y4 SA - Urogenital > Urolithiasis > Flashcards

Urolithiasis Flashcards

1
Q

Describe the history and presenting clinical signs in a dog with bladder stones

A
  • Variable - asymptomatic to complete urinary tract obstruction
  • Pollakiuria
  • Dysuria / urinary tenesmus
  • Discomfort / vocalisation on urination
  • Haematuria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Describe the physical exam findings in a dog with bladder stones

A

May feel stones in bladder
May be abdominal pain (usually not)

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

How are canine bladder stones diagnosed?

A

Imaging

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

Describe the use of imaging for bladder stones

A

Imaging tells you the presence of uroliths and location, number, size, shape, and density
The preferred contrast technique for uroliths is double contrast

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

Urates are found normally in which breed?

A

Dalmations

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

Crystal type may suggest the urolith type, but when is this not true?

A
  • If diet has changed, may be different
  • UTI (development or cure) can lead to different crystal types
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How is USG related to bladder stones?

A

A high urine specific gravity suggests an increase in concentration of urolithic precursors.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How is pH related to bladder stones?

A

Ph can suggest which urolith is present - oxalate, purines, and cystine uroliths form typically in urine with a pH less than 7.0, whereas struvite calculi form typically in urine with a pH greater than 7.0

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How is culture related to bladder stones?

A

Culture indicated because urinary tract infections may occur secondarily in patients with urolithiasis or may induce urolith formation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Which crystal has a coffin shaped appearance?

A

Struvite

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Which crystal has a pyramidal shape?

A

Calcium oxalate dihydrate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Are blood tests useful in cases of bladder stones?

A

Yes
- Underlying diseases e.g. hypercalcaemia
- Effects of obstruction
- Liver function if urate stones found

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Why is analysis of the urolith performed?

A

Essential to prevent recurrence!
If uroliths recur, resubmit!

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

Describe the composition of uroliths

A
  • A urolith is composed primarily of 1 or more minerals in combination with small quantities of organic matrix.
  • Layers of stone are: the nidus, stone, shell, and surface crystals
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Why is the nidus of the stone important?

A

The nidus is the area of obvious initiation of stone growth. – not necessarily right in the middle.
Nidus needs to be the focus of prevention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Describe the advantages and disadvantages of medical dissolution of stones

A

Advantage - Less invasive
Disadvantages
- Owner compliance with diet
- Repeated radiographs, urinalysis and culture
- Some stones do not dissolve
- May block urethra

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Which stones dissolve, and which dont?

A

Do = Struvite, urate, cystine
Don’t = Oxalate, silicate, phosphate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

List the indications for calculi removal

A

Obstruction
Increase in size or number of calculi
Persistent clinical signs
Lack of response to therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Voiding urohydropropulsion can be used to remove uroliths of what size?

A

1 to 3 mm in male dogs
up to 10 mm in female dogs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Does struvite form in acidic or alkaline urine?

A

Alkaline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What can predispose the formation of struvite crystals?

A

A urinary tract infection needs to occur for struvite to form

22
Q

Do struvite crystals form in the lower or upper urinary tract?

A

LUT (95%) > UUT (5%)

23
Q

What other elements must be present in the urine fot struvite to form?

A

urine must be oversaturated with magnesium, ammonium, and phosphate ions

24
Q

How are struvite crystals treated/managed?

A
  • Treat the UTI
  • Feed a diet with reduced protein, phosphorus and magnesium that promotes formation of acidic urine (i.e. pH <6.5)
  • High moisture food is preferred
  • Give appropriate antimicrobial agent during the entire time of medical dissolution
25
Q

How is struvite dissolution monitored?

A

Urinalysis and imaging 4-6 weeks
- Expect USG <1.020 and 20% reduction in stone size
- Repeat every 4-6 weeks
- Continue for 2-4 weeks after radiographic cure

26
Q

What are some possible reasons that struvite doesn’t dissolved?

A

The UTI isn’t controlled
Core of oxalate

27
Q

How can you prevent struvite formation?

A
  • Prevent the urinary tract infection from recurring
  • Treat bacterial infections as they arise
  • Dietary modification does not prevent infection-induced struvite uroliths
  • And many breeds are also predisposed to calcium oxalate!
28
Q

Calcium oxalate crystals form in acidic or alkaline urine?

A

Neutral-acidic

29
Q

What condition predisposed to calcium oxalate crystals?

A

Hypercalcaemia

30
Q

Describe the predispositions for calcium oxalate formation

A

Males (70%) > females (30%)
Certain breeds
Age - more common in older dogs

31
Q

How are calcium oxalate crystals treated?

A
  • Medical protocols that promote dissolution of calcium oxalate uroliths are not available
  • Uroliths must be removed physically
  • Calcium oxalate uroliths are recurrent!
32
Q

How can calcium oxalate crystals be prevented?

A
  1. Rule out: Hypercalcaemia, Metabolic acidosis and Vitamin D excess
  2. Increase urine volume:
    - Increase voiding frequency
    - High-moisture (>75% water) foods
    - Aim for USG < 1.020
33
Q

Do urates form in acidic or alkaline urine?

A

Acidic

34
Q

Describe the appearance of urates

A

Radiolucent, smooth, round or oval

35
Q

When are urates a normal finding?

A

They are the end product of purine catabolism in humans, higher primates, and Dalmatian dogs.

36
Q

Urate stones in dogs form due two which two possible distinct situations?

A

Inherited alteration of the urate transporter
PSS – portosystemic shunt

37
Q

Describe the predispositions for urate formation

A
  • Breeds: Dalmatians, English Bulldogs
  • Dogs that get PSS e.g. Yorkshire Terrier, Miniature Schnauzer
  • Sex: Males (85%) > females
  • UTIs (urease-producing bacteria)
  • High protein diet
38
Q

Which tests should you run to confirm urates?

A

Serum bile acid concentrations
Genetic Hyperuricosuria testing (SLC2A9 gene)

39
Q

How should urates be managed in dogs without liver disease?

A

Dissolution of urate uroliths usually within 4 weeks
Suitable diet
Alkalinise urine if necessary with potassium citrate or sodium bicarbonate

40
Q

Describe a suitable diet for a dog with urate crystals

A
  • Low in protein
  • Low in purines
  • Produce alkaline urine
    Examples of dissolution diet = Hills u/d
41
Q

How can recurrence of urates be prevented?

A

Continue feeding the low purine diet. Check:
- urine pH (>7)
- USG (<1.020)
- BUN (low)
- Sediment (no crystals)
Drugs-
- Consider allopurinol
- Consider potassium citrate if urine pH is consistently less than 6.6.

42
Q

Why do cystine crystals form?

A

Inherited disorder of renal tubular transport

43
Q

Describe the appearance of cystine

A

Radiolucent, smooth, small.
Crystals flat, colourless, hexagonal

44
Q

Which patients are predisposed to cystine crystals

A

Male (90%) > female
Dachshunds, others
Several genetic mutations have been identified - some are sex linked/androgen responsive

45
Q

How are cystine crystals treated?

A

Encourage water intake
Suitable dissolution diet- Hills u/d, RCW Urinary U/C
Neutering for cystine uroliths?

46
Q

What are mixed composition stones?

A

Between 5% and 15% of uroliths may be mixed or compound stones
Refers to a situation in which more than 1 mineral is present within the stone, either mixed within all layers or different parts of the stone are composed of different minerals

47
Q

Which uroliths that can be medically dissolved?

A

Struvite
Urates
Cystine

48
Q

Which urolith is most commonly seen in females?

A

Struvite

49
Q

Which intervention is important in ALL uroliths?

A

Increase water intake

50
Q

Which uroliths that are usually radiopaque, and which are radiolucent?

A

Radiopaque = oxalate, struvite
Radiolucent = urate, cystine

Y4 SA - Urogenital (12 decks)

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