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12- SA- Urinary and endocrine disease > Urolithiasis > Flashcards

Urolithiasis Flashcards

1
Q

where do uroliths tend to occur in dogs and cats

A

normally lower urinary tract, i.e. bladder & urethra

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2
Q

what are struvite uroliths made of

A

Magnesium ammonium phosphate

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3
Q

what are struvite uroliths associated with in dogs

A

Usually associated with UTIs caused by urease producing bacteria

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4
Q

are males or females more prone to struvite uroliths

A

females
likely due to increased tendency of female dogs to develop UTIs

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5
Q

list the risk factors of struvite uroliths in dogs

A

abnormal retention of urine
Any condition that predisposes to UTI - e.g. diabetes mellitus, cushings
susceptible breeds- Miniature schnauzer, Shih Tzu, Bichon

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6
Q

what are struvite uroliths associated with in cats

A

90% are sterile – in contrast to dogs (infection-induced seen predominantly in cats > 10 yrs)

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7
Q

what are the risk factors of struvite uroliths in cats

A

abnormal retention of urine
formation of concentrated urine - moisture content of food, water intake
Urine-alkanising metabolites in diets

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8
Q

list the risk factors for formation of calcium oxalate uroliths

A

acidifying diets
Oral calcium supplements given outside of mealtimes
Excessive dietary protein
Formation of concentrated urine

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9
Q

what are urate uroliths made of

A

Composed of uric acid, sodium urate or ammonium urate

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10
Q

how are urate uroliths formed

A

Impaired conversion of uric acid to allantoin ——-> increased concentration of uric acid in serum and urine.

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11
Q

what breeds are predisposed to urate uroliths

A

Dalmations and Black Russian terriers

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12
Q

which urolith is associated with porto systemic shunt

A

urate

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13
Q

list 2 risk factors of urate uroliths

A

High Purine intake (glandular meat)
Persistent aciduria in a predisposed animal

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14
Q

how do cysteine uroliths form

A

inborn error of metabolism caused by defective tubular resorption of cysteine and other amino acids

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15
Q

which dogs are more affected by cysteine uroliths

A

Predominantly intact male dogs affected

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16
Q

list 3 risk factors of cysteine uroliths

A

Genetic predisposition to cystinuria
Acidic, concentrated urine
Urine retention

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17
Q

how do xanthine uroliths form

A

Impaired Xanthine oxidase activity leads to hyperxanthinaemia and xanthinuria
Familial or congenital defect e.g. CKCS

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18
Q

list 4 risk factors of xanthine uroliths

A

Genetic predisposition
Acid urine, highly concentrated urine
Urine retention
Allopurinol treatment

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19
Q

list 2 risk factors of calcium phosphate uroliths

A

Excessive dietary calcium, primary hyperparathyroidism
UTI – with urease producing bacteria

20
Q

List the clinical signs of urolithiasis

A

lower urinary tract signs- dysuria, haematuria, pollakiuria
+/- signs of urinary obstruction
urate- signs of PSS
Not that specific

21
Q

Describe how urinalysis can help diagnose uroliths

A

Not really
pH useful- clue to urolith type - helps monitor dietary management later on
rules out UTI
crystals can be misleading

22
Q

What is most helpful when diagnosing uroliths

A

imaging key
radiography or ultrasound

23
Q

list the uroliths that are radiopaque

A

calcium oxalate
struvite
calcium phosphate

24
Q

list the uroliths that are radiolucent

A

Xanthine

need contrast to see

25
Q

what do struvite uroliths look like

A

usually round/faceted
appear smooth

26
Q

what do calcium oxalate uroliths look like

A

irregular shape

27
Q

Why does it matter that we know what type of urolith it is?

A

A diagnosis of urolithiasis without knowing the composition makes it impossible to select effective management.

28
Q

what do you see on ultrasound with uroliths

A

acoustic shadowing
Remember gravity when deciding if mass or urolith

29
Q

why can ultrasound be better than radiography when diagnosing uroliths

A

can be done conscious
will pick up radiolucent uroliths

30
Q

describe medical treatment of uroliths

A

analgesia- usually NSAID
antibiotic if concurrent UTI - generally prolonged course if struvite (C and S)

31
Q

What is a specific urolith treatment for urate

A

allopurinol - Xanthine Oxidase inhibitor – for dissolution – takes at least 4-6 weeks, sometimes required long term
not effective if PSS

32
Q

what diet is used to dissolution calcium oxalate uroliths

A

Not amenable to dissolution (dietary management is for prevention of recurrence)

33
Q

what diet is used to dissolution struvite uroliths

A

Prescription struvite dissolution diet (acidifying)

34
Q

what diet is used to dissolution urate uroliths

A

Low-purine, alkalinising diet (contraindicated if pregnant/lactating)

35
Q

what diet is used to dissolution cysteine uroliths

A

Alkanising, lower methionine protein content

36
Q

what diet is used to dissolution calcium phosphate uroliths

A

Not amenable to dissolution

37
Q

what diet is used to dissolution xanthine uroliths

A

Low purine, alkalinising

38
Q

which uroliths need surgical removal

A

Calcium Oxalate
Calcium phosphate

larger Struvite uroliths - depends on the dog and their clinical signs

39
Q

if a animal is blocked with urolith what is a surgical option

A

try and push urolith(s) back into bladder by retrograde urohydropulsion

40
Q

what do you need to warn owners about post op after urolith surgical removal

A

warn owner of likely haematuria
need to monitor urine output
watch for dysuria

41
Q

Describe how to prevent calcium oxalate uroliths recurrance

A

High moisture alkalinising diet – but monitor for Struvite crystalluria
Monitor – monthly urinalysis, aim for SG < 1.020 (dogs) & < 1.030 (cats) and pH >6.5
Correct any hypercalcaemia

42
Q

Describe how to prevent struvite uroliths recurrance

A

High moisture acidifying diet – but care re CaOx crystalluria
Monitor urine pH & SG (as for CaOx but want pH < 7
Ensure UTI fully resolved – repeat C & S at end of antibiotic course

43
Q

Describe how to prevent urate uroliths recurrance

A

High moisture alkalinising diet
Some dogs require long term Allopurinol

44
Q

Describe how to prevent cysteine uroliths recurrance

A

High moisture alkalinising diet
Dogs – consider castration, will reduce recurrence if have sex-linked genetic predisposition

45
Q

Describe how to prevent calcium phosphate uroliths recurrence

A

High moisture diet; senior diets may be useful due to lower protein

46
Q

Describe how to prevent xanthine uroliths recurrence

A

High moisture alkalinising diet

12- SA- Urinary and endocrine disease (20 decks)

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