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Year 3 renal > urolithiasis > Flashcards

urolithiasis Flashcards

1
Q

What 2 neurological conditions can appear like a blocked bladder?

A
  • lower motor neurone (blow L5)

- upper motor neurone (above L5)

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2
Q

how does lower motor neurone disease present?

A

–flaccid , overdistended bladder with urine leakage

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3
Q

how does upper motor neurone disease present?

A

firm and tense bladder, difficult to express. Very high bladder and urethral tone

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4
Q

what are the clinical signs of a blocked bladder?

A 
straining to pass urine
haematuria
vom
in and out of tray
painful
depressed
licking of genitals
enlarged / painful bladder
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5
Q

Is an obstruction an emergency?

A

Yes - they will be dead in 72 hours from point of obstruction

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6
Q

What is obstructive uropathy?

A

full bladder causes increased ureter and therefore tubular pressure – increased pressure in bowmans space and reduced GFR

also get vasoactive hormones that reduce renal blood flow and decrease GFR

both lead to ischaemic nephropathy

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7
Q

What effects can obstruction have on the bladder?

A

ischaemia
oedema
haemorrhage
mucosal sloughing

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8
Q

what systemic effects will an obstruction have?

A

hypovolaemia and hypotension

acidotic

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9
Q

what biochemical changes will happen with an obstruction?

A 
azotaemia
hyperglycaemia
acidaemia
hyperphosphataemia
hypocalcaemia
hyperkalaemia
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10
Q

Are sever biochemical changes from obstruction reversible?

A

Yes

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11
Q

What effect does hyperkalaemia have on the heart?

A

bradycardia
long PR interval
tall T waves
Vent arrhythmias

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12
Q

How do you manage hyperkalaemia?

A

IVFT

calcium gluconate to stabilise heart contractility

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13
Q

What is the first step in treating an obstruction?

A

Relieve pressure

  • cystocentesis
  • catheterise
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14
Q

What would be step 2 in treating an obstruction?

A
  • bladder lavage
  • indwelling catheter if hard to unblock or have poor urine stream
  • diuresis
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15
Q

Do you give abx to an obstructed animal with an indwelling catheter?

A

No - because will get resistant UTIs

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16
Q

What are some options for definitive treatment of an obstruction?

A
  • smooth muscle and skeletal relaxants if urethral
  • retrograde hydropulsion
  • remove calculi (cystotomy)
  • urinary diversion (cystotomy tube, urethrostomy)
  • ureteral surgery
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17
Q

what is the difference between uroliths and crystals?

A

Uroliths are macroscopic and cause signs

crystals are microscopic and dont cause disease

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18
Q

What are some consequences of nephroliths and ureteroliths?

A

pyelonephritis
renal failure if bilateral
renal colic
hydronephrosis

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19
Q

what are some signs of cystoliths?

A

dysuria
pollakiuria
haematuria
inappropriate urination

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20
Q

How can you diagnose uroliths?

A

contrast radiography as not all radiodense

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21
Q

Which uroliths cannot be seen radiographically?

A

urate

cystine

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22
Q

Which key uroliths can be seen on radiographs?

A

struvite

oxalate

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23
Q

What are some treatment options for renal and ureteral stones?

A
  • benign neglect
  • invasive surgery
  • dietary dissolution
24
Q

Which urolith cannots be dissolved?

A

calcium oxalate

25
Q

What are 2 procedures to remove stones from a bladder?

A
  • voiding urohydropropulsion

- cystotomy

26
Q

What is voiding urohydropropulsion?

A

under GA
fill bladder with saline and hold animal upright so urethral is vertical - agitate the bladder and allow stones to settle then void bladder.

Repeat several times
give 3 d Abx

27
Q

What do you do with urethral stones?

A

retrograde flush into bladder

28
Q

How do you flush urethral stones into a bladder?

A

under GA
pass catheter so just behind stone and have 1 finger in rectum just behind the stone
pump fluid into urethra so walls move away from calculi them remove finger so fluid and stone go to bladder

29
Q

Which uroliths can you try dissolving with diet?

A

structive
cystine
urate

30
Q

When is surgical management indicated?

A 
obstructed
unknown stone composition
failure of medical treatment
other abnormalities
immature animals and dont want to restrict diet
owner preference
  • ensure number and location of calculi known immediatley before
31
Q

what are the surface characteristics of calcium oxalate?

A

sharp projections

mulberry shaped or smooth round uroliths

32
Q

What are the surface characteristics of struvite?

A
  • smooth

- if multiple often appear pyramidal

33
Q

What are the surface characteristics of urate?

A

multiple and smooth

34
Q

What do silica uroliths appear like?

A

jackstone appearance

35
Q

Which uroliths are found in acidic urine?

A

oxalate
urate
cystine
silica

36
Q

which uroliths are found in acidic to neutral urine?

A

oxalate

silica

37
Q

which uroliths are found in alkaline urine?

A

struvite

hydroxyapetite

38
Q

What is an important thing to remember when giving a diet to dissolve struvite uroliths?

A

by altering urine pH can get more calcium oxalate percipitated and risk get calcium oxalate uroliths

39
Q

Why is struvite found in alkaline urine?

A

as struvite occurs alongside a UTI with urease producing pathogens so they cleave urea into ammonia and bicarb forming an alkaline urine

40
Q

What is the appearance of calcium oxalate crystals?

A 
dumbbell (monohydrate)
picket fence (monohydrate)
square envelope (dihydrate)
41
Q

What is the appearance of struvite crystals?

A

coffin lid

42
Q

what is the appearance of urate crystals?

A

yellow - brown thorn apple

43
Q

what is the appearance of cystine crystals?

A

hexagonal

44
Q

what is the appearance of calcium phosphate crystals?

A

thin prisms

45
Q

Which urolith is commonly found with a UTI?

A

struvite

46
Q

in which animals is struvite found without a UTI?

A

cocker spaniels

cats

47
Q

What are common breeds for urate crytals and why?

A 
dalmation
english bulldog
miniature schnauzer
shih tzu
yorkshire terrier

reduced conversion of uric acid to allantoin and defective transport of it out of urine

48
Q

What can you do to treat urate stones?

A

reduced protein intake
allopurinol (less uric acid)
maintain urine pH at 7 ish
diuresis

49
Q

Which urolith is castration responsive?

A

cystine

50
Q

Which uroliths are more common in females?

A

struvite

51
Q

which urolith is more common in males?

A

oxalate
urate
cystine
silica

52
Q

If uroliths are over 1cm what are they likely to be?

A

struvite

53
Q

what would a positive urine cyanide nitroprusside test be linked to?

A

cystine

54
Q

which urolith is likely to form with hypercalcaemia?

A

calcium phosphate

55
Q

which urolith is due to poor diet?

A

silica

56
Q

what can be a complication of a cystotomy?

A

get signs of cystitis

Year 3 renal (7 decks)

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