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Neurology > Urology > Flashcards

Urology Flashcards

1
Q

AKI causes

A

Less blood flow
Toxins - aminoglycosides, NSAID, ethylene glycol …
Intrinsic renal disease
Systemic disease

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2
Q

Pathophysiology of AKI

A

Initiation - damage starts (little to no signs or labs)
Extension - ischaemia, cell death
Maintenance - days to weeks
Recovery - 3m (Chr if >3m)
50% good outcome

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3
Q

CS kidney Dz

A

Anorexia
PU/PD
Emesis
CNS - ethylene glycol
CE
- uraemic breath, hypothermia, kidney pain/ enlargement

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4
Q

Kidney Dx

A

Azotaemia
Phosphate (high)
Hyperkalaemia
Ca variable
Urine - isothenuric in AKI

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5
Q

Acute or Chronic

A

AKI
-good BCS, Ac CS
-good coat, disproportionately sick
-enlarged kidneys
Chr
-low BCS, longer term BCS
-small kidneys, non regen anaemia
-poor coat

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6
Q

AKI management

A

Eliminate cause (toxins)
Support (IVFT based on hydration status)
-^renal blood and O2 flow, GFR
Furosemide - ^ output outcome unchanged

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7
Q

Kidney watching

A

Acid-base (metabolic acidosis frequent)
Hyperkalaemia
Emesis (maropitant Tx)
Hypertension (overhydration exacerbated) (amlodapine?Tx)
Nutrition

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8
Q

Dialysis

A

Haemodialysis
Peritoneal dialysis
£££

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9
Q

UTI

A

Female dogs
Adherence and multiply in tissue
Bacteriuria
Pyuria
Classes
-Sporadic Bac cystitis
-Recurrent bac cystitis
-Pyelonephritis
-Bac prostatitis
-Subclin bac uria

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10
Q

UTI clinical findings

A

Cystitis
-dysuria, pollakuria, incontinence
-not PU/PD
-pyelonephritis (PU/PD)
Bloods
-lower UTI none
-upper - consistent with septicaemia/ AKI
DX- urinanalysis, culture (not free catch)
-sediment exam

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11
Q

UTI Tx

A

Sporadic cystitis - Ab (amox) 5d, NSAIDs
Recurrent cys- 7d Tx
Pyelo - 2wks
Bac prostatitis - penetrate blood-prostate barrier
-4wks
Sub clin bac uria no Tx indicated

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12
Q

CKD causes

A

Congenital/ familial
-renal dysplasia
-polycystic kidney Dz
Acq
-idiopathic tubulointerstitial nephritis
-glomerular Dz (dog)

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13
Q

IRIS CKD stages

A

1 - 1° renal injury
2 - mild azotaemia, maladaptations
3 - uraemia, systemic complications
4- end stage renal failure

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14
Q

Criteria for staging

A

Creatinine (stable)
Proteinuria
Blood pressure

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15
Q
A
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15
Q

CKD labs

A

Urea
-correlates with CS
Creatinine
-correlates with GFR and msc mass
Albumin
-v in PLN
K
- low w/ CKD
Phosphorus
-initiate 2° hyper paraThy

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16
Q

First CKD Tx

A

IVFT
Don’t flush kidneys
Stop nephrotoxic drugs
Measure BP / UPCR
Reduce proteinuria (renal diet)
Control hyper BP- <160mmHg
-amlodipine
Combat dehydration
-feed wet diet

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17
Q

Stage 2 Tx

A

Renal diet
-less protein/P/Na
-benefit stage >2 cats, >3 dogs (or 2 and high P)
Avoid hypo kalaemia
-IVFT KCl supplement, oral K gluconate

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18
Q

Stage 3 Tx

A

Control dehydration
Control hyper BP
Treat proteinuria
Start renal diet
Supplement K (if needed)
Target nausea and emesis
-antiemetics, stim appetite (mirtazapine)
-Tx ulcers, feeding tube
Manage anaemia (EPO replace) Darbepoetin
Control metabolic acidosis

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19
Q

Behavioural meds - serotonin

A

SSRI - Fluoxetine
TCA - Clomipramine
SARI - Trazadone

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20
Q

Behavioural dopamine/ gabanergic

A

Dopamine
-Selegiline
Gabanergic
-BZ - diazepam, midazolam
-Imepitoin

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21
Q

Noradrenaline/ glutamate behaviour meds

A

Noradrenaline
-Tasipimidine
-Clonidine

Glutamate, monoaminergic
-Gabapentin/ pregabalin

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22
Q

Uroliths types

A

Urates
Struvite (only alkaline one)
Cystine
Ca oxalate

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23
Q

Urolith Dx

A

History
CE
Imaging
-double contrast radiography
Urinalysis
-USG, pH, culture

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24
Q

Urolith Tx

A

Medical dissolution
-struvite, urate cystine
-owner compliance needed
-may block urethra
Voiding urohydropropulsion

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25
Q

Struvite

A

Mg NH3 …
Alkaline urine
Radiopaque
UTI predispose (females more likely)
Dissolve
-Tx UTI
-low protein, moist diet
-acidify urine
Tx - 2 wks post radiographic cure
PrV - certain breeds predisposed, stop UTI recurrence

26
Q

Calcium oxalate

A

Neutral/ acidic urine
Radiodense
HyperCa predisposes
Older Males more than Females - mini schnauzer, yorkie
Tx- physical removal
Recurrence common
PrV- exclude Hyper Ca/ vit D excess
-high urinary volume (up void frequency) USG<1.02

27
Q

Urates

A

Most stones NH3 acid urate
Acidic urine
Radiolucent, smooth, round
Inherited urate transporter alteration (SLC2A9) / PSS
-Dalmatians/ toy breeds
Males more thane females
Test - serum bile acid []
No liver Dz - 1m dissolution, low protein, purine diet
-alkanise urine, K citrate
Meds- allopurinol, K citrate

28
Q

Cystine

A

Inh disorder renal tubular transport
Radiolucent, small, smooth, hexagonal
Male dachshund
Increase water intake, dissolution diet (renal diet)
Androgen dependent cystinuria
-mastiff, staffie, deerhound

29
Q

Behaviour ROA, HrM meds

A

ROA
-propanolol
-trazadone
-diazepam
Hrm
-deslorin (male)
-cabergoline (female)

30
Q

Glomerulopathy

A

Proteinuria
Magnitude important
-UPCR<2 tubule, > glomerular
Not always present azotaemia
Less common in cats
Immune mediate TIII / amyloidosis
Familial glomerulopathy - shar pei fever UPC ~ 9
-amyloid plaques rapid progress
Tx- colchicine

31
Q

Suspect glomerular Dz

A

Incidental proteinuria
Investigating renal Dz
Hypertension unknown
Hypo albuminaemia, high cholesterol
Thrombo embolic event

32
Q

Glomerular Dx

A

Confirm proteinuria (dipstick)
+ve -> quantify Urine Protein Creatinine Ratio
Protein uria can also be pre/ post renal
-post- UTI/ nephrolithiasis
-pre- Sys Dz, myoglobinaemia
Important evaluate persistence (2wks apart)
Renal biopsy - gold standard
-light, e-, immunofluorescence

33
Q

Glomerular Tx

A

Dog UPCR > 0.5
Cat UPCR > 0.4
ACE inhibitors - telmisartan
Immunosupression (Imm med)
-no further Dx possible
High risk thromboembolus
-clopidogrel (esp. cats)
Azotaemia
-Tx on IRIS guidelines
Sys hyper BP
-benazepril, amlodipine
Renal diet

34
Q

Indication ovariohysterectomy

A

PrV/ Tx
Metritis
Pyometra
Neoplasia (ovary/ uterine)
Subinvolution of placental sites
Vaginal hyperplasia
Vaginal prolapse
Uterine torsion
Control - DM, dermatoses

35
Q

Timing of elective spay

A

Pre 1st season
-less mammary neo
-less haemorrhage, less OP time
Dis- juvenile vulva, ana considerations
Contra- juvenile vaginitis, cong. incontinence

Between seasons -12wks post oestrus
(less will cause pseudo pregnancy)

36
Q

Pyometra

A

Cystic endometrial hyperplasiia
-potential fatal, Dev in luteal phase
-open/ closed (cervix)
CS
-vulval discharge (open)
-lethargy, emesis, dehydrated
Dx
-CS, Hx
-Biochem, haematology
-vaginal cytology, US
Tx
-IVFT - if dehydrated
-broad spec AB
-Ovariohysterectomy

37
Q

Ovarian remnant syndrome

A

GnRH stim test
Imaging
Exp coeliotomy
Excise scar tissue at ovarian pedicle
Submit to histopath

38
Q

Uterine stump pyometra

A

Progesterone source needed (ovary remnant)
CS- as for pyo
Tx- Sx

39
Q

Uterine stump granuloma

A

Uncommon
Poor aseptic technique or wrong suture material
Tx- resect remaining uterine body
Poor prognosis

40
Q

Vaginal hyperplasia/ prolapse

A

Oedematous enlargement of vaginal tissue
Mass can be traumatised
Oedema resolves after follicular phase, may recur (pro/oestrus)
Mild- collar, lubricate, reduce
Large - resection v. episiotomy

41
Q

Episiotomy indications

A

Sx vaginal explorations
Excision vaginal masses
Repair vaginal lacerations
Tx strictures/ cong defects
Exposure of urethral papilla
Facillitation manual foetal extraction

42
Q

Ovarian neoplasia

A

Epithelial
Granulosa cell tumour - most common cats, makes progesterone
-can make oestrogen
Germ cell- least common, teratoma
Hormonal dysfunction + Abd mass
Malignant effusion - carcinomatosis

43
Q

Canine uterine neoplasia

A

Mesenchymal
Mostly leiomyomas
Incidental finding in OVH

44
Q

Prostatic Dz CS

A

Urinary- dysuria
Defaec - tenesmus, flattened faeces, costipation
HL pain

45
Q

Prostatic Dz investigation

A

Palpation
Urinalysis, C & S
Radiography
Prostatic massage
Prostatic biopsy
US

46
Q

Prostate Dz

A

Benign hyperplasia (testosterone induced)
Prostatitis
Prostatic abscessation
Prostatic cysts - retention/ paraprostatic
Neoplasia

47
Q

Benign prostatic hyperplasia

A

> 5yr ME
Rectal palpation of prostate (sym enlarge)
Imaging
Tx- Med/ Sx castration

48
Q

Prostatitis / abscess

A

Ass. with BPH
Asym enlarge (rectal ex.)
Pyrexia, stiff gait (HL)
Cd Abd pain, peritonitis if rupture
Tx- repeat drain, castration, 1m AB

49
Q

Prostatic cysts

A

Varied size
Retention - ass. BPH
Paraprostatic - unknown Aet
-excise cyst, Sx drainage + omentalisation of remaining cyst
-histopath, castration, Ab (concurrent UTI)

50
Q

Prostatic neoplasia

A

Uncommon, old male dogs
Adenocarcinoma, highly malignant (v. lymphatics)
CS- weight loss, tenesmus, lumbar pain, HL weakness
Dx- pallisading new bone xray
-US, biopsy
Tx- palliative
Prostatectomy not recommended
-already metastasised, likely incontinent, dehiscence early complication

51
Q

Scrotal ablation and castration

A

Scrotal Dz
In conjunction w/ scrotal urethrostomy
PU in entire cats

52
Q

Cryptorchidism

A

Failure to descend (norm. uni)
Retain -> neo more likely
Inguinal/ Abd
Bilateral castration indicated

53
Q

Testicular swelling

A

Neoplasia
Scrotal hernia
Orchitis
Torsion
Trauma
Dermatitis

54
Q

Testes neoplasia

A

Sertoli cell tumour - make oestrogen
-feminisation, Abd distension
Seminoma
Interstitial cell tumour (often incidental)
Castration indicated

55
Q

Penis and prepuce

A

Phimosis
-can’t protrude from prepuce
-opening to small (2°)
-urine pooling -> Dz
Tx- infl - cons./ stricture - Sx
Paramphimosis
-no retraction penis to prepuce
-Tx underlying cause, flush, preputial reconstruction
Persistent priapism
lead to trauma and necrosis
-penile amputation + scrotal urethrostomy

56
Q

Abnormalities of emptying phase

A

Distended bladder
Constant dribble
No/ little normal urination time
Ddx
-obst., Chr. distension, urethral detrusor dyssynergia
-UDD - bladder and detrusor contract

57
Q

Urethral sphincter mechanism incompetence

A

Bitch (most common incontinence)
Aet- low urethral msc tone, Cd position bladder
Acq- later life large breeds
Cong- 50% resolve post 1st season
Dx- rule out others, med trial
Tx- increase msc tone- ephedrine

58
Q

Urinary incontinence investigation

A

Hx, CE
Bloods
Imaging, cytoscopy

59
Q

Phases of bladder Fn

A

Sympathetic filling and storage (hypogastric N.)
-Beta-Adr; detrusor relax
-alpha-Adr; urethral smooth msc. and trigone contract
Somatic pudendal N.
-urethral striated msc.
-Inh. detrusor reflex
ParaSym pelvic N. emptying (detrusor reflex)
-detrusor contraction
-urethral msc. relax

60
Q

Ddx filling phase

A

Involuntary contractions- cystitis
Reduced bladder neck Pa - USMI, hypoplastic bladder
Ectopic ureters
-continual dribble, intramural, unilateral, Labradors, Sx
-ureternephrectomy, LASER ablation

61
Q

Feline incontinence

A

Uncommon
Neurogenic normally (>6wks poor prog)
Juvenile - ectopic/ hypoplastic bladder
Iatrogenic
-after perineal urethrostomy

62
Q
A

Neurology (25 decks)

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