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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

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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15
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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16
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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17
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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18
Q

Behavioural meds - serotonin

A

SSRI - Fluoxetine
TCA - Clomipramine
SARI - Trazadone

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19
Q

Behavioural dopamine/ gabanergic

A

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

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20
Q

Noradrenaline/ glutamate behaviour meds

A

Noradrenaline
-Tasipimidine
-Clonidine

Glutamate, monoaminergic
-Gabapentin/ pregabalin

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21
Q

Uroliths types

A

Urates
Struvite (only alkaline one)
Cystine
Ca oxalate

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22
Q

Urolith Dx

A

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

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23
Q

Urolith Tx

A

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

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24
Struvite
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
25
Calcium oxalate
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
26
Urates
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
27
Cystine
Inh disorder renal tubular transport Radiolucent, small, smooth, hexagonal Male dachshund Increase water intake, dissolution diet (renal diet) Androgen dependent cystinuria -mastiff, staffie, deerhound
28
Behaviour ROA, HrM meds
ROA -propanolol -trazadone -diazepam Hrm -deslorin (male) -cabergoline (female)
29
Glomerulopathy
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
30
Suspect glomerular Dz
Incidental proteinuria Investigating renal Dz Hypertension unknown Hypo albuminaemia, high cholesterol Thrombo embolic event
31
Glomerular Dx
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
32
Glomerular Tx
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
33
Indication ovariohysterectomy
PrV/ Tx Metritis Pyometra Neoplasia (ovary/ uterine) Subinvolution of placental sites Vaginal hyperplasia Vaginal prolapse Uterine torsion Control - DM, dermatoses
34
Timing of elective spay
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)
35
Pyometra
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
36
Ovarian remnant syndrome
GnRH stim test Imaging Exp coeliotomy Excise scar tissue at ovarian pedicle Submit to histopath
37
Uterine stump pyometra
Progesterone source needed (ovary remnant) CS- as for pyo Tx- Sx
38
Uterine stump granuloma
Uncommon Poor aseptic technique or wrong suture material Tx- resect remaining uterine body Poor prognosis
39
Vaginal hyperplasia/ prolapse
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
40
Episiotomy indications
Sx vaginal explorations Excision vaginal masses Repair vaginal lacerations Tx strictures/ cong defects Exposure of urethral papilla Facillitation manual foetal extraction
41
Ovarian neoplasia
Epithelial Granulosa cell tumour - most common cats, makes progesterone -can make oestrogen Germ cell- least common, teratoma Hormonal dysfunction + Abd mass Malignant effusion - carcinomatosis
42
Canine uterine neoplasia
Mesenchymal Mostly leiomyomas Incidental finding in OVH
43
Prostatic Dz CS
Urinary- dysuria Defaec - tenesmus, flattened faeces, costipation HL pain
44
Prostatic Dz investigation
Palpation Urinalysis, C & S Radiography Prostatic massage Prostatic biopsy US
45
Prostate Dz
Benign hyperplasia (testosterone induced) Prostatitis Prostatic abscessation Prostatic cysts - retention/ paraprostatic Neoplasia
46
Benign prostatic hyperplasia
>5yr ME Rectal palpation of prostate (sym enlarge) Imaging Tx- Med/ Sx castration
47
Prostatitis / abscess
Ass. with BPH Asym enlarge (rectal ex.) Pyrexia, stiff gait (HL) Cd Abd pain, peritonitis if rupture Tx- repeat drain, castration, 1m AB
48
Prostatic cysts
Varied size Retention - ass. BPH Paraprostatic - unknown Aet -excise cyst, Sx drainage + omentalisation of remaining cyst -histopath, castration, Ab (concurrent UTI)
49
Prostatic neoplasia
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
50
Scrotal ablation and castration
Scrotal Dz In conjunction w/ scrotal urethrostomy PU in entire cats
51
Cryptorchidism
Failure to descend (norm. uni) Retain -> neo more likely Inguinal/ Abd Bilateral castration indicated
52
Testicular swelling
Neoplasia Scrotal hernia Orchitis Torsion Trauma Dermatitis
53
Testes neoplasia
Sertoli cell tumour - make oestrogen -feminisation, Abd distension Seminoma Interstitial cell tumour (often incidental) Castration indicated
54
Penis and prepuce
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
55
Abnormalities of emptying phase
Distended bladder Constant dribble No/ little normal urination time Ddx -obst., Chr. distension, urethral detrusor dyssynergia -UDD - bladder and detrusor contract
56
Urethral sphincter mechanism incompetence
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
57
Urinary incontinence investigation
Hx, CE Bloods Imaging, cytoscopy
58
Phases of bladder Fn
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
59
Ddx filling phase
Involuntary contractions- cystitis Reduced bladder neck Pa - USMI, hypoplastic bladder Ectopic ureters -continual dribble, intramural, unilateral, Labradors, Sx -ureternephrectomy, LASER ablation
60
Feline incontinence
Uncommon Neurogenic normally (>6wks poor prog) Juvenile - ectopic/ hypoplastic bladder Iatrogenic -after perineal urethrostomy
61

Neurology (25 decks)

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