Urology Flashcards

Question

What is unilateral renal agenesis?

Answer 1

Absence of one kidney, may occasionally be identified. the remaining kidney is often hypertrophied to compensate and affected animals may be asymptomatic.

Answer 2

A familial condition primarily affecting persian cats, but may also affect BSH cats, bull terriers, WHWT and cairn terriers. anechoic cysts may be detected by ultrasonography and genetic testing is also available for persian cats. Other familial renal diseases include basement membrane disorders, glomerulonephritis, amyloidosis and tubular disorders such as Fanconi's syndrome.

Answer 3

The upper urinary tract is usually a sterile environemtn. infection may establish in the kidneys from haematogenous spread, but more typically occursa as a result of loss of innate defence mechanisms allwing ascending infection from the bladder. the concentrated nature of urine and ureteric peristalsis normally protects against infeciton. dilute urine, glucosuria and trauma damaging the urothelium may allow establishment of infection as well as obstructive disorders and vesico ureteric reflux. pyelonephritis is renal inflammation.

Answer 4

PU/PD, haematuria, lethargy, vomiting, anorexia, renal pain, pyrexia. renal pan may be difficult to localise from abdominal pain and may also be confused with lumbar pain. chronic conditions may be less apparent although PUPD is usually present and there may be ahistory of recurrent lower urinary tract infections. Urinalysis may reveal dilute urine with active sediment (casts, white blood cells, red blood cells.) culture is required to identify causal orgnaism. Azotaemia may or may not be present. Good empiric choice of amoxicillin-clavulanate - bactericidal, concentrates in urine, broad spectrum. Extended course typically 4-6 weeks often prescribed.

Answer 5

Filtration of the plasma through a permselective membrane the BM that filters or retains substances based on their size and charge. damage to the glomerulus leads to loss of the selectivity of the BM and filtration of substances, predominantly proteins, into the urine that are not normally present. glomerular diseases may be generally classified into glomerulonephritis and amyloidosis but they are both characterised by significant proteinuria often with uPC in excess of 10. Persistent proteinuria can lead to tubular damage with the development of azotaemia.

Answer 6

different forms of glomerulonephritis exist however electron microscopy of a renal biopsy is required to differentiate them. immune complexes and infectious agents can play an important role in damaging the BM, and familial disease may result in abnormal BM formation.

Answer 7

Amyloid is a protein that is formed from serum amyloid A (an acute phase protein). its deposition within the kidney may be associated with chronic inflammatory diseases, although there are familial tendencies in sharpei dogs and abysinnian, siamese and oriental cats. In cats, the amyloid tends to be deposited within the medulla, so the degree of proteinuria may not be so extensive. Specific diagnosis of these conditions requires a renal biopsy although significant proteinuria, particularly if accompanied by hypoalbuminaemia will raise the suspicion for glomerulonephritis or amyloidosis. management is non specific and aimed at removing any underlying infectious or inflammatory causes. addressing the proteinuria with ace inhibitors and supplying a good quality diet with w33 supplementation, aspirin may be used to reduce the risk of thrombo embolic disease.

Answer 8

They are responsible for reabsorption of glucose, electrolytes and small amounts of protein filtered by the glomerulus. control of acid base status and water balance also occurs in the tubules. the most common tubular disorders are acute kidney injury and chronic kidney disease, but primary tubular disorders can also occur.

Answer 9

This may be congenital, with the basenji being the most commonly affected breed. it may also be acquired for example with infections such as leptospirosis. renal tubular reabsorption is affected, resulting in loss of variable amounts of glucose, amino acids, bicarbonate and electrolytes in the urine. fanconi syndrome may be suspected in a polyuric, polydipsia patient with Glucosuria but not hyperglycaemia. further assessment may include measuring urinary electrolytes and amino acids. treatment is primarily supportive e.g nutrition and bicarbonate supplementation, the condition will invariably progress to CKD.

Answer 10

This may be a congenital defect (norweigan elkhounds, scottish terriers) or acquired secondary to tubular damage. diagnosis is based on identifying persistent glucosuria in the absence of hyperglycaemia or loss of other substances in the urine. Management is primarily aimed at controlling urinary trat infections to which these cases are prone and ensuring adequate caloric intake.

Answer 11

These disorders result in a metabolic acidosis and may be congenital or acquired. proximal renal tubular acidosis arises when the proximal tubules cannot reabsorb bicarbonate ions and is often part of fanconis syndrome. This usually results in mild acidaemia due to compensatory acid secretion by the distal renal tubules and urine with a pH of 5.5-6.0. Distal renal tubular acidosis arises when the distal tubules cannot secrete hydrogen ions. As this is more significant factor in acid base homeostasis the metabolic acidosis arising is usually marked and the urine pH>6.0. Management o these conditions include identifying and addressing underlying causes and alkalinisation therapy typically with potassium citrate.

Answer 12

diabetes insipidus arise due to lack of anti diuretic hormone (central) or insensitivity of the kidney to effect of anti diuretic hormone (nephrogenic diabetes insipidus) this reuslts in inability to concentrate the urine with production of large volumes of dilute urine and compensatory polydipsia. most forms of NDI are acquired e.g due to hyperadrenocorticism, chronic kidney disease, liver disease, pyometra, pyelonephritis, hyperthyroidism or drugs 9corticosteroids, diuretics).

Answer 13

Acute kidney injury reflects a sudden reduction in renal function. Often difficult to identify a specific cause. the kidneys are at particular risk for ischaemia as although they only comprise 0.5% of body weight, they receive 20% of cardiac output. the renal cortex receives 90% of renal blood flow and it sustains the majority of the damage due to its high metabolic demands and concentration of nephrotoxins in the tubular epithelial cells. Ischaemia and toxic damage results in tubular cell apoptosis and necrosis. damage to the renal tubule may also invoke an inflammatory response which can lead to further ischaemia as capillaries become plugged with platelets and neutrophils.

Answer 14

Initiation: the patient has been exposed to the caudal agent, but clinical signs may not be present. intervention at this stage may prevent progression. Extension: inflammation and hypoxia lead to further nephron damage which can be fatal if the damage is too extensive. maintenance: irreversible damage has occurred and the patient has on going signs of reduced tubular function. Recovery: regeneration and repair of the damaged nephrons may occur over a period of weeks to months.

Answer 15

Ischaemia - anaesthesia, hypotension, hyperviscosity Infarction - thrombi and emboli eg cardiac disease, neoplasia Toxins - ethylene glycol, lilies, grapes, raisins, heavy metals, organic compounds, haemoglobin, myoglobin, envenomation, melamine. Infectious diseases - leptospirosis, pyelonephritis, borrelia burgdorferi (lymes diseasE), feline infectious peritonitis. Drugs - NSAIDS, aminoglycosides, amphotericin B, cisplatin, radiographic contrast agents, sulphonamides, tetracyclines, ACE inhibitors. Hypercalcaemia - rodenticides, psoriasis creams , neoplasia. Severe illness- SIRS, sepsis, acute pancreatitis, pyometra, multiple organ dysfunction syndrome, disseminated intravascular coagulation DIC, heat stroke, immune mediated haemolytic anaemia.

Answer 16

Patients with AKI will typically have short <1week history of signs such as anorexia, nasea, lethargy, vomiting, diarrhoea, weakness, and possibly altered mentation. Polyuria and polydipsia are not always present if the patient is anuric/ooliguric. Physical examination will usually reveal patients in good bodily cndition. the degree of dehydration may be variable, depending on e.g frequency of vomiting. A uraemic breath and or oral ulceration may be detected. Renal palpation may reveal painful + enlarged kidneys. The bladder may be detected. Renal palpation may reveal painful, enlarged kidneys. The bladder may be enlarged or non palpable if the patient is dehydrated or anuric. If mucous membranes are icteric then this may raise the suspicion for leptospirosis and barrier nursing should be employed. if bradycardia is identified this should raise the suspicion that hyperkalaemia may be present.

Answer 17

Routine haematology - may be normal or reveal an inflammatory leucogram if infectious disease is present. anaemia is generally more suggestive of chronic kidney disease, but could occur with AKI. Routine biochem - azotaemia, phosphorous likely to be elevated, calcium concurrently elevated - suspicion of vitamin D toxicity and increases the risk of ongoing damage from nephrocalcinosis. potassium may be elevated as a result of reduced renal tubular excretion. Acid base status - patients with AKI are frequently acidotic due to inability to excrete hydrogen ions and synthesis bicarbonate. Urinalysis : USG is typically low. gluosuria in the absence of hyperglycaemia is supportive of renal tubular damage. Imaging: ultrasonography generally more helpful to evaluate renal parenchyma than radiography, although renal enlargement and mineralisation may be detected. abnormalities seen with AKI may include hyperechoic cortices ethylene glycol renal pelvic proximal ureteric dilation, nephrolithiasis or uterolithiasis and hydronephrosis.

Answer 18

CKD, post renal azotaemia, pre renal azotaemia and hypoadrenocorticism. It is generally not possible to distinguish AKI fomr CKD based on laboratory parameters alone. patients with CKD typically have an insidious onset of signs, are in poorer body condition, may be anaemic and are likely to have small kidneys rather than large kidneys. patients with CKD may decompensate suddenly if for example they become dehydrated or get an infection (so-called acute on chronic disease). hypoadrenocorticism is an important differential diagnosis as it generally requires a favourable prognosis.

Answer 19

Ensure appropriate hydration with isotonic crystalloid (usually hartmanns or 0.9% NaCL.) Convert anuric/oliguric renal failure to polyuria to diurese uraemic toxins. address electrolyte imbalances. address acid base imbalances. provide specific therapy for the underlying disease. provide symptomatic therapy for nausea. provide nutritional support. Fluid therapy to correct dehydration and replace on going fluid deficits. fluid requirements for patients with polyuric renal failure can be substantial but if patients are anuric care must be taken that they do not become fluid overloaded. the patient should be rehydrated then if no urine is produced a fluid challenge with 5ml/kg can be given to account for sub clinical dehydration. Hyperkalaemia can be an emergency due to effect on cardiac musculature. Calcium gluconate may be given to stabilise the cardiac membrane whilst therapies to lower potassium take effect. fluid therapy will dilute the potassium and insulin and dextrose saline can be used to stimulate intracellular shift of potassium. sodium bicarbonate can also be given to encourage this.

Answer 20

Severe hypocalcaemia may be seen with ethylene glycol toxicity. administration of calcium may be necessary to address hypocalcaemic tetany and seizures. specific therapy may be difficult to provide if the underlying aetiology is unknown. where an infectious agent or sepsis is identified then appropriate intravenous antibiotics should be administered. withdrawal of potentially nephrotoxic drugs is also essential. surgery may be required if AKI is due to obstructive disorders. Supportive therapy comprises anti emetics such as maropitant and metoclopramide and gastro protectants such as H2 blockers and sucralfate for uraemic gastritis that can deelop. bathing oral mucous membranes with oral hygiene solutions may also be beneficial. if hypertension - use of amlopidine. nutritional support important to enable repair of damaged nephrons. Appetite stimulants are generally ineffective. water soluble vitamin supplementation in IV fluids may be beneficial.

Answer 21

Prognosis is often poor, although outcomes are generally dependent on the underlying cause. leptospirosis and NSAID toxicity for example generally have a good outcome. for ethylene glycol particularly if anuric, outcomes are poor. Even where haemodilalysis is available, this is usually performed primarily to stabilise the patient before renal transplantation.

Answer 22

The loss of kidney function (dilute urine + proteinuria + azotaemia) over 3 months. althogh CKD m ay be progressive from juvenile nephropathies or as a cosequence of disease causing aki, many cases have chronic tubulo interstitial nephritis of unknown aetiology. identifying a specific aetiology may be easier in the earlier stages as progressive disease results in fibrosis, atrophy, mineralisation and inflammation, regardless of the initial cause. CKD is approximately twice as common in cats and dogs with an estimated 15-20% of cats > 15 years old.

Answer 23

Polyuria/polydisia: as the renal tubules lose concentrating ability, dilute urine is produced in alrger volumes, stimulating increased thirst to prevent dehydration. This may be harder to appreciate in cats than in dogs who often present for incontinence if they are urinating in the house overnight. hyporexia/anorexia is a decreasing appetite may be due to nausea associated with increased urea levels and gastritis associated with uraemia. vomiting may be an extension of the anorexia. weight loss is non specific and secondary to decreased appetite and also loss of protein in the urine. hind limb weakness - more apparent in cats, and can be due to both loss of muscle mass, anaemia and or hypokalaemia. a plantigrade stance can also be bserved. constipation can occur in cats, secondary to dehydration. blindness can be acute in onset due to retinal haemorrhages from hypertension. behavioural changes - often ascribed to the patient getting older and can include inappropriate vocalisation , loss of toilet training, appearing wandered, uraemic or hypertensive encephalopathy. Diagnosis may be made following investigation of a history of polyuria/polydipsia or randomly following screening blood tests or urinalysis. in advanced cases patients are generally lean or poor body condition with poor muscle mass. assessing hydration may be difficult in elderly thin animals with loss of skin elasticity. The finding of a heart murmur or gallop rhythm may indicate hypertension. cats may exhibit plantigrade stance and inability to retract the claws. retinal examination may reveal choroidal oedema, tortuous retinal vessels, retinal haemorrhages or hyphahemia. Halitosis, oral ulceration and a uraemic smell can be identified on breath as condition advances.

Answer 24

Initial investigation will typically comprise urinalysis to confirm the presence of dilute urine. urine culture is also recommended due to the increased risk of uriinary tract infections, particularly if active sediment or bacteria are identified on sediment analysis. A UPC should also be performed to assess for proteinura. blood pressure measurement should ideally be performed prior to blood sampling, particularly if there is suspicion from the physical examination that the patient may be hypertensive. routine biochemistry will confirm the presence of azotaemia. Particular note should also be made of calcium and phosphorous levels and electrolytes. routine haematology is useful to assess if anaemia is present.

Answer 25

180mmHG - high

Answer 26

Cats -- >0.4urine protein: creatinine ratio | Dogs-- > 0.5

Answer 27

Diabetes mellitus, hyperadrenocorticism, hypercalcaemia, pyometra,hepatic disease, hyperthyroidism, medications, diabetes insipidus, psychogenic polydipsia.

Answer 28

Protein restriction: this should not be excessive. low normal protein levels may be adequate for other than the most uraemic patients. protein restriction is often required in order to limit phosphate levels. phosphate restriction: probably the most beneficial component to dietary management. increased fat: supplies calories. Alkalinisation: patients with CKD may suffer metabolic acidosis, therefore an alkalinising agent such as potassium citrate or sodium bicarbonate may be added. Fatty acids: in dogs, alteration of the w3 to w6 ratio has been shown to be beneficial as w3 contains some anti inflammatory properties. this has not been demonstrated in cats, possibly due to differences in metabolism of fatty acids. Antioxidants: oxidant damage to protein, lipids, DNa may play a role in progression of CKD. supplementation of antioxidans such as vitamin E, carotenoids or flavanoids may prove beneficial but at present no studies have been carried out to support or refute this idea. sodium restriction is not generally advocated as there is little evidence it contributes to hypertension. restriction of sodium may infact contribute to deleterious activation of renin angiotensin aldosterone system (RAAS). Patients may be hyperkalaemic or hypokalaemic. normal potassium levels are Therefore usually fed with potassium supplementation for those that require it. Use of renal diet is advocated from IRIS stage II onwards. Inadequate nutrition will lead to catabolism of muscle tissues which will worsen azotaemia, therefore if caloric intake cannot be met with renal diet it is better to allow the animal to eat what it wants.

Answer 29

The control of phosphate is important due to its contribution to ongoing renal damage and the development of secondary renal hyperparathyroidism. phosphate restriction should be initiated in patients with IRIS stage II renal disease, even if the phosphate level is within reference range. different target levels have been proposed based on classification. Initially introducing of a phosphate restriction diet should be used, with phosphate levels checked 4 weeks after starting the diet. if phosphate levels are still too high then a phosphate binder should eb introduced again and phosphate levels reassessed after 4 weeks. phosphate binders act primarily within the GI tract to reduce absorption of phosphate. options available include : aluminium salts, calcium salts, sevelamer hydrohloride, lanthanum carbonate. At present there is no studies to which is the best. calcium salts are considered less efficacious than aluminum, but a veterinary product is available. care should be taken in patients that have ionised hypercalcaemia. lanthanum carbonate has good phosphate binding ability and its veterinary formulation facilitates administration. The addition of vitamin E to the formulation provides an excellent antioxidant source.

Answer 30

the presence of proteinuria has been significantly associated with shorter survival times. proteinuria may be reduced by the use of an ACE inhibitor which will cause: dilation of the efferent renal arteriole, this reduces glomerular hypertension, reduction of angiotensin II, t his has an effect on systemic hypertension, may reduce podocyte hypertrophy and may reduce renal fibrosis, reduction of aldosterone, may reduce renal firosis, may increase appetite and feeling of well being, may cause an increase in azotaemia as a result of reduction in GFR, proteinuria has been shown to be deleterious and associated with a poorer outcome as it may exacerbate tubulo interstitial damage.

Answer 31

Anaemia associated with CKD is considered multi factorial in origin. contributing factors include: decreased erythropoeitin production ybt he failing kidneys, increased blood loss from GI bleeding, decreased life expectancy of circulating red blood cells, suppression of the bone marrow by uraemic toxins such as PTH, decreased precursor availability e.g iron, protein from anorexia. due to problems associated with management of anaemia, treatment should only be carried out when the patient becomes symptomatic from the anaemia. Options for treatment include erythropoeitin (eprex), darbopoeitin (aranesp) and blood transfusion.

Answer 32

Dehydration may hasten the progression of underlying renal disease. whist most patients will become polydipsic, their fluid intake may not match their urine output. ensuring adequate water is available and encouraging water consumption e.g provision of running water, flavouring of water may be beneficial. management of uraemia : use of antiemetics may contribute to restoration of appetite, although metabolism of metoclopramide may be reduced in patients with renal disease. metoclopramide is more efficient given as a constant rate infusion. uraemic gastritis can contribute to nausea and vomiting. H2 blockers and sucralphate can be used to reduce this and consideration may be given to appetite stimulants such as cyproheptadine or mirtazepine.

Answer 33

The patient should be assessed for appetite, thirst, demeanour, weight and body condition score. blood parameters that should be monitored include urea, creatinine, phosphorous, calcium, electrolytes and PCV as a minimum. ideally ionised calcium, full haematology and potentially PTH could be monitored. Urine should be evaluated for specific gravity, blood, active sediment and infections. blood pressure should be checked and a retinal exmination performed at each re visit. frequency of monitoring will depend on iris classification and stability of patient. following initial evaluation a re visit after 1 month may be appropriate to assess stability. thereafter every 4-6 months may be adequate for stable stage I/early stage II disease.

Answer 34

Urolith (calculus, stone) refers to a polycrystalline concretion located within the urinary tract. the most common location for urolith formation is the bladder lumen, although uroliths may also occur within the renal pelvis, the ureters or the urethra.

Answer 35

The bulk of a urolith is composed of inorganic or organic crystalloid with the remainder consisting of non crystalloid protein, the organic matrix. Crystalloid - many uroliths in small animals are composed predominantly of the crystalloid form of magnesium ammonium phosphate hexahydrate (struvite). Others are composed of crystalloids formed from substances such as calcium oxalate, calcium phoosphate, silica, cystine and urates. They may occasionally be a mixture. Struvite and xcalcium oxalate most common in cats. The urolith matrix is composed of small amounts of various urine proteins which may act to promote crystal deposition. substances sometimes found in the matrix include matrix substance A, tamm horsfall mucoprotein, uromucoid, albumin and globulins. male cats may develop urethral obstruction with matrix crystalline protein plugs or urethral spasms.

Answer 36

Urolith formation can be divided into two phases. the initiation phase and the subsequent growth phase. the initiation phase consists of the formation of a crystal nidus (nucleation) in the presence of urine 'supersaturation' with hcalculogenic crystalloids. nucleation is chraacterized by the appearance of submicrosopic molecular aggregates of crystalloids. to become a urolith, a crystal nucleus must have a lattice framework that allows for continued growth. Urine supersaturation with high levels of magnesium, ammonium and phosphate ions for example promotes the formation of struvite crystals. other factors such as urine Ph, available organic matrix, and the presence of crystallisation promoters or inhibitors, also influence crystal formation. continued concentric growth around the crystal nidus is dependent on persistence of the factors that initiated crystal formation. fluctuations in urine composition may cause variations in the composition of the layers of crystalloid surrounding the crystal nidus.

Answer 37

Clinical signs depend on the location of the urolith. uroliths within the urethra can cause stranguria, dysuria, anuria, abdominal discomfort due to bladder distension and uraemia, especially if urine flow is obstructed for >48 hours. renal uroliths may be asymptomatic or cause signs similar to urinary tract infections, such as haematuria, dysuria and pollakiuria. the diagnostic approach to urolithiasis is usually similar to the approach to any other LUTD.

Answer 38

Urine sediment analysis in patients with urolithiasis may reveal evidence of infection (bacteriuria, pyuria) or crystalluira (presence of microscopic crystals in the urine. Each of the crystalloids that can cause uroliths can also produce urinary crystals with a characteristic microscopic appearance. Detection of struvite, calcium phosphate or oxalate crystalluria is of limited diagnostic significance since normal small animals can excrete these crystals in the urine. patients may occasionally have uroliths without detectable crystalluria, or crystals of one type and Urolith of another type.

Answer 39

Struvite uroliths typically have mineral radiodensiity and are usully obvious on survey radiographs. uric acid or urate uroliths are typically radiolucent and may only be detectable using contrast radiographic techniques. typical urolith radiopacity listed in order of decreasing radiodensity is phosphate (struvite or calcium phosphate), oxalate, cystine and uric acid urate. uroliths of all types are usually very echodense and can therefore be easily detected via abdominal ultrasonography.

Answer 40

Although some uroliths may have a characteristic gross appearance, stone analysis (either chemical or physical) is essential for obtaining a definitive diagnosis. chemical stone analysis, although readily available, are notoriously less reliable than physical analysis. unfortunately surgery is often the only practical method of obtaining a stone for analysis.

Answer 41

Since uroliths are often associated with urinary tract infection, urine culture is always recommended in patients with urolithiasis. culture from the centre of a urolith will sometimes reveal bacteria despite negative urine cultures or obtain a species of bacterium different from that obtained by urine culture.

Answer 42

Uroliths may be treated ether medically (dissolution) or surgically. With a stonee that usuallly responds to medical therpy (struvite or uric acid/urate), trial dissolution is indicated if the patient is stable, particularly if surgical removal is potentially difficult e.g nephroliths. Surgery is indicated if the urolith causes unacceptable discomfort, is located in a life threatening site (ureters or urethra) or if the stone is typically resistant to dissolution e.g calcium oxalate, calcium phosphate, silica.) determining the stone type without surgery is an educated guess, based on signalment, frequency of occurrence and results of initial testing. failure to respond to medical therapy for the likely stone type suggests that the urolith may actually be a different type and that surgery may be required for both diagnosis and treatment.

Answer 43

Struvite is the most common (agnesium ammonium phosphate) in small animals. struvite calculi esp in dog follow infection with urease producing organisms (staph, proteus or ureaplasma) urease is an enzyme that breaks down urea, causing the release of ammonium and bicarbonate ions into the urine. supersaturation with ammonium ions promotes struvite formation while the bicarbonate ions alkalinise the urine. Struvite formation is further enhanced by the presence of alkaline formation. Struvite calculi are moe common in female dogs. sterile struvite uroliths may also occur in dogs and cats despite the absence of infection. Medical treatment consists of antibiotic therapy when appropriate, dietary modification, (diet that reduces urine saturation of magnesium, ammonium and phosphate ions.) and oral urinary acidifiers. therapeutic response may be monitored by urinalysis and culture - only if the prescribed diet is not designed to also acidy the urine, oral urinary acidifiers. surgery is indicated if a reduction in urolith size is not detected within several months despite the clearance of infection and the production of acid urine.

Answer 44

Calcium oxalates are the second most common uroliths in dogs and may be the most common in cats. they are usually located within the bladder, but may also be found in the kidneys and ureters. For these to form the urine must be supersaturated with calcium, including hypercalcaemia, a diet containing high protein, high calcium and low vitamin B6. the solubility of calcium oxalate crystals is not direrctly influenced by urine pH within the physiologic range, but acidosis may increase the amount of calcium released from the bones to buffer the acid resulting in hypercalciuria. diuresis decreases the risk of Ca oxalate urolithiasis in people. Cats consuming canned diets have 1/3 risk of cats on drier food. Nephrocalcin is a natural inhibitor of calcium oxalate crystal growth - found to be defective in the urine of dogs with calcium oxalate uroliths. it reduces tendency of calcium oxalate crystals to grow or aggregate. Other inhibitors include citrate, glycosaminoglycans, tam horsfall proteins, osteopontine. Treatment is by surgery. prevention of reoccurence includes treatment of any underlying cause of hypercalcaemia, treatment of concurrent disease and increasing water intake formation of dilute urine by dietary adjustments. Lower protein, with adequate but not excessive phosphorus, magnesium and potassium. High salts diets have been recommended to increase urine volume and decrease urine concentration.

Answer 45

Urate calculi form because of increased excretion of urates or uric acid in the urine. dalmation dogs and bulldogs have a higher frequency of urate stone formation than other breeds. Idiopathic urate stones also form in some 1-4 year old cats but the metabolic defect is unknown. Breeds that are predisposed to portosystemic shunts, such as Yorkshire terriers, may also form urate stones due to their liver disorder. In normal animals purines convert to hypoxanthine which converts to xanthine Which converts to uric acid which converts to allantoin which is a soluble end product excreted in the urine. In dalmation dogs uric acid is not converted to allantoin resulting in urine that is oversaturated with uric acid.

Answer 46

n dalmations uric acid is not converted to allantoin resulting in urine that is oversaturated with uric acid. dalmations also have a lower percent of renal tubular reabsorption than other breeds resulting in increased urate excretion. Mre common in males but may be because male dogs have more of a problem with urethral obstruction than females. the average dalmation iis first found to have stones is 4.5 years and the risk of stone formation declines as the dog ages. Other risk factors iclude increased renal excretion of ammonium, low urine pH and urinary tract infectios with urease producing bacteria with may increase ammonium ions. Dietary purines may be digested, absorbed and incorporated into the bodys purine pool to be eventually excreted in the urine. Detection of urate crystals or stones in breeds other than the dalmation or bulldog strongly suggests the presence of defective metabolism of uric acid due to profound hepatic dysfunction rather than an isolated familial metabolic defect and is usually associated with either congenital portosystemic shunts or acquired liver disease.

Answer 47

Surgery is the treatment in cases of urethral or ureteral obstruction or portosystemic shunts. medical dissolution of ammonum urate stones can be attempted in other cases which do not have liver disease. dissolution involves using a low purine diet, xanthine oxidase inhibitor, alkaliinization of urine, treatment of any urinary tract infection and promoting increased quantity of less concentrated urine. medical dissolution takes on average 8-12 weeks and is sucessful in about 1/3 of affected dogs. A calculolytic diet such as hills is usually recommended because it is purine restricted, non acidifying and has no added sodium.

Answer 48

English bulldogs have an associative risk of urate or cystine stones with dilated cardiomyopathy ad feeding an ultra low protein diet such as u/d may be contraindicated therefore a renal failure diet such as k/d with a low dose of allopurinol is the preferred diet in english bulldogs.

Answer 49

A synthetic isomer of hypoxanthine that rapidly binds to and inhibits the action of xanthine oxidase and thereby decreases production of uric acid by inhibiting conversion of hypoxanthine to xanthine and xanthine to uric acid. as prolonged administration of high doses of allopurinol may result in xanthine uroliths it is used for dietary therapy, with the option of treating infrequent recurrent episodes of urate uroliths In dissolution prtocols. the urine should be alkalinized with oral sodium b icarbonate. t maintain a urine h of approximately 7.0 which will help to reduce renal tubular production of ammonia.

Answer 50

medical management to decrease risk of uric acid/urate uroliths in dalmations consists of feeding a prescription diet which has reduced levels of animal source proteins, oral urinary alkalinizers and allopuriinol (a xanthine oxidase inhibitor that reduces urinary uric acid levels)

Answer 51

Composed of amino acid cystine. they occur in dogs & cats with cystinuria, an inborn error of metabolism characterised by abnormal transport of cystine, a non essential sulfur containing amino cacid, by the renal tubules. Cystine is normally present in low concentrations in plasma. it is freely filtered at the glomerulus and is most actively reasbrobed in the proximal tubules. cystinuric dogs reabsorb a much smaller proportion of cystine from glomerular filtrate and may eve have net cystine secretion. cystine is relatively insoluble in acid urine but becomes more soluble in alkaline urine so urolith formation enhanced by acid urine ph, highly concentrated urine and incomplete and infrequent micturition. Not all cystinuric dogs form stones, cystinuria is apredisposing factor. urine amino acid profiles reveal abonrmal quantities of cystine and in some dogs and cats lysine, arginine and ornithine. Cystine stones are radiolucent to slightly radiopaque and have a smooth to slightly irregular surface. Adult males are primarily affected, esp dachshund, english bulldogs, mastiffs and newfoundlands, Medical dissolutio involves a combination of N-glycine @MPG iiin dogs and diet to reduce urinary excretion of cystine, promote formation of alkaline urine and reduce urine concentration. this diet is used in conjunction with 2 MMPG for dissolution. dietary sodium may enhance cystinuria therefore potassium citrate is better than sodium bicarbonate to maintain alkaline urine.

Answer 52

Silica uroliths are among the least reported types of uroliths. silica forms mostly ioniic or semi ionic bonds and rarely bonds with itself. it combines with oxygen to form negatively charged silicate radicals. talc and kaolin are well known exampes of commoon silicate minerals. Development of silica uroliths may be related to diet however no specific diet has been identified. may be related to hyperexcretion of silica in urine following consumption of an absorbable form in the diet.

Answer 53

The term feline urologic syndrome was used to describe haematuria, dysuria, and pollakiuria often with urethral obstruction in cats, problems that were hypothesised to have a single unidentified cause. since it is now know that a wide range of disorders can cause these clinical signs, the term feline urinary tract disorders is now more appropriate.

Answer 54

Male cats with LUTD are prone to obstruction of the penile urethra with a plug composed of proteinaceous debris pls or minus some crystals or with a urolith. although crystals may not be the cause they form a thick gritty paste. female cats also get LUTD, but rarely obstruct because their urethra is shorter and wider. male dogs also at risk but less common than in dogs and cats. partial or complete urethral obstruction is a life threatening emergency that initially causes typical signs of LUTD (haemturia, dysuria and polalkiuria). complete obstructions causes a lack of urine, or only a few drops, produced during attempts at urination. Development of post renal azotaemia due to obstruction causes profound malaise. finding a very distended, tight painful bladder on abdominal palpation is consistent with the diagnosis.

Answer 55

Immediate problems are electrolyte imbalances (high potassium) and azotaemia, the first priority is to stabilise the patient with IV fluids and correct any major electrolyte imbalances. the urethral obstruction should then be relieved. obstruction can be sometimes relieved by penile massage. More commonly urethral catheterisation and retrograde flushing under heavy sedation or GA are required. catheterisation may be aided by digital urethral massage by the rectum. A closed urine collection system should be used. cystocentesis can traumatise an already stretched and damaged bladder and should be avoided if possible. skeletaand smooth m relaxants or antispasmodics such as dantrolene, prazosin or phenoxybenzamine may be helpful in maintaining a good flow of urine by decreasing urethrospasms. Recurrence of obstruction is a major problem. identification and removal of the underlying cause is ideal. Prevention is feeding a canned food and reducing urine specific gravity. Persistent relapses may be treated by surgical widening and shortening of the urethra. cats with confirmed oxalate stones may benefit from being fed a canned oxalate prevention diiet.

Answer 56

strictly defined, refers to any abnormality related to urination, however the term is usually reserved for patients with pollakiuria or stranguria.

Answer 57

Refers to difficulty in initiating or maintaining urine flow. the terms dysura and stranguria are often used interchangeably.

Answer 58

Blood in the urine. Haematuria may b e obvious to the naked eye or only following microscopic identification of erythrocytes within the urine sediment.

Answer 59

Presence of haemoglobin in the urine.

Answer 60

Dysuria, Stranguria and Pollakiuria almost invariably localise disease to the lower urinary tract and along with haematuria are the most common signs associated with LUTD. haematuria may occur with either renal, ureteral or lower urinary tract diseases. Haematuria at the onset of urination suggests urethral or rprostatic bleeding, while haematuria towards the end of urination suggests haemorrhage from the bladder. blood mixed evenly throughout the urine stream is most consistent with renal haemorrhage. Urinary incontinence may occur with diseases of the ureters, the bladder or most commonly the urethra. lower urinary tract diseases alone do not typically affect the general health of the patient and do not cause polyuria, polydipsia or azotaemia.

Answer 61

The vast majoirty of small animals presenting with these signs will have one of three major diseases of the lower urinary tract - cystitis, (bacterial in the dog and sterile in cat), cystic calculi or neoplasia of the baldder, urethra or prostate. the diagnostic imperative in patients with haematuria, dysuria and pollakiria is therefore to identify or exclude cystitis, calcluli and neoplasia.

Answer 62

Survey abdomiinal radiographs will reveal most cystic and urethral calculi. since fluid and tissue have the same radiodensity, survey radiographs usually will not reveal blader tumours since the intraluminal mass will be surrounded by urine of equivalent radiographic density. Primary or metastatic lower urinary tract neoplasms involving the prostate gland, sublumbar lymph nodes, lumbar vertebrae or lungs may be evident on plain abdominal thoracic raiographs. Intraluminal tumours and radiolucent calclui will usually be revealed by contrast radiographic studies such as positive, negative and double contrast cystography and urethrography. Ultrasonography will show all uroliths, changes in bladder wall, tumours and prostatic disorders. urethroscopy and cystoscopy although useful when dealing with complicated or unusual lower urinary tract diseases, are rarely necessary for the diagnosis of the commoner causes of haematuria, dysuria and pollakiuria.

Answer 63

Cystitis refers to inflammation of the bladder. cystitis in the dog is usually bacterial, whereas in the cat is often sterile and idiopathic. rare causes of cystitis in small animals include unusual infectious agents (viruses, yeast) and non infectious processes such as calclui, neoplasia, and cyclophosphamide chemotherapy. cystitis is the most common cause of dysuria, pollakiuria and haematuria in both dogs and cats.

Answer 64

Usually caused by micro organisms that have entered the bladder via the urethra. bacterial cystitis is far more common in emale dogs, probably because the relatively long urethra in males provides protection against ascending ifnection. gram negative bacteria of faecal origin (E. coli, proteus and kelbsiella) are the most common causes of bacterial cystitis in the do although some will be caused by staph and strep.

Answer 65

Anatomical barriers such as the urethral sphincter, microscopic folds in the epithelium of the proximal urethra and glycosaminoglycans secreted by the uroepithelium. mechanical flushing due to the unidirectional flow of urine, competition between pathogenic bacteria and the normal flora of the distal urethra and adjacent structures (vulva, vagina and prepuce). Intrinsic antibacterial properties of normal cat and dog urine, including high osmolality. Immunologic mechanisms such as release of secretory immunoglobulins in vaginal mucus. Processes that compromise defence mechanisms such as urinary catheterisation, disorders that lead to PUPD and a reduction in urine osmolality and systemic immunosuppression such as with DM, hyperadrenocorticism and glucocorticoid therapy predispose animals to bacterial cystitis.

Answer 66

Urinalysis in cases of bacterial cystitis usually shows haematuria, proteinuria, pyuria (WBCS in the urine) and bacteriuria. detection of bacteria within urine collected via cystocentesis confirms the presence of bacterial cystitis, since the bladder lumen is usually sterile. urine from patients with suspected bacterial cystitis should always be submitted for culture and antibiotic sensitivity testing.

Answer 67

Acute bacterial cystitis usually responds rapidly t a two week course of appropriate antiiotics. important criteria influencing antibiotic selection include: antibiotic spectrum - broad spec should be used only if sensitivity not available. gram negative infections respond to trimethoprim/sulpha, while gram positiv infections usually respond to amoxicillin or ampicillin. Route of excretion - selection of antibiotics that are concentrated and excreted n the urine. Mechanism of action - bacteriocidal antibiotics are preferable to bacteriostatic. Toxicity - should be well tolerated for 2 weeks. owner acceptability - easily administered and inexpensive.

Answer 68

Persistent or recurrenc cystitis after appropriate therapy is uncommon and suggests a persistent focus for infection e.g prostattis, pyelonephritis, calculis or neoplasia. a breakdown in local defence mechanisms or a predisposing systemic disorrder. potential underlying disorders should therefore be thoroughly investigated in patients with persistent or recurrent utis. persistent infections Despite appropriate therapy and vigorous elimination of underlying disorders may necessitate prolonged courses of Antibioics - six to eight weeks minimum, with consideration of chroonic treeatment in refractory cases.

Answer 69

Signs of LUTD in cats under 10 years of age without urethral obstruction may be caused by idiopathic cystitis, urolithiasis, urethral plugs, behavioural proglems, anatomical defects or neoplasia. If the cat is not obstructed, a UA should initially be performed. If there is an active sediment or if the cat is >10yrs old, a urine culture should be performed. Cats with idiopathic cystitis have a variable course, but the signs usually resolve in about 5-7 days and then recur later. episodes can be triggered by stress e.g moving house, new cats, new people in the house. Treatment should include feeding a wet diet to decrease the urine SG to <1.035. Amitriptyline has been used to treat severe cases but can result in weight gain and lethargy. the glycosaminoglycans GAGS layer of cats with idiopathic FLUTD is thought to be reduced or damaged and oral replacement of GAGS may have some benefit.

Answer 70

Bladder tumours are typically advanced before clinical signs become evident and therefore usually difficult to treat by the time of initial diagnosis. the presenting signs are bladder neoplasia usually dysuria, pollakiuria and haematuria identical to those caused by bacterial cystitis and can be concurrent with it, except that the patient fails to respond completely and permanently to appropriate antibiotic therapy. Bladder tumours are uncommon in the dog and rare in the cat, when present they are usually maligant. Transitional cell carcinoma usually involving the bladder trigone is the most common bladder neoplasm in the dog and cat.

Answer 71

Thorough investigation for potential bladder neoplasm is indicated in middle aged or older dogs or cats with either persistent clinical signs of lower urinary tract disease despite negative urine cultures or persistent or recurrent bacterial cystitis despite antibiotic therapy. careful physical examination may provide clues that suggest neoplasia. large bladder tumours can occasionally be detected via abdominal palpation. Rectal palpation may reveal cancer spread into the urethra, sub-lumbar lymph nodes and pelvic canal. Plain radiographs usually fail to detect bladder tumours unless the cancer has metastasised to the sub-lumbar nodes, lumbar spine or lungs. contrast radiography or ultrasonography are usually effective at revealing cystic and urethral tumours. cytology of histopathology are necessary to obtain a definitive diagnosis of malignancy. examination of urine sediment, fine needle aspiration, suction aspiration of bladder masses may be sufficient to obtain cytologic confirmation of malignancy. Tissue for histopathologic examination may be obtained by laparotomy and cystotomy.

Answer 72

Since TCC usually originates in the trigone region and aggressively invades the adjacent urethra and ureters, the typical bladder tumour is beyond feasible surgical resection by the time of presentation. TCC is unfortunately also refractory to other cancer treatment modalities such as chemo and radiotherapy. temporary palliation of clinical signs and reduction in tumour size may be achieved with oral piroxicam (an NSAID)

Answer 73

Occurs uncommonly in dogs and cats and is caused by polyps in the bladder wall. it often presents with haematuria which can be quite severe. this disorder can mimic bladder tumour, although it more often affects the ventral area of the bladder rather than the trigone. Treatment is piroxicm or other nsaids. prognosis is good.

Answer 74

the prostate is located retroperitoneally between the rectum and symphysis pubis and completely circles the urethra. with advancing age it increases in size and may be located within the abdomen. prostatic growth and secretion are androgen dependent. castration leads to decreased prostate size.

Answer 75

Common signs - urethral discharge, haematuria, rectal tenesmus, hunched stance and giat, digital rectal plapation may need to use other hand to push against the abdomen to push the prostate dorsally. evaluate for size symmetry shape pain and mveability. often have concurrent urinary tract infections. prostatic fluid is the third portion of the ejaculate so semen evaluation. prostatic assage - remove urine from the bladder by catheteri, place tip of catheter at level of prostate, massage prostate gently per rectum for 1-2 min, aspirate material into catheter. Fluid: cytology and culture. Prostatic aspiration fNA - may be rectal, perirectal or transabdominal. sample used for cytology. prostatic biopsy - percutaneous needle biopsy can be performed peri rectally or transabdomially or a biopsy may be obtained surgically. sample is used for histopathology.

Answer 76

BPh: proliferation of the glandular epithelium. complex or cystic hyperplasia: associated with squmaous metaplasia and occlusion of the ducts. formation of micro cysts within the parenchyma. BPH is arguably a normal aggeing change. very common, usually asymptomatic present in 80% of older un castrated dogs, signs of tenesmus, blocked urethral discharge and very rarely urethral obstrcuction. chronic tenesmus can lead to breakdown of pelvic diaphragm muscles. Constipation and straining may result in perineal herniation. May be caused by an imbalance between estrogens and androgens rather than excess of androgen alone. Diagnose with rectal palpation: symmetrically enlarged, non painful prostate of normal spongy consistency. Haematology and serum chem unremarkable. Prostatic wash/urinalysis show haemorrhage, bacterial cultures negative. Treatment - castraation - hyperpalstic prostate involutes over 3-4 weeks. Medical therapy for constipation may be required while prostate shrinks - low residue diet with laxaties, enemas or glycerin suppositories. The administration of delmadione is not recommended, it will only temporarily decrease size of prostate and can cause squamous metaplasia. Diethylstilbestrol can lead to irreversible bone marrow depression and squamous metaplasia of prostate. FInasteride is a synthetic steroid 5a reductase inhibitor - useful. osaterone acetate inhibits uptake by the prostate and reducing the concentration of androgen. it is also a competitive antagonist on androgen receptors in the prostate to prevent synthesis of new prostatic cells.

Answer 77

the prostate is predisposed to iinfection spread from the bladder, urethra and testis . most common organisms cultured from infected prostates are E. coli, proteus spp, pseudomoonas, staphs and streps. the normal mechanism of frequent urethral flushing with micturition, the urethral high pressure zone and a zinc associated anti bacterial factor in prostatic fluid act as natural defenses. If bacteria colonize the prostatic parencyma > microabscesstion > coalescence of multiple foci > large abscesses> rupture into the pertoneal cavity > acute deterioration, peritonitis, sepsis, shock, death. The signs are urine retention or constipation, purulent or bloody urethral dischage, abnormal posture or gait due to caudal abdominal or pelvic pain, elevation of tail base and reluctance to move tail, if the prostate has ruptured, signs of acute peritonitis will be evident.

Answer 78

Rectal palpation - painful ,enlarged prostate, may be assymetrical often with fluctuant areas. chronic suppurative prostatitis may orm adhesion around the prostate and areas of firm firbosis may be palpable within it. Haematology varies from a leukocytosis with a left shift (acute prostatitis) to leukopenia with a degenerative left shift (ruptured prostatic abscess) to normal in long term chronic prostatitis. Urinalysis shows haematuria, pyuria, possibly bacteruria. caudal abdomina radiography may show large prostate, decreased detail may be noted if peritonitis is present. Hyperechoic and hypoechoic areas within the parenchyma on ultrasound. large hypoechoic areas more suggestive of abscessation or cysts. septic exudate recovered from prostatic wash, urethral discharge of FNA. FNA is contraindicated if an abscess is suspected (risk of dissemination)

Answer 79

Acute suppurative prostatitis - antibiotic therapy based on culture and sensitivity of prostatic fluid or urine, administer for 3-6 weeks. trimethoprimsulphadiazine or enrofloxacin are recommended prior to the culture results. these drugs cross the blood prostate barrier and concentrate int he acidic prostatic fluid. if the infection is not eliminated, chronic recurrent prostatitis and utis with resistant bacteria is likely. Abscessation of the prostate - less likely to respond to antibiotic therapy. large abscesses may rupture resulting in peritonitis. surgery is indicated to drain excise or omentalize large abscesses. Repeated ultrasound guided percutaneous drainage and antibiotics has been described as primary treatment. castration may be performed when patient is stable. Complication rate is high. excision is associated with intraoperative deaths and urinary incontinence, drainage associated with sepsis, recurrent infection. Omentalization most recommended technique.

Answer 80

Prostatic cysts may result from ductal occlusion secondary to squamous metaplasia. they may be multiple within the gland or single large structures extending into the abdominal cavity or pelvic canal. prostatic cysts may become secondarily infected and show signs of abscessation.

Answer 81

They originate frmo the blend ended embyronic uterus masculinus and have no direct communication with prostatic parenchyma. they are characteristically large, extending into the pelvis and abdomen conected by a stalk to the prostate, they contain a pale yellow transudate and the walls may be calcified. they do not become infected by UTIS.

Answer 82

Compression of adjacent urinary or intestinal structures causing vague signs relating to a large caudal abdominal ass - inappetance, dysuria, constipation, tenesmus are common. less commonly urine retention, incontinence, pelvic pain. Rectal palpation: asymmetrically enlarged, fluctuant, non painful prostate. paraprostatic cysts are rarely palpable per rectum as they are usually intra abdominal. urinalysis, haematology, serum chemistry are usually normal though haematuria may be present radiography shows a caudal abdominal mass + calcified lining. positive cystourethrography may help. large hypoechoic areas within or adjacent to the prostate can be seen on ultrasound. FNA yields a modified transudate with RBCS + inflammatory cells. bacterial culture is negative unless secondarily infected prostatic cysts present.

Answer 83

Relief of urine retention and constipation. surgical therapy: resection, omentalization, ultrasound guided drainage as a primary treatment has been described. Castration decreases the secretory activity of the prostate and is indicated. DES is contraindicated (leads to squamous metaplasia and retention cysts) prognosis is good.

Answer 84

Adernomas and adenocarcinomas. carcinomas usually present with ascites after transcoleomic spread of the tumour. can be bilateral. carcinomas can metastasize to renal and paraoartic lymph nodes, liver and lungs. cystadenomas are thought to arise from the rete ovarii, are unilateral and consist of multiple thin walled cysts containing a watery fluiid.

Answer 85

Granulosa cell tumour is the most common sex cord tumour, around 50% of cases are considered active for the production of steroid hormones. in steroid producing tumours, the affected ovary is greatly increased in size and the other ovary atrophied. this the commonest ovarian tumour in the bitch and can affect any age of bitch, although more often found in the older animal. the bitch may either show signs similar to cystic ovaries or else anoestrus with the time from the previous heat greatly extended.

Answer 86

These comprise dysgerminomas, teratomas and teratocarcinomas. dysgerminomas are usually unilatera, grow by expansion and have a metastatic rate of around 2-030% mainly to abdominal lymph nodes. teratomas/carcinomas contain a combination of ectoderm, mesoderm or endoderm.

Answer 87

Epithelial, germ cell and sex cord tumours have been reported. sex cord tumours would appear to be the most common but all are rare. metastasis can occur. therapy would be as for the dog (cisplatin cannot be used in cats).

Answer 88

Leiomyoma(sarcoma) or carcinoma. very rare in the dog and cat with a very few case reports. in cats, uterine adenocarcinoma is most frequently reported with a well documented metastatic potential.

Answer 89

Typically benign tumours of the type leiomyoma, also fibroleiomyomas, fibromas and polyps can occur. they present as a red mass protruding from the vulval lips or a mass distorting the normal outline of the vagina. incidence is higher in nulliparous and entire bitches.

Answer 90

found in imported bitches or bitches living near ports in britain. can affect males and females. most common in northern states of usa. enzootic in southern states of USa, central and South America, certain parts of africa, the Far East, Middle East and southeastern europe. route of infection is from the infected penis of the male at intromission. TVT is horizontally transmitted irrespective of MHC barriers, allowing transplantation of cells during coitus.

Answer 91

Prostatic tumours are rare in the dog compared to man. the usual age of presentation in dogs is 9-11 years. prostatic intraepithelial neoplasia is recognised in man as a precursor lesion. it has also been described in dogs. recognised histological subtypes include: epithelial tumours; adenocarcinoma (most common,) squamous cell carcinoma, transitional cell carinoma. Mesenchymal tumours - haemangiosarcoma, leiomyosarcoma. the role of castration in the aetiology remains controversial. recent epidemiological studies have suggested that castration provides an increased risk of prostatic carcinomas. Most carcinomas arise from the ductal epithelium which lacks androgen receptors. this suggests that androgens do not play a part in disease initiation or progression. Treatment options include NSAIDS, chemotherapy.

Answer 92

Interstitial cell tumours - most common tumours and are often only found at post mortem examination as an incidental finding. Seminomas cause enlargement of the testicle but are rarely accompanied by systemic signs. They can be locally invasive, especially when they occur in the abdominal testes. the opposite testis is usually atrophied. Sertoli cell tumours also cause testicular enlargemnt and atrophy of the other testis. they are usually oestrogen producers and are accompanied by clinical signs associated with hyperoestrogenism including attractiveness to other male dogs, bilateral flank hair loss, preputial oedema and gynecomastia. Cryptorchidism is a risk factor for both seminomas and Sertoli cell tumours. Boxers, GSDS and weimeraners appear to be at increased risk of development. All tumour types have a low metastatic potential. the greatest potential is with seminomas and Sertoli cell tumours. metastasis is usually to regional draining lymph nodes then ultimatey to liver, lungs, spleen, kidney, adrenal glands and pancreas.

Answer 93

For all types, orchectomy with scrotal ablation is the treatment of choice. unilateral orchectomy can not be recommended. cryptorchid testicles may need to be removed by laparotomy. for dogs with bone marrow dyscrasias, the prognosis is guarded. they may require supportive care for several weeks. the bone marrow may not recover. for dogs with metastatic disease, the prognosis is poor. in these cases consider specialist referral for chemotherapy alone or chemotherapy and radiation.

Answer 94

Mammary tumours are the most common neoplasms in intact female dogs. malignant neoplasms - 50%. Affect older dogs - 10-11 years, rare in dogs <5 years. mammary gland tumours are hormonally dependent. ovariohysterectomy can greatly decrease the risk of developing mammary gland tumours. dogs spayed before their first oestrus have a risk of 0.5% after their first oestrus the risk jumps to 8% and after their second oestrus the risk goes to 26% Oestrogen and progesterone receptors hae been identified in mammary gland tumours with up to 50% of malignant tumours and up to 70% of benign tumours expressing them. obesity may play a role in canine MGT as it does with human MGT. in spayed dogs the incidence of MGT is reduced if dogs are thin at 9 to 12 months of age. may affect any breeds but poodles, english and brittany spaniels, english setters, pointers, fox terriers boston terriers and cocker spaniels are over represented. rare in male dogs but is reported. 50:50 rule - 50% of mammary masses are benign and 50% are malignant. 50% will recur or metastasize following the first surgical resection. whlie epithelial malignancies are most common, multiple histologic types ocur. inflammatory carcinomas are red, warm and oedematous and they grow and metastasize very rapidly. the grading scheme for MGT crosses conventional borders and includes distant disease as part of the criteria for a high grade tumor. after inflammatory carcinomas, sarcomas have a worse prognosis than other carcinomas.

Answer 95

Surgery is the treatment of choice for almost all MGTs unless impossible to remove. the goal of surgery is to remove the entire tumour including microscopic disease, by the simplest procedure.Nodulectomy >the simple removal of a small nodule from a mammary gland. It is suggested that this should be undertaken for firm masses smaller than 0.5cm. It is difficult to justify this type of approach due to the limitation of the surgical procedure in achieving appropriate surgical margins. Mammectomy > removal of a single gland from the chain. Partial mastectomy or regional mastectomy > the removal of > 1 gland in one region of the mammary chain. Unilateral radical mastectomy > the removal of the entire chain on one side of the bitch. the elimination of the entire chain is indicated where there are multiple tumours in most if not all the glands. technically this is a simple surgical procedure that removes all the affected tissue in one incision rather than attempting several mammectomies. Bilateral radical mastectomy - removal of both the left and right mammary chains where there are multiple masses in both the chains. a simultaneous bilateral procedure is not recommended due to difficulty in closing the wound appropriately. there are techniques to leave at the cranial end of the incision over the sternum to provide supportive tissue.

Answer 96

The use of radical Vs conservative excision has been debated, with little differences in recurrence rates and survival times. consequently the current advice is when choosing a surgical procedure the main goal of surgery is to remove all tumour using the simplest procedure possible and gaining a complete surgical excision. Where there is involvement of the underlying fascia and muscle this must be removed at the time of surgery whatever technique is employed. a radical unilateral mastectomy is however advised in such circumstances. Removal of the lymph nodes - the superficial iguinal lymph node is always removed with gland 5 since it lies nearly within the substance of the fat assocaited with the gland, but the axillary node is removed only if it is enlarged or if there is cytological evidence that there are metastases present. concurrent ovariohysterectomy at the time of mammary surgery is controversial however sapying removes the possibility of pyometra, uterine or ovarian tumours and unwanted pregnancies. because up to 50% of malignant MGTS express oestrogen or progesterone receptors, spaying has theoretical therapeutic benefit. clinical studies have shown no anti cancer benefit with OHE once the tumours have developed. If OHE is to be performed do it before tumour removal to prevent seeding of the abdomen with the tumour.

Answer 97

Size <3cm, well circumscribed tumours, stage of disease: no evidence of metastasis, well differentiated tubular/papillary carcinomas ( lower grade), no evidence of vascular or lymphatic invasion on biopsy. oestrogen receptor/progesterone receptor positive. sex: it appears that male dogs have a higher incidence of benign tumours and hence prognosis associated with mammary masses in male dogs is generally faborable.

Answer 98

Age, breed, OHE status, weight, type of surgery, number of tumours, glands involved, history of pregnancy.

Answer 99

They are the third most common tumour, accounting for 17% of all neoplasms in female cats. mean age of 10-12 years, range of 9 months to 23 years. siamese cats are at risk but any breed can develop MGTS. hormonal influences is likely. intact cats are more likely to develop mammary tumours. cats spayed at <12 months have an 86% reduction in risk. parity does not seem to affect MGT development. there is a strong association between the use of progesterone like drugs and the development of benign or malignant mammary masses in cats. Few MGT are oestrogen receptor positive. Rare in male cats but more common as compared to male dogs. 80% of mammary masses are malignant and 20% are benign. most commonly classified as adenocarcinomas and most have regions of different differentiation. disease free and overall survival depend on size of tumour at time of diagnosis, histologic grade and extent of surgical resection. tumours are often advanced at the time of diagnosis, they may adhere to overlying skin but rarely adhere to underlying abdominal wall. usually firm and nodular. may be ulceerated, associated with discharge from the nipple or involve multiple glands. Acute respiratory distress secondary to malignant pleural effusion also possible. do not confuse with benign fibroepithelial hyperplasia.

Answer 100

Occurs in young cats after a silent oestrus, or continuously calling. has been associated with chronic progestin therapy. one or more glands involved. Ovariohysterectomy is the treatment of choice but resolution may take several months.

Answer 101

CBC/chemistry and urinalysis - investigate any concurrent disease. thoracic radiography - evaluate pulmonary parenchyma for metastatic disease. cats can develop pleural effusion or interstitial changes rather than the typical nodular metastatic lesions. assess sternal lymph node. Abdominal imaging - evaluate abdominal lymph nodes for evidence of metastasis and other organs. FNA - may be difficult to interpret as some MGTS have both benign and malignant portions within the same tumour. Biopsy - excisional preffered because it is both diagnostic and therapeutic.

Answer 102

Tumours of the urinary tract may occur in the upper urinary tract which comprises the kidneys and ureters or in the lower urinary tract comprising the bladder and urethra. tumours originating in one compartment rarely spread to the other. tumours of Upper UTI are uncommon and may be clinically silent. tumours of lower UTI are more common and associated dysfunction is readily detected clinically. The most common tumours are of primary epithelial origin and are most often malignant. in addition to TCC, other epithelial tumours include SCC, adenocarcinoma undifferentiated carcinoma as well as papillomas and adenomas. bladder tumours of mesenchymal origin arising in the connecting tissues of supporting stroma also comprise both benign and malignant tumours.

Answer 103

tuours of the lower UTI in dogs comprise tumour sthat are arising int he bladder or urethra. bladder tumours tend to occur in female dogs and are more common than urethral tumours which tend to occur in male dogs. bladder tumours tend to arise in older, small terrier breeds although any age of dog and any breed can be affected. Scottish terriers may be over represented. Transitional cell carcinoma is the commonest primary bladder tumour and accounts for approximately two thirds of all bladder tumours. the remaining third of primary canine bladder tumorus comprise both malignant and benign tumours although malignant tumours in this category also exceed benign tumours by about 2:1. herbicides and insecticides have been implicated in the pathogenesis of TCC in dogs. the lower urinary tract is an uncommon site of secondary tumour spread but involvement may be seen in cases of lymphoma. locoregional spread may involve the prostate in male dogs.

Answer 104

Bladder tumours tend to occur less frequently in cats than in dogs. there appears to be no sex predilection in cats. TCC of the bladder is the commonest tumour type, however, other malignant and benign tumours also occur. urethral tumours have been rarely reported in cats. although the clinical signs are easily recognised they are variable and species differences are noted. this is likely to reflect the behaviour of the animal and how closely they are observed than any differences in the disease process. clinical signs may be misdiagnosed as a urinary tract infection or in the case of cats - feline urological syndrome in the first instance. a UTI may accompany lower urinary tract tumour but animals diagnosed with a presumed UTI that do not respond to symptomatic treatment should be investigated in the possibility for underlying lower urinary tract neoplasia. pollakiuria, Stranguria and dysuria are commonly associated with Lower urethral obstruction in male cats, when no obstruction can be detected further investigations to exclude lower urinary tract tumours are warrented.

Answer 105

Attempts should be made to exclude malignancy on sediment cytology, careful as some tumours will not exfoliate into urine. a urine dipstick test is available for detection of bladder tumour antigen in dogs. False positives likely. A mass may be palpated, sediment cytology may indicate abnormal cellular pathology, symptomatic treatment may be unsuccesful, initial investigations of a blocked cat show no lower urethral obstruction. Urine samples should be obtained by free catch or via the placement of a urinary catheter. Cystocentesis and diagnostic needle aspirate cytology should be avoided in suspected cases of bladder neoplasia due to the risk of shedding and seeding of tumour cells into the abdomen and body wall. Plain radiography unlikely to be diagnostic but does help to assess the remainder of the abdomen for abnormalities such as regional lymph node assessment and regional bony metastasis. contrast radiography including double contrast cystogram, retrograde urethrogram/vaginourethrogram may be helpful in delineating a mass lesion involving the bladder wall or mucosal surface. ultrasound is the diagnostic test of choice and especially in female cats. ultrasound will permit guided needle aspirate biopsies of any abnormality outside the lower urinary tract. Regional metastasis may be suggested by pelvic or medial iliac lymphadenopathy, prostatomegaly or irregularities of the pelvic bones. Reduce bulk of tumour which will decrease the likelihood of secondary bacterial infection and pelvic outflow obstruction and discomfort.

Answer 106

Any tumour where multifocal disease which involves the trigone is unlikely to be amenable to curative surgery unless transplantation of the ureters is achieved. consider referral for a specialist surgical opinion. benign tumours may be cured by surgery. Unlikely to be curative for malignant tumours. the majority of malignant tumours are TCC which are often multifocal and may metastasise. these often involve the trigone. surgical seeding into abdomen or laparotomy incision site is possible with surgery for TCC.

Answer 107

Chemotherapy is the treatment of choice for the majorirty of dogs with TCC of bladder or urethra. may also be used in cats. best results ben obtained with combination of mitoxantrone given systemically plus a COX-2 inhibitor such as piroxicam or meloxicam. Platinum based drugs have no treatment advantage over mitoxantrone and may accelerate renal compromise in patients with pre existing renal disease or pelvic outflow obstruction.

Answer 108

Upper urinary tract tumours are rare in dogs and comprise tumours of the kidney and ureters. unlike lower UT tumours, tumours of kidneys and ureters are often clinically silent unless the tumour involves the renal pelvis or has a tendency to in which case haematuria can be recognised clinically. renal carcinoma and nephroblastoma most often repoted. renal carcinomas tend to affect older male dogs. nephroblastoma tend to occur in young dogs of either sex. both renal carcinoma and nephroblastoma are highly metastatic and may be bilateral renal involvement because of de novo disease. metastatic tumours from a variety of sites may affect the kidney. german shepherd dogs have a breed predisposition to renal cystadenocarcinomas recognised in association with multifocal nodular dermatofibrosis.

Answer 109

Renal lymphoma is a well recognised anatomical form of lymphoma in cats and is often bilateral. other sites of lymphoma involvement should be investigated if renal lymphoma is confirmed. azotaemia and the associated clinical signs may be more commonly recognised in association with renal tumours in cats than dogs. with the exception of renal lymphoma, primary upper urinary tract tumours are rare in cats. No sex predilection. when renal tumours are detected they are usually TCC or renal carcinomas. Nephroblastoma affects young cats and is very rare. TCC, renal carcinoma and nephroblastoma are highly metastatic in the cat and may be bilateral. It is difficult to distinguish renal adenoma from low grade renal carcinoma in cats. metastatic tumours from a variety of sites may affect the kidney.

Answer 110

Systemc hypertension results in loss of autoregulation within the kidney, with the result of transmission of high pressures to the glomerulus. first choice of treatment depends on species, with ACE inhibitors being used in dogs and the calcium channel blocker amlodipine besylate being used in cats. Amlodipine causes dilation oof the afferent arteriole but if inadequate reduction in blood pressure is achieved then the high systemic blood pressure will be transmitted to the glomerulus and exacerbate renal damage therefore this may need to be combined with an ACE inhibitor.

Answer 111

Urinary tract infections. potassium supplementation: patients that are identified to be hypokalaemic should have this addressed by supplementation with potassium citrate or potassium gluconate. renal secondary hyperparathyroidiism: intrinsic calcitriol production is reduced in the diseased kidney, due to lack of a1 hydroxylase required for conversion of 25(OH) cholecalciferol to 1,25 OH cholecalciferol (calcitriol) - which has a negative feedback on the parathyroid gland to suppress PTH production, therefore PTH levels are increased in patients with CKD. calcitriol should be used to try and address this but should not be considered if phosphate and calcium levels are elevated.

Answer 112

``` Struvite (opaque) Calcium oxalate - opaque Urates - lucent Cystine - variable Silica - opaque ```

Answer 113

Cranial vaginal wall.

Answer 114

Glomerulonephritis : immune mediated forming antigen antibody complexes from another source in the body from bacteria, viruses, parasites, neoplastic or inflammatory conditions, these complexes end up getting caught in the glomeruli and inflammatory cells attack the complexes and so attack the glomeruli. the lesions themselves look membranous, membroproliferative and glmerulosclerotic. Amyloidosis: periglomerular deposition of serum amyloid A protein realised along with insulin and gets deposited on seeral organs with the kidneys being the most severaly affected. this is associated with an inflammatory condition, iinfection or neoplastic disease. sometimes this can be a familial disease in shar peis and abysinnian. Lesions tend to look a bit pink in colour and a glisten. Do biopsy for definitive diagnosis. Amyloid tends to be deposited in the medulla.

Answer 115

history - signalment, when purchased, vaccination, worming, flea treatment, diet, does cat hunt, vomiting, diarrhoea, resp signs, does travel, neurological signs, changes in behaviour, castrated any dermatological abnormalities, quantify water amount drinking, is there any weight loss, is there any blood, dysuria, periuria, other cats in the household affected. PPhysical examination - kideys, bladder, temp, weight. DDX- CKD, pyelonephritits, lymphoma, PKD, liver disease, DM, hyperthyroidism, hyperadrenocorticism, acromegaly, diabetes insipidus, hypercalcaemia,hyponatraemia, hypokalaemia, pyometra, neoplasia, drugs - diuretics, steroids, psychogenic. DM and CKD most common. Retinal exam, BP measurement, urinalysis, haematology, biochemistry. Urinalysis, protein creatinine ratio, measure thyroxine, no glucosuria > CKD.

Answer 116

DDX - cysititis, urolithias, transitional cell carcinoma. Urinalysis - sediment exam, bacterial culture. UPC. UPC cannot be done in presence of active sediment. Give antibiotics if bacteriuria. if recurs > imaging. Stones> perform surgery to remove .