Transcript DipaUrinaryDisupdatestudent1 - Dr. Brahmbhatt`s Class Handouts

ADVERSITY
“No pressure, no diamonds.”
-Mary Case
DISEASES OF THE
URINARY SYSTEM
Cystitis
Cystic calculi
Urinary obstruction
ARF & CRF
Incontinence
COMPONENTS OF THE URINARY
SYSTEM and ITS FUNCTIONS
• Functions of the kidneys
– Produce
urine:___________
– Maintain homeostasis
• Blood filtration,
reabsorption, secretion
• Fluid balance regulation
• Acid-base balance
regulation
• _____________ production
DISEASES OF THE URINARY
SYSTEM
• URINARY SYSTEM IS NORMALLY STERILE
AND RESISTANT TO BACTERIAL
INFECTION
– Voiding of urine
– Urethral/ureteral peristalsis
– _____________________ in the surface mucosal
layer
– pH
RECOGNIZING URINARY SYSTEM
DISORDERS
About 4 million cats a year are destroyed for
“elimination problems”.
DIAGNOSING URINARY SYSTEM
DISORDERS
• DIAGNOSTIC TESTS THAT MAY BE
DONE IN PATIENTS WITH URINARY
DISEASE: ________________________
Cystitis
Cystic calculi
Urinary obstruction
ARF & CRF
Incontinence
Feline Idiopathic (Interstitial)
Cystitis
FUS/ FLUTD
FACTS:
-Occurs in cats 2-6 yrs old
-Occurrence in males > females
-cause unknown, multi-factorial
-not caused by_________________
-recurrence is likely
Feline Idiopathic (Interstitial)
Cystitis
• Signs
– pollakiuria
– _____________
– Dysuria
– Periuria (sinks, tubs, carpet, etc.)
• Diagnostics
– Urinalysis/culture to r/o bacteria as cause
– Radiographs to r/o calculi;
• contrast studies may show _________________
Feline Idiopathic (Interstitial)
Cystitis
• Treatment
– Avoid unnecessary ___________
– Change diet from dry to __________
• Or salt food to ↑ water intake
– Reduce stress from other cats, kids, etc
• Provide hiding places
• ______________________________
– Behavior modification drugs (may also have pain
reducing effects
• Amitryptilline (tri-cyclic antidepressant)
• Clomipramine
– Glycosaminoglycan replacement
• _______________for cats
• Adequan
Feline Idiopathic (Interstitial)
Cystitis
• Client info
– Disease is ________________
• As many as 85% of cats will have resolution of clinical
signs in 7-10 days
– May be recurring problem
– No definitive cure
– Reduce stress
Canine Bacterial Cystitis
• Cause:
______________up the
urethra
• Signs
–
–
–
–
↑ frequency of urination
Hematuria
Dysuria
Cloudy urine, abnormal
color
– Frequent licking of
vaginal/urethral area
Canine Bacterial Cystitis
• Diagnostics
– Urinalysis:
• ____________,
bacteria
• Common bacteria:
E.coli, Proteus spp.
– Urine culture/sensitivity
• Collect by
_________________
– Or mid-stream
collection
Canine Bacterial Cystitis
• Treatment
– Antibiotics according to sensitivity
• Treat acute infections x 10-14 d
• Subsequent infections x 4-6 w
– Avoid trauma to urinary tract during surgery
– Patients needing indwelling catheters should have
a __________________
Closed Urinary Catheter System
Canine Bacterial Cystitis
• Client info
– Many uncomplicated urinary
tract infections resolve
without ______________
– Give antibiotics as directed
for the time prescribed
• Relapses are common due
to inadequate treatment
– ___________ may be source
of recurring infections in male
dogs
– Urine cultures should be
repeated during treatment to
assess effect
Cystitis
Cystic calculi
Urinary obstruction
ARF & CRF
Incontinence
Feline Uroliths and Urethral Plugs
Feline Uroliths and Urethral Plugs
“Plugged” or “Blocked” male cats are
commonly seen in small animal practice
and can be fatal if not relieved
– The two most common causes of urethral blockage
are uroliths and urethral plugs
• UROLITHS: composed of _______________ and a
small amount of matrix
• URETHRAL PLUGS: composed of small amount of
minerals and large amount of _________________
Photo 1: Three different types of struvite
that may occur in cats:
A and B, sterile urocystoliths;
C, infection-induced urocystolith;
D, matrix-struvite urethral plug.
Feline Uroliths and Urethral Plugs
• Signs (more severe if
complete obstruction
has occurred)
–
–
–
–
–
_________________
Dysuria
Periuria
Anorexia, vomiting
Collapse, death
• Non-specific signs:
– Hiding
– Crying while urinating
– Frequent trips to the
litterbox
Feline Uroliths and Urethral Plugs
• Uroliths (bladder
stones) found anywhere
in urinary tract
– Formed from minerals in
diet
– Some are radiopaque
(Ca++ oxalate, urate,
struvite) and can be seen
on x-ray
– Some are _________ and
require double contrast
(cystine: air, dye)
Pneumocystogram
Feline Uroliths and Urethral
Plugs
• Uroliths damage bladder, making it more susceptible
to bacterial infection, hematuria
• Uroliths can cause blockage of the urethra of males
– Bladder will fill with urine
– ____________ will stop working
– Blood/body will become toxic (azotemic)
Feline Uroliths and Urethral plugs
Feline Uroliths and Urethral Plugs
• Dx
– Palpation of bladder
• Obstructed bladders are full and tight
– Radiographs may show uroliths on routine films
• Double contrast studies may be indicated
– Ultrasonography can locate position of urolith
– _________________ is necessary to determine its
constituents
Feline Uroliths and Urethral
Plugs
Normal double-contrast cystogram
Double-contrast cystogram
with stones
pneumocystogram
Ultrasound of bladder stone
Feline Uroliths and Urethral Plugs
• Treatment
– Medical treatment (chronic, nonobstructed)
• Dissolve _____________uroliths (most
common- ~60%) by acidifying urine and
feeding diet low in Mg (Hill’s S/D, c/d, others)
– Should resolve in 4-8 wk
– Re-radiograph, and continue diet 1 mo after uroliths
gone
• _____________ to remove stones
• Antibiotics according to culture/sensitivity
Feline Uroliths and Urethral Plugs
Feline Uroliths and Urethral Plugs
• Medical treatment (obstructed)
– This is a medical emergency
– Anesthetize (short acting)
• ***USE LESS ANESTHESIA IN AZOTEMIC
CATS***
– Pass Tom cat catheter and back flush
– Sew catheter in place for 1-3 d, using a closed
system
Feline Uroliths and Urethral Plugs
Closed Urinary Catheter System
Feline Uroliths and Urethral Plugs
• Surgical treatment (chronic obstructers)
– _____________________
• New opening for urethra is created proximal to
narrowing
• Urethral opening looks similar to female
anatomy
*Goal of surgery is to decrease the likelihood of
life-threatening obstruction*
Feline Uroliths and Urethral Plugs:
Perineal Urethrostomy
Feline Uroliths and Urethral Plugs:
Perineal Urethrostomy
Canine Urolithiasis
Os Penis
Canine Urolithiasis
Uroliths damage mucosa of urinary tract making it susceptible to
infection
Uroliths can obstruct urine flow in males
• Signs
– pollakiuria
– Dysuria
– Hematuria
• Dx
– Urinalysis
• Crystalluria
• Hematuria
• _____________________
– Radiographs
• double contrast if necessary
Canine Urolithiasis
Canine Uroliths
Urolith
Breed
Struvite
min sch
cats
(Mg Ammonium Phos)
Sex
female (80%)
Contributing factors
alkaline urine
Rx
acidify urine
bacteria→urease→↑pH antibiotics
minerals (diet)
Only Hill’s s/d (dissolve)
↓protein (ammonia)
↑H2O intake (flush stones)
acidy urine
Calcium Oxalate
(30-50% of min sch
all stones)
Urates
cats
males
Lhasa, Yorkie
min poodle
Shih Tzu
Dalmatians males
E bulldogs
min schnauzer
Shih Tzu
Yorkshire terrier
diet high in protein
hypercalcemia
Cushing’s Dis
use of cortisone
acid urine
Sx removal (only Rx)
↓ dietary Ca
Hill’s u/d, w/d, k/d
↑ uric acid from kidneys Allopurinol
acid urine
(gout in humans)
K+ Citrate (↑ urine pH)
Hill’s u/d,
Canine Uroliths
Struvite
Calcium Oxalate
Urate
Type of stone cannot be determined by appearance; chemical analysis is required
Urolithiasis (Canine)
• Treatment
– Medical (objective is to dissolve stones if Struvite)
• ______________________
• Acidify urine
– Urinary acidifiers (methionine, Methogel)
• ↑ urine output
– Add salt to diet
– Antibiotics for bacterial infection
– Surgical removal (for Ca Oxalate)
• Some uroliths are not amenable to Medical Rx
• However, the cause of uroliths must be dealt with medically
(prevention)
• _____________________ IS VITAL FOR APPROPRIATE
TREATMENT
Cystotomy
Canine Urolithiasis: Cystotomy for stone
removal
Canine Urolithiasis
What do you see? How many?
Canine Urolithiasis
What do you see?
Flush toward bladder (8 times)
Saline flush
One in bladder, 2 in urethra
Canine Urolithiasis
What do you see?
Canine Urolithiasis
• Client info
– Special diet may be required for ____________
– Table scraps/treats should be limited
– Long-term antibiotics may be required
– Uroliths may recur at any time
– Always provide plenty of ______________
– Allow plenty of bathroom time and frequency
References
• Alleice Summers, Common Diseases of
Companion Animals
• http://veterinarymedicine.dvm360.com/vetmed
/article/articleDetail.jsp?id=738082