Lecture 2

Question 1

What are the common lower urinary tract signs?

Answer 1

-hematuria/blood in urine
-stranguria/straining to urinate
-pollakiuria/small, frequent amounts

Question 2

What are the differentials in an animal displaying lower urinary tract signs?

Answer 2

-cystoliths
-urethroliths
-cystitis
-prostatitis
-neoplasia
-feline idiopathic cystitis

Question 3

What is the importance of palpating a patient’s bladder size?

Answer 3

-small bladder indicates no blockage
-large bladder could be a result of a blockage

Question 4

Which conditions must be considered with hematuria that are NOT localized to the urinary tract?

Answer 4

platelet and coagulation disorders

Question 5

Which conditions must be considered with PUPD that are NOT localized to the urinary tract?

Answer 5

endocrine and metabolic disorders

Question 6

What are the possible differentials for a patient having abnormal urination in the house?

Answer 6

-pollakiuria
-polyuria
-incontinence
-behavioral

Question 7

Why is it important to obtain a dietary history in patients with urinary signs?

Answer 7

-dietary moisture content can affect urine concentration/dilution and USG
-high protein, meat-based diets can cause urine pH < 7

Question 8

Why is it important to obtain a drug history in patients with urinary signs?

Answer 8

-diuretics and steroids can affect concentrating ability
-drugs and infections can alter pH

Question 9

What pH change is seen in patients with urease-producing bacteria?

Answer 9

more alkaline urine pH

Question 10

What are the key aspects of the physical exam for a patient with urinary signs?

Answer 10

-observe micturition
-hydration status
-examine external anatomy
-evaluate kidneys
-evaluate bladder
-rectal exam

Question 11

What should be observed regarding micturition on a physical exam?

Answer 11

-urine stream strength
-stranguria vs tenesmus
-blood in urine

Question 12

How is hydration status assessed in a urinary patient?

Answer 12

-USG
-mucous membrane moisture
-CRT
-skin turgor
-mentation
-serial body weight

Question 13

What are the findings in a 5% dehydrated patient?

Answer 13

-dry oral mucous membranes
-no panting or pathologic tachycardia

Question 14

What are the findings in an 8% dehydrated patient?

Answer 14

-mild to moderate decreased skin turgor
-dry mucous membranes
-slight tachycardia
-normal pulse

Question 15

What are the findings in a 10% dehydrated patient?

Answer 15

-moderate to marked decreased skin turgor
-dry oral mucous membranes
-tachycardia
-normal pulse
-eyes sunken into orbits

Question 16

What are the findings in a 12% dehydrated patient?

Answer 16

-marked loss of skin turgor
-dry mucous membranes
-sunken eyes
-weakness
-depressed
-possible moribund shock

Question 17

What should be assessed regarding the external anatomy in a urinary patient?

Answer 17

-masses
-discharge
-salivary staining
-recessed vs. normal vulva

Question 18

What should be assessed regarding the kidneys in a urinary patient?

Answer 18

-location
-size
-shape
-pain

Question 19

What should be assessed regarding the urinary bladder?

Answer 19

-size/degree of distention
-position in abdomen
-evidence of pain
-wall thickness
-intraluminal calculi

Question 20

What should be assessed on a rectal exam?

Answer 20

*urethra
-thickening
-masses
-stones
*prostate
-want smooth, symmetrical, bi-lobed, non-painful
*fecal consistency
*lumbar-sacral pain

Question 21

Which laboratory tests are done in patients with upper urinary tract disease?

Answer 21

-CBC
-chem
-urinalysis
-blood culture
-possible UPC
-possible urine culture

Question 22

Which laboratory tests are done in patients with lower urinary tract disease?

Answer 22

-prostate evaluation
-urinalysis
-urine culture

Question 23

What are the characteristics of proteinuria?

Answer 23

-alkaluria can give false positive protein on dipstick
-normal UPC in dogs and cats should be less than 0.2

Question 24

What can cause glucosuria?

Answer 24

-hyperglycemia
-renal tubular defect

Question 25

What is the renal threshold for blood glucose?

Answer 25

dogs: 200 mg/dL cats: 250 mg/dL

Question 26

When are urine ketones seen?

Answer 26

-diabetic patients -patients with negative energy balance

Question 27

What are the characteristics of azotemia?

Answer 27

-build-up of nitrogen-containing compounds in the blood -can be assessed with BUN, creatinine, and/or SDMA

Question 28

What are the characteristics of creatinine?

Answer 28

-by-product of muscle metabolism -produced at a fairly stable rate -can be falsely lowered in animals with poor muscle condition -better assessment of azotemia than BUN

Question 29

What can cause an increased BUN?

Answer 29

-high dietary protein -GI bleeding -decreased GFR

Question 30

What can cause a decreased BUN?

Answer 30

-low dietary protein -liver dysfunction -diuresis

Question 31

What are potential causes of pre-renal azotemia?

Answer 31

*decreased GFR -reduced renal blood flow -decreased cardiac output *increased dietary protein

Question 32

What are the findings in pre-renal azotemia?

Answer 32

azotemia with fully concentrated urine; indicates normal kidneys

Question 33

What causes renal azotemia?

Answer 33

primary, intrinsic, parenchymal renal disease that can be acute, chronic, or acute-on-chronic

Question 34

What is the normal progression in renal azotemia and why?

Answer 34

-azotemia follows loss of concentrating abilities -loss of concentrating ability begins when 66% of nephrons are non-functional; azotemia occurs when 75% of nephrons are non-functional

Question 35

What are the findings in renal azotemia?

Answer 35

azotemia with inappropriately concentrated urine

Question 36

What are the causes of post-renal azotemia?

Answer 36

-obstruction of urine flow -rupture of urinary tract

Question 37

What are the possible consequences of post-renal azotemia?

Answer 37

*back pressure transferred to the kidneys, which impairs: -renal blood flow -GFR -tubular function

Question 38

What are the clinical signs of post-renal azotemia?

Answer 38

-painful, acute abdomen -urethral obstruction w/ lower urinary tract signs -ureteral obstruction with lethargy, vomiting, anorexia, and pain -variable USG

Question 39

What does "normal" USG depend on?

Answer 39

-hydration status -history of water consumption -diet -medications

Question 40

What are the ranges for USG?

Answer 40

-hyposthenuria: 1.00 to 1.007 -isosthenuria: 1.008 to 1.012 -inadequate conc: 1.013 to 1.029 in dogs; 1.013 to 1.039 in cats -adequate conc: > 1.030 in dogs, > 1.040 in cats

Question 41

Which radiograph views should be taken in a urinary patient?

Answer 41

-lateral -VD -penile urethra shot in males

Question 42

When is ultrasound helpful in urinary patients?

Answer 42

-assessing renal parenchyma -renal pelvic and ureteral dilation -renal blood flow abnormalities -urinary bladder masses -differentiating masses from cysts -interventional procedures

Question 43

What is the use of CT in urinary patients?

Answer 43

-assess urinary and repro. anatomy -ectopic ureter evaluation -evaluating masses

Question 44

What is the use of cystoscopy in urinary patients?

Answer 44

-assess urinary and reproductive anatomy -incontinence -bladder or urethral masses -recurrent or persistent UTI -chronic hematuria or dysuria -stones -urinary trauma -vaginal diseases

Question 45

What are contrast studies used to detect?

Answer 45

-bladder or urethral tear -stones -strictures -abnormal communication with adjacent structures