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ADVERSITY

ADVERSITY. “ No pressure, no diamonds.” -Mary Case. DISEASES OF THE URINARY SYSTEM Cystitis Cystic calculi Urinary obstruction ARF & CRF Incontinence. BLOOD FLOW THROUGH THE KIDNEYS.

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ADVERSITY

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  1. ADVERSITY “No pressure, no diamonds.” -Mary Case

  2. DISEASES OF THE URINARY SYSTEMCystitisCystic calculiUrinary obstructionARF & CRFIncontinence

  3. BLOOD FLOW THROUGH THE KIDNEYS • Renal arteriole > glomerulus > bowman’s capsule > proximal convoluted tubule > loop of Henle > ELIMINATED: distal convoluted tubule > collecting ducts > renal pelvis > urine

  4. COMPONENTS OF THE URINARY SYSTEM and ITS FUNCTIONS • Functions of the kidneys • Excretion: • produce urine • Maintain homeostasis • Blood filtration, reabsorption, secretion • Fluid balance regulation • Acid-base balance regulation • Hormone production

  5. DISEASES OF THE URINARY SYSTEM • URINARY SYSTEM IS NORMALLY STERILE AND RESISTANT TO BACTERIAL INFECTION • Voiding of urine • Urethral/ureteral peristalsis • Glycosaminoglycans in the surface mucosal layer • pH

  6. RECOGNIZING URINARY SYSTEM DISORDERS About 4 million cats a year are destroyed for “elimination problems”.

  7. DIAGNOSTIC TESTS THAT MAY BE DONE IN PATIENTS WITH URINARY DISEASE URINALYSIS (dipstick and sediment exam) RADIOGRAPHS DIAGNOSING URINARY SYSTEM DISORDERS

  8. DISEASES OF THE URINARY SYSTEM CystitisCystic calculiUrinary obstructionARF & CRFIncontinence

  9. Feline Idiopathic (Interstitial) Cystitis aka FUS/ FLUTD FACTS: -Occurs in cats 2-6 yrs old -Occurrence in males > females -cause unknown, multi-factorial -not caused by bacterial infection -recurrence is likely

  10. Feline Idiopathic (Interstitial) Cystitis • Clinical Signs • pollakiuria • Hematuria • Dysuria • Periuria (sinks, tubs, carpet, etc.)

  11. Feline Idiopathic (Interstitial) Cystitis • Diagnostics • Urinalysis/culture to r/o bacteria as cause • Only 1%-3% of all feline cystitis is caused by bacteria • Radiographs to r/o calculi; • contrast studies may show thickened bladder wall

  12. Feline Idiopathic (Interstitial) Cystitis • Treatment • Avoid unnecessary antibiotics • Change diet from dry to moist • Or salt food to ↑ water intake • Reduce stress from other cats, kids, etc • Provide hiding places • Pheromonotherapy • Behavior modification drugs (may also have pain reducing effects • Amitryptilline (tri-cyclic antidepressant) • Clomipramine • Glycosaminoglycan replacement • Cosequin for cats • Adequan

  13. Feline Idiopathic (Interstitial) Cystitis • Client info • Disease is self-limiting • 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

  14. Canine Bacterial Cystitis • Cause: Ascending bacteria up the urethra • Signs • ↑ frequency of urination • Hematuria • Dysuria • Cloudy urine, abnormal color • Frequent licking of vaginal/urethral area

  15. Canine Bacterial Cystitis • Diagnostics • Urinalysis: • ↑WBC’s, bacteria • Common bacteria: E.coli, Proteus spp. • Urine culture/sensitivity • Collect by cystocentesis or mid-stream collection

  16. 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 system

  17. Closed Urinary Catheter System

  18. Canine Bacterial Cystitis • Client info • Many uncomplicated urinary tract infections resolve without Rx • Give antibiotics as directed for the time prescribed • Relapses are common due to inadequate treatment • Prostate may be source of recurring infections in male dogs • Urine cultures should be repeated during treatment to assess effect

  19. DISEASES OF THE URINARY SYSTEM CystitisCystic calculiUrinary obstructionARF & CRFIncontinence

  20. Feline Uroliths and Urethral Plugs “Plugged” or “Blocked” male cats are commonly seen in small animal practice and can be fatal if not relieved

  21. Feline Uroliths & Urethral Plugs • The two most common causes of urethral blockage are uroliths and urethral plugs • UROLITHS: composed of minerals and a small amount of matrix • URETHRAL PLUGS: composed of small amount of minerals and large amount of matrix

  22. Feline Uroliths and Urethral Plugs • Signs • Hematuria • Dysuria • Periuria • Anorexia, vomiting • Collapse, death • Non-specific signs: • Hiding • Crying while urinating • Frequent trips to the litterbox

  23. 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 radiolucent (cystine) and require double contrast Pneumocystogram

  24. 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 • Kidneys will stop working • Blood/body will become toxic (azotemic)

  25. Feline Uroliths and Urethral plugs

  26. Feline Uroliths and Urethral Plugs • Dx • Palpation of bladder • Obstructed bladders are full and tight • Radiographs may show uroliths on routine films • Ultrasonography can locate position of urolith • Urolith analysis is necessary to determine its constituents • EKG: atrial standstill, bradycardia, hyperkalemia

  27. Feline Uroliths and Urethral Plugs Double-contrast cystogram with stones Normal double-contrast cystogram pneumocystogram

  28. Ultrasound of bladder stone

  29. Feline Uroliths and Urethral Plugs • Treatment • Medical treatment (chronic, non-obstructed) • Dissolve struvite 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 • Cystotomy to remove stones • Antibiotics according to culture/sensitivity

  30. Feline Uroliths and Urethral Plugs

  31. 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

  32. Feline Uroliths and Urethral Plugs

  33. Closed Urinary Catheter System

  34. Feline Uroliths and Urethral Plugs • Surgical treatment (chronic obstructers) • Perineal urethrostomy (PU) • 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*

  35. Feline Uroliths and Urethral Plugs:Perineal Urethrostomy

  36. Feline Uroliths and Urethral Plugs: PerinealUrethrostomy

  37. Canine Urolithiasis Os Penis

  38. Canine Urolithiasis • Uroliths damage mucosa of urinary tract making it susceptible to infection • Uroliths can obstruct urine flow in males • Clinical Signs • pollakiuria • Dysuria • Hematuria

  39. Canine Urolithiasis • Dx • Urinalysis • Crystalluria • Hematuria • ↑ bacteria • Radiographs

  40. Canine Urolithiasis

  41. Canine Uroliths Urolith Breed Sex Contributing factors Rx Struvite min sch female (80%) alkaline urine acidify urine (Mg Ammonium Phos) cats bacteria→urease→↑pH antibiotics minerals (diet) Only Hill’s s/d (dissolve) ↓protein (ammonia) ↑H2O intake (flush stones) acidy urine Calcium Oxalate cats males diet high in protein Sx removal (only Rx) (30-50% of min schhypercalcemia↓ dietary Ca all stones) Lhasa, Yorkie Cushing’s Dis min poodle use of cortisone Hill’s u/d, w/d, k/d Shih Tzu acid urine Urates Dalmatians males ↑ uric acid from kidneys Allopurinol E bulldogs acid urine (gout in humans) min schnauzer K+ Citrate (↑ urine pH) Shih Tzu Hill’s u/d, Yorkshire terrier

  42. Canine Uroliths Struvite Calcium Oxalate Urate Type of stone cannot be determined by appearance; chemical analysis is required

  43. Urolithiasis (Canine) • Treatment • Medical (dissolve stones if Struvite) • diet • Acidify urine • Urinary acidifiers (methionine, Methogel) • ↑ urine output • Add salt to diet, increase water intake • Antibiotics for bacterial infection • Surgical removal ( Ca Oxalate) • Some uroliths are not amenable to Medical Rx • However, the cause of uroliths must be dealt with medically (prevention) • STONE ANALYSIS IS VITAL FOR APPROPRIATE TREATMENT

  44. Canine Urolithiasis: Cystotomy for stone removal

  45. Canine Urolithiasis What do you see?

  46. Canine Urolithiasis • Client info • Special diet may be required for life-time • Table scraps/treats should be limited • Long-term antibiotics may be required • Uroliths may recur at any time • Always provide plenty of fresh water • Allow plenty of bathroom time and frequency

  47. EDUCATION “It is possible to store the mind with a million facts and still be entirely uneducated.” - Alec Bourne

  48. DISEASES OF THE URINARY SYSTEM CystitisCystic calculiUrinary obstructionARF & CRFIncontinence

  49. Renal Failure • ~20% of Cardiac output • Filtered by renal corpuscle • Reabsorbed by kidney tubules • Waste excreted as urine • Renal Failure due to: • ↓ blood flow (hypoperfusion) • Damage to nephron and glomerular filtration declines resulting in azotemia

  50. AZOTEMIA • Pre-renal • dehydration • Renal • Primary kidney disorders • Post-renal • Urinary tract obstruction

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