Equine Med- Urinary

kelseyfmeyer's version from 2016-10-03 18:51


Question Answer
what is urine volume like in a horse compared to other species?high vol of urine- 10L is avg amt horse drinks a day... and urinate to equate with that
how would you describe the color and viscosity and clarity of equine urine? pH?cloudy and viscous (high mucus content), Calcium carbonate crystals, and ALKALINE pH (remember herbivores=alkaline and carnivores acidic)
horses normally have what crystals in their urine and why?calcium carbonate, comes with a steady diet of plants
what can you assess of the UT with a rectal exam?can palpate L kidney (Ca pole) and feel bladder, mare urethra- will feel if sthing wrong with it
main lab analysis points for urinary system assessment?Creatinine & BUN, Electrolytes, Urinalysis
2 imaging types you can do to assess urinary system?Cystoscopy, Ultrasound
if high globulins, think..Abs
if they are not azotemic upon exam, all that means is that...The kidney damage could be <75% still
dark colored pee might mean what is happening?hemolysis possibly
remember anemia + inflammation...could be anemia DUE to inflammation
how do you collect urine in a horse? how DONT you?Can't do cysto on a horse! (unless maybe it is a teeeeny baby) So you will want to cath. For MARES can use a bitch cath, for MALES you will need a stallion cath- flexible with a stylet. If you are scoping, can collect pee through t he scope
Before you cath to collect urine, you should prolly sedate, but DONT use these to sedate (and why)Don't use alpha 2 agonists-- they dilute urine and might mess up your USG
if you think you have hemoglobinuria, you would be able to check it because in order to have hemoglobinuria you would need ___hemoglobinemia
how would you be able to differentiate a hemoglobinuria from a myoglobinuria?CK would be elevated if muscles were damaged enough to release myoglobin.
bilirubinuria can be eliminated if on the CBC...there isnt bilirubinemia lol
hemoglobinuria vs hematuria?CENTRIFUGE it--- if its blood it will pellet to the bottom and plasma will be yellow.
Pigmenturia: 3 main causes (and some other less common causes?) Hematuria, Hemoglobin, myoglobin, (Bilirubin, Plant ingestion (white clover), Drug ingestion (doxycycline, rifampin) )
what two drugs can cause pigmenturia?doxycycline, rifampin
once you collect your urine sample, how quickly do you need to assess it?1-2 hours
USPG aka?USG (look for Hyposthenuria, isothenuria, etc)
what is the downside to test strips?if the urine is brown, the whole test strip is gonna be brown
what are possible places where bleeding--> hematuria?kidney, urethra, bladder, ureter, repro tract too... (bc crossover of the two systems)
is cystoscopy a sterile procedure?yes
so once you empty the urine in the bladder you can use cystoscopy to asses many things, as well as help collect urine-- what is particularly useful about collecting urine with cystoscopy?you can collect from each kidney independently from ureteral openings
If you are looking at the urethra with a scope and you see this, what is it called? urethral "rent" aka a tear in the urethra
If you see frank blood coming out of the ureteral openings, where is the blood coming from and why are you confident of that?KIDNEY-- ureter doesnt have enough vasculature to produce a measureable amount of frank blood
possible causes of renal hemorrhage?bad infection (pyelonephritis), stones (nephrolithiasis), kidney parasites ("verminous nephritis dioctophyma renale"), toxins (NSAIDs=ARF, Blister beetle tox aka cantharidin), neoplasia
which breed gets idiopathic renal hematuria?arabians
you will know the hematuria is from blister beetles will see the rest of the horse and it will look like it is on the verse of death
which kidney interfaces with the spleen again?L
be sure to look at what owners are giving for drugs- if they are using mult drug, must be aware thatno need for animal to be on 2 full doses of two things at the same time (like bute and banamine)
if the cause of azotemia would be pre-renal, chem would show...HIGH ALBUMIN (bc prerenal=dehydration)
flowchart for understanding various azotemias
IF you think there is something wrong with the urinary system, and the horse is sick, what should you try to do first?try to collect a urine sample first, because giving fluids can mess up your USG
what are some of the major lab results which would make you think Acute renal failure? Azotemia + isosthenuria + hypocalcemia +/- hyperkalemia
how might electrolytes be affected by acute renal failure?HYPOcalcemia, +/- HYPERkalemia
what are the major categories of things that would cause renal failure?(1) hemodynamic (2) Nephrotoxic (3) other
what are some hemodynamic reasons for acute renal failure? Anything that disrupts renal blood flow!! THIS INCLUDES Systemic inflammation!! (Diarrhea, endotoxemia, shock, blood loss)
what are some substances which are nephrotoxic?NSAIDs/Aminoglycosides/Tetracyclines, Myoglobin/Hemoglobin, Heavy metals, Oak, oxalate containing plants, red maple, Cantharidin toxicity (blister beetle)
what are two infective reasons a horse might get acute renal failure? Pyelonephritis (ascending), Leptospira interrogans
how do NSAIDs lead to ARF? what are some factors which influence how bad it is?NSAIDs inhibit COX-- dec prostaglandins. Prostaglandin inhibition REDUCES VASODILATION (indirectly causing vasoconstriction but remember NSAIDs don't actually cause vasoconstriction) which lowers renal blood flow--> Ischemia of tubules= ARF. There is some individual variation and some horses are more sensitive than others. It also is much worse if there is dehydration at the same time.
additional SEs of NSAIDs include...ulcers of RDC or stomach
how much fluids do you give to a ARF horse?TWICE of what maintenance is!! (remember maintenance is 50ml/kg/day) (and SHOCK dose is 50-80ml/kg) Also be aware of what electrolytes are in the horse versus the electrolytes in the fluid (so if hyperK horse dont want fluid with K in it) [in class she said it is hard to fluid overload a horse-- unless they don't have working kidneys]
what is their peeing like with ARF? which is the worst news? Typically oliguric or polyuric, Anuric is bad news…
If they are not producing urine after fluids (are anuric), what are two diff kinds of things you can give to help them do that?(1) Diuretics, ie furosemide (2) Dopamine/Mannitol
what is some additional supportive care you can provide for a ARF horsE?Pain management, NSAIDs (provided NSAIDs arent what caused the problem), GI protectants, Peritoneal dialysis
if you want to monitor an ARF patient, what two things should you be looking at, and how often? Monitor creatinine and BUN, Recheck every 12-24 hours after initiation
what are CSs of chronic renal failure? Weight loss, anorexia, rough hair, Mouth may give you a clue!!--> Ulcers, tartar and halitosis
unique CSs to tell ARF from CRF are?mouth signs-- ulcers/tartar and halitosis
how will CRF present upon rectal exam?Kidneys small and firm on recta
**what is Ca like for ACUTE renal failure versus CHRONIC renal failure?ACUTE: LOW. CHRONIC: HIGH
what is the electrolyte balance like for CHRONIC renal failure?HYPERCa++, ↓ Na, Cl, P
what is the BUN:Cr ratio like for CRF?BUN:Cr ratio is >10:1 (So BUN is ten times higher)
will acute or chronic have anemia?Why?CHRONIC bc dec EPO production
prog of CRF? what can you use as a tool to tell the owner apprx how much time they have left?Prognosis dependent on Severity and duration, but it is Typically grave. Cr < 5mg/dL= months-years. Cr > 10mg/dL= weeks
so how do you know if it is pee versus some other fluid?crt is higher than in the bood... and see CaCo crystals in pee
4 main reasons for a horse to have Urinary incontinence?(1) Urolithiasis (often a recurring problem) (2) Sabulous cystitis (3) Spinal cord dz (4) Sorghum/Sudan grass toxicity
which two grasses can cause urinary incontinence along with ataxia and cystitis?Sorghum/Sudan grass toxicity
what on earth is sabulous cystitis?CaCO3 sludge in the bladder due to incomplete emptying
what grass is really high in Ca?alfalfa
3 examples of spinal dz which can lead to urinary incontinance?(1) UMN/LMN damage (2) EHV-1 (3) Polyneuritis equi
what is polyneuritis equi?Polyneuritis equi is uncommon and caused by a progressive immune-mediated lymphocytic infiltration and demyelination of the sacrococcygeal and lumbosacral nerve roots of the cauda equina.
diff between UMN and LMN bladder?UMN damage: remember that UMN are inhibitory on LMN. if UMNs are damaged you will see spastic paralysis. If the LMNs are damaged you will see flaccid paralysis bc the nerves to tell the mms to do anything are shot