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Rumi Urinary 2

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sihirlifil's version from 2018-04-04 00:04

Obstructions & rupture

Question Answer
Acute urethral obstruction: observationsDysuria (tread, tail twitch, vocalize, stretch out)
Stranguria (heave, posture)
Hematuria (urine, ground, preputial hair)
Pollakiuria
Colic
Acute urethral obstx: are there CS that may not lead you to urinary prob?Mild bloat, depression, anorexia, D+, constipation/tenesmus, rectal prolapse
Chronic urethral obstx: how does it presentSimilar to acute obstruction
Risk for hydronephrosis, esp if >36h
Severe azotemia, e-lyte & acid/base abnormalities (similar to uroperitoneum)
What’s going on here
Hydronephrosis (sequel of chronic urethral obstruction)
If obstructed SR, what tx do you want to try 1st?Snip urethral processs!
SR: How common is re-obstruction?71% successful urethral process amputations re-obstructed within 1 year
Urethral obstruction: initial medical txStabilize
Fluid therapy: 0.9% NaCl, dextrose, insulin, bicarb. address azotemia, acidosis
Urethral obstruction: if still obstructed after initial medical tx, what do?Cystocentesis
Peritoneal lavage
Urethral relaxation (Ace, phenoxybenzamine)
NSAIDs for inflammation
Analgesia
How does urethral rupture occur?Calculi cause pressure necrosis of urethral wall --> urine ezcapes into tissues of inguinal area, prepuce, & ventral abdominal wall (marked swelling)
What happened to this guy?
Urethral rupture
Urethral rupture: clin path?Severe hemoconcentration & azotemia
Inc/dec WBC count, toxic neutrophils, increased fibrinogen if tissue necrosis --> infxn
Urethral rupture: TxFix 1ry problem!
”Slice & dice”” = fenestrate dead tissue for drainage
Supportive care… duration for healing depends on size of necrotic area
How does bladder rupture occur?Fluid pressure builds up (can be single tear, pinpoint leaks, necrosis of large section of bladder wall)
Bladder rupture: CSBladder is small, animal not straining (not palpable)
Depression if several days, dehydration (fluid shifts)
Fluid distension of abdominal cavity (ventral)
Ammonia odor to breath (urea diffuses into saliva, oral bacteria hydrolyze into ammonia)
Bladder rupture: Tx?Repaired in surgery, or allowed to heal on its own (omentum adhere over tear)
If grossly distended may have permanent dmg, remain flaccid
Uroabdomen: Differential dx?5F’s! Fat, fluid, fetus, flatus, food
What happens with persistent hemoabdomen?High concentration of solutes imparts high osmotic pressure --> peritoneal fluid [CR] greater than 2z higher than serum [CR]!!!
How does uroabdomen cause death?
memorize

Upper UTIs

Question Answer
Most common cause of UTIsAscending >>hematogenous; urethritis --> cystitis --> ureteritis --> pyelonephritis (urachus is entrypoint for neonates too)
Adults: Female >> male
Which agents are common in UTI?Corynebacterium renale, E. coli & other coliforms
C. renale: how does it infect?Normal skin flora but high ## = dz
Contagious spread
Iatrogenic (bladder catheterization)
E. coli: how does it infect?Fecal contamination, dystocias, prolapses, poor conformation
Cystitis: CSPollakiuria
Dysuria (may vocalize, tread, swish tail)
Retains urination posture
No fever or abnormalities on CBC
Cystitis: how is UA?Variable results. Normal/hge/purulent
Blood & protein on dipstick
Sediment: RBC, WBC, bacteria. NO RENAL CASTS
Pyelonephritis: CSSame as cystitis plus:
Lordosis
Colic (Treading, tail swishing, kicking at belly)
Fever, inflammatory leukogram (WBC + fibrinogen)
Which agents implied in pyelonephritis?Leptospirosis (zoonotic!)
Campylobacter
Salmonella
Which dx for UTIs?Urine dipstick analysis is critical during each PE
Positive for blood & protein. Casts present if pyelonephritis
Cystitis or pyelonephritis? Pyelonephritis
Treatment of UTIs?Treat 1ry problem! (Acute is more responsive & better prognosis)
Antibiotics: beta-lactams, sulfonamides. (C&S, broad) 2-3w. Need high concentration in bladder! No enrofloxacin! Only legal for pneumonia in beef cattle, no ELDU
Adjunct therapy for UTI?Hydration/diuresis
Acidify urine
UTI: prognosis?Relapses common… guarded to poor
Leptospirosis: in who? causes what?All agricultural animals & HUMANS (zoonotic!)
Syndromes: abortion, hemolytic anemia, mastitis, & combos
Lepto: transmission?Reservoir is adapted host, shed in high conc in urine. Spread via contact w/ urine-contaminated “stuff”, incubate 3-7d, death 2-3d later or slow recovery if anemic
Shed before CS appear
L. hardjo-bovis: pathogenesis?Entry via ORAL, some skin penetration
Lepto: Non-host-adapted CSAcute! ABORTION, hemolytic anemia IV, hburia)
Hepatitis, nephritis, anterior uveitis
Lepto: Host-adapted CSMild, subclinical. Transient malaise
Agalactia, abortion, anterior uveitis
Lepto: DxPaired serology (Not as useful for L. hardjo-bovis): >1:100 w/ CS. Can survey herd for endemic status
FAT of urine, tissue, fetus
Culture/PCR urine
UA: dark field microscopy
Lepto: TxAntibx: Long-acting tetracyclines, ceftiofur (NOT GOOD FOR MASTITIS!), tulathromycin (aka Draxxin)
Supportive, remember zoonotic risks!
Lepto: controlEliminate carriers, hygiene
Vax: Lepto 5-way (variable for L. hardjo-bovis), Spirovac (specific L. hardjo-bovis, doesn’t clear chronic carriers! must clear w/ oxytet)
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