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Exam 3
Uroliths
40
Veterinary Medicine
Professional
04/04/2017

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Cards

Term
What is a urinary stone?
Definition
-organized concretion found in urinary tract that contains organic & inorganic material
Term
True or False: The presence of crystalluria predisposes to stone formation.
Definition
-FALSE, the presence of crystalluria does NOT predispose to stone formation
Term
When does crystalluria require treatment?
Definition
-assoc w/ a urolith
-assoc w/ a urethral plug
Term
Which uroliths are radiopaque?
Definition
-Ca oxalate
-apatite
-struvite
-silica
Term
Which uroliths are radiolucent?
Definition
-ammonium urate
-cystine
Term
How do we fix uroliths medically?
Definition
-dissolution
-promote movement/expulsion
-voiding urohydropropulsion
-
Term
How do we fix uroliths surgically?
Definition
-ureterotomy
-cystotomy
-urethrotomy
-ureteral stent placement
-subcutaneous ureteral bypass system
-extracorporeal shock wave litotripsy (ESWL)
-IR/IR: endoscope w/ basket +/- laser lithotripsy, uretral stent placement
Term
Which uroliths are amendable to dissolution?
Definition
-struvite
-cystine
-purine
Term
Which uroliths are refractory to dissolution?
Definition
-Ca oxalate
-silica
Term
What strategies are used to promote movement/expulsion of uroliths?
Definition
-fluid therapy
-diuretics
-pain meds
Term
For which uroliths do we use urohydropropulsion?
Definition
-small stones
Term
In which animals can we urohydropropulse uroliths?
Definition
-male & female dogs
-female cats
Term
For which uroliths can we use endoscopy for?
Definition
-stones located in urethra or bladder
-good for few small stones
Term
How do we place a ureteral stent in dogs? Cats?
Definition
-Dogs: retrograde fasion using fluoroscopic guidance
-Cats: surgically
Term
What are the advantages of ureteral stents?
Definition
-ensures patency from kidney to bladder and prevent further hydronephrosis
Term
What is the typical outcome of surgery to fix uroliths?
Definition
-bladder: usually great outcome
-ureter: risk of complications is greatly increased
Term
What does a subcutaneous ureteral bypass system do to fix uroliths?
Definition
-essentially creates a enw ureter
Term
What are the two most common types of stones in dogs?
Definition
-Ca oxalate
-struvite (MAP)
Term
What is the other name for struvite stones?
Definition
-magnesium ammonium phosphate
Term
Which bacteria are associated w/ UTIs due to struvite uroliths?
Definition
-Staph & Proteus
Term
Are males or females more affected by struvite uroliths?
Definition
-females
Term
Describe the dietary therapy of struvite uroliths.
Definition
-reduce protein, phosphorus, magnesium
-promote acidic urine
-high moisture food
-ideally USG < 1.020
Term
How do we medically dissolve struvites?
Definition
-CAN be medically dissolved
-100% of sterile struvite stones dissolved in 3-6w
-abx therapy MUST be continued until the stones are dissolved
Term
What are the risk factors for calcium oxalate?
Definition
-hypercalciuria: hypercalcemia, met acidosis, high sodium consumption, vit D excess
-recommend analyzing serum ionized ca
Term
Describe the dietary therapy for calcium oxalate.
Definition
-avoid Ca supplements
-avoid high Ca foods
-avoid high oxalate foods
-high moisture food
-USG < 1.020
Term
How do we medically dissolve calcium oxalate?
Definition
-we don't NOT an option
Term
What meds do we use for calcium oxalate uroliths?
Definition
-potassium citrate to alkalinize pH
-hydrochlorothiazide: do not used in patients w/ hypercalcemia
Term
What is the other name for purine stones? How common are they?
Definition
-aka urate stones
-only account for around 5% total stones in dos
Term
What are some common risk factors for purine/urate stones?
Definition
-hyperuricosuria: certain breeds, PSS
-acidic urine
-concentrated urine
Term
Which breeds are associated w/ hyperuricosuria due to purine uroliths?
Definition
-Dalmation
-English Bulldogs
-Black Russian Terrier
Term
How do we manage purine stones?
Definition
-correct PSS if present
-if no PSS or liver dz present: high moisture low purine diet, aim for slightly alkaline urine, close monitoring
-allopurinol: prevent or dissolve urate stones in animals w/out liver dz
Term
What are the two most common feline stones?
Definition
-struvite
-ca oxalate
Term
What is the typical signalment of struvite stones in cats? Where do they most commonly occur?
Definition
-cats 2-10y
-bladder most commonly
Term
What makes feline struvite stones different from canine struvite stones?
Definition
-they are sterile in cats
Term
What is our major concern w/ prolonged acidic urine in cats being treated for struvite stones?
Definition
-may leed to formation of Ca oxalate stoens
Term
What leads to development of Ca oxalate stones in cats?
Definition
-supersaturation
Term
What are some risk factors that lead to Ca oxalate stones in cats?
Definition
-hypercalciuria: hhypercalcemia, met acidosis, inc Na consumption, vit D excess
Term
How do we dissolve Ca oxalate stones?
Definition
-medical dissolution is NOT an option
Term
Why do we try to dilute the urine to prevent uroliths? Give some examples of this strategy.
Definition
-more dilute the urine the less likely that ions will meet & have an interaction
-ex: canned food, dry food w/ water added, multiple water bowls
Term
Do we acidify or alkalinize for struvite stones? What about Ca oxalate stones?
Definition
-acidify
-alkalinize
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