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URINARY SYSTEM - Coggle Diagram

- - - - Ascending Bacterial infection
      - Decending Bacterial infection
      - Predisposing Factors
        
        Trauma: Calculi, parturition, contaminated catheterization
        
        Urine stagnation: Hypocalcaemia, late pregnancy (foetus exerts pressure on bladder)
        
        urine stasis or damage to mucosa
        
        👩🏾, wider longer urethra
      - E coli, C. renale
        
        similar to pyelonephritis
    - - Dysuria, pollakuria, haematuria, pyuria, urine dribbling, ached stance after voiding, stranguria (urethral plug)
      - Grunting, bruxism, colic signs
      - Blood, purulent debris, crystals at ventral commissure of vulva
      - Dx
        
        Pain, may be painful kidney if pyelonephritis as well
        
        Cystoscopy: cattharal, haemorrhagic, fibrinous, purulent, lesions
        
        Clinical pathology
        
        Microscopic exam of urine sediment: RBCs, WBCs, desquamated epithelial cells
        
        Culture and antibiogram (aids with tx)
      - Systemic signs of septicaemia: lethargy, congested MM
    - - Less pronounced (may be missed and lead to pyelonephritis) -> pronounces bladder thickening (rectal exam)
    - - Enzootic haematuria, clinically similar to cystitis
      - pyelonephritis
    - - Penicilin (DOC) Depocilin
        
        2 WKS min
        
        Repeat culture halfway through tx, see if organism is less of developed into mixed infection
        
        assess renal function
      - Ad lib drinking water ➡free flowing urine ➡ flushing effect
      - Acidify urine with NH4Cl (C. renale prefers alkaline urine) sheep 10g / day, cow 50g / day) – 100 – 300mg/kg/day
      - Hydration salt licks and water access
      - NOT aminoglycosides ➡ toxic nephrosis
  - - - Lumbosacral trauma
      - overstretched bladder (blockage)
      - increased pressure around urethra
    - - Full bladder
      - Leaks urine when stands or moves
      - Urine scalding➡Perineal dermatitis
      - poor tail and anal tone based on pudendal nerve damage
    - - Vit B complex and Dexamethasone (used when nerve or spinal injury suspected)
      - Catheter: drain bladder + Ab
      - poor px
  - - - ⚠Obstruction ➡ rupture of bladder / urethra ➡ death
      - Back damming of urine ➡ Hydronephrosis or kidney damage ➡life threatening azotaemia
      - Uremia due to urine and BUNaccumulation
    - - Silicates
        
        Hard, spikey, free range cattle on pasture (soils rich in silicates)
      - Carbonate
        
        Alkaline urine, oxalate rich pastures
      - High Phosphorus rations (grains)
        
        Struvite (Mg, Ammonium,m Phosphate)
        
        CaPO4
    - - cattle: sigmoid flexure
      - sheep: urethral process
    - - Anorexia, depression and mild bloat (uremia)
      - +/- history of colic and straining to urinate or defecate
      - crystal formation on prepuce, super-saturation of urine
      - Clin path
        
        • proteinuria and hematuria on examination with a dipstick. • Azotemia • Hyperphosphatemia • Metabolic acidaemia • Hyperkalemia
  - - - Chronic (2-4w) ingestion of Pteridium aquilinum (Bracken Fern)
        
        Limpopo, Mpumalanga, KZN, EC, SC
        
        Grows on the edge of forest, eaten during winter
    - - Ptaquiloside- CARCINOGENIC + BPV-2
        
        BPV-2 in normal patient causes pre-neoplastic lesions in the bladder. Lower dose chronic ingestion of BF -> bladder neoplasm
        
        Also BM damage with larger dose-> anaemia, leukopaenia
        
        Excreted into milk -> human health risk👫
      - Thiaminase 👶🏽
    - - Suppression of BM
        
        Bleeding tendency, bloody faeces/urine, thrombocytopaenia, haemorrhage of m, anaemia -> tacchypnoea👶🏽
        
        Bladder tumors
        
        High fever, anorexia
        
        DDs
        
        Acute Bacterial Cystitis
        
        Consider numbers: will see this in MANY animals, not just 1
        
        Red Water (bloody urine)
    - - PROGNOSIS IS POOR, FOCUS ON PREVENTION
        
        Tell farmer not to graze in the area (unless lots of palatable grass around- BF = unpalatable)
  - - - C. renale
      - High protein diet -> high urea produced by liver -> excreted into bladder -> C. renale breaks urea -> ammonia (urease) -> irritant
        
        Thrives in alkaline urine
    - - Debris from ulcer -> blockage of prepuce -> straining to urinate, dribbling, wool staining, fly strike
      - Enlarge, swollen prepuce with debris
        
        DD: Urolithiasis
      - unwilling to breed
      - No urination -> uraemia, death
      - If they mate with female (unlikely) -> venereal ulcerative vulvitis
      - Chronic: necrosis, obstruction, anuria, hydro nephrosis, bacterial cytstitis/pyelonephritis
    - - Remove wool, debride tissue with topical hydrogen peroxide / Cu sulphate
      - Systemic penicillin for deep ulceration
      - Clean bedding
      - No breeding for 6m
- - - - ISCHEAMIC Nephrosis (PCT affected most)
        
        ACUTE Ischaemic Necrosis
        
        Ax
        
        Sudden decrease in blood volume
        
        rumen atony (bloat) -> physical occlusion of renal Aa.
        
        Haemoglobin / Myoglobin in blood
        
        Pathophys
        
        ⬇ CO -> vasoC -> renal ischemia -> ⬇ GFR -> accumulation of metabolites, uremia, ⬇ urine production
        
        CHRONIC Ischaemic Necrosis
        
        Ax
        
        CHF
      - ⭐TOXIC Nephrosis (PCT)
        
        Ax
        
        Drugs (Aminoglycosides, Suphonamides, Ionophors, NSAIDS)
        
        Metals, multimin (Cu)
        
        NB to weigh and dose accurately, caution in an hypoproteinaemic animal (protein bound)
        
        ⭐Pulpy Kidney Disease
        
        Clostridum Perfringens Type D
        
        Plants: Oxalates, Tannins
        
        Mycotoxins
        
        Ethylene glycol (antifreeze)
    - - proteinuria
      - Azotaemia
      - Ureamia
      - hematuriaor granularcasts
      - Glucosuria
      - Varying degrees of electrolyte imbalances
    - - Toxic nephrosis: Rumenotomy and evacuation
      - fluids and electrolytes (up to 2-3w) for valuable animals
      - progressive reduction of BUN and creatinine levels are a positive prognosticindicator
      - Dieuretic if anuric / olguric
      - Monitor venous blood gas to detect metabolic acidaemia: excessive Cl
    - - Renal azotaemia, uriniferous breath
      - Oliguria -> Anuria / Polyuria
      - Non specific (Ureamia)
        
        Melena, bleeding tendencies
        
        Gas bloat
        
        Tacchycardia, tacchypnoea due to dehydration
        
        Depression, dehydration, recumbency
        
        Muscle weakness, tremors
        
        Poor BCS
  - - - INFECTIOUS (AG / AB Complexes)
        
        Chronic, Systemic Illness
        
        Johne's disease
        
        BVD
        
        Fasciola
        
        Leptospira
        
        Amyloidosis: secondary to bacterial infection -> SAA -> Isoforms aggregate + deposit in the kidney
      - IMMUNE MEDIATED (Auto-immune disease)
        
        Complement System
        
        T cells, NK cells
    - - May progress to Nephrotic Syndrome
        
        Proteinuria (Frothy)
        
        Hypoproteinaemia
        
        Peripheral oedema
        
        Hyperlipidaemia
        
        Hypernatraemia
      - Hypoproteinaemia: weight loss, poor productivity
      - Generalized oedema, chronic diarrhoea, lethargy
      - Rectal Palpation- mildly enlarged, non-painful L kidney
    - - Fluid + Electrolytes (Hyponatremia + Hypochloraemia)
        
        Sodium chloride (RL may be contra-indicated if high plasma K)
      - Treat underlying cause
      - Decreased protein & salt in diet -> increased loss exacerbates dehydration
      - Diuretics for anuria & oliguria
  - - - Descending / haematological
        
        Pseudomonas septicaemia
      - Ascending infection
        
        Opportunistic commensals
        
        Omphalitis
        
        Dystocia resolution
        
        Catheters
      - Predisposing Causes of Bacterial infection
        
        Urine stasis
        
        Blocked ureters
        
        Pregnancy, pressure on bladder
        
        Obstructive urolithiasis 🔵
        
        Nephroliths
        
        bacterial infection may also -> nephrolith formation
        
        Rock rose -> urine retension
        
        Environmental
        
        Cool temp
        
        Female: short, wide urethra, unhygienic dystocia resolution
      - Corynebacterium renale, E coli (specific)
    - - Toxaemia: Fever, loss of appetite, tachypnoea, tachycardia, congestion/ grey mm, dehydration
      - Poor BCS
      - Colic signs ( tail swish, bruxism, treading, kicking abdomen)
      - Signs of uraemia of bilateral
      - Pyuria, haematuria,turbid, stranguria
    - - Colic causes
      - Urolithiasis
      - Vaginits, vulvar trauma, bladder paresis
    - - ABx: PENICILLIN 2-3w - C. renale, AMOXICILLIN- E coli
      - Alteration of pH (C. renale likes alkaine, E coli likes acidic - send to lab. Take away grass -> alkaline or Ammonium cl=> acidify
      - Nephrectomy if severe
    - - Renal pelvis more hypoxic + more hypertonic -> ⬇phagocytic function -> ⬆susceptibility
    - - Rectal Exam: Acute = enlargement, loss of lobules, pain. Chronic: thickened, contracted bladder, enlarged ureter
        
        Chronic signs more likely to be missed
      - US: Hypo / Hyperechoic renal cortex
      - Clin Path
        
        RBC, Leukocytes, cell debris
        
        pH > 8.5
        
        USG 1.008 - 1.021
        
        Hypalbuminaemia, hypergammaglobulinemia if severe
        
        Grave Px: Serum Creatinine >1.5 BUN > 100
    - - Isolate affected animals
      - Avoid catherterization
      - Good hygeine with dystocia resolution
  - - - Leptospira, gram- spirochete, aerobe, doesn't stain well, hooked ends
    - - Infertiliity, abortion, weak offspring, poor milk yeild
      - Chronic infection of kidney tubules -> release of toxins targeting kidney + liver. Multisystemic
  - - - C. perfringens D
      - G+, endospore forming- Alpha, Epsilon, anaerobic
      - Naturally found in SI + soil
      - Low morbidity, mortality close to 100%
      - PKD = enterotoaxaemia, bacteria not found systemically
      - PREDISPOSING FACTORS
        
        Increased feed intake "Overeating disease"
        
        Lambs with heavy milking ewes
        
        New access to better pasture / high grain
        
        Deworming
        
        Species
        
        Sheep
        
        Age
        
        3-10w lambs, esp to high milking ewes
        
        10m lambs - feedlot lambs switched tohigh nutritional diet
        
        Lack of vaccination
    - - RAPID PROGESSION- Tx often unrewarding
    - - ⭐ Peracute
        
        Sudden death
      - Acute (Also die)
        
        Pronounced hyperglycaemia(toxin increases glycogen mobiility)
        
        Dullness, depression, yawning, anorexia
        
        Brain oedema: Clonic convulsions, staggering, coma,
        
        +-Green pasty diarrhoea - more in goats
        
        Frothing at the mouth
        
        Pyrexia in goats
      - Adult sheep: survive for 24h
        
        Lag behing, staggering, bloat terminally
        
        Rapid, shallow, irregular respiration
        
        Head pressing
    - - Good BCS
      - Straw coloured fluid in epicardium, endocard, pulmon oedema
      - Congestion of intestinal mucosa, creamy ingesta
      - Soft kidney- only valuable if PM done soon after death
    - - Bacteriology on intestinal tract
      - Ingesta smears with gram stain
      - Clin Path: glucose assay of urine
      - Histopath of colon, ileum, jejunum, brain
    - - Vaccination. Usually vaccinate 2w before deworming
      - Avoid sudden increase in food quality
      - Scenario: Sheep with severe haemonchus burden, no PKD vaccination. Deworm + antibiotic (tetracycline, penicillin) + vaccine