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urinary utcvm test 2

test 2

QuestionAnswer
Canine Prostatic Disease
Name Top 4 Differentials for Canine Prostatic Dz= -Benign Prostatic Hyperplasia -Bacterial Prostitis -Prostatic or Paraprostatic Cyst -Prostatic Neoplasia
Top Tx For Prostatic Dz= 1. Castration or anti-androgenic drug (neoplasia or BPH) 2.Antimicrobial with appropriate pka to enter the prostate (tx for bact prostitis) 3.Surgically drain tract (cyst)
Does neutering guarentee dog will have no problems or devlop prostatic disease or hypoplasia Hell No
Anatomical location of prostate and what is it commonly called -barbies butt in pelvic canal -located around proximal urethra
Male neutered dog presents with weight loss, hindlimb tremors, urinary incontinence,urinary obstruction. Enlarged barbies butt in pelvic canal upon anal exam -Name number one differential -Prostatic Neoplasia
Male intact dog presents with hematuria, urethral discharge, hindlimb stiffness,and tenesmus -Top 2 differentials 1.BPH 2.Chronic Bacterial Prostitis *****these two dz will be localized aka symptoms around the urogenital tract
What is BPH defined as? Glandular hyperplasia of the prostate
What hormones regulate BPH (Benign Prostatic Hyperplasia) 1. Testosterone(DHT is what actually works on the cell) 2.Estrogen
Describe the mechanism of how DHT and estrogen cause prostatic hyperplasia Estrogens upregulate DHT receptors in the prostate and when increased DHT binds-> Hyperplasia -seem to think a change in the androgen:estrogen ratio (decreased androgen and static or slightly increased estrogen predispose an animal to this pathology)
What are the consequences of glandular hyperplasia? 1.Increased secretions(big gland big secretion) 2. Cyst formation 3.increased vascular permeability and bleeding (aka inflammation) 3.Hematuria
Case 1. 7 yo lab comes in owner omplaining of the "dog straining to defecate, bloody urine, and a yellow to red slimy stuff that dribbles out of his penis on the floor sometimes at home" What is your number 1 differential? -BPH (clinical signs match for this patient- hematuria, increased ureathral discharge,hematuria, tenesmus
You do a physical exam specifically a prostatic exam- what do you expect to find -prostate (barbies butt)will be mild to moderately enlarged smooth and symmetric.--- when you press on the prostate the dog seems to be pain free because he doesnt bite your assistant's head off.
Now you really suspect BPH- how do you confirm it diagnostically? 1.Rads--see enlarged prostate// 2.Sonograph-- see small homogeneous cysts/// 3.Urethral Brush--fluid will have inc. RBC, prostatic epithelial cells will be enlarged
You've now confirmed it is indeed BPH so what do you do about it 1. Castration- should resolve the problem quickly.... if clinical signs continue-> you guessed wrong dog has something else going on.
Case 2. 8 yo Male intact Scottish terrier. Owner tells you this is a stud dog and "he aint gettin the bitches bred". Other than that normal dog.You do a physical exam and find an enlarged prostate. Whats your number one differential? -BPH
What diagnostic test? and what will you expect to find? 1.Rads--- Will see moderatly enlarged prostate/// 2. Sonography-- homogenous cysts
What is your best treatment recommendation for the ownwer in which the dogs best interest the highest priority? -Castration
You tell him castration and he almost walks out the door. Owner says this is not an option. Now what do you suggest? -Medical treatment
You tell him you can treat this medically...He asks if he can give the dog some of his viagra. You tell him that wont work. What 2 drug options do you suggest and which one do you recommend based on safety? 1. Finasteride ****safest 2. Megesterol (Progestins)
How does Finasteride work? -Blocks conversion of testosterone to DHT by blocking 5-alpha reductase
Name a couple of side effects for the other drug used to treat BPH, Megesterol Acetate(Progestins) side effects are diabetes mellitus, immunosuppression, hypothyroid, mammary hyperplasia... Megesterol works by providing negative feedback on the pituitary
Bacterial Prostitis
Case 3. Intact male Dog comes in owner complaining of the dog just ***recently ill*** started vomiting alot, has lost weight, and is kinda stiff in its back end. So, you do a PE -intact male dog acutely ill= Acute Bacterial Prostitis
Case 2 continued... You do a physical exam and the dog has a fever and snaps when you go to feel of his abdomen(indicatind pain). This keys you in so you do a prostate exam. You find a midly large prostate that is painful. Whats your first differential? -Acute Bacterial Prostatitis
What would you expect to see on the CBC with Acute Bact. Prostitis -Leukocytosis with a neutrophillia characterized by a left shift (inc segs and bands)
What would you expect to find on the chemistry panal (liver enzymes and NPN) with ABP -Inc. ALP/Bilirubin and dec glucose (sepsis) -Pre-renal Azotemia
Urinalysis findings with ABP? Will be active (Hematuria, Pyuria, Bacteriuria
Rads with ABP? mild prostatic enlargement and loss of contrast around prostate
How did this infection get there?? -More than likely ascended up urethra and infiltrated prostate
Treatment for Acute Bacterial Prostitis? -Baytrel (Fluoroquinolones)
What drug characterisitics do the Fluoroquinolones need to adequately treat the prostate Want a drug that is very lipid soluble, weakly ionized, and a weak base(high pka value). Want this type of drug because the prostate a) is hard to penetrate b)will be inflamed so more acidic(the drug must be trapped or ionized) and poorly protein bound dr
Is a relapse common after tx? Yes, the best way to fully rseolve it is to take the home away from the bacteria or shrink the prostate= castration
How will a chronic bacterial prostitis differ from an acute infection? will be similar to those of BPH. notes (got lazy)
Created by: wedgmon