Clinical Examination of the Urinary System PDF

CLINICAL EXAMINATION OF THE URINARY SYSTEM. Function of urinary system: 1- Excretion of waste products of metabolism as urea, uric acid, creatinine, ammonia and hydrogen ions. 2- Regulation of the desirable constituents of blood such as water, glucose, amino acids and minerals through selective reab...

CLINICAL EXAMINATION OF THE URINARY SYSTEM. Function of urinary system: 1- Excretion of waste products of metabolism as urea, uric acid, creatinine, ammonia and hydrogen ions. 2- Regulation of the desirable constituents of blood such as water, glucose, amino acids and minerals through selective reabsorption from renal tubules. 3- Regulation of blood pressure (through rennin enzyme). 4- Homeostasis of blood (through erythropoietin hormone). 5- Regulation of acid- base balance. 6- Regulation of osmotic pressure. *Principal manifestation s of urinary tract diseases: I. Abnormal constituents of urine: 1- Protineuria (Albuminuria) 2- Glucosuria and ketonuria. 3- Hematuria. 4- Heamoglubinuria. 5- Myoglubinuria 6- Crystaluria. 7- Pyouria. 8- Casts and cells. 9- Bile pigment. 10- Creatinuria. II. Change in the volume of urine. 1- Polyuria (increase in the volume of urine) * Transient polyuria → following excessive water intake or administration of diuretics which increase the glomerular flirtation or decrease the tubular absorption. * Continuous polyuria → in case of diabetes insipidus, diabetes mellitus, chronic interstitial nephritis (damage of the renal tubules) or chronic nephrosis. 2- Oligouria (decrease in the volume of urine) in case of: * Fluid loss as in case of dehydration, diarrhea or reduced water intake * In case of partial obstruction of the urethra. 3- Anuria (complete absence of urine) in case of: Complete urethral obstruction.* *Tubular necrosis due to mercury poisoning. III- Pain and dysuria. *It means difficult urination (painful urination) its signs are:  Arching of back, paddling with hind limbs, kicking of belly and grunting with urination. e.g.: cystitis, urethritis, calculi and pyelonephritis. *Renal failure: It means the terminal stage of renal insufficiency (complete loss of kidney functions) it occurs when progressive damage of nephrons and failure of renal compensation. *Uremia: it is the terminal stage of renal failure which manifested by: - Depression, muscular weakness and tremors. - Loss of body conditions due to hypoprotenemia. - Myocardial asthenia due to hypokalemia and hyponatremia. - Deep labored breathing with urinefrous odor. - Bradycardia and decreased respiration. - Recumbancy followed by coma and death. - In lab: increase of uric acid level in blood up to 50mg/ 100 ml blood. *Clinical examination of the urinary system 1-Act of urination: (Posture) -Cattle: Female→elevation of tail, slight arching of back with abduction of hind limbs. Male→ there is no protrusion of penis outside the prepuce but urine descend from the perpetual orifice, urination occur during walking, standing or feeding. -Horses: Usually urinate at rest Both male and female → extension of both forelimbs with lowering of abdomen. So, increase of intra-abdominal pressure. Stallion → protrusion of penis from the perpetual cavity. -Sheep → as cattle. -Dog: -Bitch → flexion of the hind legs, so lowering of prenium to the ground. -Male → raising and abduction of one hind limb and appear to direct the discharge urine toward a selected object. *Any abnormal posture during urination indicates disease problem. e.g.: cystitis in male dog → squatting posture.  Cystitis in cattle→ arching of back, paddling with hind limbs, kicking of belly and grunting with urination. 2-Frequency of urination: Depend on the quantity of water consumed (intake) + water produced by metabolic processes and amount of water lost by defecation, respiration and lactation. * Horses and cattle → 5-6 times daily. * Sheep and goat → 1-3 times daily. * Adult male dog → frequent interval urination. *Abnormalities in frequencies: *Pollakuria → abnormal frequent urination or without in the excreted urine volume. e.g.: uretritis & irritation of the bladder. *Physical examination of the urinary system 1- Examination of Kidneys:- * In large animal → by rectal palpation. * In small animal → by external palpation. *Anatomy and position of the kidney: 1-In cattle: it is normally lobulated. The right kidney is bean shape and present more anteriorly than the left kidney & can not be reached by hand (except caudal lobe). It is related ventrally to the last rib & transverse process of the 1st lumbar vertebrae. Left kidney is pyramidal in shape and present ventral to 3 rd, 4th and 5th lumbar vertebrae and lie slightly to the left of the median plan (L3→L5). When the rumen is distended to normal size, it pushes the L.K across the median plane & become ventral & caudal to R.K. 2--Horses: R.K → heart of the playing cards. It presents ventral to the transverse process of the 1st lumber vertebrate. L.K → present ventral to the transverse process of the 3 rd lumber vertebrae. 3-Sheep & goat: as cattle, bean shape kidney. 4-Dog: bean shape kidney, lies in the lumber region.  *Aspects of examination 1- Size -If enlarged → acute nephritis, neoplasms, pyelonephritis, hydronephrosis and glomerulonephritis. -If atrophied → chronic interstitial nephritis 2-Consistency Normal → firm. Doughy (fluctuated) → abscess. Hard → tumors. In cattle: normally both kidneys are lobulated, absence of lobulation occurs in case of pyelonephritis. 3-Condition of the surface:- Normal → smooth and lobulated. Abnormal → irregular surface → in case of localized tumors or abscess. 4- Sensitivity (tenderness) In acute renal disease → painful reaction. 5- Adhesion to the surrounding organs & tissues. 2-Examination of the ureters: Normally the ureters not palpated & detected on the rectal palpation. -If detected, they are cord like and this thickness may be detected as in case of uretritis and pyelonephritis. 3-Examination of the urinary bladder: -The U.B present at the floor of pelvic cavity in female & in bulls lies under the rectum as soft pear shaped body in the empty stage. -Over distension of U.B as in case of urethral obstruction with calculi male and paralysis of the bladder in female, so the U.B will be present in pelvic and abdominal cavity. During rectal exploration of the U.B it has soft thin wall and fluctuating when full.- If the thickness of the bladder wall occur → cystitis and pyelonephritis. 4-Examination of the urethra Cattle, ewe and doe → has a suburethral diverticulum which includes the external urethral orifice which can be viewed by using a dilating vaginal speculum and light source. Ram & buck → has urethral process which usually leads to urine retention.  *Special examination of the urinary system. 1- Catheterization. A) Therapeutic uses: ection of antibiotic and antiseptic locally in the U.B for the treatment a case of cystitis. * For acidification of acid urine by injection of KCl to prevent the ppt.of salts. * In case of urethral obstruction by calculi. B) Diagnostic uses: urinary calculi. on of urine samples.* of cattle:- metal tube about 25cm. pplied due to presence of sigmoid flexure. sheep and goat: in cattle, while catheter cannot be applied in ram no buck due to urethral process. equine: → long rubber catheter. n: 1- Fixation of the animal then lifting of tail. 2- The catheter should be clean, sterile, and lubricated. 3- Introduce your hand per vagina, and then introduce your finger in the suburethral diveticulum (blind sac). 4- By the other hand introduce the catheter till inter into the blind sac then redirection the catheter till locate the ext. urethral orifice→ slit like. 5- In case of stallion→ at first protrusion of the penis by administration of tranquillizer as comblen or chloral hydrate (for relaxation of retractor penis muscle). → then introduce the catheter into the ext. urethral orifice, or withdrawal of the penis out the prepuce in order to introduce the catheter into the urethra. *Urine sample examination: I-Physical examination: 1-Color and appearance→ normally urine is shade and yellow. * Abnormally→ light yellow → polyuria  Or intense golden yellow→ febrile conditions Or red urine→ hemoglobinuria, hemateuria, or myoglobineuria. 2- Viscosity: Fresh bovine urine is watery. Fresh horse urine is viscous due to increased mucus derived from the glands of renal pelvis and ureters. * Abnormal increase in urine viscosity→ plasma protine in urine (inflammatory product) 3- Transparency: Normal urine of cattle and canine is clear and transparent. Normal urine of horses is turbid and opaque. 4- PH of urine: In cattle & horse → alkaline urine. In dog and cat → acidic urine. II-Chemical examination: * Reaction. * Glucose. * Keton bodies. * Bilrubin. * Protine. III- Microscopical examination 5-10 ml of urine → centrifugation at 1000rpm for 10 min. → drops of sediment on clean dry glass slide & covers it by cover slip. -Organized sediment a- Epithelial cells. b- Leukocytes. c- Erythrocytes. d- Casts.e- Parasites. -None organized a- crystals (acidic or alkaline urine) III-Cultural examination- IV- Radiographic examination V- Renal function tests. VI- Renal biopsy VII- Ultrasonography.