Veterinary Medicine - July 2008 - (Page 383)

Figure 5—Genital tract source: Diagnostic procedures and potential outcomes If you suspect genital tract disease, perform a CBC, serum chemistry proﬁle, urinalysis, and urine bacterial and fungal* culture (by cystocentesis). If parasites are identiﬁed, treat the infection and pursue other diagnostic tests such as diagnostic imaging of the urogenital tract. If microbial growth is identiﬁed, treat the infection as a complicated infection and use the antimicrobial sensitivity results. If other abnormalities are identiﬁed, pursue additional testing as indicated. If the urinalysis results are normal with or without other abnormalities, perform a urinalysis on a voided sample. Abnormalities that might be found include a mass or neoplastic changes, evidence of trauma, cysts or anatomical defects, and inﬂammatory, toxic, embolic, or congestive changes. If the second urinalysis results are normal, perform diagnostic imaging of the urogenital tract. (Additional diagnostic tests might include ultrasoundguided aspiration, biopsy, or culture; cystourethroscopy; or an abdominal exploratory.) If the second urinalysis results include RBCs with or without WBCs or bacteria, consider evaluating samples from a prostatic wash, an ejaculate (dogs), or a vaginal wash or swab (dogs and cats). If no abnormalities are found, go to the unknown source algorithm (Figure 7). *Fungal culture is primarily indicated when systemic evidence of fungal infection is present, urinalysis reveals fungal organisms, the patient is immunocompromised, or the patient has a history of antibiotic-resistant or repeated episodes of urinary tract infection. The results of these tests may reveal proestrus or suggest uterine subinvolution. If not, but other abnormalities are present, pursue additional tests as indicated. If the results are normal, perform diagnostic imaging of the urogenital tract. Always assess the clinical relevance of these ndings in relationship to the urine collection technique and the total clinical evaluation of the patient. For example, crystals can be a normal nding in urine samples and are not considered a cause of hematuria, although their presence may be associated with potential sources of hematuria such as uroliths. If you suspect a lower urinary tract infection (UTI), it is reasonable to try to eradicate the infection in an attempt to resolve the hematuria. Ideally, treat bacterial infections by selecting antibiotics based on bacterial culture and antimicrobial sensitivity testing results. Treat patients with multiple episodes of UTIs, systemic signs of illness, systemic fungal infections, genital tract infections, or upper UTIs with longer courses of antimicrobial drugs. These patients should undergo further diagnostic procedures to identify complicating factors and other organ system involvement. If parasites are identi ed in urine, such as Capillaria or Dioctophyma species ova or Diro laria species micro lariae, administer an appropriate parasiticide. In patients with Dioctophyma or Diro laria species infections, perform additional diagnostic procedures before treatment VETERINARY MEDICINE July 2008 383

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Veterinary Medicine - July 2008 Contents Leading Off Practical Matters Idea Exchange Clarification Dental Corner The Diagnostic Approach to Hematuria Guidelines for Evaluating Hypercalcemic Cats CE Form Advertiser Index Marketplace/Classifieds Mind Over Miller

Veterinary Medicine - July 2008

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