The aim of learning is not knowledge but action. - PowerPoint PPT Presentation

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The aim of learning is not knowledge but action.

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... for selected clinical problems to recite a diagnostic and/or treatment plan for selected specific disease of the urinary ... tract patent suspect ARF ... – PowerPoint PPT presentation

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Title: The aim of learning is not knowledge but action.


1
The aim of learning is not knowledge but action.
  • Wish Id said that..
  • Jill McClure, DVM, MSDiplomate, ACVIM, ABVP

2
Educational Objectives
  • to recognize clinical problems which may suggest
    renal disease
  • to recite a list of differentials (rule-outs) for
    selected clinical problems
  • to recite a diagnostic and/or treatment plan for
    selected specific disease of the urinary system

3
Educational Objectives
  • to identify problems from a history and set of
    clinical and/or laboratory data
  • to interpret clinical and laboratory data by
    following an algorithm in order to arrive at a
    presumptive diagnosis

4
Problem-oriented approach
  • Recognize a problem
  • Know what tests to request
  • Know how to interpret he results
  • Know how to manage the diagnosis

5
What is the problem?????
  • oliguria/anuria
  • polyuria
  • polydipsia
  • dysuria
  • abnormal urine
  • edema
  • chronic weight loss
  • diarrhea
  • colic
  • metabolic lameness

6
Oliguria/Anuriadecreased / no urine output
  • Normal urine output 1-2 ml/kg/hr
  • 15 l /1000 horse/day
  • affected by environment, water intake, diet

7
Decreased urine output
  • Failure to form
    (renal failure)
  • Failure to pass (obstruction or
    diversion)

8
What is a minimum data base?
  • pieces of information to collect BEFORE starting
    to think
  • problem-specific

9
Minimum data base for oliguria/anuria
  • History
  • previous disease
  • drugs therapy
  • toxins
  • feed
  • Physical exam
  • document problem
  • urethral patency
  • injury preventing posturing
  • hydration status
  • rectal exam

10
Minimum data base for oliguria/anuria
  • Lower tract patent
  • suspect ARF
  • CBC
  • BUN, Cr
  • Electrolytes
  • Minerals
  • Albumin, protein
  • UA
  • FE

11
Expanded Data Base for oliguria/anuria
  • Patent lower tract
  • renal biopsy
  • toxin analysis
  • cantharadin
  • heavy metals

12
What is an algorithm?
  • logical pathway used to interpret findings in
    order to arrive at a diagnosis
  • a road map for diagnosis

13
Oliguria/Anuria
14
Oliguria/Anuria
15
Rule-outs for oliguria/anuria with patent lower
tract
  • Toxic
  • antibiotics
  • aminoglycosides
  • drugs
  • NSAIDS
  • bugs
  • cantharadin
  • pigments
  • myoglobin
  • Vascular
  • hypovolemia
  • Toxic
  • heavy metals

16
Oliguria/Anuria
17
Oliguria/Anuria
18
Oliguria/Anuria
19
Rule-outs for oliguria/anuria with lower tract
obstruction
  • Traumatic
  • ruptured bladder
  • Idiopathic
  • urolithiasis
  • smegma accumulation

20
Expanded Data Base for oliguria/anuria
  • Patent lower tract
  • renal biopsy
  • toxin analysis
  • cantharadin
  • heavy metals
  • Obstructed lower tract
  • abdominocentesis
  • urethroscopy
  • biopsy
  • urolith analysis
  • radiography

21
Minimum data base for oliguria/anuria
  • Lower tract patent
  • suspect renal
  • CBC
  • BUN, Cr
  • Electrolytes
  • Minerals
  • Albumin, protein
  • UA
  • FE
  • Lower tract obstructed
  • CBC
  • BUN, Cr
  • Electrolytes
  • Minerals
  • UA
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