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Treatment > Block 2 > Flashcards

Block 2 Flashcards

1
Q

Which kidney is farther behind?

A

Left kidney (left behind)

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2
Q

What is a nephrotomy?

A

Cutting into the kidney

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3
Q

What are the 7 indications for a nephrotomy?

A

Renal calculi
Persistent hydronephrosis
Persistent hematuria
Mass / neoplasia
Trauma
Infection
Donation

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4
Q

What are the 3 highest risks for a nephrotomy?

A

Hemorrhage
Damage to kidney
Increased kidney values

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5
Q

Where do you ligate the ureter during a nephrectomy?

A

At the trigone

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6
Q

What are the 2 indications for a sub-ureteral bypass system (SUBs)

A

Ureteroliths within renal pelivis dilation
Ureteral stricture

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7
Q

What needle is used for SUBs?

A

Huber needles

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8
Q

What are the 3 complications with SUBS

A

Urine leakage
Encrusting of the nephrostomy tube or cystotomy tube
Infection

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9
Q

Describe how to perform a uretertomy?

A

Incise over inciting cause and remove stones

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10
Q

What are the 2 complications with ureterotomy?

A

Stricture and dehiscence

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11
Q

What does a ureteral stent do?

A

Placed from kidney to bladder to treat stones, strictures, or neoplasia

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12
Q

What are the 4 complications of ureteral stents?

A

Continued infection
Stent migration
Trauma to ureter
Urinary leakage

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13
Q

What is an ectopic ureter?

A

Ureter that is entering in abnormal location into bladder or directly into the urethra

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14
Q

What are extramural ectopic ureters?

A

Ectopic ureter that bypasses the bladder completely

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15
Q

What are the treatment options for extramural ectopic ureters?

A

Surgery only

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16
Q

What are the treatment options for intramural (enter bladder) ectopic ureters?

A

Laser ablation OR surgery

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17
Q

What are the 2 surgical options for ureteral reimplement?

A

End to side
Side to side

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18
Q

What is the non surgical approach to correcting a ectopic ureter?

A

Laser ablation
-Cystoscopy and a laser to tunnel to the level of the bladder

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19
Q

What is the surgery of the ectopic ureter called?

A

Neuorecterocystotomy

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20
Q

What does a end to side neuorecterocystotomy look like?

A

Cut ureter and implant via a stab incision into the bladder

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21
Q

What does a side to side neuorecterocystotomy look like?

A

Incise into bladder and through the bladder incise into the ureter

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22
Q

What are the 4 complications with these surgeries?

A

Strictures
Uroabdomen
Infections
Incontinence

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23
Q

Where do the ureters enter the bladder?

A

Dorsolaterally

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24
Q

Where does the vascular supply enter the bladder?

A

Dorsally

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25
Q

What is the main artery of the bladder?

A

Caudal vesical artery

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26
Q

What is really important to know about the anatomy of the bladder?

A

**Nerves, ureters, and blood supply of the bladder all enter dorsally!!!

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27
Q

What is the singular most common surgical bladder disease?

A

Urolithiasis

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28
Q

What can urolithiasis cause secondary?

A

UTIs

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29
Q

What are the top 3 most common surgical diseases of the bladder?

A

Urolithiasis
Trauma
Masses (polyps or neoplasia)

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30
Q

What are the 2 options for treatment of urolithiasis?

A

Medical and interventional

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31
Q

What is the medical therapy for urolithiasis?

A

Dissolution

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32
Q

What are the only 3 stones you can dissolve?

A

Struvite, urate, and cystine

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33
Q

What is lithotripsy?

A

Breaking apart with a laser

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34
Q

What is the minimum urethral size for lithotripsy?

A

5 French

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35
Q

What is the holding layer for the bladder?

A

Submucosa

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36
Q

How fast does the mucosa of the bladder heal?

A

5-7 days

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37
Q

How fast does it take for the bladder to get to full strength?

A

14-21 days

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38
Q

How much of the bladder can you take?

A

75%

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39
Q

Which direction of the bladder should you never cut?

A

On the dorsal side!

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40
Q

What is the most common bladder surgery?

A

Cystotomy

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41
Q

What suture type do you use for a cystotomy?

A

Monocryl

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42
Q

How many layers do you need to close the bladder?

A

Can do just the submucosa (holding layer)

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43
Q

What is another more advanced surgical option for urolithiasis?

A

PCCL = percutaneous cystolithotomy

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44
Q

What should you do immediatly post surgery for urolithiasis?

A

Radiographs!

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45
Q

What is seen on bloodwork for uroabdomen?

A

Azotemia
Dehydration (High USG, albumin, PCV/TP)
Metabolic acidosis
Hyperkalemia

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46
Q

What can you not use when comparing fluid in abdomen to blood when determining uroabdomen?

A

BUN, reaches even osmolality quickly

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47
Q

What should you see being HIGH in abdominal fluid in a uroabdomen compared to blood?

A

Creatinine and potassium

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48
Q

Where are masses most common in the bladder?

A

Trigone

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49
Q

What is the most common neoplasia of the bladder?

A

Transitional cell carcinoma

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50
Q

What is the widest diameter of male urethra?

A

2mm (pre and post prostatic)

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51
Q

What is diameter of male urethra at bulbourethral glands?

A

1.3mm

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52
Q

What is diameter of male urethra at end?

A

0.7mm

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53
Q

Are uroliths more common in dogs or cats?

A

Dogs

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54
Q

What is the most common surgical option for urethral uroliths?

A

urethrostomy (not urethrotomy)

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55
Q

What is a urethrotomy?

A

Creation of temporary opening in urethra

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56
Q

What type of urethrotomy/urethrostomy do dogs get?

A

Scrotal

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57
Q

What type of urethrotomy/urethrostomy do cats get?

A

Perineal

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58
Q

Why perform a urethrotomy?

A

If a stone can’t be pushed back

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59
Q

Why perform a urethrostomy?

A

Recurrent or persistent urethral obstruction

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60
Q

If you perform a urethrostomy, what must you do?

A

Neuter

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61
Q

For a perineal urethrostomy (cat), what level must be reached?

A

Bulbourethral gland

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62
Q

What does a urethrostomy not cure in male cats?

A

FIC!!

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63
Q

What 2 groups of dogs are most likely to have a urethral prolapse?

A

Brachycephalic dogs (English Bulldogs)
Intact males

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64
Q

What is a strong recommendation for a dog that has a persistent urethral prolapse?

A

Neuter

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65
Q

If a patient receives a urethropexy, what is an important complication that needs to be reduced?

A

Need to keep patient calm (ace and butorphanol) and can’t breed for 4-6 weeks

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66
Q

What percent of malignancies in dogs are attributed to bladder cancer?

A

2%

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67
Q

What is the most common bladder cancer in dogs and cats?

A

Transitional cell carcinoma
aka urothelial carcinoma

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68
Q

How do urinary tumor patients normally present?

A

With lower urinary tract signs - hematuria, stranguria, pollakiuria, dysuria

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69
Q

What is the most common area of the bladder to develop a tumor?

A

Trigone!

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70
Q

What are the 4 treatments for urinary tumors?

A

Surgery
NSAIDs
Radiation
Chemotherapy

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71
Q

What is an important thing to remember when performing neoplasia surgery in the bladder?

A

Potential for “seeding”

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72
Q

What is an NSAID that has been proven to work against urinary tumors?

A

Piroxicam (Feldene)

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73
Q

What are the 3 things that piroxicam does to decrease cancer

A

Induction of apoptosis of cancer cells
Inhibition of angiogenesis
Reduction in cell proliferation

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74
Q

What are the 2 other NSAIDs that are COX-2 inhibitors that have been shown to be as good as piroxicam?

A

Deracoxib and firocoxib

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75
Q

What is the chemotherapy drug that has the best response rate to urinary tumors?

A

Vinblastine

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76
Q

What was said to be the best option for treating neoplasia of the bladder?

A

Combination of chemotherapy and NSAID (piroxicam and miloxantrone)

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77
Q

What infection is higher in patients with urinary cancers?

A

UTI

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78
Q

What are the 2 most common isolates from urinary cancer UTIs?

A

E. coli and staph

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79
Q

What is a successful way to relieve an obstruction produced from the urinary neoplasia?

A

Urethral stent
This is a salvage procedure

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80
Q

Are urinary cancers usually treatable?

A

Usually no

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81
Q

What is the most common kidney neoplasia in young dogs?

A

Nephroblastoma

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82
Q

What is the renal tumor caused by a missense mutation in German Shepherds?

A

Renal cystadenocarcinoma

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83
Q

What is the most common renal cancer in cats?

A

Renal lymphoma

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84
Q

How is renal lymphoma most often treated?

A

Chemotherapy

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85
Q

What is the typical medical protocol for spays?

A

Opioid and sedative IM
Induction IV
Inhalant
NSAID

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86
Q

What drug is Zorbium

A

Buprenorphine - Partial mu agonist

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87
Q

How long does Zorbium take to take effect?

A

1-2 hours

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88
Q

How long does zorbium act for?

A

4 days

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89
Q

What is a good drug protocol for pig spays?

A

TKX + morphine

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90
Q

What do you need to be aggressive with during mastectomies?

A

Pain management, they are very painful!

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91
Q

What can be done post op to help with the pain from mastectomies?

A

Full mu, CRI of ket or fentanyl

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92
Q

What is high during a uroabdomen/

A

BUN, creatinine, potassium
Dehydration and metabolic acidosis

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93
Q

What drug is specifically good for goats undergoing cystotomies?

A

Benzodiazepines

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94
Q

If the procedure is especially painful, what should be considered?

A

a CRI

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95
Q

What are the 2 most common signalments for cows that have pyelonephritis?

A

Females
Less than 90 days post calving

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96
Q

What are the 3 risk factors for ruminants toward pyelonephritis?

A

Dystocia
Abortion
Post-partum infections

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97
Q

What is the primary agent in ruminants to cause pyelonephritis?

A

Corynebacterium renale

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98
Q

What are the 3 laboratory findings for pyelonephritis?

A

Leukocytosis
Hyperfibrinogenemia
Hyperglobulinemia

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99
Q

What are the 3 things that should be done for treatment of pyelonephritis?

A

Antibiotics - aggressive and long term
Diuresis - rehydrate and remove debris. Replace protein loss
Nephrectomy

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100
Q

Which antibiotic is best used for treatment of the pyelonephritis?

A

Penicillin

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101
Q

Should you continue to treat if it is bilateral pyelonephritis?

A

No!

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102
Q

Which flank should you approach the kidney from?

A

Either

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103
Q

What is the cause of amyloidosis?

A

Chronic inflammation

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104
Q

What is the treatment for amyloidosis?

A

There isnt one

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105
Q

What is possible after a nephrectomy for pyelonephritis?

A

Transient post-operative worsening of renal enzymes

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106
Q

What 2 species are the most common to have urolithiasis?

A

Goats and sheep

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107
Q

What is the main predisposing factor for a blockage?

A

Early castration
Testosterone on urethral diamteter

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108
Q

What is the most common type of stone in Ohio?

A

Struvite

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109
Q

What type of diet causes phosphorus based stones?

A

Grains

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110
Q

What type of diet causes calcium based stones?

A

Legumes

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111
Q

Which type of stone can you not see on radiographs?

A

Struvite

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112
Q

What is a risk factor for producing struvite stones/

A

Alkaline pH

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113
Q

What may be heard in severe blockage cases?

A

Arrhythmias

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114
Q

What drug group do you not want to give to blocked goats?

A

Alpha 2s - diuretic!

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115
Q

What position should you sit the blocked goat in?

A

On their rump

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116
Q

What type of stones can you seen on radiographs (3)

A

Calcium oxalate
Calcium carbonate
Silicate

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117
Q

What 3 markers do you expect to see on a blocked goat?

A

Creatinine
BUN
Potassium

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118
Q

What 3 things can you provide for medical management?

A

Ammonium chloride (will disolve struvite stones)
Acepromazine - muscle relaxer
Salt block to increase thirst

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119
Q

What are 4 decent options for pain management?

A

Morphine
Torb
Banamine
Meloxicam

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120
Q

What are 2 fluid options in blocked goats?

A

Calcium gluconate - cardioprotectant
Dextrose

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121
Q

What else can be provided to reduce concern of cystitis?

A

Penicillin or Naxcel (ceftiofur)

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122
Q

What are the steps to a urethral amputation?

A

Premed with midazolam and ketamine
Proceed with an angled cut

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123
Q

What is an option for stabilization until referral?

A

PTC or percutaneous tube cystotomy

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124
Q

What are 4 complications with PTCs?

A

Loss of bladder distention
Inadvertent gastrointestinal perforation
Balloon or tube malfunction
Security

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125
Q

What are the complications with perineal urethrostomy?

A

Urine scald
UTI
Stricture
Hemorrhage

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126
Q

What is a perineal urethrostomy?

A

They incise the urethra in the perineal area and pull it out as the new pee pee hole

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127
Q

What are 4 ways to prevent blocking goats?

A

Delayed castration
Increased water intake
Diet modification
Periodic dissolution

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128
Q

When should the umbilical stalk be dry by?

A

3-4 days

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129
Q

When should th umbilical stump fall off?

A

3-4 weeks

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130
Q

What should the umbilicus be treated with immediately after birth?

A

Either 7% iodine or 4% chlorhexidine

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131
Q

What is an external umbilical infection called?

A

Omphalitis

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132
Q

What is a urachal infection called?

A

Urachal abscess

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133
Q

What is an umbilical vein infection called?

A

Omphalophlebitis

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134
Q

What is an umbilical artery infection called?

A

Omphaloarteritis

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135
Q

What is the most common type of umbilical infection?

A

Omphalitis

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136
Q

What is the least common type of umbilical infection?

A

Omphaloarteritis

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137
Q

How do you treat an external abscess?

A

Lance it
Antibiotics (for 5-10 days) with cold hose therapy and some NSAIDS for pain

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138
Q

How far do you remove of the urachus?

A

All the way to the bladder apex

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139
Q

What clinical signs will a really sick obstructed patient present with?

A

Bradycardia
Hypotensive
Hypothermic

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140
Q

What is the largest concern for a really sick, blocked cat?

A

Hyperkalemia

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141
Q

What do you do to reduce the risk of cardio issues?

A

give calcium gluconate is bradycardia, hyperthermic, and hypotensive

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142
Q

How long does calcium gluconate last?

A

Only last 20-30 minutes

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143
Q

What should a patient be on before giving the calcium gluconate?

A

ECG

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144
Q

what is given after the calcium gluconate to actually reduce the blood potassium?

A

Insulin

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145
Q

What does the insulin do?

A

Opens the Na/K ATPase which moves the potassium intracellular

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146
Q

Why is calcium gluconate given before insulin?

A

It takes 15-30 minutes for insulin to take effect

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147
Q

What needs to be given in conjunction with insulin?

A

Dextrose

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148
Q

How does dextrose also help by itself?

A

The dextrose allows for endogenous insulin release

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149
Q

What is another thing you can use beside insulin to drive potassium into the cell?

A

Terbutaline

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150
Q

What is the mechanism for terbutaline?

A

B2 agonist

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151
Q

What are adverse side effects of terbutaline?

A

B2 spill over - tachycardia
B2 mediated vasodilation

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152
Q

What is another thing you can use beside terbutaline and insulin?

A

Sodium bicarbonate

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153
Q

What is the mechanism of action of sodium bicarbonate?

A

H/K antiporter

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154
Q

What does sodium bicarbonate also help to do?

A

Helps reduce metabolic acidosis

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155
Q

What are some adverse effects of sodium bicarbonate?

A

Decreased inionized calcium
Usually not required if appropriate fluid therapy is done. Alkalemia as bad if not worse than the academia if overshot

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156
Q

What is the next step after figuring out hyperkalemia?

A

Giving IV fluids

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157
Q

What does providing IV fluids help with?

A

Resolve azotemia, acidosis, hyperkalemia, dehydration, and hypovolemia

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158
Q

What does decompression provide for blocked cats?

A

Cystocentesis leading to immediate decompression and stabilization before catheterization

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159
Q

What should be used for the cystocentesis?

A

A 3 way stock cock

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160
Q

What should be done if when passing a urinary catheter, the cat is vocalizing or moving?

A

Give more drugs!

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161
Q

What mix of drugs should you not provide when catheterizing cat?

A

Full mu + benzo
Opioid + alphax + benzo

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162
Q

What do you hydropulsion with?

A

Saline lubricant

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163
Q

What catheter do you use for the urinary catheter?

A

Open tipped catheter (tomcat, slippery sam, or mila) - mila seems to be best

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164
Q

After passing a catheter and decompression, what is next?

A

Empty the bladder then flush with saline

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165
Q

Finally, suture the catheter in place and attach a sterile collection system

A
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166
Q

What do you do if you can’t pass a catheter?

A

Intermittent cystocentesis until surgery can be performed

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167
Q

How does uroabdomen present?

A

Severe azotemic, hyperkalemic, and acidotic

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168
Q

Does uroabdomen constitute a surgical emergency?

A

NO!

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169
Q

What should be done after uroabdomen patient is stabilized?

A

Given a urinary catheter

Keep bladder/abdomen empty

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170
Q

How long does a bladder defect take to heal?

A

3-5 days

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171
Q

Small tears may be conservatively managed but large tears will need surgery

A
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172
Q

Can bacteria be in urine without an infect?

A

Yes

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173
Q

Is urine naturally sterile?

A

No

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174
Q

What are 2 causes of bacteria in urine that aren’t UTIs?

A

FIC
Asymptomatic bacteriuria

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175
Q

What are the 2 groups that are most likely to get a UTI?

A

Spayed female dogs and cats over 10 years

Also incontinent animals and animals with urine retention

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176
Q

What are the 2 goals to therapeutic success of treating a UTI?

A

Eradication of infection
Avoidance of resistance to antibiotics

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177
Q

What are the 2 forms of acquired resistance?

A

Random DNA mutation
Plasmid transfer of DNA by transduction or conjugation

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178
Q

What percent of female dogs have subclinical bacteriuria

A

8.9%

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179
Q

There is a poor correlation between a UA and culture results. Lost of false positives

A
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180
Q

What are good antibiotics for UTI?

A

Amoxicillin or sulfas

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181
Q

What does MIC stand for?

A

Minimum inhibitory concentration

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182
Q

What does MPC stand for?

A

Mutant prevention concentration

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183
Q

How long must a patient be on a antibiotic

A

An adequate time above MIC
Most important thing is that T>MIC

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184
Q

Which antibiotics are more time reliant and need dosed more often?

A

B-lactams, cephalosporins, and macrolides

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185
Q

Which antibiotics are concentration dependent?

A

Fluroquinolones and aminoglycosides

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186
Q

If you have a recurrent or resistant UTI, what should your diagnostic approach be?

A

Culture
Find where infection is hiding

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187
Q

Can you use cranberry extract to help prevent UTIs?

A

Do not use in patients that create calcium oxalate stones!!

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188
Q

Is D-mannose ok?

A

Not recommended but safe

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189
Q

Is methenamine ok?

A

Transforms to formaldehyde in acidic urine

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190
Q

What type of dogs does the urethral sphincter mechanism incompetence occur in?

A

Spayed female dogs

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191
Q

What can be used for medical management of urethral sphincter mechanism incompetence?

A

Alpha agonists
Estrogen compounds

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192
Q

What is an alpha agonist that can be used for urethral sphincter mechanism incompetence?

A

Phenylpropanolamine (proin)

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193
Q

What are 3 side effects of proin?

A

Hypertension
Change in behavior
Change in appetite

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194
Q

There is an extended release proin but it isnt labeled for dogs under 10lbs

A
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195
Q

What are estrogen compounds that can be used to treat urethral sphincter mechanism incompetence?

A

DES
Estriol

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196
Q

What are the side effects of DES and estradiol?

A

Vulvar and mammary swelling
Attractiveness to male dogs

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197
Q

What are 2 surgical approaches to urethral sphincter mechanism incompetence

A

Artificial urethral sphincter
Injection of GAX collagen

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198
Q

What causes overactive bladders?

A

Low compliance of the detrusor muscle

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199
Q

What is the treatment for overactive bladders?

A

Anticholinergic drugs

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200
Q

What are the 3 anticholinergics that can treat low compliance?

A

Oxybutynin
Imipramine
Dicyclomine

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201
Q

What is FOO

A

functional outflow obstruction
Bladder contracts but urethra fails to relax

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202
Q

What is a strategy in males that suffer from FOO?

A

Neuter

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203
Q

What is a medical treatment for functional outflow obstruction (FOO)?

A

Alpha antagonist

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204
Q

What alpha antagonist can work to cure FOO?

A

Prozasin
Tamsulosin
Phenoxybenzamine

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205
Q

What is another option medically treating FOO?

A

Acepromazine, diazepam, anti-anxiety (trazodone/fluoxitine)

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206
Q

What is a good way to follow up and monitor FOO?

A

Measure residual volume

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207
Q

May also need to teach owner how to catheterize their dog

A
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208
Q

What is DUD?

A

Detrusor-urethral dyssynergia
Sphincter will contract after flow is initiated, leaving a large amount of residual urine

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209
Q

How to treat DUD?

A

Reducing smooth and striated muscle tone and reducing anxiety

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210
Q

What is the treatment for functional obstruction dysautonomia?

A

Bethanechol

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211
Q

Where is the lesion in automatic UMN bladder?

A

cranial to S1-S2

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212
Q

Where is the lesion in automatic LMN bladder?

A

At S1-S2

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213
Q

What is critical in an automatic LMN bladder?

A

Bladder is fully expressed and emptied

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214
Q

What sort of diet are PLN patients put on?

A

Protein and phosphate restricted diets

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215
Q

Do PLN only patients need the phosphate restriction?

A

No!

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216
Q

What is a supplement that can be given to protect kidneys in PLN patients?

A

Omega 3

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217
Q

What 2 things do omega 3s do to benefit PLN patients?

A

Reno protective
Suppress inflammation

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218
Q

If the kidney diet is already supplemented with omega 3s, do you need to supplement more?

A

No

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219
Q

What happens when RAAS is activated?

A

This is due to low flow within the kidney so the efferent arterial constricts to maintain GFR

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220
Q

What happens with chronic RAAS activation?

A

Endothelial damage that causes proteinuria and inflammation

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221
Q

What are the 3 drugs that block RAAS?

A

Angiotensin converting enzyme inhibitor (ACEi)
Angiotensin receptor blockers (ARB)
Aldosterone antagonist

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222
Q

With the use of ACE inhibitors and the decrease of GFR, what do you expect to see as a result?

A

Azotemia

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223
Q

What is better between ACEi and angiotensin receptor blockers?

A

ARBs

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224
Q

What ARB drug is on the market?

A

Telmisartan

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225
Q

Since aldosterone triggers the kidney to excrete potassium, what do you expect to see with ACEi and ARB?

A

An increase in serum potassium (hyperkalemia)

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226
Q

What are 2 commercial ACE inhibitors?

A

Enalapril
Benazepril

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227
Q

What should be checked 2 weeks after starting these medications?

A

Blood pressure
Chemistry panel (azotemia and potassium)

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228
Q

What protein is lost in proteinuria?

A

Albumin

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229
Q

What happens with hypoalbuminemia?

A

Differences in oncotic pressure that allows plasma water to leak into the abdomen (ascites)

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230
Q

What side effect do you need to be hyperaware of while using a diuretic and an ACEi/ARB?

A

Dehydration causing serious kidney damage

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231
Q

The RAAS slow down the GFR so that more fluid can be filtered but the diuretics increase the amount being filtered out so both combined are additive causing a lot of fluid loss

A
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232
Q

What is the mechanism of action of furosemide?

A

NaKCl pump blocker in loop of Henle

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233
Q

What are the 2 diuretic options/

A

Furosemide
Spironolactone

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234
Q

What is something that furosemide can cause?

A

Loss of potassium

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235
Q

What is the mechanism of action of spironolactone?

A

Aldosterone antagonist

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236
Q

What is a concern for spironolactone?

A

It is potassiums sparing
Patients that are on an ACEi or an ARB that may already be hyperkalemic may have issues here

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237
Q

What is often paired with RAAS inhibitor drugs to control hypertension?

A

Amlodipine
(hydralazine is another)

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238
Q

What is the mechanism of action of amlodipine?

A

Ca channel blocker

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239
Q

Typically, if the hypertension isn’t that high, you can start with just using a RAAS inhibitor but if this isnt the case, you will need to switch to using both RAAS inhibitor and amlodipine (or even more)

A
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240
Q

What immunosuppressive drug does she like for PLN?

A

Mycophenolate

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241
Q

What is an issue with PLN to do with clotting?

A

Decreased clotting time due to loss of antithrombin III

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242
Q

What is the most effective treatment of AKI?

A

Careful fluid management

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243
Q

What 2 phases are treatment most successful in AKI?

A

Induction and extension phases

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244
Q

what is the average fluid loss per day in dogs?

A

22 mL/kg/day

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245
Q

What is the primary sensible fluid loss?

A

Urine

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Perfectly
246
Q

What is an amount less than needed to excrete was products?

A

Oliguria ( <0.5 mL/kg/hr)

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247
Q

What is the normal need to execute products?

A

Nonoliguria (0.5-2.0)

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248
Q

What is maintenance fluid therapy?

A

66mL/kg/day

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249
Q

Can you give excess fluids to force diuresis?

A

No!

250
Q

What is the ins and outs method in AKI?

A

Matching the amount put in to the amount that comes out

251
Q

What are the 3 components to volume calculation?

A

Insensible loss (respiration and normal stool)
Urine volume replacement
Ongoing loss (V+, D+, body cavity drainage)

252
Q

What is the average insensible loss?

A

22 ml/kg/day

253
Q

What happens after administration of crystalloid fluid?

A

80% will move into the interstitium causing edema leading to decreased oxygen and metabolite diffusion

254
Q

What is the shock dose of crystalloids in dogs? cats?

A

60-90 ml/kg
45-60 ml/kg
1/4 is given over 5 to 15 min

255
Q

What is the formula for correcting dehydration?

A

body weight x estimated % dehydration = fluid deficit in L

256
Q

What percent dehydrated are apparently normal patients assumed to be?

A

5%

257
Q

When should a colloid solution be given?

A

If hypoalbuminemia is present

258
Q

Should synthetic colloids be used?

A

No! Associated with a higher risk of AKI

259
Q

Do diuretics to increase urine output improve the outcome of AKI?

A

No!

260
Q

Do the use of diuretics to treat over hydration have a benefit?

A

Yes

261
Q

What is a good diuretic to use?

A

Mannitol

262
Q

Furosemide should not be given to patients with amino glycoside-induced AKI

A
263
Q

What may be seen in uremic patients when assessing hydration status?

A

Dry mouth (xerostomia)

264
Q

What is the amount of urine production ion a healthy animal?

A

1-2 ml/kg/hr

265
Q

What is a good way to determine urine volume?

A

Placing an indwelling catheter (most precise method)

266
Q

What may be the only sign of FIC?

A

Periuria

267
Q

What is the ratio of male to female cats with FIC?

A

Roughly equal

268
Q

What is the ratio of male to female cats with FIC when blocked?

A

2:1

269
Q

What are 2 main risk factors for cats with FIC?

A

Overweight and indoor only

270
Q

What is the best way to treat FIC?

A

Decrease stress in the home

271
Q

What are ways to decrease stress in the home?

A

multiple food places, waters, and litter boxes

272
Q

What are the 3 parts to the 3 pronged approach for FIC?

A

Decrease stressors
Water and food
Increase natural behavior

273
Q

What about water can be changed?

A

Increase water intake
Goal of USG <1.030

274
Q

Is there evidence of efficacy of using NSAIDS or steroids with FIC?

A

NO!

275
Q

What are some medical therapy options?

A

Usually daily pilling causes more stress

During a flare up can use gabapentin

Fluoxetine can be used daily to reduce flares

276
Q

How many FIC cats recur?

A

40-60%

277
Q

What shape are struvites?

A

rectangle

278
Q

Are struvites dissolvable?

A

Yes

279
Q

Where is the most common area to see struvite?

A

Bladder

280
Q

What are the 3 predisposing dietary factors?

A

High Mg
High Phosphorus
Low quality foods

281
Q

What should the pH of the urine be to help dissolve the struvite?

A

Low!!

282
Q

What food should you feed to help dissolve then prevent struvite?

A

Hills c/d

283
Q

What percentage of stones are struvite in dogs?

A

50%

284
Q

What sex gets struvite more often?

A

Female

285
Q

Is struvite associated with UTI from staph?

A

YES!

286
Q

What should you be aware of as dissolution of struvite continues?

A

Bacteria!

287
Q

What stones tend to develop in acidic urine?

A

Calcium oxalate

288
Q

Is there a sex predilection in cats?

A

No

289
Q

Should you treat with antibitoics throughout the stone dissolution?

A

Yes + 1 month

290
Q

Do Calcium Oxalate dissolve?

A

Nope

291
Q

What is the most common stone in cats?

A

Calcium oxalate

292
Q

How do you remove CaOx stones?

A

Have to physically remove

293
Q

What are 2 ways to decrease chance of developing CaOx stones?

A

Increase water intake
Stay away from acidifying diets

294
Q

What supplement should you avoid giving in cats for CaOx stones?

A

Vitamin C

295
Q

What dogs get CaOx stones?

A

Old dogs

296
Q

in cats and dogs with urate stones, what should you look for?

A

Hepatic dysfunction

297
Q

Are urate stones dissolvable in cats?

A

No

298
Q

What diet should patients with urate stone be on?

A

Low protein diets

299
Q

What do Dalmatians not do?

A

Do not convert uric acid to allantoin

Urate stones much more common in Dalmatians

300
Q

are urate stones dissolvable in dogs?

A

Yeah

301
Q

What pH should the urine maintain for most stones?

A

Neutral

302
Q

How many types of cystine mutations are there

A

3

303
Q

What should you do to avoid the cystine mutation complications?

A

Neuter!

304
Q

Do cystine show up on rads?

A

No! Use ultrasound

305
Q

What is the most important factor in prevention of stones?

A

Dilute urine
USG < 1.030

306
Q

What is a less invasive method of removing stones?

A

Lithotripsy - laser followed by hydropulsion

Not useful with cystine stones

307
Q

Are nephroliths usually removed in SA?

A

No unless recurrent UTI

308
Q

What is the most common cause of ureteral obstruction in cats?

A

Ureteroliths (95% CaOx)

309
Q

How long does it take to cause permanent renal impairment?

A

4 weeks
Big kidney little kidney

310
Q

What is the first step in medical management of stones?

A

IV fluid diuresis

311
Q

What is IV fluid diuresis?

A

Increase of fluids to push the stone through (Very painful_

312
Q

What does IV fluid diuresis help to do?

A

Stabilize patient, reduce azotemia, improve perfusion

313
Q

What are 2 drugs that will help to relax the ureter?

A

Prozasin (alpha antagonist)
Tamsulosin (alpha 1 A)

314
Q

What is a side effect of prozasin?

A

Risk of hypotension

315
Q

What pain control can you use?

A

Gabapentin
Opioids

316
Q

How many cats did the medical management of diuresis work on?

A

7/52 (not a lot)

317
Q

What are 2 surgical management options for ureter stones?

A

Feline ureteral stenting
Subcutaneous ureteral bypass

318
Q

What are the steps in inseminating a mare

A

Mare determined best time to inseminate
Stallion owner notified
Semen collected
Semen diluted with extender to provide nutrients during shipping
Semen packaged and shipped overnight
Mare inseminated

319
Q

What type of semen to bovine AI give?

A

Exclusively frozen

320
Q

Does frozen or cooled semen require more precise timing?

A

Frozen

321
Q

How long does frozen seem last after being thawed?

A

12-24 hours

322
Q

How long can cooled semen be stored?

A

Up to 48 hours

323
Q

Where is the sit of insemination of horses?

A

Body of the uterus

324
Q

Where is the site of insemination of cows?

A

Body of the uterus

325
Q

Where is the site of insemination of dogs?

A

Vagina (fresh or cooled) or body of the uterus (fresh, cooled, or frozen)

326
Q

What is the success rate of cow AI? Equine? Canine?

A

60%
70% (fresh, cooled) 50% (frozen)
90% (fresh, cooled) 60% (frozen)

327
Q

How long is proestrus in dogs?

A

9 days

328
Q

How long is estrus in dogs?

A

9 days

329
Q

What is day 0 in dogs?

A

Start of estrus or at luteal surge

330
Q

How can you determine if a bitch is in heat from a vaginal cytology?

A

If there are cornified cells (cells look like corn flakes)

331
Q

Is it normal for there to be intracellular bacteria for a dog in heat?

A

Yes!!

332
Q

How is ovulation confirmed in a bitch using progesterone?

A

If the progesterone has risen by 3-4 ng/mL

333
Q

How many days after the LH surge does the bitch ovulate?

A

Roughly 48 hours (2 days)

334
Q

In a vaginoscopy, how will the vagina appear during estrus?

A

dried up

335
Q

Day 0 - LH surge
Day 2 - Ovulation
Day 4 - Fertile period

A
336
Q

Where must frozen semen be placed in bitches?

A

In the uterus

337
Q

When do you inseminate with the frozen semen?

A

5-6 days after LH surge

338
Q

What two species are pseudopregnancies clinically relevant in?

A

Dogs and goats

339
Q

What is another name for pseudopregnancy?

A

Cloudburst

340
Q

What can you give dog to prevent stimulation of mammaary glands?

A

Prolactin antagonist

341
Q

How long does pseudopregnancy in dog take to resolve?

A

4-8 weeks

342
Q

How do you treat cloudburst (pseudopregnancy in goats)

A

May resolve on own

Give prostaglandin
1 injection - 50% resolution
2 injections - 95% resolution
3 injections 100% resolution

343
Q

What will happen in subsequent cycles for goats?

A

Only 20-50% fertility in subsequent cycles

344
Q

What is the most common cause of obstruction in dogs vs cats

A

Dogs - stones
Cats - FIC

345
Q

How do you terminate a mare pregnancy before 35 days?

A

Single PGF2alpha injection

346
Q

How do you terminate a mare pregnancy 35-120 days?

A

3-5 daily injections of PGF2alpha

347
Q

How do you terminate a cattle pregnancy before 150 days?

A

Prostaglandin

348
Q

How do you terminate a cattle pregnancy after 150 days?

A

Dexamethasone

349
Q

What is the best option for termination of pregnancy in dogs?

A

Spay

350
Q

What percent of bitches aren’t pregnancy after a single breeding?

A

62%

351
Q

What canine pregnancy termination tactic is no longer used!!!!

A

Estrogens!! “Mismate shot”

352
Q

What is the mismate shot that works?

A

Prostaglandin shot

353
Q

What do you have to be aware about of the prostaglandin shots?

A

Ensure pregnancy, it makes the dog really sick

Single dose is not enough!

354
Q

Prostaglandins must be administered until abortion is complete. They can abort some but whelp others

A
355
Q

What is another injection that can be given. What is the downside?

A

Glucocorticoids (dexamethasone)
Downside is that live fetuses may pass

356
Q

What are the positives of glucocorticoids (dex)?

A

Inexpensive
Preserves future fertility
80% effective
Begin after day 35, if above day 50, live, non-viable pups will be delivered

357
Q

What is an emergency reason for castration

A

Testicular torsion

358
Q

What do you want to avoid doing when prepping for the prescrotal approach?

A

Clipping or applying scrub to the scrotum (very sensitive)

359
Q

What side of the table do you stand on for a prescrotal castration?

A

The patient’s left

360
Q

Go through what suture sizes you would use for PDS of ligation?

A

0 for >15
2-0 for 10-15
3-0 for 2-10
4-0 for <2

361
Q

Where do you place the clamps in an open castration?

A

Fenestrate window between deferent duct (pampiniform plexus) and the vaginal tunic

362
Q

Where do you cut for a cat in a scrotal approach?

A

Incise over each testicle

363
Q

Where do you cut for a puppy in a scrotal approach?

A

In between each testicle

364
Q

What will poorly secured ligations on pedicles cause?

A

Hemoperitoneum (hemorrhage)

365
Q

What is a complication with an open castration?

A

Cremaster muscle hemorrhage

366
Q

If you can’t find the testicle, where is it always?

A

At the end of the deferent duct

367
Q

What are 2 things that crypts have a higher rate of?

A

Neoplasia
Torsion

368
Q

What is an odd complication with crypt castration?

A

Inadvertent complete prostatectomy
(Prostate is mistaken for testicle)

369
Q

What is the most common source of hemorrhage in spay/neuter?

A

Dropped pedicle

370
Q

What should you do before each closure?

A

Check gutter

371
Q

What are easy bedside diagnostics to identify hemorrhage?

A

PCV/TP
Blood pressure
FAST scan

372
Q

What does the PCV need to be on an abdominocentisis to consider hemorrhage?

A

> 10%
Or similar to peripheral

373
Q

Should you immediately jump to surgery if you think there may be hemorrhage?

A

No!

374
Q

What is first step if you identify there is hemorrhage?

A

Gain IV access and give fluid bolus

375
Q

What is a non surgical approach to treating the hemorrhage?

A

Place an abdominal compression bandage

376
Q

What is a seroma?

A

Accumulation of fluid within the dead space

377
Q

Is a seroma an infection

A

No

378
Q

What is the treatment for seroma?

A

Warm compression for 3 days

379
Q

What are the 3 parts to ovarian remnant syndrome

A

Estrus causing undesired behaviors
Risk of pyometras
Loss of protection from mammary tumors

380
Q

What should be the top differential for post spay patients with persistent signs of estrus?

A

Ovarian remnant syndrome

381
Q

After surgical removal of ovarian tissue, what should you do?

A

Submit to histopath for confirmation it was ovarian tissue

382
Q

What is seen on bloodwork with stump pyometras?

A

Neutropenic
Nonregenerative anemia
Azotemia

383
Q

What is treatment for stump pyo?

A

Broad spectrum antibiotics
Remove abscessed uterine tissue

384
Q

How common are mammary tumors in cats?

A

3rd most common

385
Q

How common are mammary tumors in intact dogs?

A

Most common!

386
Q

How old are dogs and cats with mammary tumors?

A

Old

387
Q

How much does being intact for a cat increase the chance for mammary tumors?

A

7x

388
Q

What age of spay has the most protection against developing a mammary tumor for cats?

A

before 6 months

389
Q

There is no protective effects of a spay for dogs after how many estrus cycles?

A

3

390
Q

Treatment with progesterone-like agents increases the risk by how much?

A

2.3x

391
Q

What percent of mammary tumors are malignant in dogs?

A

Roughly 50%

392
Q

What are the 4 parts of the staging / work up of mammary tumors?

A

FNA of masses
Thoracic rads
Abdominal US
Palpation of mammary glands

393
Q

What is the 50:50 rule of mammary tumors?

A

50% are malignant
50% that are malignant will metastasize or reoccur

394
Q

How do you treat a mass <1cm?

A

lumpectomy

395
Q

How do you treat a mass > 1 cm and central on mammary mass

A

Mammectomy

396
Q

How do you treat masses in adjacent glands?

A

Regional mastectomy

397
Q

How do you treat multiple masses in multiple glands on same side?

A

Unilateral chain mastectomy

398
Q

How do you treat masses in multiple glands bilaterally?

A

Bilateral chain mastectomy

399
Q

What is the only time we remove rectus fascia, partial or full-thickness body wall?

A

Radical mastectomy where they are fixed to body wall

400
Q

What is a stage 1 tumor?

A

<3cm

401
Q

What is a stage II tumor?

A

3-5cm

402
Q

What is a stage III tumor?

A

> 5cm

403
Q

What is a stage V tumor?

A

Any tumor but distant metastasis

403
Q

What is a stage IV tumor?

A

Any size mass but regional LN

404
Q

What is prognostic in cat’s mammary tumors?

A

Size

404
Q

What is 80:20 rule in cats?

A

80% of mammary tumors are malignant in cats

405
Q

What is the recommended treatment of cat mammary tumors?

A

Chain mastectomy

406
Q

OVH before 3rd estrus in dogs and before 6m in cats
Lumpectomy is not ok in cats
Size matters in mammary tumors >3cm is poor prognosis in cats and dogs

A
407
Q

Are inflammatory carcinomas a good prognosis?

A

NO! not surgical

408
Q

What’s the very first thing you should do when an obviously blocked cat comes in?

A

ECG
Monitor bradycardia

409
Q

How long does calcium gluconate work?

A

20-30 minutes

409
Q

What are 4 common ECG changed with hyperkalemia?

A

Prolonged P-R interval
Prolonged QRS
Spiked T wave
Absent P wave

410
Q

What should patient be hooked up to while being given calcium gluconate?

A

ECG

411
Q

What is the first thing that should be administered to a blocked cat?

A

Calcium gluconate

412
Q

What situation is terbutaline not good for?

A

Heart disease patients

413
Q

What can occur to potassium after resolution of obstruction?

A

Hypokalemia

413
Q

Are blocked cats acidotic or alkalitic?

A

Acidotic

414
Q

Can you use a classic tomcat catheter for urinary catheterization?

A

NO!

414
Q

What catheter is used for U catheterizing cats?

A

Mila

415
Q

Dogs require heavy sedation for urinary catheterization

A
416
Q

Is uroabdomen a surgical emergency?

A

No!

417
Q

How many calories should cats consume?

A

50kcal/kg

418
Q

What are 3 anti-nausea drugs?

A

Cerenia
Ondansetron
Mirtazapine

418
Q

What is the go-to for appetite stimulation in cats?

A

Mirtazapine

419
Q

What are 2 anti-emetics?

A

Ondansetrons
Mirtazapine

420
Q

How is mirtazapine administered?

A

transdermal

421
Q

What is the go to for dogs?

A

Capromorelin (Entyce)

422
Q

What is the equivalent to entyce for cats?

A

Elura

423
Q

Which form of mirtazapine has less side effects?

A

Transdermal

424
Q

What is the mechanism of action for Elura?

A

Gherkin agonist

425
Q

What are the side effects (2) for elura that causes a contraindication in CKD patients

A

Bradycardia and hypotension

426
Q

What is the most important thing to modify in a formulated diet for CKD patients?

A

Phosphorus

427
Q

If phosphorus is still high on phosphorus diets, what can be given?

A

Phosphorus binders

428
Q

Does protein need to be lower in CKD diets?

A

No

429
Q

What happens to FGF23 when fed an phosphorus limited diet?

A

Decreases

429
Q

Are nutritional or functional sources of phosphorus more bioavailable?

A

Functional sources

430
Q

What happens to FGF23 with higher IRIS staging

A

Tend to be higher

431
Q

In cats with lower FGF23 concentrations, do they tend to have higher or lower azotemia?

A

Lower!

Basically, lower FGF23 is better and cats on low phosphorus diets tend to have lower FGF23. GOOD!

432
Q

Tell me about the calcium to phosphorus ratio

A

Diets with a Ca:P ratio of less than 1 cause kidney damage

433
Q

Is inorganic or organic phosphates better?

A

Organic

434
Q

Are organic and inorganic phosphates labeled on the bag?

A

No!

435
Q

Too little calcium will cause renal damage

A
436
Q

What is the ideal range for Ca:Phos diet?

A

1.0:1.4

436
Q

What might tend to happen to calcium after eating a low phosphorus diet?

A

Development of hypercalcemia

437
Q

Does calcitriol (vitamin D) help cats with CKD?

A

No evidence

438
Q

What is functionally lost with kidney disease?

A

Ability to concentrate urine

439
Q

Due to the inability to concentration urine, what is caused?

A

Dehydration

440
Q

What does dehydration cause?

A

Inappetance, lethargy, weakness, constipation, stone formation, UTI

441
Q

What can the owner do to manage hydration (2)?

A

SQ fluids
Water fountains

442
Q

Cats with chronic kidney disease found to be at an increased risk of presenting for constipation

Significantly lower dedication frequency in CKD cats compared to healthy cats

A

Teach owner to use a fecal chart!

443
Q

Why do you need to manage hypokalemia with constipation associated with CKD?

A

Need potassium for GI movement

444
Q

How do you increase potassium in CKD patients

A

Pick a diet higher in potassium
Or supplement

445
Q

Should you pick potassium citrate or potassium gluconate as supplement?

A

Potassium citrate, its alkalinizing (usually CKD patients are acidotic)

446
Q

What negative things comes from colonic metabolism?

A

Protiens -> uremic toxins

447
Q

What are 2 drugs to help produce less uremic toxins?

A

Azodyl and porus one

448
Q

What is a benefit of porus one?

A

Can be sprinkled on food

449
Q

Systemic hypertension becomes a large issue with CKD

A
450
Q

What should you always check on cats with retinal lesions?

A

Their urine values

451
Q

When should you treat a cat for hypertension?

A

If its&raquo_space;200

451
Q

What is a stable drug to use for hypertension in cats with retinal damage?

A

Amlodipine

452
Q

What drug is the first choice for proteinuria in cats?

A

Telmisartan

453
Q

What percent of cats with CKD have anemia

A

Like 50%

454
Q

Does anemia increase with IRIS stage?

A

Yes

455
Q

What type of anemia is it?

A

Non-regenerative

456
Q

What are 2 medical treatments for CKD anemia?

A

Darbepoetin
Varenzin

456
Q

What is the current treatment of choice for CKD animals

A

Darbepoetin

457
Q

What is a downside to treating anemia caused by CKD with darbepoetin?

A

Expensive

458
Q

What should be done often with cats on darbypoieten?

A

Check for polycythemia
Hypertension!!

459
Q

You may also see iron deficincies in CKD cats

A

Can’t give oral iron supplements

459
Q

What are 3 reasons to remove warts on penis caused by bovine papilloma virus?

A

Reluctance to breed
Phimosis
Paraphimosis

459
Q

What is paraphimosis

A

Can’t retract penis

459
Q

What is phimosis

A

Can’t extend penis

460
Q

What are 3 ways to remove the penile warts?

A

Sharp dissection
Electrocaudery
CO2 laser

461
Q

What is preputial avulsion?

A

Separation of internal lamina from penis

462
Q

What is the recovery for preputial avulsion?

A

8 weeks sexual rest

463
Q

How do you treat a preputial prolapse?

A

Reduce edema
Replace prepuce

464
Q

What is a reefing procedure?

A

Prepucial resection and anastomosis

8 weeks sexual rest

465
Q

Does reefing procedure or preputial amputation have a better prognosis?

A

Reefing

466
Q
A
467
Q

When are vaginal prolapses?

A

Before calving

468
Q

When are rectal prolapses?

A

Before calving

469
Q

When are uterine prolapses?

A

After calving

469
Q

Which one of the prolapses are emergencies?

A

Uterine prolapse

470
Q

Why is the uterine prolapse an emergency an emergency?

A

Pulling on uterine artery

471
Q

Which one of the prolapses is hereditary?

A

Vaginal and Rectal

472
Q

What is first degree prolapse?

A

Only seen when cow is on ground

473
Q

What is second degree prolapse?

A

Vaginal floor protrudes all the time

474
Q

What is third degree prolapses?

A

Cervix and majority of vagina exposed

475
Q

What is fourth degree prolapse?

A

Chronic often with vaginal necrosis

476
Q

What epidural should be used?

A

Sacrococcygeal epidural

477
Q

What is an option to keep in during calving?

A

Modified Minchev

477
Q

What is considered normal loss for neonates?

A

10%

478
Q

What are sick neonates?

A

ALWAYS AN EMERGENCY

478
Q

What 5 things should the owner bring in?

A
  1. the entire litter
  2. the mom
  3. a way to keep them warm
  4. the dead pups
  5. data sheets on the pups
479
Q

*****What are the 4 H’s of sick neonates

A

Hypothermia
Hypovolemia
Hypoglycemia
Hypoxia

480
Q

What is fading puppy syndrome?

A

Litter was dying and we dont know why (lots of potential reasons)

481
Q

What can you not rely on to determine hydration status of pups?

A

Skin tent

481
Q

What is #2 cause of death in neonates/

A

Sepsis

482
Q

What are 2 ways to determine hydration status of pups?

A

MM color
USG (<1.020)

483
Q

What temp must pups be above to digest milk

A

94

484
Q

What is normal temp for pups

A

96-98

484
Q

What antibiotics need to be avoided in neonates?

A

Aminoglycosides
Tetracyclines

485
Q

What is the first line of treatment in pups?

A

Antibiotics
-Septic until proven otherwise

486
Q

When is gut closure from colostrum of pups?

A

12-16hrs

487
Q

What is the #1 cause of death in neonates?

A

Hypothermia

488
Q

What is neonatal isoerythrolysis (NI)

A

A blood type kittens born to B mother

489
Q

Where are testes at birth in horses?

A

Testis are inguinal

490
Q

How long does it take the gubernaculum to regress

A

first month of life

490
Q

How to treat NI?

A

Step nursing immediately
Blood transfusion

491
Q

What are 2 reasons to do a closed castration

A

Opens conduit to abdomen

Can force intestines through inguinal ring

492
Q

What should you give before castration of horse?

A

Tetanus vax

493
Q

What is the rule of thumb for pressure on emasculator?

A

1 minute for each year of life

494
Q

How long should a gelding be kept away after gelding?

A

30 days

Semen allegedly viable for 7 days

494
Q

What do you need to do after geldings?

A

Force exercise 30 minutes 1-2 times daily for 3-5 days

495
Q

Should you castrate descended testicle if you can’t find the other testicle?

A

No!!!

495
Q

What are the 2 types of crypts?

A

Inguinal retention
Abdominal retention

496
Q

What is the method of stopping hemorrhage ?

A

Pack with a gauze roll

497
Q

What should you do if eventuation occurs?

A

Wrap horse and refer

498
Q

If a hernia is reversible, it can be reduced multiple days per day for 3-6 months

A
499
Q

What is priapism

A

persistent erection

500
Q

What is paraphimosis

A

can’t retract

501
Q

What is more of an emergency?

A

Priapism

502
Q

How do you treat priapism?

A

Anticholinergic
Lavage of corpus cavernous
Removal of penis

503
Q

What is the most common genital tumor?

A

SCC

504
Q

How do you treat paraphimosis

A

Sling
Removal of penis

504
Q

How old is the bitch before you should consider a c section?

A

> 6 years

505
Q

What are 3 indications for small animal C section?

A

Prolonged gestation
Maternal toxemia
Dystocia
(elective)

506
Q

What size litters indicate C section?

A

<3 pups
>7 pups

507
Q

What breeds should you consider a c section with?

A

Brachycephalic (head size and pelvis size)

508
Q

Should you ever do a c section out of convenience?

A

NO!!!!

509
Q
A
509
Q

When should you perform an elective C section?

A

within 48 hours of natural partition

510
Q

When is the estimated due date?

A

63-65 days after LH surge

510
Q

How do you predict date of partition?

A

No single way
Use estimated date
Fetal maturation
Progesterone

510
Q

What is the normal fetal HR?

A

> 200

511
Q

When are the tails, teeth, and paws ossified?

A

roughly 4 days before birth

512
Q

What will progesterone be between within 12-48 hours of birth?

A

2-3ng/mL

Need to be above 2 to maintain pregnancy

513
Q

Why dont singletons trigger birth?

A

Fetal cortisol initiates birth, a singleton will not produce enough cortisol

514
Q

What are the 2 cardiovascula impacts on pregnancy?

A

Functional anemia (increased plasma volume)
Decreased BP

515
Q

What are the CNS effects from pregnancy?

A

Decreased MAC

516
Q

What local pain control measures should you take for a c section?

A

Line block with lidocaine

517
Q

Where is the incision made into the uterus?

A

Ventral midline incision

518
Q

How do you remove the umbilical cord from the pups?

A

Place 2 hemostatic clips and cut between

519
Q

What type of placenta does the canine placenta have?

A

Zonary

520
Q

What should you do if you get a macerate fetus? (stillborn)

A

Biopsy and culture placental sites and submit fetal tissue

521
Q

How can you safely provide pain control post C section?

A

carprofen

522
Q

What is the major goal of c section anesthesia?

A

Minimize effects of anesthetic drug

523
Q

What are the big 4 Hs of anesthesia?

A

Hypotension
Hypothermia
Hypoxemia
Hypoventilation

524
Q

What causes bradycardia in neonates?

A

Myocardial hypoxia

525
Q

Does atropine cross the placenta?

A

YES!

526
Q

What anticholanergic doesn’t cross the placenta?

A

!!!!Glycopyrrolate!!!

527
Q

Atropine has little effect on heart rate until the pip is about 14 days old

A

Doesn’t help to give pups atropine

528
Q

How is cardiac output increased (compensatory) during pregnancy?

A

Increase in HR and SV

529
Q

What is the equation for cardiac output?

A

CO = HR x SV

530
Q

What is the equation for blood pressure?

A

BP = CO x systemic vascular resistance

531
Q

What is the supine position?

A

Laying on the back

532
Q

What occurs in pregnancies when women are in the supine position?

A

Compression of vena cava and a decrease in preload (decrease in cardiac output)

533
Q

What is caused by a pregnancy?

A

Elevation on diaphragm

534
Q

What 3 things decrease as a result of elevation of diaphragm?

A

Functional residual capacity
Expiratory reserve volume
Residual volume

535
Q

Due to delayed gastric emptying, stomach may not be empty at time of surgery

A
536
Q

Pneumonia has been reported in _____ of dogs that died following c section.

A

50%

537
Q

What is the reason for decreased MAC during pregnancy?

A

Progesterone

538
Q

Can all of the premed drugs affect the neonate?

A

YES!!!!

539
Q

What drug groups are contraindicated in pregnancies?

A

Alpha-2s due to vasoconstriction

540
Q

If you must use alpha 2s, what should you do after induction?

A

Reversal

541
Q

What drugs should be avoided in dehydrated and/or hypotensive animals?

A

NSAIDS

542
Q

Alphax has been shown to have better APGAR after 1 hour but no difference with Propofol after 24 hours

A
543
Q

If you are administering an opioid, when should you give it/

A

After delivery of all neonates

544
Q

What patient position helps to reduce pressure on diaphragm?

A

Reverse trendelenburg

545
Q

Prior to recovery, what can you do to help with pain management?

A

Perform epidural (morphine PF)

546
Q

What needs to be given to the neonates if opioid, benzodiazepines, or dex was given to dam

A

Naloxone
Flumazenil
Atipamezole

547
Q

What is the acupuncture stimulatory point?

A

GV26

548
Q

What is an uncomplicated UTI?

A

UTI in a healthy animal and no underlying systemic conditions (easier to treat)

549
Q

What is a complicated UTI?

A

Usually anatomical abnormalities, systemic disease, or recurrent infection

550
Q

What is empirical therapy?

A

Treatment started before culture results

551
Q

What is a normal USG in cats?

A

Above 1.035

552
Q

What cuff size is chosen for BP?

A

30=40% circumference of limb

553
Q

How many BP measurements should be taken?

A

5-6
discard the first and average the rest

554
Q

What does a high anion gap mean?

A

Metabolic acidosis

555
Q

When should you IRIS stage?

A

When the patient is stable

556
Q

What appetite stimulant should a CKD patient be started on?

A

Mirataz

557
Q

What are most CKD diets supplemented with?

A

Potassium

558
Q

What hypertension drug should a CKD cat be put on?

A

Amlodipine

559
Q

What should be changed before starting on a phosphate binder?

A

Diet!

560
Q

What is a drug option form anemia in CKD patients?

A

Darbopoetin

561
Q

How long are cows in heat for?

A

6-12 hrs

562
Q

What is pgf2alpha

A

Prostaglandin

563
Q

What does progesterone?

A

Blocks heat and ovulation

564
Q

Where does progesterone come from?

A

The CL

565
Q

What does PGF do when administered?

A

Destroys CL and progesterone declines

566
Q

Where is estradiol produced?

A

In the follicle

567
Q

What induces ovulation?

A

LH surge

568
Q

What is the precursor to LH?

A

GnRH

569
Q

Where are the receptors for LH and FSH?

A

On the follicle

570
Q

How many calves are born per cow a year?

A

1

571
Q

How long is uterine involution?

A

30 days

572
Q

How long is estrus cycle?

A

21 days

573
Q

How long after LH surge is ovulation?

A

28h (1 day)

574
Q

What drug blocks ovulation?

A

Progesterone

575
Q

When is estradiol high?

A

When progesterone is low

576
Q

What are the 4 steps of ovsync

A

GnRH, 7 days later PG
2 days later GnRH, 16 h later AI

577
Q

First GnRH causes ovulation or lutes follicle present. PGF lyses any luteal tissue present. 2nd GnRH induces ovulation

A
578
Q

What does CIDR release?

A

GnRH

579
Q

Do we believe an owner when they say its time for the pup to give birth?

A

No!!

580
Q

What 3 things occur about 1-2 weeks before partition in dogs?

A

Clear/tan vulvar discharge
Anorexia or panting
Mammary development

581
Q

What happens to a pups body temp about 24 hrs prior to birth?

A

Drops 2 degrees
Never take a dog to C section based on temperature!

582
Q

What is the easiest and most reliable way to predict partition?

A

Serum progesterone

583
Q

What is stage I of parturition?

A

Cervical dilation
No contractions
Nesting/restless
Up to 12 hours

584
Q

What is stage II of parturition?

A

Water breaks and cervix dilates
NO FRANK BLOOD
Up to 4 hours until first pup and 2 hours between pups

585
Q

What is stage III of parturition?

A

Passage of placenta

586
Q

What if there is green vulvar discharge before pups?

A

BAD! Emergency c section

587
Q

***What is dose of oxytocin?

A

0.1-0.25mL

588
Q

How many times may you give oxytocin?

A

“3 strikes you’re out”

589
Q

What is controlled vaginal delivery

A

Under GA, no contractions

590
Q

What are the 2 maternal causes of dystocia?

A

Failure of expulsive forces
Obstruction of birth canal

591
Q

What are the 4 fetal causes of dystocia?

A

Failure to initiate birth
Fetopelvic disproportion
Fetal maldisposition
Fetal death

592
Q

What are the survival times for dystopias in mares, ruminants, dogs?

A

Mare - 30 minutes
Ruminants - 3-6 hours
Dogs 1-2 hours

593
Q

What direction do the front joints bend? Back joints?

A

Front - same direction
Back - opposite directions

594
Q

How long after foaling is a foal heat?

A

1 week

595
Q

How do you create more space for a calf?

A

Rotating the calf 45 degrees creates more area

596
Q
A

Treatment (2 decks)

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