Block 2 Flashcards
Which kidney is farther behind?
Left kidney (left behind)
What is a nephrotomy?
Cutting into the kidney
What are the 7 indications for a nephrotomy?
Renal calculi
Persistent hydronephrosis
Persistent hematuria
Mass / neoplasia
Trauma
Infection
Donation
What are the 3 highest risks for a nephrotomy?
Hemorrhage
Damage to kidney
Increased kidney values
Where do you ligate the ureter during a nephrectomy?
At the trigone
What are the 2 indications for a sub-ureteral bypass system (SUBs)
Ureteroliths within renal pelivis dilation
Ureteral stricture
What needle is used for SUBs?
Huber needles
What are the 3 complications with SUBS
Urine leakage
Encrusting of the nephrostomy tube or cystotomy tube
Infection
Describe how to perform a uretertomy?
Incise over inciting cause and remove stones
What are the 2 complications with ureterotomy?
Stricture and dehiscence
What does a ureteral stent do?
Placed from kidney to bladder to treat stones, strictures, or neoplasia
What are the 4 complications of ureteral stents?
Continued infection
Stent migration
Trauma to ureter
Urinary leakage
What is an ectopic ureter?
Ureter that is entering in abnormal location into bladder or directly into the urethra
What are extramural ectopic ureters?
Ectopic ureter that bypasses the bladder completely
What are the treatment options for extramural ectopic ureters?
Surgery only
What are the treatment options for intramural (enter bladder) ectopic ureters?
Laser ablation OR surgery
What are the 2 surgical options for ureteral reimplement?
End to side
Side to side
What is the non surgical approach to correcting a ectopic ureter?
Laser ablation
-Cystoscopy and a laser to tunnel to the level of the bladder
What is the surgery of the ectopic ureter called?
Neuorecterocystotomy
What does a end to side neuorecterocystotomy look like?
Cut ureter and implant via a stab incision into the bladder
What does a side to side neuorecterocystotomy look like?
Incise into bladder and through the bladder incise into the ureter
What are the 4 complications with these surgeries?
Strictures
Uroabdomen
Infections
Incontinence
Where do the ureters enter the bladder?
Dorsolaterally
Where does the vascular supply enter the bladder?
Dorsally
What is the main artery of the bladder?
Caudal vesical artery
What is really important to know about the anatomy of the bladder?
**Nerves, ureters, and blood supply of the bladder all enter dorsally!!!
What is the singular most common surgical bladder disease?
Urolithiasis
What can urolithiasis cause secondary?
UTIs
What are the top 3 most common surgical diseases of the bladder?
Urolithiasis
Trauma
Masses (polyps or neoplasia)
What are the 2 options for treatment of urolithiasis?
Medical and interventional
What is the medical therapy for urolithiasis?
Dissolution
What are the only 3 stones you can dissolve?
Struvite, urate, and cystine
What is lithotripsy?
Breaking apart with a laser
What is the minimum urethral size for lithotripsy?
5 French
What is the holding layer for the bladder?
Submucosa
How fast does the mucosa of the bladder heal?
5-7 days
How fast does it take for the bladder to get to full strength?
14-21 days
How much of the bladder can you take?
75%
Which direction of the bladder should you never cut?
On the dorsal side!
What is the most common bladder surgery?
Cystotomy
What suture type do you use for a cystotomy?
Monocryl
How many layers do you need to close the bladder?
Can do just the submucosa (holding layer)
What is another more advanced surgical option for urolithiasis?
PCCL = percutaneous cystolithotomy
What should you do immediatly post surgery for urolithiasis?
Radiographs!
What is seen on bloodwork for uroabdomen?
Azotemia
Dehydration (High USG, albumin, PCV/TP)
Metabolic acidosis
Hyperkalemia
What can you not use when comparing fluid in abdomen to blood when determining uroabdomen?
BUN, reaches even osmolality quickly
What should you see being HIGH in abdominal fluid in a uroabdomen compared to blood?
Creatinine and potassium
Where are masses most common in the bladder?
Trigone
What is the most common neoplasia of the bladder?
Transitional cell carcinoma
What is the widest diameter of male urethra?
2mm (pre and post prostatic)
What is diameter of male urethra at bulbourethral glands?
1.3mm
What is diameter of male urethra at end?
0.7mm
Are uroliths more common in dogs or cats?
Dogs
What is the most common surgical option for urethral uroliths?
urethrostomy (not urethrotomy)
What is a urethrotomy?
Creation of temporary opening in urethra
What type of urethrotomy/urethrostomy do dogs get?
Scrotal
What type of urethrotomy/urethrostomy do cats get?
Perineal
Why perform a urethrotomy?
If a stone can’t be pushed back
Why perform a urethrostomy?
Recurrent or persistent urethral obstruction
If you perform a urethrostomy, what must you do?
Neuter
For a perineal urethrostomy (cat), what level must be reached?
Bulbourethral gland
What does a urethrostomy not cure in male cats?
FIC!!
What 2 groups of dogs are most likely to have a urethral prolapse?
Brachycephalic dogs (English Bulldogs)
Intact males
What is a strong recommendation for a dog that has a persistent urethral prolapse?
Neuter
If a patient receives a urethropexy, what is an important complication that needs to be reduced?
Need to keep patient calm (ace and butorphanol) and can’t breed for 4-6 weeks
What percent of malignancies in dogs are attributed to bladder cancer?
2%
What is the most common bladder cancer in dogs and cats?
Transitional cell carcinoma
aka urothelial carcinoma
How do urinary tumor patients normally present?
With lower urinary tract signs - hematuria, stranguria, pollakiuria, dysuria
What is the most common area of the bladder to develop a tumor?
Trigone!
What are the 4 treatments for urinary tumors?
Surgery
NSAIDs
Radiation
Chemotherapy
What is an important thing to remember when performing neoplasia surgery in the bladder?
Potential for “seeding”
What is an NSAID that has been proven to work against urinary tumors?
Piroxicam (Feldene)
What are the 3 things that piroxicam does to decrease cancer
Induction of apoptosis of cancer cells
Inhibition of angiogenesis
Reduction in cell proliferation
What are the 2 other NSAIDs that are COX-2 inhibitors that have been shown to be as good as piroxicam?
Deracoxib and firocoxib
What is the chemotherapy drug that has the best response rate to urinary tumors?
Vinblastine
What was said to be the best option for treating neoplasia of the bladder?
Combination of chemotherapy and NSAID (piroxicam and miloxantrone)
What infection is higher in patients with urinary cancers?
UTI
What are the 2 most common isolates from urinary cancer UTIs?
E. coli and staph
What is a successful way to relieve an obstruction produced from the urinary neoplasia?
Urethral stent
This is a salvage procedure
Are urinary cancers usually treatable?
Usually no
What is the most common kidney neoplasia in young dogs?
Nephroblastoma
What is the renal tumor caused by a missense mutation in German Shepherds?
Renal cystadenocarcinoma
What is the most common renal cancer in cats?
Renal lymphoma
How is renal lymphoma most often treated?
Chemotherapy
What is the typical medical protocol for spays?
Opioid and sedative IM
Induction IV
Inhalant
NSAID
What drug is Zorbium
Buprenorphine - Partial mu agonist
How long does Zorbium take to take effect?
1-2 hours
How long does zorbium act for?
4 days
What is a good drug protocol for pig spays?
TKX + morphine
What do you need to be aggressive with during mastectomies?
Pain management, they are very painful!
What can be done post op to help with the pain from mastectomies?
Full mu, CRI of ket or fentanyl
What is high during a uroabdomen/
BUN, creatinine, potassium
Dehydration and metabolic acidosis
What drug is specifically good for goats undergoing cystotomies?
Benzodiazepines
If the procedure is especially painful, what should be considered?
a CRI
What are the 2 most common signalments for cows that have pyelonephritis?
Females
Less than 90 days post calving
What are the 3 risk factors for ruminants toward pyelonephritis?
Dystocia
Abortion
Post-partum infections
What is the primary agent in ruminants to cause pyelonephritis?
Corynebacterium renale
What are the 3 laboratory findings for pyelonephritis?
Leukocytosis
Hyperfibrinogenemia
Hyperglobulinemia
What are the 3 things that should be done for treatment of pyelonephritis?
Antibiotics - aggressive and long term
Diuresis - rehydrate and remove debris. Replace protein loss
Nephrectomy
Which antibiotic is best used for treatment of the pyelonephritis?
Penicillin
Should you continue to treat if it is bilateral pyelonephritis?
No!
Which flank should you approach the kidney from?
Either
What is the cause of amyloidosis?
Chronic inflammation
What is the treatment for amyloidosis?
There isnt one
What is possible after a nephrectomy for pyelonephritis?
Transient post-operative worsening of renal enzymes
What 2 species are the most common to have urolithiasis?
Goats and sheep
What is the main predisposing factor for a blockage?
Early castration
Testosterone on urethral diamteter
What is the most common type of stone in Ohio?
Struvite
What type of diet causes phosphorus based stones?
Grains
What type of diet causes calcium based stones?
Legumes
Which type of stone can you not see on radiographs?
Struvite
What is a risk factor for producing struvite stones/
Alkaline pH
What may be heard in severe blockage cases?
Arrhythmias
What drug group do you not want to give to blocked goats?
Alpha 2s - diuretic!
What position should you sit the blocked goat in?
On their rump
What type of stones can you seen on radiographs (3)
Calcium oxalate
Calcium carbonate
Silicate
What 3 markers do you expect to see on a blocked goat?
Creatinine
BUN
Potassium
What 3 things can you provide for medical management?
Ammonium chloride (will disolve struvite stones)
Acepromazine - muscle relaxer
Salt block to increase thirst
What are 4 decent options for pain management?
Morphine
Torb
Banamine
Meloxicam
What are 2 fluid options in blocked goats?
Calcium gluconate - cardioprotectant
Dextrose
What else can be provided to reduce concern of cystitis?
Penicillin or Naxcel (ceftiofur)
What are the steps to a urethral amputation?
Premed with midazolam and ketamine
Proceed with an angled cut
What is an option for stabilization until referral?
PTC or percutaneous tube cystotomy
What are 4 complications with PTCs?
Loss of bladder distention
Inadvertent gastrointestinal perforation
Balloon or tube malfunction
Security
What are the complications with perineal urethrostomy?
Urine scald
UTI
Stricture
Hemorrhage
What is a perineal urethrostomy?
They incise the urethra in the perineal area and pull it out as the new pee pee hole
What are 4 ways to prevent blocking goats?
Delayed castration
Increased water intake
Diet modification
Periodic dissolution
When should the umbilical stalk be dry by?
3-4 days
When should th umbilical stump fall off?
3-4 weeks
What should the umbilicus be treated with immediately after birth?
Either 7% iodine or 4% chlorhexidine
What is an external umbilical infection called?
Omphalitis
What is a urachal infection called?
Urachal abscess
What is an umbilical vein infection called?
Omphalophlebitis
What is an umbilical artery infection called?
Omphaloarteritis
What is the most common type of umbilical infection?
Omphalitis
What is the least common type of umbilical infection?
Omphaloarteritis
How do you treat an external abscess?
Lance it
Antibiotics (for 5-10 days) with cold hose therapy and some NSAIDS for pain
How far do you remove of the urachus?
All the way to the bladder apex
What clinical signs will a really sick obstructed patient present with?
Bradycardia
Hypotensive
Hypothermic
What is the largest concern for a really sick, blocked cat?
Hyperkalemia
What do you do to reduce the risk of cardio issues?
give calcium gluconate is bradycardia, hyperthermic, and hypotensive
How long does calcium gluconate last?
Only last 20-30 minutes
What should a patient be on before giving the calcium gluconate?
ECG
what is given after the calcium gluconate to actually reduce the blood potassium?
Insulin
What does the insulin do?
Opens the Na/K ATPase which moves the potassium intracellular
Why is calcium gluconate given before insulin?
It takes 15-30 minutes for insulin to take effect
What needs to be given in conjunction with insulin?
Dextrose
How does dextrose also help by itself?
The dextrose allows for endogenous insulin release
What is another thing you can use beside insulin to drive potassium into the cell?
Terbutaline
What is the mechanism for terbutaline?
B2 agonist
What are adverse side effects of terbutaline?
B2 spill over - tachycardia
B2 mediated vasodilation
What is another thing you can use beside terbutaline and insulin?
Sodium bicarbonate
What is the mechanism of action of sodium bicarbonate?
H/K antiporter
What does sodium bicarbonate also help to do?
Helps reduce metabolic acidosis
What are some adverse effects of sodium bicarbonate?
Decreased inionized calcium
Usually not required if appropriate fluid therapy is done. Alkalemia as bad if not worse than the academia if overshot
What is the next step after figuring out hyperkalemia?
Giving IV fluids
What does providing IV fluids help with?
Resolve azotemia, acidosis, hyperkalemia, dehydration, and hypovolemia
What does decompression provide for blocked cats?
Cystocentesis leading to immediate decompression and stabilization before catheterization
What should be used for the cystocentesis?
A 3 way stock cock
What should be done if when passing a urinary catheter, the cat is vocalizing or moving?
Give more drugs!
What mix of drugs should you not provide when catheterizing cat?
Full mu + benzo
Opioid + alphax + benzo
What do you hydropulsion with?
Saline lubricant
What catheter do you use for the urinary catheter?
Open tipped catheter (tomcat, slippery sam, or mila) - mila seems to be best
After passing a catheter and decompression, what is next?
Empty the bladder then flush with saline
Finally, suture the catheter in place and attach a sterile collection system
What do you do if you can’t pass a catheter?
Intermittent cystocentesis until surgery can be performed
How does uroabdomen present?
Severe azotemic, hyperkalemic, and acidotic
Does uroabdomen constitute a surgical emergency?
NO!
What should be done after uroabdomen patient is stabilized?
Given a urinary catheter
Keep bladder/abdomen empty
How long does a bladder defect take to heal?
3-5 days
Small tears may be conservatively managed but large tears will need surgery
Can bacteria be in urine without an infect?
Yes
Is urine naturally sterile?
No
What are 2 causes of bacteria in urine that aren’t UTIs?
FIC
Asymptomatic bacteriuria
What are the 2 groups that are most likely to get a UTI?
Spayed female dogs and cats over 10 years
Also incontinent animals and animals with urine retention
What are the 2 goals to therapeutic success of treating a UTI?
Eradication of infection
Avoidance of resistance to antibiotics
What are the 2 forms of acquired resistance?
Random DNA mutation
Plasmid transfer of DNA by transduction or conjugation
What percent of female dogs have subclinical bacteriuria
8.9%
There is a poor correlation between a UA and culture results. Lost of false positives
What are good antibiotics for UTI?
Amoxicillin or sulfas
What does MIC stand for?
Minimum inhibitory concentration
What does MPC stand for?
Mutant prevention concentration
How long must a patient be on a antibiotic
An adequate time above MIC
Most important thing is that T>MIC
Which antibiotics are more time reliant and need dosed more often?
B-lactams, cephalosporins, and macrolides
Which antibiotics are concentration dependent?
Fluroquinolones and aminoglycosides
If you have a recurrent or resistant UTI, what should your diagnostic approach be?
Culture
Find where infection is hiding
Can you use cranberry extract to help prevent UTIs?
Do not use in patients that create calcium oxalate stones!!
Is D-mannose ok?
Not recommended but safe
Is methenamine ok?
Transforms to formaldehyde in acidic urine
What type of dogs does the urethral sphincter mechanism incompetence occur in?
Spayed female dogs
What can be used for medical management of urethral sphincter mechanism incompetence?
Alpha agonists
Estrogen compounds
What is an alpha agonist that can be used for urethral sphincter mechanism incompetence?
Phenylpropanolamine (proin)
What are 3 side effects of proin?
Hypertension
Change in behavior
Change in appetite
There is an extended release proin but it isnt labeled for dogs under 10lbs
What are estrogen compounds that can be used to treat urethral sphincter mechanism incompetence?
DES
Estriol
What are the side effects of DES and estradiol?
Vulvar and mammary swelling
Attractiveness to male dogs
What are 2 surgical approaches to urethral sphincter mechanism incompetence
Artificial urethral sphincter
Injection of GAX collagen
What causes overactive bladders?
Low compliance of the detrusor muscle
What is the treatment for overactive bladders?
Anticholinergic drugs
What are the 3 anticholinergics that can treat low compliance?
Oxybutynin
Imipramine
Dicyclomine
What is FOO
functional outflow obstruction
Bladder contracts but urethra fails to relax
What is a strategy in males that suffer from FOO?
Neuter
What is a medical treatment for functional outflow obstruction (FOO)?
Alpha antagonist
What alpha antagonist can work to cure FOO?
Prozasin
Tamsulosin
Phenoxybenzamine
What is another option medically treating FOO?
Acepromazine, diazepam, anti-anxiety (trazodone/fluoxitine)
What is a good way to follow up and monitor FOO?
Measure residual volume
May also need to teach owner how to catheterize their dog
What is DUD?
Detrusor-urethral dyssynergia
Sphincter will contract after flow is initiated, leaving a large amount of residual urine
How to treat DUD?
Reducing smooth and striated muscle tone and reducing anxiety
What is the treatment for functional obstruction dysautonomia?
Bethanechol
Where is the lesion in automatic UMN bladder?
cranial to S1-S2
Where is the lesion in automatic LMN bladder?
At S1-S2
What is critical in an automatic LMN bladder?
Bladder is fully expressed and emptied
What sort of diet are PLN patients put on?
Protein and phosphate restricted diets
Do PLN only patients need the phosphate restriction?
No!
What is a supplement that can be given to protect kidneys in PLN patients?
Omega 3
What 2 things do omega 3s do to benefit PLN patients?
Reno protective
Suppress inflammation
If the kidney diet is already supplemented with omega 3s, do you need to supplement more?
No
What happens when RAAS is activated?
This is due to low flow within the kidney so the efferent arterial constricts to maintain GFR
What happens with chronic RAAS activation?
Endothelial damage that causes proteinuria and inflammation
What are the 3 drugs that block RAAS?
Angiotensin converting enzyme inhibitor (ACEi)
Angiotensin receptor blockers (ARB)
Aldosterone antagonist
With the use of ACE inhibitors and the decrease of GFR, what do you expect to see as a result?
Azotemia
What is better between ACEi and angiotensin receptor blockers?
ARBs
What ARB drug is on the market?
Telmisartan
Since aldosterone triggers the kidney to excrete potassium, what do you expect to see with ACEi and ARB?
An increase in serum potassium (hyperkalemia)
What are 2 commercial ACE inhibitors?
Enalapril
Benazepril
What should be checked 2 weeks after starting these medications?
Blood pressure
Chemistry panel (azotemia and potassium)
What protein is lost in proteinuria?
Albumin
What happens with hypoalbuminemia?
Differences in oncotic pressure that allows plasma water to leak into the abdomen (ascites)
What side effect do you need to be hyperaware of while using a diuretic and an ACEi/ARB?
Dehydration causing serious kidney damage
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
What is the mechanism of action of furosemide?
NaKCl pump blocker in loop of Henle
What are the 2 diuretic options/
Furosemide
Spironolactone
What is something that furosemide can cause?
Loss of potassium
What is the mechanism of action of spironolactone?
Aldosterone antagonist
What is a concern for spironolactone?
It is potassiums sparing
Patients that are on an ACEi or an ARB that may already be hyperkalemic may have issues here
What is often paired with RAAS inhibitor drugs to control hypertension?
Amlodipine
(hydralazine is another)
What is the mechanism of action of amlodipine?
Ca channel blocker
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)
What immunosuppressive drug does she like for PLN?
Mycophenolate
What is an issue with PLN to do with clotting?
Decreased clotting time due to loss of antithrombin III
What is the most effective treatment of AKI?
Careful fluid management
What 2 phases are treatment most successful in AKI?
Induction and extension phases
what is the average fluid loss per day in dogs?
22 mL/kg/day
What is the primary sensible fluid loss?
Urine
What is an amount less than needed to excrete was products?
Oliguria ( <0.5 mL/kg/hr)
What is the normal need to execute products?
Nonoliguria (0.5-2.0)
What is maintenance fluid therapy?
66mL/kg/day
Can you give excess fluids to force diuresis?
No!
What is the ins and outs method in AKI?
Matching the amount put in to the amount that comes out
What are the 3 components to volume calculation?
Insensible loss (respiration and normal stool)
Urine volume replacement
Ongoing loss (V+, D+, body cavity drainage)
What is the average insensible loss?
22 ml/kg/day
What happens after administration of crystalloid fluid?
80% will move into the interstitium causing edema leading to decreased oxygen and metabolite diffusion
What is the shock dose of crystalloids in dogs? cats?
60-90 ml/kg
45-60 ml/kg
1/4 is given over 5 to 15 min
What is the formula for correcting dehydration?
body weight x estimated % dehydration = fluid deficit in L
What percent dehydrated are apparently normal patients assumed to be?
5%
When should a colloid solution be given?
If hypoalbuminemia is present
Should synthetic colloids be used?
No! Associated with a higher risk of AKI
Do diuretics to increase urine output improve the outcome of AKI?
No!
Do the use of diuretics to treat over hydration have a benefit?
Yes
What is a good diuretic to use?
Mannitol
Furosemide should not be given to patients with amino glycoside-induced AKI
What may be seen in uremic patients when assessing hydration status?
Dry mouth (xerostomia)
What is the amount of urine production ion a healthy animal?
1-2 ml/kg/hr
What is a good way to determine urine volume?
Placing an indwelling catheter (most precise method)
What may be the only sign of FIC?
Periuria
What is the ratio of male to female cats with FIC?
Roughly equal
What is the ratio of male to female cats with FIC when blocked?
2:1
What are 2 main risk factors for cats with FIC?
Overweight and indoor only
What is the best way to treat FIC?
Decrease stress in the home
What are ways to decrease stress in the home?
multiple food places, waters, and litter boxes
What are the 3 parts to the 3 pronged approach for FIC?
Decrease stressors
Water and food
Increase natural behavior
What about water can be changed?
Increase water intake
Goal of USG <1.030
Is there evidence of efficacy of using NSAIDS or steroids with FIC?
NO!
What are some medical therapy options?
Usually daily pilling causes more stress
During a flare up can use gabapentin
Fluoxetine can be used daily to reduce flares
How many FIC cats recur?
40-60%
What shape are struvites?
rectangle
Are struvites dissolvable?
Yes
Where is the most common area to see struvite?
Bladder
What are the 3 predisposing dietary factors?
High Mg
High Phosphorus
Low quality foods
What should the pH of the urine be to help dissolve the struvite?
Low!!
What food should you feed to help dissolve then prevent struvite?
Hills c/d
What percentage of stones are struvite in dogs?
50%
What sex gets struvite more often?
Female
Is struvite associated with UTI from staph?
YES!
What should you be aware of as dissolution of struvite continues?
Bacteria!
What stones tend to develop in acidic urine?
Calcium oxalate
Is there a sex predilection in cats?
No
Should you treat with antibitoics throughout the stone dissolution?
Yes + 1 month
Do Calcium Oxalate dissolve?
Nope
What is the most common stone in cats?
Calcium oxalate
How do you remove CaOx stones?
Have to physically remove
What are 2 ways to decrease chance of developing CaOx stones?
Increase water intake
Stay away from acidifying diets
What supplement should you avoid giving in cats for CaOx stones?
Vitamin C
What dogs get CaOx stones?
Old dogs
in cats and dogs with urate stones, what should you look for?
Hepatic dysfunction
Are urate stones dissolvable in cats?
No
What diet should patients with urate stone be on?
Low protein diets
What do Dalmatians not do?
Do not convert uric acid to allantoin
Urate stones much more common in Dalmatians
are urate stones dissolvable in dogs?
Yeah
What pH should the urine maintain for most stones?
Neutral
How many types of cystine mutations are there
3
What should you do to avoid the cystine mutation complications?
Neuter!
Do cystine show up on rads?
No! Use ultrasound
What is the most important factor in prevention of stones?
Dilute urine
USG < 1.030
What is a less invasive method of removing stones?
Lithotripsy - laser followed by hydropulsion
Not useful with cystine stones
Are nephroliths usually removed in SA?
No unless recurrent UTI
What is the most common cause of ureteral obstruction in cats?
Ureteroliths (95% CaOx)
How long does it take to cause permanent renal impairment?
4 weeks
Big kidney little kidney
What is the first step in medical management of stones?
IV fluid diuresis
What is IV fluid diuresis?
Increase of fluids to push the stone through (Very painful_
What does IV fluid diuresis help to do?
Stabilize patient, reduce azotemia, improve perfusion
What are 2 drugs that will help to relax the ureter?
Prozasin (alpha antagonist)
Tamsulosin (alpha 1 A)
What is a side effect of prozasin?
Risk of hypotension
What pain control can you use?
Gabapentin
Opioids
How many cats did the medical management of diuresis work on?
7/52 (not a lot)
What are 2 surgical management options for ureter stones?
Feline ureteral stenting
Subcutaneous ureteral bypass
What are the steps in inseminating a mare
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
What type of semen to bovine AI give?
Exclusively frozen
Does frozen or cooled semen require more precise timing?
Frozen
How long does frozen seem last after being thawed?
12-24 hours
How long can cooled semen be stored?
Up to 48 hours
Where is the sit of insemination of horses?
Body of the uterus
Where is the site of insemination of cows?
Body of the uterus
Where is the site of insemination of dogs?
Vagina (fresh or cooled) or body of the uterus (fresh, cooled, or frozen)
What is the success rate of cow AI? Equine? Canine?
60%
70% (fresh, cooled) 50% (frozen)
90% (fresh, cooled) 60% (frozen)
How long is proestrus in dogs?
9 days
How long is estrus in dogs?
9 days
What is day 0 in dogs?
Start of estrus or at luteal surge
How can you determine if a bitch is in heat from a vaginal cytology?
If there are cornified cells (cells look like corn flakes)
Is it normal for there to be intracellular bacteria for a dog in heat?
Yes!!
How is ovulation confirmed in a bitch using progesterone?
If the progesterone has risen by 3-4 ng/mL
How many days after the LH surge does the bitch ovulate?
Roughly 48 hours (2 days)
In a vaginoscopy, how will the vagina appear during estrus?
dried up
Day 0 - LH surge
Day 2 - Ovulation
Day 4 - Fertile period
Where must frozen semen be placed in bitches?
In the uterus
When do you inseminate with the frozen semen?
5-6 days after LH surge
What two species are pseudopregnancies clinically relevant in?
Dogs and goats
What is another name for pseudopregnancy?
Cloudburst
What can you give dog to prevent stimulation of mammaary glands?
Prolactin antagonist
How long does pseudopregnancy in dog take to resolve?
4-8 weeks
How do you treat cloudburst (pseudopregnancy in goats)
May resolve on own
Give prostaglandin
1 injection - 50% resolution
2 injections - 95% resolution
3 injections 100% resolution
What will happen in subsequent cycles for goats?
Only 20-50% fertility in subsequent cycles
What is the most common cause of obstruction in dogs vs cats
Dogs - stones
Cats - FIC
How do you terminate a mare pregnancy before 35 days?
Single PGF2alpha injection
How do you terminate a mare pregnancy 35-120 days?
3-5 daily injections of PGF2alpha
How do you terminate a cattle pregnancy before 150 days?
Prostaglandin
How do you terminate a cattle pregnancy after 150 days?
Dexamethasone
What is the best option for termination of pregnancy in dogs?
Spay
What percent of bitches aren’t pregnancy after a single breeding?
62%
What canine pregnancy termination tactic is no longer used!!!!
Estrogens!! “Mismate shot”
What is the mismate shot that works?
Prostaglandin shot
What do you have to be aware about of the prostaglandin shots?
Ensure pregnancy, it makes the dog really sick
Single dose is not enough!
Prostaglandins must be administered until abortion is complete. They can abort some but whelp others
What is another injection that can be given. What is the downside?
Glucocorticoids (dexamethasone)
Downside is that live fetuses may pass
What are the positives of glucocorticoids (dex)?
Inexpensive
Preserves future fertility
80% effective
Begin after day 35, if above day 50, live, non-viable pups will be delivered
What is an emergency reason for castration
Testicular torsion
What do you want to avoid doing when prepping for the prescrotal approach?
Clipping or applying scrub to the scrotum (very sensitive)
What side of the table do you stand on for a prescrotal castration?
The patient’s left
Go through what suture sizes you would use for PDS of ligation?
0 for >15
2-0 for 10-15
3-0 for 2-10
4-0 for <2
Where do you place the clamps in an open castration?
Fenestrate window between deferent duct (pampiniform plexus) and the vaginal tunic
Where do you cut for a cat in a scrotal approach?
Incise over each testicle
Where do you cut for a puppy in a scrotal approach?
In between each testicle
What will poorly secured ligations on pedicles cause?
Hemoperitoneum (hemorrhage)
What is a complication with an open castration?
Cremaster muscle hemorrhage
If you can’t find the testicle, where is it always?
At the end of the deferent duct
What are 2 things that crypts have a higher rate of?
Neoplasia
Torsion
What is an odd complication with crypt castration?
Inadvertent complete prostatectomy
(Prostate is mistaken for testicle)
What is the most common source of hemorrhage in spay/neuter?
Dropped pedicle
What should you do before each closure?
Check gutter
What are easy bedside diagnostics to identify hemorrhage?
PCV/TP
Blood pressure
FAST scan
What does the PCV need to be on an abdominocentisis to consider hemorrhage?
> 10%
Or similar to peripheral
Should you immediately jump to surgery if you think there may be hemorrhage?
No!
What is first step if you identify there is hemorrhage?
Gain IV access and give fluid bolus
What is a non surgical approach to treating the hemorrhage?
Place an abdominal compression bandage
What is a seroma?
Accumulation of fluid within the dead space
Is a seroma an infection
No
What is the treatment for seroma?
Warm compression for 3 days
What are the 3 parts to ovarian remnant syndrome
Estrus causing undesired behaviors
Risk of pyometras
Loss of protection from mammary tumors
What should be the top differential for post spay patients with persistent signs of estrus?
Ovarian remnant syndrome
After surgical removal of ovarian tissue, what should you do?
Submit to histopath for confirmation it was ovarian tissue
What is seen on bloodwork with stump pyometras?
Neutropenic
Nonregenerative anemia
Azotemia
What is treatment for stump pyo?
Broad spectrum antibiotics
Remove abscessed uterine tissue
How common are mammary tumors in cats?
3rd most common
How common are mammary tumors in intact dogs?
Most common!
How old are dogs and cats with mammary tumors?
Old
How much does being intact for a cat increase the chance for mammary tumors?
7x
What age of spay has the most protection against developing a mammary tumor for cats?
before 6 months
There is no protective effects of a spay for dogs after how many estrus cycles?
3
Treatment with progesterone-like agents increases the risk by how much?
2.3x
What percent of mammary tumors are malignant in dogs?
Roughly 50%
What are the 4 parts of the staging / work up of mammary tumors?
FNA of masses
Thoracic rads
Abdominal US
Palpation of mammary glands
What is the 50:50 rule of mammary tumors?
50% are malignant
50% that are malignant will metastasize or reoccur
How do you treat a mass <1cm?
lumpectomy
How do you treat a mass > 1 cm and central on mammary mass
Mammectomy
How do you treat masses in adjacent glands?
Regional mastectomy
How do you treat multiple masses in multiple glands on same side?
Unilateral chain mastectomy
How do you treat masses in multiple glands bilaterally?
Bilateral chain mastectomy
What is the only time we remove rectus fascia, partial or full-thickness body wall?
Radical mastectomy where they are fixed to body wall
What is a stage 1 tumor?
<3cm
What is a stage II tumor?
3-5cm
What is a stage III tumor?
> 5cm
What is a stage V tumor?
Any tumor but distant metastasis
What is a stage IV tumor?
Any size mass but regional LN
What is prognostic in cat’s mammary tumors?
Size
What is 80:20 rule in cats?
80% of mammary tumors are malignant in cats
What is the recommended treatment of cat mammary tumors?
Chain mastectomy
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
Are inflammatory carcinomas a good prognosis?
NO! not surgical
What’s the very first thing you should do when an obviously blocked cat comes in?
ECG
Monitor bradycardia
How long does calcium gluconate work?
20-30 minutes
What are 4 common ECG changed with hyperkalemia?
Prolonged P-R interval
Prolonged QRS
Spiked T wave
Absent P wave
What should patient be hooked up to while being given calcium gluconate?
ECG
What is the first thing that should be administered to a blocked cat?
Calcium gluconate
What situation is terbutaline not good for?
Heart disease patients
What can occur to potassium after resolution of obstruction?
Hypokalemia
Are blocked cats acidotic or alkalitic?
Acidotic
Can you use a classic tomcat catheter for urinary catheterization?
NO!
What catheter is used for U catheterizing cats?
Mila
Dogs require heavy sedation for urinary catheterization
Is uroabdomen a surgical emergency?
No!
How many calories should cats consume?
50kcal/kg
What are 3 anti-nausea drugs?
Cerenia
Ondansetron
Mirtazapine
What is the go-to for appetite stimulation in cats?
Mirtazapine
What are 2 anti-emetics?
Ondansetrons
Mirtazapine
How is mirtazapine administered?
transdermal
What is the go to for dogs?
Capromorelin (Entyce)
What is the equivalent to entyce for cats?
Elura
Which form of mirtazapine has less side effects?
Transdermal
What is the mechanism of action for Elura?
Gherkin agonist
What are the side effects (2) for elura that causes a contraindication in CKD patients
Bradycardia and hypotension
What is the most important thing to modify in a formulated diet for CKD patients?
Phosphorus
If phosphorus is still high on phosphorus diets, what can be given?
Phosphorus binders
Does protein need to be lower in CKD diets?
No
What happens to FGF23 when fed an phosphorus limited diet?
Decreases
Are nutritional or functional sources of phosphorus more bioavailable?
Functional sources
What happens to FGF23 with higher IRIS staging
Tend to be higher
In cats with lower FGF23 concentrations, do they tend to have higher or lower azotemia?
Lower!
Basically, lower FGF23 is better and cats on low phosphorus diets tend to have lower FGF23. GOOD!
Tell me about the calcium to phosphorus ratio
Diets with a Ca:P ratio of less than 1 cause kidney damage
Is inorganic or organic phosphates better?
Organic
Are organic and inorganic phosphates labeled on the bag?
No!
Too little calcium will cause renal damage
What is the ideal range for Ca:Phos diet?
1.0:1.4
What might tend to happen to calcium after eating a low phosphorus diet?
Development of hypercalcemia
Does calcitriol (vitamin D) help cats with CKD?
No evidence
What is functionally lost with kidney disease?
Ability to concentrate urine
Due to the inability to concentration urine, what is caused?
Dehydration
What does dehydration cause?
Inappetance, lethargy, weakness, constipation, stone formation, UTI
What can the owner do to manage hydration (2)?
SQ fluids
Water fountains
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
Teach owner to use a fecal chart!
Why do you need to manage hypokalemia with constipation associated with CKD?
Need potassium for GI movement
How do you increase potassium in CKD patients
Pick a diet higher in potassium
Or supplement
Should you pick potassium citrate or potassium gluconate as supplement?
Potassium citrate, its alkalinizing (usually CKD patients are acidotic)
What negative things comes from colonic metabolism?
Protiens -> uremic toxins
What are 2 drugs to help produce less uremic toxins?
Azodyl and porus one
What is a benefit of porus one?
Can be sprinkled on food
Systemic hypertension becomes a large issue with CKD
What should you always check on cats with retinal lesions?
Their urine values
When should you treat a cat for hypertension?
If its»_space;200
What is a stable drug to use for hypertension in cats with retinal damage?
Amlodipine
What drug is the first choice for proteinuria in cats?
Telmisartan
What percent of cats with CKD have anemia
Like 50%
Does anemia increase with IRIS stage?
Yes
What type of anemia is it?
Non-regenerative
What are 2 medical treatments for CKD anemia?
Darbepoetin
Varenzin
What is the current treatment of choice for CKD animals
Darbepoetin
What is a downside to treating anemia caused by CKD with darbepoetin?
Expensive
What should be done often with cats on darbypoieten?
Check for polycythemia
Hypertension!!
You may also see iron deficincies in CKD cats
Can’t give oral iron supplements
What are 3 reasons to remove warts on penis caused by bovine papilloma virus?
Reluctance to breed
Phimosis
Paraphimosis
What is paraphimosis
Can’t retract penis
What is phimosis
Can’t extend penis
What are 3 ways to remove the penile warts?
Sharp dissection
Electrocaudery
CO2 laser
What is preputial avulsion?
Separation of internal lamina from penis
What is the recovery for preputial avulsion?
8 weeks sexual rest
How do you treat a preputial prolapse?
Reduce edema
Replace prepuce
What is a reefing procedure?
Prepucial resection and anastomosis
8 weeks sexual rest
Does reefing procedure or preputial amputation have a better prognosis?
Reefing
When are vaginal prolapses?
Before calving
When are rectal prolapses?
Before calving
When are uterine prolapses?
After calving
Which one of the prolapses are emergencies?
Uterine prolapse
Why is the uterine prolapse an emergency an emergency?
Pulling on uterine artery
Which one of the prolapses is hereditary?
Vaginal and Rectal
What is first degree prolapse?
Only seen when cow is on ground
What is second degree prolapse?
Vaginal floor protrudes all the time
What is third degree prolapses?
Cervix and majority of vagina exposed
What is fourth degree prolapse?
Chronic often with vaginal necrosis
What epidural should be used?
Sacrococcygeal epidural
What is an option to keep in during calving?
Modified Minchev
What is considered normal loss for neonates?
10%
What are sick neonates?
ALWAYS AN EMERGENCY
What 5 things should the owner bring in?
- the entire litter
- the mom
- a way to keep them warm
- the dead pups
- data sheets on the pups
*****What are the 4 H’s of sick neonates
Hypothermia
Hypovolemia
Hypoglycemia
Hypoxia
What is fading puppy syndrome?
Litter was dying and we dont know why (lots of potential reasons)
What can you not rely on to determine hydration status of pups?
Skin tent
What is #2 cause of death in neonates/
Sepsis
What are 2 ways to determine hydration status of pups?
MM color
USG (<1.020)
What temp must pups be above to digest milk
94
What is normal temp for pups
96-98
What antibiotics need to be avoided in neonates?
Aminoglycosides
Tetracyclines
What is the first line of treatment in pups?
Antibiotics
-Septic until proven otherwise
When is gut closure from colostrum of pups?
12-16hrs
What is the #1 cause of death in neonates?
Hypothermia
What is neonatal isoerythrolysis (NI)
A blood type kittens born to B mother
Where are testes at birth in horses?
Testis are inguinal
How long does it take the gubernaculum to regress
first month of life
How to treat NI?
Step nursing immediately
Blood transfusion
What are 2 reasons to do a closed castration
Opens conduit to abdomen
Can force intestines through inguinal ring
What should you give before castration of horse?
Tetanus vax
What is the rule of thumb for pressure on emasculator?
1 minute for each year of life
How long should a gelding be kept away after gelding?
30 days
Semen allegedly viable for 7 days
What do you need to do after geldings?
Force exercise 30 minutes 1-2 times daily for 3-5 days
Should you castrate descended testicle if you can’t find the other testicle?
No!!!
What are the 2 types of crypts?
Inguinal retention
Abdominal retention
What is the method of stopping hemorrhage ?
Pack with a gauze roll
What should you do if eventuation occurs?
Wrap horse and refer
If a hernia is reversible, it can be reduced multiple days per day for 3-6 months
What is priapism
persistent erection
What is paraphimosis
can’t retract
What is more of an emergency?
Priapism
How do you treat priapism?
Anticholinergic
Lavage of corpus cavernous
Removal of penis
What is the most common genital tumor?
SCC
How do you treat paraphimosis
Sling
Removal of penis
How old is the bitch before you should consider a c section?
> 6 years
What are 3 indications for small animal C section?
Prolonged gestation
Maternal toxemia
Dystocia
(elective)
What size litters indicate C section?
<3 pups
>7 pups
What breeds should you consider a c section with?
Brachycephalic (head size and pelvis size)
Should you ever do a c section out of convenience?
NO!!!!
When should you perform an elective C section?
within 48 hours of natural partition
When is the estimated due date?
63-65 days after LH surge
How do you predict date of partition?
No single way
Use estimated date
Fetal maturation
Progesterone
What is the normal fetal HR?
> 200
When are the tails, teeth, and paws ossified?
roughly 4 days before birth
What will progesterone be between within 12-48 hours of birth?
2-3ng/mL
Need to be above 2 to maintain pregnancy
Why dont singletons trigger birth?
Fetal cortisol initiates birth, a singleton will not produce enough cortisol
What are the 2 cardiovascula impacts on pregnancy?
Functional anemia (increased plasma volume)
Decreased BP
What are the CNS effects from pregnancy?
Decreased MAC
What local pain control measures should you take for a c section?
Line block with lidocaine
Where is the incision made into the uterus?
Ventral midline incision
How do you remove the umbilical cord from the pups?
Place 2 hemostatic clips and cut between
What type of placenta does the canine placenta have?
Zonary
What should you do if you get a macerate fetus? (stillborn)
Biopsy and culture placental sites and submit fetal tissue
How can you safely provide pain control post C section?
carprofen
What is the major goal of c section anesthesia?
Minimize effects of anesthetic drug
What are the big 4 Hs of anesthesia?
Hypotension
Hypothermia
Hypoxemia
Hypoventilation
What causes bradycardia in neonates?
Myocardial hypoxia
Does atropine cross the placenta?
YES!
What anticholanergic doesn’t cross the placenta?
!!!!Glycopyrrolate!!!
Atropine has little effect on heart rate until the pip is about 14 days old
Doesn’t help to give pups atropine
How is cardiac output increased (compensatory) during pregnancy?
Increase in HR and SV
What is the equation for cardiac output?
CO = HR x SV
What is the equation for blood pressure?
BP = CO x systemic vascular resistance
What is the supine position?
Laying on the back
What occurs in pregnancies when women are in the supine position?
Compression of vena cava and a decrease in preload (decrease in cardiac output)
What is caused by a pregnancy?
Elevation on diaphragm
What 3 things decrease as a result of elevation of diaphragm?
Functional residual capacity
Expiratory reserve volume
Residual volume
Due to delayed gastric emptying, stomach may not be empty at time of surgery
Pneumonia has been reported in _____ of dogs that died following c section.
50%
What is the reason for decreased MAC during pregnancy?
Progesterone
Can all of the premed drugs affect the neonate?
YES!!!!
What drug groups are contraindicated in pregnancies?
Alpha-2s due to vasoconstriction
If you must use alpha 2s, what should you do after induction?
Reversal
What drugs should be avoided in dehydrated and/or hypotensive animals?
NSAIDS
Alphax has been shown to have better APGAR after 1 hour but no difference with Propofol after 24 hours
If you are administering an opioid, when should you give it/
After delivery of all neonates
What patient position helps to reduce pressure on diaphragm?
Reverse trendelenburg
Prior to recovery, what can you do to help with pain management?
Perform epidural (morphine PF)
What needs to be given to the neonates if opioid, benzodiazepines, or dex was given to dam
Naloxone
Flumazenil
Atipamezole
What is the acupuncture stimulatory point?
GV26
What is an uncomplicated UTI?
UTI in a healthy animal and no underlying systemic conditions (easier to treat)
What is a complicated UTI?
Usually anatomical abnormalities, systemic disease, or recurrent infection
What is empirical therapy?
Treatment started before culture results
What is a normal USG in cats?
Above 1.035
What cuff size is chosen for BP?
30=40% circumference of limb
How many BP measurements should be taken?
5-6
discard the first and average the rest
What does a high anion gap mean?
Metabolic acidosis
When should you IRIS stage?
When the patient is stable
What appetite stimulant should a CKD patient be started on?
Mirataz
What are most CKD diets supplemented with?
Potassium
What hypertension drug should a CKD cat be put on?
Amlodipine
What should be changed before starting on a phosphate binder?
Diet!
What is a drug option form anemia in CKD patients?
Darbopoetin
How long are cows in heat for?
6-12 hrs
What is pgf2alpha
Prostaglandin
What does progesterone?
Blocks heat and ovulation
Where does progesterone come from?
The CL
What does PGF do when administered?
Destroys CL and progesterone declines
Where is estradiol produced?
In the follicle
What induces ovulation?
LH surge
What is the precursor to LH?
GnRH
Where are the receptors for LH and FSH?
On the follicle
How many calves are born per cow a year?
1
How long is uterine involution?
30 days
How long is estrus cycle?
21 days
How long after LH surge is ovulation?
28h (1 day)
What drug blocks ovulation?
Progesterone
When is estradiol high?
When progesterone is low
What are the 4 steps of ovsync
GnRH, 7 days later PG
2 days later GnRH, 16 h later AI
First GnRH causes ovulation or lutes follicle present. PGF lyses any luteal tissue present. 2nd GnRH induces ovulation
What does CIDR release?
GnRH
Do we believe an owner when they say its time for the pup to give birth?
No!!
What 3 things occur about 1-2 weeks before partition in dogs?
Clear/tan vulvar discharge
Anorexia or panting
Mammary development
What happens to a pups body temp about 24 hrs prior to birth?
Drops 2 degrees
Never take a dog to C section based on temperature!
What is the easiest and most reliable way to predict partition?
Serum progesterone
What is stage I of parturition?
Cervical dilation
No contractions
Nesting/restless
Up to 12 hours
What is stage II of parturition?
Water breaks and cervix dilates
NO FRANK BLOOD
Up to 4 hours until first pup and 2 hours between pups
What is stage III of parturition?
Passage of placenta
What if there is green vulvar discharge before pups?
BAD! Emergency c section
***What is dose of oxytocin?
0.1-0.25mL
How many times may you give oxytocin?
“3 strikes you’re out”
What is controlled vaginal delivery
Under GA, no contractions
What are the 2 maternal causes of dystocia?
Failure of expulsive forces
Obstruction of birth canal
What are the 4 fetal causes of dystocia?
Failure to initiate birth
Fetopelvic disproportion
Fetal maldisposition
Fetal death
What are the survival times for dystopias in mares, ruminants, dogs?
Mare - 30 minutes
Ruminants - 3-6 hours
Dogs 1-2 hours
What direction do the front joints bend? Back joints?
Front - same direction
Back - opposite directions
How long after foaling is a foal heat?
1 week
How do you create more space for a calf?
Rotating the calf 45 degrees creates more area
