Elimination & Detox 2: Sx of UT Flashcards
why is it IMPORTANT that the KIDNEYS are RETROPERITONEAL?
because they’re in this THIRD SPACE, may be showing MORE SUBTLE CLINICAL SIGNS because FLUID CAN LEAK INTO THERE BEFORE IT BECOMES A BIG SYSTEMIC PROBLEM
___ are prone to the BLADDER MOVING POSITION depending on HOW FULL IT IS, while ___ have BLADDER STAY IN SAME POSITION in the ___ ___
DOGS = MOVE
CATS = SAME POSITION in CAUDAL ABDOMEN
LIGAMENTS of the BLADDER…
VENTRAL = ???
LATERAL..
–> what does it ATTACH?
–> WHY IS IT IMPORTANT FOR SURGEONS?
where do BLOOD & NERVE SUPPLIES ENTER the BLADDER?
VENTRAL ligament = connects BLADDER to LINEA ALBA & PELVIC SYMPHYSIS
LATERAL
–> attaches BLADDER to PELVIC WALLS
–> URETERS COURSE THROUGH LATERAL LIGAMENTS BEFORE ENTERING BLADDER AT TRIGONE, so IMPORTANT TO AVOID IATROGENIC INJURY
BLOOD & NERVE SUPPLY enters DORSALLY
BLOOD & NERVE SUPPLY to the URETHRA comes off of the ___ ___ VESSELS, and in MALES is the ___ ___, while in FEMALES is the ____ ____
INTERNAL PUDENDAL, PROSTATIC ARTERY, VAGINAL ARTERY
RENAL AGENESIS…
= what is it? what PART of the body does this TEND TO OCCUR TO?
= when ONE OF THE KIDNEYS DOES NOT DEVELOP, usually the RIGHT ONE
what is the MOST COMMON CONGENITAL ABNORMALITY of the UT?
ECTOPIC URETERS
ECTOPIC URETERS…
= what is it? & 3 locations & which is MOST COMMON
DOGS vs. CATS & FEMALES vs. MALES?
breed predisposition?
what HISTORY would we expect?
= when ONE or BOTH URETERS EMPTY OUTSIDE THE BLADDER, such as…
1. URETHRA (most common)
2. PROSTATE
3. VAGINA
tend to occur more in FEMALES > MALES in BOTH CATS & DOGS!
THERE IS A BREED PREDISPOSITION, SKYE TERRIERS & HUSKIES!
expect HISTORY OF INCONTINENCE since BIRTH
2 findings ON PE for ECTOPIC URETERS? (on female)
- WETNESS of PERIVULVAR HAIR with ODOR & IRRITATION
- URINE SCALDING of SURROUNDING SKIN
URINE SCALDING AROUND SKIN & WETNESS of PERIVULVAR HAIR with ODOR & IRRITATION
likely DZ?
ECTOPIC URETERS
ECTOPIC URETERS…
INTRAMURAL vs. EXTRAMURAL in DOGS vs. CATS?
INTRAMURAL are MORE COMMON IN DOGS
CATS more likely to have EXTRAMURAL & BILAERAL
5 SEQUELAE of ECTOPIC URETERS? which is COMMON?
- PYELONEPHRITIS & CYSTITIS
–> MOST COMMON - HYDRONEPHROSIS
–> from URETER NOT DRAINING KIDNEY PROPERLY - HYDROURETER
–> from CHRONIC INFECTION, OBSTRUCTION & LACK OF PERISTALSIS - HYPOPLASTIC BLADDER
–> from LACK OF NORMAL FILLING in URETER - URETEROCELE
DIAGNOSIS of ECTOPIC URETER…
on CBC/CHEM & UA?
what is the GOLD STANDARD?
–> if you DO NOT HAVE THIS, what are 3 other good options?
CBC/CHEM = look for AZOTEMIC if BILATERAL or INFECTION has occurred
UA = look for EVIDENCE OF INFECTION
GOLD STANDARD = CYSTOSCOPY
if CYSTOSCOPY not available…
1. EXCRETORY UROGRAPHY
2. RETROGRADE VAGINOURETHROGRAPHY
3. CT
what do you see?
ID IMAGING TECHNIQUE
what is this BEING USED TO DIAGNOSE?
see URETERS with OBLONG SHAPE that DO NOT FILL PROPERLY
IMAGING TECHNIQUE = RETROGRADE VAGINOURETHROGRAPHY
used to DIAGNOSE ECTOPIC URETERS
SURGICAL TREATMENT for ECTOPIC URETERS…
should be performed WHEN? & why?
perform EARLY to PREVENT SECONDARY ABNORMALITIES resulting from INFECTION or OBSTRUCTION
NEOURETEROSTOMY…
treatment for WHAT?
steps? (5)
treatment for INTRAMURAL ECTOPIC URETERS
steps?
1. start with VENTRAL MIDLINE CYSTOTOMY (must OPEN BLADDER to get to URETERS)
- inspect TRIGONE for URETERAL OPENINGS/SWELLINGS
- use SCALPEL to make 3-5 MM INCISION through BLADDER MUCOSA into URETERAL LUMEN
- SIMPLE INTERRUPTED SUTURES
- PLACE CATHETER DISTALLY to ID URETER & LIGATE or RESECT
INTRAVESICULAR TECHNIQUE…
used to treat WHAT?
4 steps?
used to treat EXTRAMURAL ECTOPIC URETERS
4 steps?
1. CUT URETER
2. use HEMOSTAT & POKE HOLE in APEX OF BLADDER
3. PULL END OF URETER INTO BLADDER
4. SUTURE URETER INTO BLADDER
PROGNOSIS for ECTOPIC URETERS when…
SURGERY ALONE?
SURGERY + MEDICAL MANAGEMENT?
we should MONITOR for ___ POST-OPERATIVELY
SURGERY ALONE = RESOLUTION of INCONTINENCE occurred in about 20-60% of DOGS
SURGERY + MEDICAL MANAGEMENT? = ADDITIONAL 7-30% of dogs RESOLVED INCONTINENCE!
we should MONITOR for UTIs POST-OPERATIVELY
what is the MOST COMMON COMPLICATION of ECTOPIC URETERS?
what CLINICAL SIGN does it cause?
URETHRAL SPHINCTER MECHANISM INCONTINENCE
causes PERSISTENT INCONTINENCE
HYDRAULIC OCCLUDER…
used to treat WHAT?
two steps?
in MALE DOGS, be sure to…
if we STILL SEE the issue, what can we do?
used to treat URINARY INCONTINENCE
steps?
1. placed AROUND URETHRA & stabilize with a SUTURE
2. then, FILL WITH SALINE via PORT
in MALE DOGS, go CAUDAL TO THE PROSTATE to AVOID DAMAGING/OBSTRUCTING URETERS
if we STILL SEE URINARY INCONTINENCE, can INJECT SALINE into PORT to TIGHTEN OCCLUDER
URETEROCELE…
= what is it?
pathophysiology? (2)
treatment? (1)
= CYSTIC DILATION of PORTION OF URETER that ENTERS TRIGONE
pathophysiology?
1. DILATION of URETER in TRIGONE can COMPRESS NECK OF THE BLADDER
2. causes LOWER URINARY TRACT SIGNS like STRAINING & IRRITATION
treatment? = usually need to RESECT THE DILATED PORTION OF URETER
PERSISTENT URACHUS…
= what is it?
treatment? (2)
= when URACHAL REMNANTS PERSIST instead of FORMING THE VENTRAL LIGAMENT OF THE BLADDER, leading to URINE LEAKAGE from UMBILICUS
treatment?
1. SURGICAL EXCISION
2. ANTIBIOTIC THERAPY
RENAL NEOPLASIA…
commonality in DOGS/CATS?
often __ behavior
MOST COMMON renal neoplasia in..
DOGS?
CATS?
UNCOMMON in DOGS/CATS
often MALIGNANT behavior
MOST COMMON renal neoplasia in..
DOGS? = CARCINOMA unless VERY YOUNG, THEN NEPHROBLASTOMA
CATS? = LYMPHOMA
DIAGNOSIS of RENAL TUMORS..
usually occurs in WHAT AGE/SEX animals?
breed predilection?
4 clinical signs? which one is MOST COMMON IN CATS?
2 common PE findings? one is +/-
usually occurs in OLDER MALE DOGS & CATS
NO BREED PREDILECTION
4 signs?
1. ANOREXIA
2. DEPRESSION
3. WEIGHT LOSS
4. HEMATURIA –> especially in CATS
2 PE?
1. ABDOMINAL ENLARGEMENT w/ PALPABLE MASS
2. +/- LAMENESS
DIAGNOSIS of RENAL TUMORS…
IMAGING? which is MOST SENSITIVE/CONFIRMATORY?
IMAGING via…
1. RADS (abdominal & thoracic)
2. US
3. CT –> SENSITIVE & CAN CONFIRM TUMORS
PERINEPHRIC PSEUDOCYSTS
etiology?
= what is it?
what should we do PRIOR to DRAINING?
etiology is UNKNOWN
= SUBCAPSULAR FLUID ACCUMULATION in a CYST in the KIDNEY
we should MAKE SURE IT’S NOT URINE PRIOR to DRAINING
ID LESION
PERINEPHRIC PSEUDOCYSTS
ID DZ
LAB FINDINGS for RENAL TUMORS…
do we expect to find CONCURRENT UTIs? if so, WHAT 3 CLINICAL SIGNS ARE MOST COMMON?
___ FAILURE may be present if DISEASE is ____
DO NOT expect to find CONCURRENT UTIs w/ tumors, but CAN see…
1. HEMATURIA
2. PYURIA
3. PROTEINURIA
RENAL FAILURE may be present if DISEASE is BILATERAL
RENAL TUMORS can be associated with ___ SYNDROMES, resulting in… (three)
PARAENOPLASTIC SYNDROMES
- POLYCYTHEMIA
- HYPERCALCEMIA/HYPOGLYCEMIA
- HYPERTROPHIC OSTEOPATHY
TREATMENT of RENAL NEOPLASIA…
when can we perform NEPHRECTOMIES? (2)
tx for CATS W/ LYMPHOMA?
PROGNOSIS is WORSE FOR ___ > ___
____ is OFTEN PRESENT AT TIME OF DIAGNOSIS
NEPHRECTOMIES if it’s…
1. ONLY UNILATERAL
2. NO EVIDENCE of METASTASIS
CATS W/ LYMPHOMA likely to RESPOND TO CHEMO
PROGNOSIS is WORSE for SARCOMA > CARCINOMA
METASTASIS is OFTEN PRESENT AT TIME OF DIAGNOSIS
URETERAL NEOPLASIA…
PRIMARY in DOGS & CATS?
SECONDARY = which is MOST COMMON?
PRIMARY is RARE IN DOGS & NOT REPORTED IN CATS
SECONDARY = TRANSITIONAL CELL CARCINOMA
what is the MOST COMMON BLADDER TUMOR?
___ is COMMON & SPECIFICALLY we can see ____ ____ to… (3)
TRANSITIONAL CELL CARCINOMA!
METASTASIS is COMMON & SPECIFICALLY we can see LOCAL EXTENSION to…
1. URETERS
2. URETHRA
3. PROSTATE
BLADDER TUMORS are MORE OFTEN ____
MALIGNANT
what is the GOLD STANDARD for BLADDER NEOPLASIA DIAGNOSIS?
what should we AVOID when PERFORMING THIS DIAGNOSTIC & why?
what is ANOTHER GOOD OPTION for DIAGNOSIS?
CYSTOSCOPY & BIOPSY so that WE CAN SEE INVOLVEMENT OF PROSTATE, URETHRA, BLADDER etc.
AVOID PERCUTANEOUS NEEDLE because it can SEED TUMOR
CT is ALSO ANOTHER GOOD OPTION
if we need to SURGICALLY TREAT BLADDER TUMORS, we should EXCISE with ____ MARGINS & we can ____ up to ____-____% of the BLADDER
we can also add what 2 medical treatments?
1 CM MARGINS & REMOVE up to 70-80% OF THE BLADDER
2 medical treatments?
1. NSAIDs
2. CHEMOTHERAPY
