Elimination & Detox 2: Urinary Sx Ruminants Flashcards
what is the PIZZLE?
what animal DOES NOT HAVE THIS?
URETHRAL PROCESS
BULLS DO NOT HAVE THIS
why should we NOT install a CATHETER RETROGRADE in MALE & FEMALE RUMINANTS?
what should we do INSTEAD?
MALE RUMINANTS = SIGMOID FLEXURE makes RETROGRADE CATHETERIZATION VERY DIFFICULT, also URETHRAL DIVERTICULUM
FEMALE RUMINANTS = URETHRAL DIVERTICULUM
better to do CYSTO on RUMINANTS
in EXAMINING THE URINARY SYSTEM of RUMINANTS…
what 2 WAYS can we perform US? which one looks at BLADDER & KIDNEYS best?
what are we looking for in RADIOLOGY?
what 3 things are we looking for in ENDOSCOPY?
in US…
1. TRANSCUTANEOUSLY
2. TRANSRECTALLY –> best for BLADDER & KIDNEYS
in RADIOLOGY = looking for OBSTRUCTIVE UROLITHIASIS
in ENDOSCOPY…
1. RULE IN OR OUT URINARY MASS
2. CONGENITAL DEFECT in URINARY TRACT
3. STRICTURE in URETHRA
presenting complaint for UROLITHIASIS generally tends to be….
7 common CLINICAL SIGNS?
this can be diagnosed VIA…
presenting complaint for UROLITHIASIS generally tends to be VERY VAGUE
clinical signs?
1. lethargic
2. bruxism (grinding teeth)
3. vocalizations
4. MUSCLE FASCICULATIONS
5. STRAINING POSTURE/STRANGURIA
6. ABDOMINAL DISTENTION
7. COMPLETE ANURIA or URINE DRIPPING
this can be diagnosed VIA A PHONE CALL!
this ruminant is VOCALIZING and maintaining THIS POSITION…
what should be your TOP DIFFERENTIAL?
how would you DESCRIBE this animal with one CLINICAL SIGN?
TOP DIFFERENTIAL = OBSTRUCTIVE UROLITHIASIS
CLINICAL SIGNS = STRANGURIA
compared to OTHER ruminants, SHEEP with UROLITHIASIS…
they RARELY…
ARE MUCH LESS DEMONSTRATIVE, will just LAY DOWN & ISOLATE
they RARELY VOCALIZE
is CONSTANT DRIPPING of urine ever normal?
NO!
what 2 findings on ABDOMINAL PALPATION might we find for UROLITHIASIS?
2 means of palpation?
2 urolithiasis findings?
1. DISTENDED, HARD, FIRM BLADDER
2. PULSATING URETHRA
2 means of palpation?
1. TRANSRECTAL (cattle)
2. DIGITAL (small ruminants)
what are 5 CLINICAL SIGNS of RUPTURED BLADDER in RUMINANTS?
these usually manifest WHEN in DZ?
what do we often see on PE? (1 big one, 1 +/-)
5 clinical signs?
1. DEPRESSION/RECUMBENCY
2. DEHYDRATION
3. SCLERAL INJECTION
4. ENOPHTHALMIA (sunken eyes)
5. BRADYCARDIA from HYPERKALEMIA
these usually manifest after animal is BLOCKED FOR SEVERAL DAYS
on PE = BILATERAL ABDOMINAL DISTENTION +/- FLUID WAVE
how does a RUPTURED BLADDER usually PRESENT GROSSLY?
usually PINPOINT PERFORATIONS in bladder where URINE OOZES OUT OF due to EXTREMELY DISTENDED BLADDER that’s UNDERGONE NECROSIS
if a ruminant is presenting with DEPRESSION & ENOPHTHALMIA, what disease should we suspect?
SUSPECT RUPTURED BLADDER
this animal is likely experiencing WHAT disease?
if this is VERY chronic, what might occur?
–> what is a STRONG clinical sign of this?
animal likely experiencing URETHRAL RUPTURE
if VERY CHRONIC = FISTULA can develop where URINE ESCAPES OUT OF THE SKIN
–> usually accompanied by STRONG SMELL
URETHRAL RUPTURE
= how does it usually occur?
what often occurs if you touch the prepuce? why?
will the prepuce be hot or cold?
= PRESSURE NECROSIS tends to occur at SITE OF OBSTRUCTION & URINE LEAKS into SQ TISSUES of PERINEUM, PREPUCE & VENTRAL ABDOMEN
if you touch the prepuce, usually cause INDENTATIONS called PITTING EDEMA; occurs due to NECROSIS
prepuce should be COLD because NOT WELL VASCULARIZED from EDEMA (NOT INFLAMMATORY)
URETEROLITHIASIS/NEPHROLITHIASIS…
commonality in SMALL RUMINANTS vs. LARGE?
BEFORE offering surgery, what should we do?
VERY UNCOMMON in SMALL RUMINANTS, just tends to occur in STEERS
BEFORE offering surgery for this, INVESTIGATE KIDNEY
in UROLITHIASIS in ruminants…
usually see ____ AZOTEMIA
in PROLONGED cases (>___-___ HOURS), can see WHAT 4 electrolyte derangements?
what DIAGNOSTIC TOOL & FINDING can help confirm? give 2 possible parameters
usually see POST-RENAL AZOTEMIA
in PROLONGED cases (>24-36 HOURS), can see…
1. HYPERKALEMIA
2. HYPONATREMIA
3. HYPOCHLOREMIA
4. HYPERPHOSPHATEMIA
DIAGNOSTIC TOOL = ABDOMINOCENTESIS
FINDING from ABDOMINOCENTESIS = ABDOMINAL CREATININE:SERUM CREATININE RATIO
–> textbook states 2:1
–> in reality, VERY HIGH 1:1 IS OK TO HELP CONFIRM UROLITHIASIS
US for UROLITHIASIS in ruminants…
often performed trans____ or trans____ (in cattle only)
usually see WHAT finding on the bladder? in SMALL vs. LARGE breeds of SMALL RUMINANTS?
INSIDE the bladder can also see…
US often performed transABDOMINALLY or transRECTALLY (in cattle only)
usually see MARKEDLY DISTENDED BLADDER, and in small ruminants…
1. SMALL BREEDS = >5cm
2. LARGE BREEDS = >8cm
INSIDE the bladder can also see ECHOGENIC MATERIAL
ID WHERE the lesion that’s CAUSING UROPERITONEUM is
what likely is it?
likely UROLITHIASIS
we should perform RADIOGRAPHS on EVERY ___ ____ ____
rads can be taken either ____ or in _____ RECUMBENCY
we should make sure to include both the ____ & ____ in our views
if we DO NOT SEE RADIODENSE CALCULI…
EVERY OBSTRUCTED SMALL RUMINANT
rads can be taken either STANDING or in LATERAL RECUMBENCY
we should make sure to include both the PERINEUM & PREPUCE in our views
if we DO NOT SEE RADIODENSE CALCULI, DOES NOT RULE OUT UROLITHIASIS, JUST MIGHT NOT HAVE STONES THAT ARE RADIOPAQUE
ID what’s obstructing this small ruminant & why
CALCIUM CARBONATE STONES, they’re usually VERY RADIOPAQUE
when should we use CONTRAST RADIOGRAPHY in SMALL RUMINANTS? (2)
2 ways that we can INJECT CONTRAST?
when should we use CONTRAST RADIOGRAPHY in SMALL RUMINANTS?
1. when we suspect a URETHRAL RUPTURE
2. when we suspect URETHRAL OBSTRUCTION that’s caused by NON-RADIOPAQUE UROLITH
how can we inject contrast?
1. RETROGRADE by placing catheter in DISTAL URETHRA (just a little bit)
2. via CYSTOCENTESIS to inject contrast INTO BLADDER & let animal URINATE IT OUT
what DIAGNOSTIC method is this?
name TOP & BOTTOM circle findings
CONTRAST RADIOGRAPHY
TOP = DISTENDED URETHRA
BOTTOM = CONTRAST EXTRAVASATING OUT
ENDOSCOPY in SMALL RUMINANTS…
limitation? (1)
helps to visualize… (2)
limitations = hard for SMALL RUMINANTS bc SMALL URETHRA
helps to visualize…
1. STRICTURE
2. CONGENITAL ABNORMALITY
TREATMENT OPTIONS for SMALL RUMINANT with OBSTRUCTIVE URETHROLITHIASIS… (3)
which one is usually NON-REWARDING?
what should we WARN the owners about?
- IMMEDIATE SALVAGE is possible via EUTHANASIA, especially if animal is MARKETED
- MEDICAL Tx usually NON-REWARDING, better to just try and AMPUTATE SOME OF URETHRAL PROCESS
- SURGICAL Tx has MANY OPTIONS but usually just reserved for PETS
SHOULD WARN OWNERS OF POSSIBLE RECURRENCE because MANY ANIMALS HAVE GENETIC PREDISPOSITION
PRE-OP considerations/treatments for URETHROLITHIASIS SURGERY in SMALL RUMINANTS (4)
- makes sure PROPER FLUID LOAD, can give ISOTONIC FLUID
- if HYPERKALEMIA, can give DEXTROSE, SODIUM BICARBONATE or INSULIN to push K INTRACELLULARLY
- CYSTOCENTESIS to EVACUATE BLADDER prior to Sx either US-GUIDED or BONNANO CATHETER (left in bladder for 24 hours)
- PRUDENT USE of NSAIDs due to NEPHROTOXICITY
we should DEFINITELY NOT use NSAIDs if the patient is…
what should we opt for INSTEAD?
AZOTEMIC
INSTEAD, opt for OPIOIDS
BONNANO CATHETER…
= what is it?
when is it used?
= URINARY CATHETER that can be left/safely remains IN BLADDER for 24 HOURS to help STABILIZE METABOLICALLY UNSTABLE PATIENTS
used usually when patients are UNSTABLE & CANNOT UNDERGO IMMEDIATE SURGERY
URETHRAL PROCESS AMPUTATION…
this should ONLY be suggested if WHAT 2 THINGS ARE TRUE?
___ is NECESSARY
restraint of animal?
post-op risk?
ONLY be suggested if…
1. OBSTRUCTION is AT URETHRAL PROCESS
2. we can REESTABLISH FLOW
SEDATION is NECESSARY
restraint? = animal restrained on VD or LATERAL RECUMBENCY with PELVIS & HOCKS FLEXED to MANIPULATE PENIS OUT OF SHEATH
post-op risk = CAN GET OBSTRUCTED AGAIN SOMEWHERE ELSE
ID STONES
CALCIUM CARBONATE STONES
what is the GOLD STANDARD of TREATMENT for UROLITHIASIS in SMALL RUMINANTS?
TUBE CYSTOSTOMY
TUBE CYSTOSTOMY…
= used to treat WHAT?
3 pros?
4 cons?
= GOLD STANDARD tx for UROLITHIASIS
pros?
1. allows CLEARANCE of CYSTIC CALCULI via NORMOGRADE FLUSHING to remove EVERYTHING IN THE BLADDER
2. PRESERVES NORMAL ANATOMY
3. allows BYPASS OF URINE during POST-OP PERIOD
cons?
1. HIGH COST!
2. LONGER POST-OP care & HOSPITAL STAY
3. MAY REQUIRE SECOND SURGERY
4. DOES NOT PREVENT RECURRENCE
TUBE CYSTOSTOMY…
position?
necessary for patient to be under…
6 steps?
position = DORSAL RECUMBENCY
necessary for patient to be under GENERAL ANESTHESIA
steps?
- make PARAMEDIAN INCISION in CAUDAL ABDOMEN
- DECOMPRESS & EVACUATE CONTENTS OF BLADDER
- INSERT CATHETER at TRIGONE
- REMOVE STONES IN BLADDER & FLUSH NORMOGRADE
- +/- can leave a FOLEY CATHETER IN via making SEPARATE STAB INCISION on BLADDER & BODY WALL for CATHETER TO COME OUT OF
- INFLATE FOLEY CATHETER to keep it in bladder & suture via PURSE-STRING SUTURE
why do we insert a FOLEY CATHETER into TUBE CYSTOSTOMY?
at day 5…
at day 15…
BYPASS URINE FLOW for IMMEDIATE POST-OP PERIOD to AVOID STRAINING & INFLAMMATION
day 5 = CLAMP CATHETER for a FEW HOURS AT A TIME to LOOK FOR URINATION
day 15 = CATHETER needs to be OCCLUDED FOR 2 days and GOAT URINATES NORMALLY
why do we need to wait 2 WEEKS to REMOVE FOLEY BLADDER from TUBE CYSTOSTOMY?
what are we hoping has happened?
we are hoping that an ADHESION has formed between BLADDER & BODY WALL so that WE DO NOT GET UROABDOMEN, and this can ONLY OCCUR AFTER 14-15 DAYS
WE DO NOT WANT TO GO BACK TO SURGERY!
6 POSSIBLE COMPLICATIONS from TUBE CYSTOSTOMY?
label as RARE or LESS RARE
- GA complications (RARE)
- URETHRAL RUPTURE from AGGRESSIVE FLUSH, so don’t use syringes any greater than 20 CC (RARE)
- POST-OP PERITONITIS or UTI (rarely) (RARE)
- IATROGENIC UROABDOMEN when FOLEY CATHETER PULLED TOO SOON (RARE)
- CAN’T RESTORE URETHRAL PATENCY at the time of surgery (LESS RARE)
- recurrence of UROLITHIASIS (LESS RARE)
PERINEAL or PERMANENT URETHROSTOMY…
= what is it?
animal is usually in ___ recumbency
should make a ___ INCISION ____ the penis
= CREATING A NEW OPENING to the URETHRA to BYPASS AN OBSTRUCTION, usually at an opening in the PERINEUM (BELOW THE ANUS)
animal is usually in DORSAL recumbency
should make a LINEAR INCISION TOWARDS the penis
PERINEAL or PERMANENT URETHROSTOMY…
two pros?
4 cons?
2 RARE complications?
3 COMMON complications?
two pros?
1. LOWER COST from SHORTER HOSPITAL STAY
2. VALID OPTION for URETHRAL RUPTURE or if TUBE CYSTOSTOMY has been attempted
4 cons?
1. STRICTURE = VERY LIKELY WITH PU and can cause MST <1 YEAR
2. LOSS OF NATURAL BREEDING
3. RECURRENCE of OBSTRUCTION
4. does NOT allow EVACUATION OF CYSTIC CALCULI (in bladder)
2 RARE complications?
1. GA complications
2. CANNOT RESTORE URETHRAL PATENCY due to PELVIC URETHRAL OBSTRUCTION
3 COMMON complications?
1. POST-OP STRICTURE
2. URINE SCALDING
3. RECURRENCE of UROLITHIASIS
