GU Emergencies Flashcards
Acute Kidney Injury
(AKI)
Causes
- Ischemic or physiologic events
- Nephrotoxins
- Certain diseases
Chronic Kidney Failure
(CKF)
Causes
- Progressive congenital disease
- Renal disease acquired during life
FLUTD
Feline Lower Urinary Tract Disease
Physical Obstruction
Where (Urologic)
- Urethra
- Urinary bladder
- Ureters
- Renal pelvis
Uroliths
- Composed of oganized crystals of phosphate, urate, cystine, and oxalate
- Caused by congenital abnormality in metabolism or excretion of these minerals
Stones
Urethral Plugs
- Malleable, disorganized substance
- Composed of struvite crystals and a matrix
- Formed from excessive bladder mucus secondary to irritation
Micturition
Action of urinating
Type of Obstruction Common
Dogs and Cats
Dogs
* often caused by organized uroliths
* urinary calculi most common
Cats
* debris less organized
* usually forms a urethral plug at tip of penis
Male vs Female Cat Obstructions
Females
* rare
* shorter urethra and wider urethral lumen
Males
* common
* lumen is small throughout entire length
* smaller lumen at the tip (where things get trapped)
Signs of a Blocked Cat
- Alert or Depressed*
- Stranguria
- Pollakiuria
- Spending longer times in the litter box
- Urinating outside of box
- Hematuria
- Restless
- Vocalization
- Uncomfortable
- Excessive grooming of urogenital region
*depends on duration and degree of obstruction
Stranguria
Straining to urinate
Pollakiuria
Passing small amounts of urine frequently
Blood Work to Run for Blocked Cats
- BUN
- Creatinine
- Electrolytes
- TP / PCV
- Glucose
- Potassium
Typical Treatment for Blocked Cats
- Analgesics / Antibiotics
- IV and Urinary Catheters
- BW - renal values
- ECG - monitor for cardiac arrhythmias cause by hyperkalemia
Sedations for Blocked Cats
Done prior to placing a urinary catheter unless patient is obtunded
* ketamine and midazolam
* Propofol
Isoflurane
Cystocentesis
Blocked Cats
Be cautious as the bladder is extremely friable and prone to injury
More accurate assessment of:
* bacteria
* cells
* crystals
* presence of blood or protein
* specific gravity
* pH of bladder
Hyperkalemia
Signs
- Bradycardia
- Diminished P waves
- Widened QRS complexes
- Increased T waves
Hyperkalemia
Treatment
- Dextrose/Glucose +/- Insulin given IV
- Calcium gluconate given slowly IV
Dextrose
- Can be administered with or without insulin
- Used to drive potassium into the cells and correct hyperkalemia and cardiac disturbances
Also called Glucose
Urinary Catheter Goals
- Record rate of urine output
- Prevent reobstruction during the first 24 hrs after the initial obstruction has been relieved
- Keep the bladder decompressed help bladder wall “re tighten”
Urinary Catheter Management
with Cats
- Catheter should always be connected to a collection system
- Do not leave cats unattended
- Measure urine output every 2-4 hours
- E-collar may be necessary
Diuresis Period
Obstructed Cats
What, What to Monitor, Reducing
- Fluid administration must match urine output
- Fluids exceed if cat is dehydrated
- Monitor serum electrolytes and weight
- Monitor K levels - supplement if dropped
- Monitor and decrease fluid if urine output continues to match
Dystocia
- Difficult birth
- More common in dogs
- Occurs when there are forceful uterine contractions for 30 minutes with no deliveries
Dystocia
Causes
- Narrowing of the birth canal from a previous pelvic fracture
- Large or malpositioned fetus
- Physics - size/breed
- Uterine Inertia
Uterine Inertia
No contractions occurring
* going longer than 2 hours between puppy deliver
* uterus just stops contracting
Which breeds do we see uterine inertia in
- Large breed dogs with multiple puppies
- Seen if mom is not healthy enough
Screening Calls
Dystocia
- Do we know the number of fetuses?
- Have any been delivered? Alive?
- When was the first baby delivered?
- How long has it been since the first baby?
- Is mom BAR/QAR or Lethargic/Weak?
- How are contractions? (forcefull, weak, none at al)
Dystocia
Preparing Supplies
- IV catheter and Fluids
- Radiology / Ultrasound
- Incubators
- Surgery
- PCV / TP
- CBC
Monitoring Mom
Post C-Section
- Babies should ONLY go back to mom when she’s fully awake from anesthesia - slow introduction (one at a time)
- Run TP / PCV is hemorrhage from uterus significant
Monitoring Puppies
Post C-Section
- Place in incubator or keep warm and oxygenated until mom awake to care for them
- Get weight
- Be sure pups manually or nurse fed within 2 hours of delivery
Dystocia
Signs
- In active labor for over an hour, no deliveries
- Greater than 2 hours between deliveries
- Weak/Infrequent labor contractions
- Depressed or Weak
- Signs of toxemia
- Palpable fetuses
- Mammaries enlarged with milk
Dystocia Treatment
Prior to needing a C-Section
- Attempt to manipulate fetuses
- Radiograph for head count and obstruction check
- Slowly give Ca Gluconate via IV*
- Give Oxytocin IM to prepare for delivery
*sensitizes uterus to oxytocin
Dystocia
Oxytocin
- Can be given up to 3 times IM
- If no stimulation from uterus, C-Section required
Pyometra
- Pus in the uterus
- Suspect in older, intact female dogs
- Occurs less frequently in cats
Pyometra
Common Signs
- Lethargy
- Vomiting / Anorexia
- Polyuria / Polydypsia
- Vaginal discharge
- Recent heat cycle
- Abdominal distention
Pyometra
Preparations
- IV Catheter and Fluids (LRS)
- Radiology / Ultrasound
- Surgery
- Antibiotics / Analgesics
- Blood collection supplies
Pyometra
Blood Tests
- CBC
- BUN and Creatinine
Kidney levels elevated due to dehydration
Length of Pregnancy
Also known as gestation period
* 9 weeks
* there is a range
How many stages of labor
3
First Stage of Labor
- 6-24 hrs before birth of first puppy
- Seeking seclusion
- Nesting
- Restless / Panting
- Anorexia / Vomiting
- Clear vaginal discharge
- Temp drop, 99 or below
Second Stage of Labor
Babies are born
Third Stage of Labor
Delivery of the placenta
Delivery Time
And Time Between
Once active contractions have occurred, a puppy should be born within 30 minutes
* normal time between babies can be minutes to 2 hours; not a concern as long as mom is not in distress
Lochia or Uteroverdin
Green vaginal discharge after the first puppy is delivered
* sign that placenta has separated from uterus
* need to get a puppy soon!!
Ultrasound for Babies
HR
- Normal = 200 bpm
- Distress = <170 bpm
