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Small animal surgery I > Kidney and Ureters > Flashcards

Kidney and Ureters Flashcards

1
Q

What blood vessel do the renal arteries come off of?

A

Aorta

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2
Q

What % of nephroliths are Ca oxalates?

A

41%

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3
Q

What are the clinical signs of a nephrolithiasis?

A

Could be absent or non-specific. Depression, anorexia, hematuria, pain

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4
Q

How would you diagnose nephrolithiasis?

A

Radiographs, ultrasound

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5
Q

What is the criteria for treatment with nephrolithiasis?

A

Know the type of calculi, the location, and the effects

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6
Q

When would you need to perform surgery on a patient with nephrolithiasis?

A

Obstruction, infection created by the calculi

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7
Q

If the patient with nephrolithiasis is asymptomatic, what should you do?

A

Monitor/imaging, medical management

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8
Q

In a nephrolithotomy, how would you cut to enter the abdomen?

A

Ventral midline

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9
Q

What special instruments are used for a nephrolithotomy?

A

Rumel tourniquet, bulldog vascular clamp

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10
Q

T/F: For a nephrolithotomy, you want to make a sagittal incision into the kidney.

A

True

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11
Q

How can you close the kidney after a nephrolithotomy?

A

Sutureless - hold for 5 minutes -> fibrin seal (suture capsule)

Horizontal mattress

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12
Q

What is a pyelolithotomy?

A

Longitudinal incision into the renal pelvis to remove stones

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13
Q

What medication do you give to a patient after performing a nephrolithotomy?

A

Diuretic to maintain renal perfusion and minimize clot formation

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14
Q

How can you diagnose renal trauma?

A

Contrast excretory urography, exploratory celiotomy, ultrasound

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15
Q

How do you treat minor kidney trauma?

A

Conservatively

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16
Q

How do you treat moderate kidney trauma?

A

Surgical repair

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17
Q

How do you treat major kidney trauma?

A

partial nephrectomy, nephroureterectomy

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18
Q

What are the indications for a nephroureterectomy?

A

Severe infection or trauma, obstructive calculi with persistent hydronephrosis, neoplasia, transplant

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19
Q

How do you perform a nephroureterctomy?

A

Mobilize kidney, identify and ligate vessels, separate and ligate ureter at vesicoureteral junction

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20
Q

Why would you ever do a partial nephrectomy?

A

When you need to keep the function of the kidney, since the other kidney is fully damaged

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21
Q

How do you diagnose hydronephrosis?

A

Abdominal radiographs, excretory urogram, ultrasound

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22
Q

How long should hydronephrosis be in effect to have complete resolution?

A

Less than a week

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23
Q

How would you surgically treat hydronephrosis?

A

nephroureterectomy

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24
Q

What is pyelonephritis?

A

Inflammation of the renal pelvis, through complication with obstruction?

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25
Q

How do you treat advanced pyelonephritis?

A

nephroureterectomy

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26
Q

How do you treat giant kidney worm?

A

nephrectomy, nephrotomy

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27
Q

T/F: Renal neoplasia is usually benign.

A

False. MALIGNANT

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28
Q

What are some primary renal tumors?

A

Renal cell carcinoma, TCC, nephroblastoma

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29
Q

What are some metastatic renal tumors?

A

Lymphosarcoma, hemangiosarcoma, SCC

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30
Q

Which is the most common renal tumor in the dog?

A

Renal cell carcinoma

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31
Q

What is the mean survival time in dogs with renal cell carcinoma?

A

9 months

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32
Q

How do you treat renal cell carcinoma?

A

nephroureterectomy and chemotherapy

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33
Q

What is the most common neoplasia in the cat kidney?

A

Renal lymphoma

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34
Q

How long is the mean survival time for patients with embryonic nephroblastoma?

A

6 months

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35
Q

How do you diagnose renal neoplasia?

A

Palpation, radiographs, ultrasound, CT, MRI, urography

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36
Q

How would treat renal neoplasia?

A

Exploratory laparatomy, unilateral nephroureterectomy

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37
Q

What are some indications for performing a renal biopsy?

A

Suspected neoplasia, nephrotic syndrome, renal cortex disease, non-diagnosed ARF

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38
Q

What are some contraindications for performing a renal biopsy?

A

Coagulopathy, hypertension, severe chronic hydronephrosis

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39
Q

How much of the kidney do you want for collect for a biopsy?

A

> 5-6 glomeruli

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40
Q

What gauge needle range is typically used for a renal biopsy?

A

14-18 G

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41
Q

What are the techniques used for renal biopsy?

A

Percutaneous, ultrasound guided, keyhole, laparoscopic assisted

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42
Q

What is the most preferred method of renal biopsy?

A

Ultrasound guided

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43
Q

How do you close a wedge/incisional biopsy of the kidney?

A

Mattress suture

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44
Q

What are some potential complications with renal biopsies?

A

Severe hemorrhage, hematuria, hydronephrosis

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45
Q

What species are renal transplants performed on?

A

Cats

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46
Q

What are the indications for renal transplants?

A

Irreversible acute renal failure, decompensated chronic renal failure, polycystic disease

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47
Q

What suture material do you use for a renal transplant?

A

8/0 nylon

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48
Q

How long will patients with renal transplant need to be on immunosuppressants?

A

Lifelong

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49
Q

What is the means survival time of successful renal transplant patients?

A

1.5-2 years

613 days

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50
Q

What is the ureter’s function?

A

To transport urine

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51
Q

What other abnormalities are associated with ectopic ureter?

A

Hydroureter
Small/absent kidney
Pelvic Bladder

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52
Q

T/F: Cats commonly get ectopic ureters

A

False. RARE

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53
Q

What are some clinical signs of dogs with ectopic ureter?

A

Incontinence, poor house training, UTI, urine scalding

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54
Q

How do you diagnose ectopic ureter?

A

Excretory urography, CT, U/S, cystoscopy

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55
Q

What are the two classifications of ectopic ureter?

A

Extramural, intramural

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56
Q

What occurs with intramural ectopic ureters?

A

The ureter enters norally, but exits abnormally

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57
Q

What surgical procedures can you use to fix ectopic ureters?

A

Neoureterocystostomy (end-to-side and side-to-side), Laser transection of the wall

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58
Q

What are cystoscopic laser treatments for?

A

Intramural ureters

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59
Q

What 90% improvement happens with surgical correction of ectopic ureters, when given with medication?

A

90%

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60
Q

What medication do you give to patients after ectopic ureters, to control incontinence?

A

PPA

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61
Q

What is a ureterocele?

A

Dilation of distal ureter

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62
Q

If a ureterocele gets obstructed, what will you see?

A

Azotemia

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63
Q

How do you diagnose a ureterocele?

A

IV urography (see cobra head), ultrasound

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64
Q

How do you treat an intravesicular ureterocele?

A

Ureterocelectomy

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65
Q

How do you treat an ectopic ureterocele?

A

Neoureterocystotomy with ureterocelectomy

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66
Q

What is the #1 cause of ureteral trauma?

A

Iatrogenic

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67
Q

How would you diagnose ureteral trauma?

A

Uroretroperitoneum or a uroabdomen

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68
Q

How do you treat ureteral trauma?

A

Nephroureterctomy, ureteroureterostomy, neoureterocystostomy, urinary diversion

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69
Q

Which part of the ureter do you perform a ureteroureterostomy?

A

the proximal ureter

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70
Q

How is a ureteral stent used?

A

It is left proximal to the anastomosis of the ureter and extended down to the bladder via urethra

71
Q

What is a nephrostomy tube for?

A

To divert urine after ureter surgery, hydronephrosis, or obstruction

72
Q

What is the indication for a transureteroureterostomy?

A

When the proximal ureteral length is not long enough to reach the bladder, but can cross to the other side and attach to the other ureter

73
Q

What are some ways to treat a loss in ureter length?

A

Renal Descensus, Nephrocystopexy distally, Psoas Hitch

74
Q

What procedure is used if a significant amount of length is lost in the distal ureter?

A

Bladder wall flap

75
Q

What is the most common indication for ureteral surgery?

A

Ureterolithiasis

76
Q

T/F: Cats primarily have ureterolithiasis

A

True

77
Q

How would you diagnose ureterolithiasis?

A

Radiographs, ultrasound

78
Q

What are indications are needed for surgical treatment of urolithiasis?

A

Complete obstruction, azotemia, pyelonephritis, unsuccessful medical treatment

79
Q

How long will it take to leave <65% of GFR left in an obstructed ureter?

A

1 week

80
Q

T/F: Most cats have preexisting interstitial nephritis unrelated to obstruction

A

True

81
Q

How do you treat urolithiasis?

A

Cystotomy and retrograde flushing and removal via pyelithotomy.

Ureterotomy

82
Q

What are the advantages of a permanent ureteral stent?

A

Decrease the morbidity, shorter hospitalization, less complications

83
Q

How do you perform a surgical stent on a dog?

A

Similar approach to a distal cystotomy

84
Q

What is the SUB system?

A

Subcataneous ureteral bypass. Bypasses urine from kidney to ureter and goes straight from kidney to bladder

85
Q

T/F: You cut the lateral ligaments during a cystotomy

A

False. Ventral ligament

86
Q

Which nerve provides sympathetic innervation to the bladder?

A

Hypogastric nerve

87
Q

Which nerve provides parasympathetic innervation to the bladder?

A

Pelvic nerve

88
Q

What are the blood vessels for the bladder?

A

Caudal vesicular, prostatic/vaginal artery

89
Q

What are some surgical diseases the bladder?

A

Ruptured bladder, cystic calculi, neoplasia, urinary incontinence

90
Q

What is the urachus?

A

An embryonic channel that communicates the bladder and the allantoic sac

91
Q

What is are the urachal abnormalities seen at birth?

A

Persistent urachus, vesicouracheal diverticulum, cyst, sinus

92
Q

What signs will you see with persistent urachus?

A

Urine dribbling, omphalitis, ventral abdominal dermatitis, UTI

93
Q

How can you diagnose and treat persistent urachus?

A

Place contrast medium in umbilicus, and surgically remove the tube

94
Q

What happens with a vesicouracheal diverticulum?

A

An outpouching of the bladder from the atrophied urachus

95
Q

How would you treat a vesicouracheal diverticulum?

A

Partial cystectomy and diverticulectomy

96
Q

How would you treat a urachal cyst or sinus?

A

Surgical excision

97
Q

What are some acute clinical signs of bladder rupture?

A

Hematuria, anuria, abdominal pain

98
Q

What are some progression signs of bladder rupture?

A

dehydration, acidosis, azotemia, hyperkalemia, death in ~72 hours

99
Q

T/F: In any trauma case, always assume bladder rupture until it is ruled out

A

True. Need to do radiographs or ultrasound

100
Q

How do you diagnose a ruptured bladder?

A

Positive contrast urethrocystogram, abdominocentesis - urea in peritonium

101
Q

How do you treat a ruptured bladder?

A

Immediate surgical repair, urinary diversion, exploratory laparotomy

102
Q

When would you do a cystopexy?

A

For a tube cystostomy, perineal hernia, urinary incontinence

103
Q

What do you connect the bladder to in a cystopexy?

A

Abdominal wall

104
Q

How many lines of sutures are used in a cystopexy?

A

2

105
Q

T/F: Tube cystostomies have high complication rates

A

True. Fistula formation, pet chewing, breaking, leakage

106
Q

What is the most common bladder disease?

A

Ca oxalate cystic calculi

107
Q

What are some clinical signs of cystic calculi disease?

A

thickened bladder, lower urinary tract syndromes

108
Q

How can you diagnose cystic calculi?

A

Radiographs, pneumocystography, double contrast cystography, U/S

109
Q

What are some non-surgical treatments for cystic calculi?

A

Hydropropulsion, transurethral cystoscopy, dietary modification, lithotripsy

110
Q

What is the most common surgery of the bladder, and used to remove uroliths?

A

Cystotomy

111
Q

T/F: Ventral cystotomy is the preferred method of surgery

A

True. You can visualize ureteral orifices

112
Q

Where would you apply stay sutures for a cystotomy?

A

Lateral aspects and apex of the bladder

113
Q

What is the least traumatic way to handle the bladder?

A

With stay sutures

114
Q

What do you submit for culture and sensitivity on a cystotomy?

A

Urine, stones, mucosal tissues

115
Q

What suture patterns should be used to close a cystotomy?

A

Cushing followed by Lembert, simple continuous of submucosa followed by cushing/lembert, double simple cutaneous appositional patterns

116
Q

What tests can you do to check your cystotomy?

A

Leak test/compression, post-op radiographs

117
Q

How quickly does it take for the bladder to heal after surgery?

A

2-3 weeks

118
Q

What uncommon disease that is non-neoplastic, affects females, and resembles TCC, is confirmed through biopsy?

A

Polypoid cystitis

119
Q

What is the most urinary tract tumor located in the dog?

A

Bladder

120
Q

T/F: most bladder tumors are malignant

A

True

121
Q

T/F: Bladder is the most common site for urinary tract tumors

A

False. Lymphoma is first

122
Q

What are some predisposing factors for TCC?

A

Obesity, insecticide exposure, herbicide

123
Q

How can you diagnose TCC?

A

Cytology, cystoscopy (very diagnostic), radiographs with or without positive contrast cystography, ultrasound

124
Q

T/F: FNA is contraindicated in TCC

A

True. Avoid

125
Q

Instead of an FNA, what can you use to get sample of a potential TCC?

A

Transurethral biopsy

126
Q

What test is best used a routine screening for bladder tumor on older patients?

A

Bladder tumor antigen test

127
Q

How would you treat a bladder tumor?

A

Partial cystectomy (>1 cm borders) with potential anastomosis of vessels, chemotherapy,

128
Q

What is the mean survival time of after treatment of bladder tumors?

A

4-6 months

129
Q

What are the surgical diseases associated with the urethra?

A

Strictures, obstructions, trauma, prolapse, incontinence, congenital

130
Q

What are the surgical procedures used for the urethra?

A

urethrostomy, urethrotomy

131
Q

T/F: In the male, the urethra is shorter and wider

A

False. Female is

132
Q

What is the most common developmental abnormality of the male genitalia?

A

Hypospadias - incomplete formation of the penile urethra

133
Q

What do you call the protrusion of the urethral mucosa through its orifice?

A

Urethral prolapse

134
Q

What breed is most likely to get a urethral prolapse?

A

Young male brachycephalic dogs

135
Q

What signs do you see with urethral prolapse?

A

Bleeding, licking, red mass

136
Q

What are some ways to treat a mild urethral prolapse?

A

Purse string reduction, urethropexy folded into itself, or castration

137
Q

How do you treat a severe urethral prolapse?

A

Resection and anastomosis using catheter and tourniquet

138
Q

How fast does the urethral mucosa regenerate?

A

7 days

139
Q

What potential problem with the urethra increases happens that increases surgical time and makes it difficult to identify tissue?

A

Edema

140
Q

What suture material do you want to use for urethral surgery?

A

Monofilament absorbable (PDS, Maxon)

141
Q

What suture material do you want to avoid?

A

Braided absorbable (Vicryl)

142
Q

How can you diagnose urethral obstruction?

A

Radiographs, ultrasound, contrast urethrography

143
Q

What are the goals when treating a urethral obstruction?

A

End with working kidneys, balance electrolytes, relieve obstruction, treat UTI, prevent reoccurrence

144
Q

How would you perform a retrograde hydropropulsion?

A

Palpate the stone, compress the urethra, pass the catheter, pinch off orifice, inject saline, distend the urethra, relieve compression

145
Q

What catheters can you use for a cat retrograde hydropropulsion?

A

tomcat catheter, slippery sam, red rubber catheter

146
Q

What is often surgically performed to remove calculi in the urethra?

A

Cystotomy combined witha urethrotomy

147
Q

Why would you perform a urethrostomy?

A

to prevent reoccurrence if medical prevention is not feasible

148
Q

Where would incise for a urethrotomy in a dog?

A

Pre-scrotal

149
Q

What muscle do you need to retract when performing a prescrotal urethrotomy?

A

retractor penis muscle

150
Q

What suture material and size do you use to close a prescrotal urethrotomy?

A

4/0 or 5/0 monofilament absorbable (PDS)

151
Q

When would you ever perform a perineal urethrotomy on a dog?

A

If the calculi is lodged between the scrotum and the ischial arch

152
Q

When would you perform a urethrostomy?

A

Permanent damage to the urethra, recurrent obstruction, cannot remove obstruction

153
Q

What location is preferred for dogs and cats, respectively?

A

Scrotal, perineal

154
Q

What benefits does a scrotal urethrostomy have over other locations?

A

Less hemorrhage and urine scald

155
Q

What should you also do to the dog when performing a scrotal urethrostomy?

A

Castrate

156
Q

How would you suture a scrotal urethrostomy and why?

A

Laterally to prevent impingement on the urethra

157
Q

How long is the urethra incision on a scrotal urethrostomy?

A

2.5-4 cm long or 5-8 times the urethral diameter

158
Q

What suture material and size would you use for a scrotal urethrostomy?

A

4/0-5/0 monofilament. absorbable or non-absorbable works

159
Q

When would you perform a urethrostomy with a cystotomy?

A

When stones are in the ischial arch

160
Q

What are some complications with a scrotal urethrostomy?

A

hemorrhage, dehiscence, urine scald, stricture, UTI

161
Q

Why is a prescrotal urethrostomy worse than a scrotal?

A

Has a higher incidence of urine scald

162
Q

When would you perform a perineal urethrostomy on a dog?

A

Only when a more distal approach is not possible

163
Q

A perineal urethrostomy is considered a ______ procedure to treat FLUTDS and calculi in _____ cats.

A

salvage; male

164
Q

What are the indications for performing a perineal urethrostomy in a cat?

A

frequent obstructions, strictures, trauma

165
Q

What do you need to do to the anus before opening the perineum for a perineal urethrostomy?

A

Anal purse string

166
Q

What shape incision do you create around the scrotum and prepuce in a perineal urethrostomy?

A

Elliptical

167
Q

What tissue forceps do you use for traction at the end of the prepuce in a perineal urethrostomy of a cat?

A

Allis tissue forceps

168
Q

What muscles are cut from the penis in a perineal urethrostomy?

A

ischiocavernosus and ischiourethralis and retractor penis muscle

169
Q

What suture do you use for a perineal urethrostomy when connecting the urethral mucosa to the skin?

A

5/0 monofilament

170
Q

How often do complications with perineal urethrostomies occur?

A

25%

171
Q

If stricture occurs after a perineal urethrostomy, what caused it?

A

Poor surgical technique

172
Q

What do you do if after a perineal urethrostomy, you notice subcutaneous urine?

A

catheterize for 5-7 days

173
Q

When would you perform an antepubic urethrostomy?

A

If the perineal urethrostomy failed and cannot be fixed

Small animal surgery I (8 decks)

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