Kidney & Ureter Flashcards
- drainage system
- removes urine, excess fluids, and metabolic waste
Urinary tract
- Excretion of nitrous and other metabolic waste
- Regulation of water, electrolyte and acid-base balance
- Production of renin, prostaglandin, erythropoietin and Vit D3
- Glucogenesis
Kidney
(Physiology)
When doing a kidney/urinary tract surgery..
- Patient position: ________ recumbency
- Surgeon position: ________ the kidney of interest
- Approach: _______
- Patient position: dorsal recumbency
- Surgeon position: opposite the kidney of interest
- Approach: ventral midline
Removal of the whole kidney
Mas madali, one kidney lang need i-consider.
Total Nephrectomy
Consider the function of the contralateral kidney because if not functioning well, then do ___ _______________
partial nephrectomy
Removing a portion just a portion of the kidney (just the affected portion)
Partial Nephrectomy
the ________ are non regenerative, hence, you cannot be uncertain with the procedures
nephrons
before proceeding to any procedure, place a non-crushing tissue forceps or clamps over the ____ and the ____
artery, vein
Two types of partial nephrectomy
- Guillotine type
- Incision type
The blood vessels are closed, and identified if there are bleeding ones
this will be difficult because the arteries and veins have been occluded beforehand
Incision type
Sutures are pre-placed through the parenchyma
Non-crushing tissue forcep – applied to both artery & vein
Cut the portion you have to remove
Close the parenchyma
Appose the kidney edges together
Capsules are kept intact (seal that would prevent leakage from the kidney)
Guillotine type
Electrocoagulation is avoided
Partial nephrectomy
To ensure the function of the contralateral kidney, undergo:
- Biochemistry tests
- Diagnostic imagings
- Exploratory laparotomy
Surgical opening of the kidney
Nephrotomy
suture on
kidney parenchyma
placed on the renal cortex only
Horizontal mattress suture
used to close the capsule
2 layers of capsule closure
simple continuous
Incising the proximal portion of the ureter to approach the calculi located in the area
Difference bet. nephrectomy: no need to apply non-crushing forcep in vessels, because incision is in the proximal aspect of urethra (minimal bleeding)
Pyelolithotomy
- Done to remove obstructive calculi lodged on the ureter itself
- Incision is made on the ureter
- Higher risk of postoperative leakage
- The procedure is risky because it involves making a transverse incision on the organ, but remember that the ureter is very small, so be careful not to transect it (refer to picture below)
Ureterotomy
Recommended incision & closure for ureterotomy
longitudinal incision and transverse closure (so luminal size is larger)
Closure pattern utererotmy
simple continuous or
Lembert pattern
Advantage of transverse closure:
- mas lumalaki yung luminal diameter
- less risk of urinal stricture (hindi sasara butas)
insertion of a urinary catheter
Catheterization
- Urine sample collection
- Decompression of an enlarged urinary bladder
Cystocentesis
(5) Types of Catheter
- Rubber
- Silicone
- PVC
- Stainless steel
- Foley catheter
Urethra is shorter, & bladder is larger.
Therefore, blockage is more uncommon.
Female animals
Opening of the urinary bladder
Cystotomy
Cystotomy incision for
male -
female -
male - paramedian
female - ventral midline
location of Lazy vet procedure that’s prone to urine spillage
ventral aspect of urinary bladder
surgical incision of the urethra
Urethrotomy
permanent opening created in cases of recurrent urethral problems
Urethrostomy
(2) Types of Urethrotomy
- Pre-scrotal
- Perineal
- Since it is temporary, castration may or may not be done.
- Create an opening only
Do not close, let it granulate
Pre-scrotal urethrotomy
usually not done, cuz most of the blockage are located at the os penis
Perineal urethrotomy
Perineal urethrotomy post op problem they’ve encountered with closing the urethra is ___ ____
urine scalding
seen as bruising
Urethrostomy most common site
pre-pubic
(4) sites of Urethrostomy
- Pre-scrotal
- Scrotal
- Perineal
- Pre-pubic
Since it is a permanent opening and we’ve seen someone that did not perform castration, the problem with that is whenever the animal would have the erection, the sutures attaching the skin and the urethral mucosa together get disrupted.
If ____ urethrostomy will be performed, castration must be performed as well! (also true for cats)
Scrotal urethrostomy
Theis soft and thin
It will tear apart if you simply attach or appose it and the skin
→ will cause dehiscence and cause tearing of the urethra.
urethral mucosa
It is important to include the ____ layer of the penis which will add integrity to the suture.
fibrous layer
DO NOT incise this in urethrostomy
corpus cavernosum
Feline Perineal Urethrostomy
Animal position: ________
Surgical approach: _______
Animal position: ventral recumbency
Surgical approach: parapreputial
