Lecture 9: Small Animal Urogenital Flashcards
What is your landmark for the right gutter
Descending duodenum
what structures are in the right gutter?
right adrenal gland, right kidney, right ovary, right limb of pancreas
what structures are in the left gutter?
left ovary, left kidney, left adrenal gland
To expose the right kidney, right adrenal, right ovary and right limb of the pancreas what must you move
Descending duodenum
Does the right kidney sit more cranial or caudal, compared to the left
Cranial
What structure can the right adrenal gland be hiding under
Caudate lobe of liver
which gutter is it easiest to see the caudal vena cava and portail vein?
right gutter
What is the landmark for the left gutter
Descending colon
To expose left kidney, left adrenal and left ovary what must you retract
Descending colon
The renal vessels and ureter are located on the ___ aspect of the kidney
Medial
what arteries are these?
The ureters course ___to the bladder
cranial/dorsal
The adrenal glands sit ___- relative to kidneys
Cranial medially
which sex’s bladder is more dorsal?
male
what is indicated by the black circles
Adrenal glands
Where do the ureters attach
Dorsal aspect of the bladder on the trigone/ ureterovesicular junction
The uterus sits ___ to the bladder
Dorsal
The urinary bladder apex is cranial or caudal
Cranial
What structures are contained within the spermatic cord
Testicular artery, vein and nerve, ductus deferens (vas deferens) surrounded by vaginal tunic
Identify 1-3
- Pampiniform plexus (venous network)
- Ductus deferens
- Vaginal tunic
The contents of the spermatic cord pass through what structure to course down towards the testicle
Inguinal canal
Where does the vasculature that supplies the male and female urogenital system come from
Dorsal aspect off the aorta
Do you want to do a cystotomy on the dorsal or ventral aspect and why
Ventral, less vasculature
What connects the ovaries to the body wall
Suspensory ligament
What ligament do you want to break off during spay to allow for better visualization
Suspensory ligament
What vein and artery do you need to ligate during spay
Uterine
What structure is a swelling of the caudal uterine body
Cervix
What ligament attaches ovary to the uterine horn
Proper ligament
If you are unsure whether you grabbed the ureter or the uterine horn how can you differentiate between the two
Tract back Caudally and see if you see the bifurcation of the uterine Horn, if not you have the ureter
What is being held by the hemostat
proper ligament
identify 1-3
- Suspensory ligament
- Vascular pedicle
- Uterine horn
what ligament is this
Broad ligament
What is the red arrow pointing to
Round ligament
What ligament provides a tight band of tension that can be broken down to increase exposure during spays
Round ligament
What is the black arrow pointing to
uterine artery
What is indicated by the asterisks
Mineralized opacity in the urinary bladder, potential stone
what is indicated by the white arrows
Urethral stones
Where should you make your incision for cystotomy and why
Ventral aspect of bladder to avoid vessels and ureters
What do you want to do after you scope out bladder stones
Flush normograde and retrograde
What is indicated by the arrow and how should it be approached during cystotomy
Arrow: caudal superficial epigastric vessel
During cystotomy best to make incision on either side but if not possible can cut through it and ligate
What is the holding layer for cystotomy closure
Submucosa
What is indicated by the yellow arrows
Struvite bladder stones (magnesium stones) that appear smooth on rads
What is the most common stone type
Struvite
___induced stones are more common in dogs
UTI
Sterile Struvite stones are more common in what species
Cats
What pH do Struvite stones tend to form in
Alkaline urine with pH >6.5-7.1
What pH do calcium stones tend to form in
Acidic urine
What stones can you use dietary dissolution
Magnesium (not calcium)
How long can dietary dissolution of stones take and what should you be doing in meantime
Can take 8 weeks, repeat rads every 4 weeks, monitor for urethral obstruction
Up to __% of urine samples in normal dogs have Struvite crystals
50%
T or F: crystalluria is always an indicator of stone formation
False! 50% of normal dogs have crystals in their urine so important to ask about urinary behavior and perform rads
How does voiding urohydropropulsion work
Fill bladder with saline and express stones out
Only works for stones < 5mm and in dogs >8kg
Case example: 9yr, FI KCCS with 1 week lethargy, decrease appetite, PU/PD, febrile, increase HR and RR. Mildly tense on abdominal palpation, abdomen feels distended and doughy. CBC shows marked neutrophilia with left shift, chem shows hyperglobulinemia and hypoalbuminemia. UA=1.010, pH=7, bacteriuria and pyuria. The following x-ray was taken. What is the problem
pyometra
When can pregnancy be detected by palpating vesicles
25-35 days
In pregnant small animal, uterine swelling can be seen on radiographs when
21-45 days
When can calcification of skeletal structures be seen during pregnancy
Day 45
When can gestational sacs be seen on ultrasound
As early as 20-22 but easier to see by day 25 with heartbeat
What are you looking for in ultrasound of suspected pyometra
Placing prob on ventral aspect, visualize bladder and then look dorsal to bladder to find uterus and note an anechoic fluid filled structures
What is the following ultrasound indicative of
Pyometra
When does pyometra typically present after estrus
2-4 months
At what age is pyometra typically diagnosed
> 7
What bacteria is commonly cultured in pyometra
E. Coli
What type of pyometra has purulent vaginal discharge
Open cervix pyometra
What type of pyometra may have no vaginal discharge and are more systemically ill
Closed cervix pyometra
What is the survival rate of pyometra with surgery
95%
What is the survival rate of pyometra with surgery if there is a uterine rupture
50%
What is the survival rate of pyometra with medical management
85% with 30% recurrence
When is breeding recommended if pursuing medical management of pyometra
Next cycle
What is the treatment for pyometra
Ovariohysterectomy
What percent of dogs and cats are cryptochorid
15% dogs and 1% cats
When are testicles palpable in scrotum
6-8 weeks
What side/testicle descends first
Left
What side is cryptorchidism more common on
Right for inguinal and abdominal
For large breed dogs is inguinal or abdominal cryptorchidism more common
Abdominal
What are cryptorchidism patients at greater risk for
Intrabdominal testicular torsion and neoplasia
Neuter before ___yrs old is recommended
5 yrs
T or F: cryptorchidism is heritable and therefore breeding is not recommended
True
What is a good method to use to find undescended testicle
Find the prostate and then the ductus deferens and trace it
When performing a rectal exam, what structures would you mainly feel in an Intact male at the tip of your finger
Prostate, Trigone of bladder (potential stones)
During a rectal exam when you flip finger ventrally to palpate dorsally what structures are you examining
LN, aortic pulse, and LS pain
When doing a rectal exam and examining ventral aspect what you are examining
Urethra, check for any masses or stones
If you are unable to distinguish between an anal gland abscesses and a fistula what can you do
Prescribe antibiotics in both scenarios because that will treat the abscess and temporarily the fistula, but the fistula will come back if just treated with antibiotics because it is immune mediated and therefore needs immunosuppressive drugs
What is indicated by the asterisks
sublumbar lymphadenopathy that is compressing colon
What is indicated by the arrow
enlarged prostate that is compressing colon
**some mineralization present in the prostate that can be indicative of metastatic neoplasia
What is the site of a simple abdominocentesis
On linea alba, 1-2cm caudal to umbilicus
If unable to obtain fluid from simple abdominocentesis what can you do
4 quadrant abdominocentesis around umbilicus
