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3. Cat & Dog 2 > Louis CaOx Stones > Flashcards

Louis CaOx Stones Flashcards

1
Q

small numerous stones in bladder - likely what kind? what should we do?

A
  • Likely Caox but you never know!
  • Removal of theses stones is recommended
    > can’t dissolve (dispite what food resps say)
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2
Q

should we always perform urolith analysis?

A
  • yes, all uroliths should be submitted (even recurrence)
  • quantitative analysis
  • results in less than 2 weeks
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3
Q

options for stone removal, from most to least invasive

A
  • cystotomy
  • laporoscopic cystotomy
  • cystoscopy
  • voiding with hydropulsion
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4
Q

CaOx more likely in

A

adult neutered male dogs

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5
Q

Surgical Removal of stones advantages, disadvantages

A

Advantages
* Uroliths type diagnosed
* Anatomic abnormality correction
* Urinary bladder sample for culture
<><>
Disadvantages
* Long anesthesia
* Invasive
* Incomplete removal of uroliths (14%)
* Suture induced stone formation
> 9.5% of recurrent stones suture
induced (1999-2006)
> 18.5% in 2018!!!!
> Surgical technique, suture type??

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6
Q

advantages of non0invasive stone removal procedures, and what our options are?

A

Shorter hospital stay and less pain
* Voiding urohydropropulsion
* Endoscopic
> Basket removal
> Lithotripsy

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7
Q

Voiding Urohydropropulsion
* Indications
* Advantages

A

Indications
* Stones< urethral diameter
* Female (short and large urethra)
<><>
Advantages
* Minimally invasive
* Easy to perform
* Removal and analysis of stones

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8
Q

Voiding Urohydropropulsion contraindications

A

Contra-indications
* Large or Jack-shaped stones
* Male cats: risk of obstruction

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9
Q

Intracorporeal Lithotripsy purpose
- how it works?

A

break up larger stones
* Ho:YAG laser
* Endoscopic guidance under
anesthesia
* Fragmentation of the stones in the bladder and urethra
* Fragments removed by voiding urohydropulsion or basket

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10
Q

Candidates for Lithotripsy
- patients and stones

A

Patients
* Female dog or cat > 4kg
* Male dogs with urethral stones
Stones
* <2cm in females
* <1cm in males
* Urethral stones easier
* <5 stones for males

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11
Q

Intracorporeal Lithotripsy effectiveness

A
  • Complete fragmentation of stones in all female dogs and 86.7% of male dogs
  • Complete urolith removal in 82-84% dogs
  • Removal rate higher in females (83-96%) than in males (68- 81%) (Lulich 2009)
  • Complete urolith removal in 100% dogs with urethroliths
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12
Q

Post-operative care for Lithotripsy

A
  • Antibiotic (amoxicillin)
  • Anti-inflammatory # 5 days
  • Micturition monitoring
  • Stone analysis
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13
Q

Lithotripsy vs Cystotomy
- how do they compare

A
  • Similar urolith removal and complications
    <><>
    Lithotripsy
  • 23 minutes longer (average)
  • Discharged 12 hours sooner
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14
Q

Lithotripsy Limitations

A
  • Equip mentcost
  • Operator experience
  • Size of the patient/scope
  • Only for bladder and urethral stones
  • Remaining fragments: nidus for new stones?
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15
Q

Percutaneous Cystolithotomy (PCCL)
- when is this technique appropriate?
- how do we approach it? general technique?

A
  • For male dogs (litho not possible)
  • For male cats
  • Under general anesthesia
  • Mini incision (1.5cm) regarding bladder apex * Babcock to grab the bladder wall
  • 3 Stay sutures
  • Incision of bladder wall + suction
  • Port and endoscope
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16
Q

What type of diet should a dog with stones (unknown type) be fed before analysis results?

A

Maintenance canned diet or Urinary S/O

17
Q

best method of stone prevention? how can we facilitate this?

A

Increase Water Consumption
* Use a pet water fountain (continuous filtered fresh running water)
* Provide the pet with fresh water in water dishes in multiple sites
* Add a small amount of flavoring agent to drinking water (tuna juice or low- sodium bouillon)
* Add additional water to dry or wet food
* Offer the dog or cat ice cubes (additional fluid & treat)
* Offer several meals per day

18
Q

Prevention CAOx
- rule out which pre-disposing factors?

A
  • Cushing
  • Obesity
  • Hyperparathyroidism
19
Q

Prevention of Calcium Oxalate Uroliths

A
  • ↑ water consumption
    <><><>
    Potassium citrate
  • Complexes with calcium (soluble Calcium Citrate)
  • Mild urine alkalinization (↑ solubility of CaOx)
    <><><>
    For hypercalcemic cats
  • Higher fiber content diet
  • Vitamin B6
  • Hydrochlorothiazide
20
Q

Diet for Calcium Oxalate Stones Prevention, and goals of this

A
  • Canned diet
  • Goal USG:
  • <1.020 in dogs
  • <1.040 in cats
  • Hill’sc/d,PurinaSt/Ox, Royal Canin Urinary S/O
    <><>
    goal is to increase water consumption, avoid acidifying urine
21
Q

Diet for Calcium Oxalate Stones Prevention - advice specific to schnauzer?

A

schnauzer predisposed to pacreatitis
<><>
Becarefulwith Schnauzer (too much fat)
* If hyper lipidemic: Royal Canin Low Fat S/O index (canned)
* If not hyperlipidemic: Royal Canin Urinary S/O Moderate Calorie
* Hill’s w/d

22
Q

acceptable human foods for dogs prone to stones?

A
  • Vegetables: avocado, cabbage, cauliflower, mushrooms, green peas, radishes, white potatoes
  • Fruit: avocado, banana, grapefruit, mangos, melons (cantaloupes, honeydew, watermelon), plums
  • Melon increase water intake
23
Q

Detrimental Human Food for uroliths

A
  • Meats/fish: bologna, herring, oysters, salmon, sardines
  • Vegetables: asparagus, baked beans, broccoli, carrots, celery, corn, cucumber, eggplant, green beans, green peppers, lettuce, spinach, sweet potatoes, tofu, tomatoes
  • Dairy: cheese, ice cream, milk, yogurt
  • Fruits: Apples, apricots, cherries, most berries, limes, lemons, oranges,
    pineapple, tangerine
  • Grains and nuts: corn bread, fruit cake, grits, peanuts, pecans, soybeans, wheat germ
24
Q

urate stones prevention
- what are common causes we can look for?
- diets?
- what are appropriate treats?
- goal for urine ph?

A
  • Chase the shunt or hepatic dysfunction
  • Genetic test
  • Low purine diet
    > Prescription Diet u/d, RoyalCanin
    Low Purine in dogs
    > Hill’s prescription diet k/d in cats
  • Treats: carrots, apple slices, air-popped popcorn
  • Urine alkalinization
25
Q

urate stones prevention
- what to give if crystals persist after diet change?
- how to monitor?

A
  • Monitor urinary tract infection
  • If urate crystals persist → Allopurinol
  • ↑ Water consumption
  • Urine pH, USG, Sediment at 2, 4 weeks and then every 3 months
  • Double contrast radiography or Ultrasound every 2 months
  • If still uroliths free → every 4 months
26
Q

cystine stone prevention
- recurrence? why?
- diet goals?
- other

A
  • Risk of recurrence high (inherited defect)
    <><>
    Diet to provide:
  • ↑ urine dilution
  • Low protein-purine levels
  • Alkaline urine
  • Limit sodium intake
  • Taurine and carnitine supplementation
    <><>
  • Hill’s u/d
  • UC Low Purine (Royal Canin)
  • +/- 2MPG (thiola) to dissolve cystine
27
Q

Androgen- dependent type III Cystinuria
- how to prevent? how can we tell the cause?

A
  • If Males of these breeds
  • Castration recommended
  • If cystinuria ↓ 2 months after castration, ↓ risk of recurrence
  • If cystinuria persists after 4 months, not androgen dependent
28
Q

silicate stone prevention
- avoid ingesting what?

A
  • Avoid ingestion of soil, Soybean hull, rice hull, …
  • Avoid pica
  • Limit vegetable content of the diet
  • ↑ water intake
29
Q

calcium phosphate stone prevention
- what to target?

A

Identification and treatment of hypercalcemia
* Primary hyperparathyroidism
* Excess vitamin D
* Systemic acidosis
* Excess dietary calcium or phosphorus
<><><>
↑ water consumption
* Canned formula

30
Q

how to prevent mixed stones,

A
  • Avoid formation of stone type of the nidus (1st to form)
  • If Struvite: avoid Infection
  • If Calcium oxalate: ↑ water intake
31
Q

how to prevent suture induced stones

A
  • Avoid surgery
  • Suture material that dissolves rapidly (poliglecaprone vs polydioxonone)
32
Q

Uroliths Recurrence
- rate
- speed for struvite, cystine, calcium oxalate, purine

A
  • Overall 25% recurrence rate
  • Struvite within few days
  • Cystine within 2-12 months
  • Calcium oxalate 42% at 2y
  • Purine 33%
33
Q

when should we recheck for crystals after removal?
- struvute
- cystine
- calcium oxalate

A
  • Struvite within few days
    > recheck every 2 weeks
    <><><><>
  • Cystine within 2-12 months
  • Calcium oxalate 42% at 2y
    > recheck every 2-4 months for other types of stones
34
Q

what do we do at a urolith recheck?

A

USG goal
<1.020 in dogs
<1.045 in cats
<><>
Urinalysis
- pH
- crystals
<><>
Abdominal radiographs
- if small stones, voiding, urohydropulsion

3. Cat & Dog 2 (50 decks)

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