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SAM 2 > Obstructive Urinary Tract Disease > Flashcards

Obstructive Urinary Tract Disease Flashcards

1
Q

What is the most significant cause of renal disease and acute uremia in cats?

A

Ureteral obstruction by calcium oxalate stones or non-mineralized debriss

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2
Q

What is the normal diameter of a feline ureter?

A

0.4mm

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3
Q

What is the normal diameter of a canine ureter?

A

1-3mm

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4
Q

Why are cats more predisposed to ureteral obstruction than dogs?

A

Ureter size

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5
Q

Does an acute unilateral ureteral obstruction usually present clinically?

A

No

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6
Q

What is more common, acute unilateral or bilateral ureteral obstruction?

A

Unilateral

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7
Q

How do the kidneys look in acute bilateral ureteral obstruction?

A

Bilaterally enlarged and painful

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8
Q

What is big kidney little kidney syndrome?

A

Unilateral atrophy due to past injury and fibrosis and contralateral hypertrophy due to an acute obstruction

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9
Q

What obstructive kidney disease carries the most guarded prognosis?

A

Bilateral CKD with concomitant ureteral obstruction

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10
Q

What is the typical presenting complaint for ureteral obstruction?

A

Severe acute uremia (anorexia, deprression, vomiting, uremic odor, lethargy, oligo/anuria), Ureterocolic signs

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11
Q

What age group of cats especially like to get ureteral obstruction?

A

> 7 years

Worse if they have concurrent CKD

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12
Q

Can ureteral obstructions be incidentally diagnosed on ultrasound?

A

Yes- may not have clinical signs yet

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13
Q

T/F: Radiographs are always useful for diagnosing ureteral obstruction.

A

False- depends on species and severity/type of obstruction

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14
Q

What is the percentage rate of false negatives for diagnosing ureteral obstruction on survey radiographs?

A

20-30%

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15
Q

What are some things to look for when assessing radiographs for ureteral obstruction?

A

Radiodensities in the retroperitoneal space, expansion of the retroperitoneal space, marked renal asymmetry

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16
Q

What type of stone are you most likely going to see on radiographs?

A

Calcium oxalate

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17
Q

What is the principle feature of ureteral obstruction when assessing with ultrasound?

A

Hydronephrosis and dilation of the proximal ureter

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18
Q

How sensitive is ultrasound for diagnosis of ureteral obstruction?

A

70-80%

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19
Q

How long must an animal be obstructed for before you get ultrasonographic changes?

A

4-7days

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20
Q

What radiographic modality is useful to help define the indication and location for surgical intervention?

A

Antegrade pyelography or CT

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21
Q

What is antegrade pyelography?

A

Incorporates ultrasound guided pyelocentesis and antegrade injection of positive contrast media into the renal pelvis and ureter to delineate the size and patency of the ureter

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22
Q

What is antegrade pyelographyy used to reliably determine?

A

Presence, degree, and proximal location of ureteral obstruction in cats

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23
Q

What is the preferred modality to confirm uroliths and patency of ureters?

A

CT with contrast

24
Q

T/F: Ureteroliths are very easy to manage and remove.

A

False- they’re literally the worst.

25
Q

T/F: 20-30% of ureterolith obstructions spontaneously resolve within 3-4 days.

A

True

26
Q

What is an important aspect of medical management of ureteral obstruction patients?

A

Stabilizing uremia

27
Q

What should be performed if surgery is contraindicated?

A

Hemodialysis

28
Q

What should be used if a ureteral obstruction patient is oliguric?

A

Mannitol

29
Q

What therapy can help ureteral obstruction patients but hasn’t actually been proven?

A

Prazosin and amitryptilline therapy- relaxes the ureter and may help the ureteroliths pass easier

30
Q

Do you want to provide pain management of ureteral obstruction patients?

A

YES don’t be mean

31
Q

Is lithotripsy a better choice for dogs or cats?

A

Dogs

32
Q

Why is lithotripsy a poor choice for cats?

A

Stones are often resistant to fragmentation and particles are often too large for the ureter to pass

33
Q

What is the standard of care for ureteral obstruction?

A

Surgical placement of a ureteral stent

34
Q

What is a ureteral stent?

A

A soft polyurethane fenestrated catheter that has a double pigtail design that are placed inside the entire length of the ureter to keep it patent

35
Q

How are ureteral stents placed in the dog and the cat?

A

Dogs- retrograde via cystoscopy

Cats- Antegrade surgically

36
Q

What is a subcutaneous ureteral bypass system?

A

The development of an indwelling ureteral bypass using a combination of locking-loop nephrotomy/cystotomy tubes

37
Q

What do you look for to help confirm a diagnosis of urethral obstruction?

A

Enlarged bladder, signs of urinary urgency, difficulty expressing the bladder manually, resistance when attempting to pass a urinary catheter

38
Q

What is done to initially stabilize a blocked cat?

A

Heat, fluids, ECG, emergency panel, cystocentesis

39
Q

Why is an ECG done on blocked animals?

A

Assess for arrythmias due to electrolyte imbalances (hyperkalemia or hypocalcemia)

40
Q

What is the treatment for a blocked animal with hyperkalemia?

A

Fluids to control shock, calcium gluconate, IV insulin, Dextrose, Bicarb

41
Q

Why do we give a hyperkalemic patient IV insulin?

A

Insulin stimulates the uptake of potassium and removes it from circulation

42
Q

Why are hyperkalemic patients given bicarbonate?

A

Protect/correct metabolic acidosis

43
Q

What is the most common method to relieve an obstructed cat?

A

Retrograde (typically via catheterization)

44
Q

What are some other methods to relieve an obstruction?

A

Penile massage, cystocentesis, penile extrusion, rectal massage of urethra

45
Q

What should be considered when trying to pass a urinary catheter in a male cat?

A

Straightening of the urethra/penis

46
Q

What should be monitored in the ongoing management of a blocked patient?

A

Urine production and output

47
Q

What is the ideal way to manage a blocked cat after the obstruction is removed?

A

Indwelling catheter with pain managment and anti-spasmostics with regular bloodwork

48
Q

Why are anti-spasmotics useful in managing a blocked cat?

A

Relaxes urinary system- no real studies but Christie says it helps

49
Q

What is feli-way?

A

Pheremones of a momma cat that make your cat more relaxed

50
Q

What are the most likely causes of urethral rupture in a cat?

A

Urethral obstruction and traumatic catheterization

51
Q

What are some common lab abnormalities associated with urethral obstruction?

A

Hyperkalemia, hyponatremia, acidosis

52
Q

What are some consequences of a urethral rupture?

A

Stricture or urethrocutaneous fistula

53
Q

How do you diagnose a urethral rupture?

A

Positive contrast retrograde urethrogram

54
Q

What is the most common etiology of a uroabdomen?

A

Trauma to the bladder- can happen prior or after manipulation

55
Q

What is used to confirm uroabdomen?

A

Creatinine levels of abdominal fluid (should be higher ~2x that of the blood)

56
Q

Is it appropriate to fix the bladder prior to stabilizing the patient?

A

No- stabilize patient (fluids etc) prior to surgically fixing the bladder

SAM 2 (21 decks)

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