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RUSVM SAM 2 > Obstructive Urinary Tract Dz > Flashcards

Obstructive Urinary Tract Dz Flashcards

1
Q

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

A

Urethral obstruction from calcium oxalate ureteroliths

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2
Q

What is the diameter of a normal feline utter?

A

0.4mm

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3
Q

What is the diameter of a normal canine ureter?

A

1-3mm

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4
Q

What are the 4 outcomes of ureteral obstruction?

A

Acute unilateral obstruction

Acute bilateral obstruction

Big kidney -little kidney

Bilateral chronic kidney disease with concomitant ureteral obstruction

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5
Q

What do you see clinin acute unilateral ureteral obstruction?

A

Generally, unilateral ureteral obstruction is clinically silent, potentially transient, and not associated with azotemia.

Abdominal pain, erratic/elusive behavior, or hematuria

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6
Q

How does acute bilateral ureteral obstruction present clinically?

A

Severe acute signs with bilaterally enlarged and painful kidney

Azotemia, oliguria, or anuria

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7
Q

What do you see clinically in a patient with big kidney- little kidney?

A

Past unilateral ureteral obstruction that has caused the kidney to progress to a fibrotic end-stage

Contralateral kidney is acutely obstructed —> hypertrophy

Abdominal pain, severe azotemia, variable urine production

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8
Q

What do you see clinically in a patient with bilateral chronic kidney disease with concomitant ureteral obstruction?

A

Most guarded prognosis even with resolution of obstruction

Underlying kidney dz may be secondary to fibrotic changes from previous ureteral obstruction or other intrinsic kidney dz that can predisposed to uroliths formation.

Overt uremia

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9
Q

What are the presenting complains in patients with ureteral obstrucion?

A 
Severe acute uremia
Anorexia
Depression 
Intermittent vomiting 
Uremic odor 
Lethargy 
Weight
Oligo/anuria

Uterocolic signs (generalized pain, ureter run just dorsal to colon in retroperitoneal space)

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10
Q

T/F: ureteral obstruction is more common in older cats

A

True

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11
Q

What might you see on a radiograph of a patient with ureteral obstruction?

A

Barely perceptible radiodensities in retroperitoneal space

Expansion of retroperitoneal space

Presence of marked renal asymmetry

  • can be superimposed on colon-> difficult to determine if mineral opacities are in the colon or the ureter
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12
Q

What are the principle features of ureteral obstruction seen on ultrasound?

A

Hydronephrosis

Dilatation of the proximal ureter

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13
Q

What is the preferred imaging modality to confirm mineralization/mon-mineralized urothliths in the ureters?

A

CT

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14
Q

What method of imaging provides reliable information of presence, degree, and proximal location of ureteral obstruction in cats?

A

Antegrade pyelography

—> incorporates US guided pyelocentesis and antegrade injection of positive contrast media in the renal pelvis

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15
Q

How are ureteral obstructions managed?

A 
Benign neglect 
Extracorporeal shock wave lithotripsy 
Nephrectomy 
Ureteral stent 
Subcutaneous ureteral bypass 
Pyelostomy tube
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16
Q

How would you medically manage ureteral obstruction??

A

Stabilize uremia
If surgery contraindicated (fluid overload/hyperkalemia) —> hemodialysis

Oliguria —> mannitol

Ureteral relaxants —> prazosin and amitryptilline

Pain management

17
Q

T/F: lithotripsy is a good potion for managing ureteral obstruction in cats

A

False

Good for dog
Poor for cat -> resistant to fragmentation, particles too large for 0.4mm diameter lumen to pass

18
Q

What is the best standard of care for ureteral obstruction ?

A

Ureteral stent

-made of soft polyurethane type catheters with double pigtail design with multiple fenestrations along their length

19
Q

How are ureteral stents placed in dogs and cats?

A

Dog - Cystoscopy (retrograde)

Cat - surgically (antegrade)

20
Q

What is a subcutaneous ureteral bypass system?

A

Indwelling ureteral bypass using locking-loop nephrotomy/cystotomy tube

21
Q

How can you diagnose urethral obstruction?

A

Enlarged bladder (male cat)
Signs of urinary urgency
Difficulty manually expressing urine
Resistance in passage of a urethral catheter

22
Q

An obstructed cat comes into your clinic, what do you do immediately?

A

IV line —> correct dyhydration and volume expansion

Therapeutic cysto -> pass urethral catheter -> collect urine/monitor output

ECG —> hyperkalemia or hypocalcemia

Stat bloods

23
Q

What is your emergency treatment of hyperkalemia??

A

Fluids
-shock rate -45ml/kg (NaCL)

-calcium gluconate (cardioprotective)

IV insulin with dextrose

Bicarb

24
Q

What do you do for ongoing management of a blocked cat?

A

Indwelling U-cath placement
Monitor urine production/urine sediment
Analgesia

Lab parameters
Exam parameters

Anti-spasm optics

Post obstructive diuresis

25
Q

What can you do if your owner cannot afford treatment for an obstructed urethra?

A 
Euthanize 
OR 
No indwelling catheter 
-> just unblock and anti-spasmotics 
->repeated cysto and anti-spasmotics
26
Q

What anti-spasmotics can be used in ureteral obstruction?

A

Prazosin/phenoxybenzamine (a1 antagonsit)

De-stress (feliway)

27
Q

How can you diagnose urethral rupture?

A

Biochem

  • > hyperkalemia
  • > hyponatremia
  • > acidosis

Positive contrast retrograde urethrogram

28
Q

What is usually the cause of uroabdomen

A

Trauma/obstruction

RUSVM SAM 2 (44 decks)

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