Surgical disorders of the urinary tract + umbilicus Flashcards
What could you do to examine the urinary tract?
- Take history
- Clinical exam - rectal
- Clinical pathology - biochem / haematology, Urinalysis
- Endoscopy - cystoscopy
- Ultrasonography
- (Radiography + scintigraphy)
What would you look at with endoscopy?
- Evaluation of urine outflow from ureters - Every 20-45 seconds under xylazine sedation
- Catheterisation of ureters - Confirm unilateral / bilateral renal/ureteral disease
What can you do with ultrasound?
- Transrectal
- Bladder in adults
- Transcutaneous
- Kidneys
- Bladder
- Umbilicus
- Guided needle biopsy of kidney(s)
Why would you do radiography?
- Urinary tract in foals / yearlings
Why would you do laparoscopy?
- Visualisation of perirenal regions, ureters & bladder
- Offers various treatment options
Why would you scintigraphy?
- Assessment of renal function
Why would you perform a nephrectomy?
- Renal neoplasia
- Pyelonephritis non-responsive to medical treatment
What would you need to rule out in any case of urinary incontinence?
- Ectopic ureters
What animals get ruptured bladders?
- Foals 1-5 days of age
- More common in colts
- Usually occur during parturition but clinical signs take time to develop
- Uncommon in adult horses but can occur
What are clinical signs of a ruptured bladder?
- Depression / off suck
- Progressive abdominal distension
- Mild / moderate colic
- Increased frequency of urination and small urination volume, or no urination
How is a ruptured bladder diagnosed?
- History & presenting signs
- Biochemistry & haematology - Hyper K+, Hypo Na+, hypo Cl-, Dehydration, Metabolic acidosis
- Peritoneal fluid analysis - Peritoneal creatinine more than double serum creatinine
- Ultrasonography
- Radiography & contrast studies
How would you stabilise a ruptured bladder?
- Stabilisation is critical prior to general anaesthesia
-HyperK+ can cause fatal arrythmias
-K+ must be <5.5Meq/L before induction of anaesthesia - Methods to rehydrate and reduce K+:
= i.v. saline / Hartmann’s solution
-+/- sodium bicarbonate
-Calcium borogluconate
-Insulin / glucose - Abdominal drainage (slow) – reduce K+ but also improves ventilation
- Rule out concurrent disorders e.g. sepsis
- Antibiotics
- Check IgG status
What would surgical treatment of ruptured bladder be?
- Surgical repair via midline laparotomy with resection of umbilicus and urachus
- The prognosis is good but also depending on other underlying conditions
What are urolithiasis more common in?
- Adult Males - can block urethra
- females = remain in bladder
What are 2 types of calcium carbonate urolithiasis?
- Type 1 = more common = spiculated, yellow / green
- Type 2 = smooth + white
How are urolithiasis diagnosed?
- History & presenting signs
- Haematuria, Stranguria, +/- pollakiuria, pyuria or incontinence
- Clinical examination - Rectal + External palpation
- Ultrasonography
- Endoscopy
How would you treat urolithiasis?
- Surgical removal - laparotomy, laparoscopy
- Electrohydraulic / laser lithotripsy
- If the horse cannot urinate due to a distal urethral obstruction, a temporary perineal urethrotomy may be needed
What is seen with urolithiasis?
- Haematuria after exercise
What are other bladder disorders?
- Sabulous cystitis =
-Secondary problem, consequent to bladder paralysis or other physical or neurologic disorders interfering with complete bladder emptying - Neoplasia (SCC)
- Bladder eversion - Due to excessive straining
= Parturition or foaling
What can urolithiasis in the urethra cause?
- Acute urinary obstruction + colic
= surgical removal
What other problems occur in the urethra?
- Obstruction due to soft tissue lesions (neoplasia)
- Lacerations - penile trauma
What is the urachus?
- remnant of channel between bladder and
umbilicus where urine drains in the foetus
What is a patent urachus?
- Urachus fails to close spontaneously or can reopen if sepsis occurs
- Moisture around umbilicus +/- dripping of urine
- Check for concurrent septicaemia/septic arthritis/ physitis
- Assess IgG status
How would you treat a patent urachus?
- Medical =
- Antibiotics
- Topical agents (concentrated phenol or 7% iodine
solution or with silver nitrate applicators)
(Often self-resolving) - Surgical (if needed)
= Resection of the urachus
What is umbilical sepsis?
- First 1-2 weeks of life but can occur later
- Foal depressed & off suck
- Swollen, painful umbilicus
- Ultrasonography of the umbilicus reveals enlargement of structures
How is umbilical sepsis treated?
- Assess IgG status & assess for concurrent septicaemia / septic arthritis / physitis
- Blood culture, haematology & biochemistry
- Systemic antibiotics
- Surgical resection if no response to therapy / deterioration
What can happen with an umbilical hernia?
When would you surgically repair?
- Can cause strangulation of bowel if entrapped = immediate surgery
- Surgical repair required if:
- Large defect (>3-5cm)
- Defects persists more that 6 months
- Defect enlarges
- Associated with colic
