Unit 3 - Urinary Flashcards
Where are uroliths most likely to localize?
Sigmoid flexure, trigone of the bladder, and urethral process
You have a red urine sample. How do you differentiate if the cause is RBC, myoglobin, and hemoglobin?
If you spin it down and it pellets and the rest of the urine is clear it is RBC.
If you spin it down and it is still red, then it is either myoglobin or hemoglobin. To differentiate between the two, spin some blood down in a PCV tube. If the serum is red then it is due hemoglobin. If it is clear then it is due to myoglobin.
Where do both kidneys lay?
On the right side - the right is under the last rib, the left is further caudal
What does the bovine kidney look like?
It is multi-lobulated
What can cause sheath swelling?
Water belly
Retroprepucial abscess
Penile hematoma
What is water belly?
Obstructive urolithiasis
How do cattle present with waterbelly?
Dripping from the prepuce
Pitting edema
Don’t feel well
How do goats present with waterbelly?
Sawhorse stance
Grinding teeth
Urethralis muscle is pulsating
Showing signs of colic
What can be a predisposing factor to urolithiasis?
Male anatomy
Age of castration and urethral diameter
Breed
Amount of water intake
How can age of castration affect the size of the urethral diameter?
If they are castrated too soon, the diameter is likely not as large as it can be
What nutritional management can effect stone composition?
Ca:P balance
Grain intake
Roughage source
What types of stones can ruminants get?
Struvite Amorphus Mg Ca Phosphate Ca phosphate Ca carbonate Ca oxalate Silicates
What is the ideal nutritional makeup for goats?
High roughage with minimal to no concentrate
Desirable Ca:P
Lots of rumination, excretion of phosphorus in saliva
What may you see on CBC and chemistry in urolithiasis patients?
Stress leukogram to left shift Azotemia Hypophosphatemia to hyperphosphatemia Hyponatremia, hypochloremia Hyperkalemia possible, but not necessarily present in call cases
What drugs should be on board for the urethral process amputation?
Either sedation (midazolam/diazepam, acepromazine, opioid) or an epidural (lumbosacral)
What medical therapy is recommended for urolithiasis treatment?
Judicious fluid therapy to correct electrolyte imbalances
Anxiolytics and pain control
Urine acidification (6-6.5)
How is Walpole’s (acetic acid) solution used for treatment of urolithiasis?
A cystocentesis is done and the bladder is infused with an acidic solution to acidify the urine (pH 5) and dissolve struvite stones.
Place a tanscutaneous pig-tail catheter
Be careful with repeated use - if you are going to open the bladder don’t o it
What are some long-term options for urolithiasis treatment?
Tube cystostomy
Ischial urethrostomy in breeding bulls
Bladder marsupialization
Vesiculopreputial anastomosis
What are some salvage procedures for treatment of urolithiasis?
Penile amputation
Urethrostomy
Urethrotomy at site of obstruction
What is the gold standard treatment for urolithiasis?
Tube cystostomy
What males can a tube cystostomy be done in?
Breeding rams and bucks
What is a tube cystostomy?
Diversion of urine via a Foley catheter to allow the urethra to heal
How many days post operative does a tube cystostomy patient need to have in hospital?
5-7 days
How is a tube cystostomy done?
Make a paramedian incision next to the penis,
Exteriorize the bladder
Make a stab incision into the bladder
Empty the bladder
Scoop out the stones
Close the bladder with an inverting absorbable suture (2-layer)
Place foley catheter through the body wall via a second paramedian incision and placed into the bladder.
The foley catheter is filled with saline and the catheter is finger trapped to the skin
What is bladder marsupialization?
Creating a permanent stoma of the bladder to the body wall itself
What is the biggest concern with bladder marsupialization?
Urine scald
What population is an ischial urethrostomy done in?
Breeding bulls
How is an ischial urethrostomy done?
Epidural anesthesia
Cut at the level of the ischium down to the level (stay midline) of the urethra.
Cut into the urethra and place a foley catheter
How does the urethra heal after an ischial urethrostomy?
By second intention
How is a penile amputation done?
Cut around the area of the sigmoid flexure.
Transect the penis at this level and just leave it in its sheath.
Suture the proximal portion of the penis with mattress sutures to the body wall.
Make sure to not suture the urethra
Suture the dorsal and ventral edges of the incision closed.
What post op management is recommended for urethrostomies?
Fluid therapy Antibiotics Pain control Urine acidification Diet and management changes
What is the most common urinary disease in cattle?
Pyelonephritis
What etiologic agents are commonly isolated in patients with pyelonephritis?
Corynebacterium
T. pyogenes
E. coli
What are the risk factors for pyelonephritis?
Dystocia, bladder paralysis
What CS are for pyelonephritis?
Variable fever, ADR, abnormal urination (hematuria, pyuria, abnormal color)
How is pyelonephritis treated?
Beta-lactams - PPG ceftiofur
Urine culture and sensitivity
Nephrectomy
Euthanasia if bilateral
