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Renal > Urinary Tract Obstruction > Flashcards

Urinary Tract Obstruction Flashcards

1
Q

Causes of upper urinary tract causes?

A

Vaginouretral fistula d/t ligature of the ureter at spaying

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2
Q

Causes of intra urethral obstruction?

A
  • tumour
  • granulomatous inflammation
  • prostatitis
  • calculi
  • foreign bodies
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3
Q

Extra urethral causes of obstruction?

A
  • bladder/pelvis masses
  • prostatic dz
  • trauma (penile, pelvic, iatrogenic with perineal rupture repair, TPO)
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4
Q

Causes of bladder displacement

A
  • retroflexion with perineal rupture
  • displacement (abdo wall rupture/pelvic fractures)
  • bladder torsion (often 2* to surgery not replacing)
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5
Q

Neurogenic causes of urine retention? LOOK UP

A

> LMN
- flaccid, over distended, easy to express, urine leakage
- sacral nerves affected (anywhere L5 caud jally)
- may be congenital (Manx cats)
- lumbosacral dz, cauda equina syndrome, vertebral fx
UMN
- more common
- firm, tense bladder
- lesions cranial to sacral nerve segmented
- intervertebral disk dz, tumours, luxations, fx
functional urethral obstruction (reflex dysynergia)
- more common dogs
- no relaxation of urethra
- hard to Tx

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6
Q

Which animals most commonly affected with urethral obstruction?

A
  • males
  • just caudal to os penis or any bend
  • penile urethra in cats
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7
Q

General history Clinical signs of urethral obstruction

A
  • dependant if obstruction complete or partial, acute or chronic, underlying cause
  • inability or difficulty passing urine
  • may be mistaken for constipation
  • vulval/penile bleeding, Haematuria, V+
  • collapse
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8
Q

PE findings with urethral obstruction

A

> full bladder
- beware rupture may feel like no bladder!
inability to pass catheter
- can give false results, just because you can get in doesn’t mean there is no blockage
poss mass on palp of pelvic region
- abdo pain, depression, unproductive straining and abdo distension

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9
Q

pathophysiology of obstruction

A
  • changes similar regardless of underlying cause
  • urethral -> bladder, kidney effects, 2* systemic effects
  • upper tract less life threatening unless both kidneys affected
  • can be lethal
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10
Q

How does obstructive uropathy affect kidney function

A
  • ^ ureteral and tubular pressure -> bowmans space
  • GFR falls
  • v renal blood flow maintains low GFR
    > ischaemia nephropathy may result in permenant nephron loss
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11
Q

Is azotaemia d/t urethral obstruction reversible?

A

Yes!! No matter how severe

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12
Q

Will a bladder be able to acutely distend to the rib cage?

A

No only chronic (will rupture if acute)

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13
Q

What Effects can obstruction have on bladder ?

A

> overdistension

  • dependnt on rate of urine production, bladder capacity and compliance
  • ^ intravesical pressure prevents ureteral emptying -> ureteral reflux
  • ischaemia, oedema, haemorhage and mucosal sloughing may occour
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14
Q

Systemic effects of obstruction. Reversible?

A 
> hypovolaemia, hypotension 
> biochem 
- azotaemia
- acidaemia 
- hyperohosphataemia
- hypocalceamia (phosphate ^ binds free ca)
- hyperkalaemia 
> all reversible
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15
Q

How is hyperkalaemia seen on ECG?

A
  • prolonged pR interval
  • tall or peaked T waves
  • brady cardia
  • ventricular arrythmias
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16
Q

How do hyperkalaemic ECG traces differ in cats and dogs?

A
  • cats more wide and bizarre almost like VPC but will not be tachycardic
17
Q

What Is the most life threatening bit of obstruction?

A

Hyperkalaemia and hypovolaemia.

- CNS depression, vomiting, anorexia

18
Q

How can hyperkalaemia be identified and managed?

A
  • HR ( place IV catheter for IVFT
  • before sedating etc. (Tx hypovolaemia don’t worry about rupture atm!)
  • dilutes potassium
  • calcium gluconate IV (stabilises myocardium to counteract potassium)
    > cystocentesis to alleviate blockage
  • risk of leakage of urine into abdo, potential per acute septic peritonitis if have a UTI
  • empty completely
  • don’t put off GA
  • prophylactic Abx
  • allows stabilisation temporarily
  • buys time to call in back up
  • in cats risk of UTI very low
19
Q

When shouldn you relieve the obstruction and empty the HR bladder?

A

Only when stable

- needs GA or sedation unless moribund

20
Q

What should be remembered when passing a catheter in a male cat

A
  • kink in the urethra
  • pull penis caudally and dorsal lay to straighten
  • stay suture or tissue forceps
  • don’t push catheter, float the catheter into bladder
  • lube, penile massage, flushing for clots, generally avoid stylet
  • avoid Walpoles solution (v caustic for bladder and damage to urethral)
21
Q

What needs to be done after unblocking

A
  • save urine/plug for analysis (better if taken from cysto otherwise diluted with saline)
  • bladder lovage with warm saline (until urine clear)
  • when removing catheter express bladder and evaluate urine stream (urethral spasm can block)
  • > if required place Indwelling catheter and closed collection system
  • not always necessary, not well tolerated, may worsen urethral spasm
22
Q

Should Abx be given prophylactically when they have a catheter in?

A

NO will not stop UTI but will make bacteria growing there resistant

23
Q

What occours naturally following obstruction?

A 
> post obstructive diuresis
- match fluid ins and outs 
- (osmotic effect of retained solutes and damage to tubular feels) 
>  hypokalaemia poss 
- check electrolytes
- supplements IV FLUIDS 
- oral in food
24
Q

What should be monitored for after obstruction

A
  • UTIs
  • Detrusor atony d/t excessive distension
  • bladder outflow obstruction d/t bloodclot or sloughed mucosa
  • stricture formation
25
Q

What pharmacological agents may help post-obstruction

A 
- Smooth muscle relaxants
> a adrenergic blockers
- phenoxybenzamine
- prazosin
> skeletal muslce relaxants 
- dantrolene
- diazepam
26
Q

What further investigation may need to be done post-obstruction clearance?

A
  • not always done in first instance (may be better to r/o lesion)
  • plain and contrast rads
  • ultra sound and endoscopy
27
Q

How can urinary tract obstruction be managed?

A

> surgery
- removing obstruction (urethrotomy, cystotomy)
- urinary diversion (cystotomy tube min 1w, can be permenant /scrotal/perineal urethrostomy / vaginitis-urethroplasty)
- re-establish urethral patency (end to end anastomoses in pelvic urethra for trauma or neoplasia)
minimally invasive techniques/flushing
- retrograde hydropulsion
medical or conservative management
cutting edge technologies

28
Q

Is urethrotomy a good procedure?

A

No better to flush into bladder and do a cystotomy

29
Q

Eg. of cutting edge techniques for obstructions

A 
> urethral stenting
- strictures and tumours
>  balloon dilation 
- stricture
> endoluminal lithotripsy
- calculi 
> endoluminal resection/ablation 
- tumours/polyps
30
Q

Which is most common upper or lower obstruction?

A

??-

31
Q

Egs of ureteral surgery

A
  • ureteronephrectomy
  • ureterotomy
  • ureteral anastomosis
  • ureteroneocystostomy (± psoas cystopexy, ± renal descensus)
  • implants (subcut ureteral bypass system, ureteral stent, nephrostomy tube
32
Q

Surgical options for management of upper urinary tract obstruction

A
  • nephrotomy

- pyelolithotomy

Renal (23 decks)

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