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Urinary II > Uroabdomen and Surgery of the Kidney > Flashcards

Uroabdomen and Surgery of the Kidney Flashcards

1
Q

describe the sources and causes of leakage from the urinary tract into the peritoneal space

A

sources:
1. kidney
2. ureter
3. bladder (TOP SOURCE)
4. urethra

causes:
1. trauma (TOP CAUSE)
2. iatrogenic

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2
Q

what are the clinical signs of uroabdomen?

A
  1. +/- urination: depends on where urine leaking from
  2. +/- abdominal swelling
  3. +/- hematuria
  4. vomiting
  5. inappetance
  6. malaise
  7. +/- painful
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3
Q

describe diagnosis of uroabdomen

A
  1. blood chemistry abnormalities:
    -BUN: elevated
    -creatinine: elevated
    -potassium: may be elevated
  2. abdominal fluid contains:
    -BUN
    -creatinine
    -potassium
  3. creatinine or potassium ratio around 2:1 abdominal fluid : blood = diagnostic!!
  4. cytology: if bacteria present, rapid correction is indicated!
  5. diagnostic imaging: defines the source of the leaking!
    -abdominal rads first!
    -ultrasound: may not be specific (AFAST versus diagnostic)
    -(vagino-) urethrocystogram: better for LUT
    -intravenous pyelogram: contrast in vein, watch get filtered in kidney and come out, better for UUT
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4
Q

describe treatment of uroabdomen

A
  1. acute stabilization
  2. remove urine from peritoneal space
    -abdominocentesis
    -bladder catheter
    -peritoneal catheter
    -IV fluids
    -correct electrolyte disturbances
  3. then correct primary problem!
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5
Q

describe repair options for uroabdomen (2)

A
  1. primary surgical repair:
    -advantage: rapid resolution
    -disadvantage: anesthesia and abdominal surgery
    -caudal abdominal approach, debride, and close bladder
  2. longterm (7-14 day) urinary catheter:
    -advantage: avoid anesthesia and surgery
    -disadvantage: long term hospitalization, ascending infection, may still require surgery
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6
Q

summarize uroabdomen

A
  1. frequently a result of trauma
  2. bladder is most frequent source
  3. azotemia, hyperkalemia, abdominal effusion
  4. abdominal fluid : plasma creatinine ratio 2:1 is diagnostic
  5. imaging with contrast is helpful to diagnose location
  6. MEDICAL, not surgical emergency
  7. stabilize by removal of fluid IV resuscitation, correction of electrolyte imbalances, pain meds
  8. surgical repair indicated when patient is stable
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7
Q

describe exposure of the kidneys for surgery

A

right kidney: use duodenum as retractor
-duodenum and mesoduodenum are most lateral on abdomen; pull medial to expose kidney, ureter, ovary on that side

left kidney: use colon and mesocolon as retractor

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8
Q

describe renal vein and artery in surgery

A

renal vein is ventral (closer to you in surgery)

renal artery is dorsal

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9
Q

describe renal biopsy

A

ask: do the benefits outweigh the risk, and will what you find change what you recommend for medical management? not very common!

indications:
1. renal neoplasia
2. nephrotic syndrome
3. renal cortical disease: protein losing glomerulopathy
4. acute renal failure of unknown cause

contraindications:
1. coagulopathy
2. pylonephritis
3. ureteral obstruction
4. hydronephrosis

method: really only biopsy the outer cortex, too many opportunities for bleeding and urine leakage if biopsy other spots
1. ultrasound guided: small sample, unable to treat hemorrhage, least invasive

  1. laparoscopic: good sample (14g), insufflation reduced hemorrhage, specialized equipment
  2. open wedge renal biopsy: best sample, ability to treat hemorrhage, most invasive

what can go wrong:
1. bleeding! stay in cortex

  1. small sample size: may not represent focal or multifocal lesion
  2. urine leakage: stay in cortex
  3. results may not influence therapy
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10
Q

describe preop considerations for ureteronephrectomy

A
  1. will the patient survive on 1 kidney?
  2. difficult to determine single function
  3. remove ureter and kidney
    -would be big long blind ended pouch for urine to just sit and get nasty if not
  4. need excellent exposure
  5. need retraction
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11
Q

describe indications for ureteronephrectomy

A
  1. SEVERE infection: pyelonephritis
  2. traumatic injury
  3. hydronephrosis

partial nephrectomy (nephron sparing) an option in patients with reduced renal function

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12
Q

describe what can go wrong with ureteronephrectomy

A
  1. bleeding!!
    -large vessels need good ligatures! exposure
  2. leakage of urine
  3. chronic infection: must remove all of ureter
  4. renal failure
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13
Q

describe nephrotomy

A
  1. midline incision through the kidney to the renal pelvis; referral surgery
  2. indication: removal of urolith that one cannot get through the renal pelvis
  3. nephrolith removal indicated when:
    -obstructive
    -chronic/recurrent infection
    -causing other clinical signs (hematuria)
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14
Q

describe what could go wrong with nephrotomy?

A
  1. acute kidney failure:
    -ischemic injury
    -parenchymal injury
  2. acute kidney injury:
    -GFR affected temporarily, but may be minimal based on
    -technique, ischemia time, hemorrhage, anesthetic protocols
  3. bleeding
  4. urine leakage
  5. ureteral obstruction: debris from stone flushed into ureter
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15
Q

describe pyelotomy/pyelolithotomy

A
  1. removal of a stone in the renal pelvis; a referral surgery
  2. need to have some amount of obstruction/hydronephrosis to enable access
  3. less risk of renal injury versus nephrotomy bc
    -no vascular occlusion
    -no trauma to renal parenchyma
  4. may require magnification
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16
Q

describe what could go wrong with pyelotomy.pyelolithotomy?

A
  1. less risk of acute kidney injury
  2. urine leakage
  3. stricture or occlusion of the ureter
17
Q

describe donor screening for kidney transplant

A
  1. generally less than 3 years of age
  2. larger cats are better
  3. screening is similar to recipient
    -CBC, chem, UA, urine culture, UPC, T4 levels, infectious disease titers, blood type
  4. exclusion: advanced age, any renal or cardiac disease, hypertension
18
Q

describe renal harvest

A
  1. left kidney is ideal, but depends on renal artery anatomy
  2. ureteral papillae technique
  3. simultaneous versus delayed transplantation
    -cold storage and delayed implantation, flush with sucrose phosphate solution to reduce damage
19
Q

describe recipient pre-transplantation screening

A
  1. CBC, chem, UA, urine culture
  2. 3-view thoracic rads and abdominal rads
  3. abdominal US
  4. cardiac eval
  5. FIV, FLV, toxoplasmosis testing
  6. BP eval
  7. thyroid panel
  8. dental eval
20
Q

describe timing of transplantation

A
  1. no one really knows
  2. creatinine at least 4mg/dl
  3. not decompensated CKD
  4. recipient of appropriate medical therapy
21
Q

describe outcomes of kidney transplant

A
  1. 2-3 year median survival time
  2. daily immunosuppressive meds
  3. frequent check-ups
  4. good quality of life
  5. complications: infection, diabetes, cancer, ureteral stricture, rejection

Urinary II (38 decks)

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