Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Y3 MOD > Surgery of the urinary tract – kidneys and bladder > Flashcards

Surgery of the urinary tract – kidneys and bladder Flashcards

1
Q

What are the main principles of urogenital surgery?

A
  • Apply Halsted principles
  • Gentle tissue handling
  • Suture material: monofilament absorbable
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Describe the anatomy of the kidneys

A
  • Paired, bean-shaped retroperitoneal organs
  • R more cranial than the L
  • L more mobile than R; both more mobile in cats
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the normal length of the kidneys in cats and dogs?

A

Renal size measured on VD abdominal radiographs
Cat: 2-2.5 x L2 length
Dog: 2.5-3.5 x L2 length

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Name some developmental abnormalities of the kidney

A
  • Renal agenesis (kidney and ureter not present)
  • Renal dysplasia (disorganised parenchyma)
  • Renal ectopia: should be functioning normally, just not in the right place
  • Polycystic kidney disease (Persians, Bull terriers) *cysts can also be acquired
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the indications for a renal biopsy?

A
  • Renal mass (commonest indication)
  • Haematuria of upper urinary tract origin
  • Renal cortical disease / Protein-losing glomerulopathy
  • Renal failure where underlying cause cannot be determined
    • Be aware that if the kidney is already diseased, a biopsy may cause further damage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Renal biopsy should be performed after which other diagnostics?

A
  • Haematology
  • Serum biochemistry
  • Urinalysis/urine bacteriology
  • Diagnostic Imaging
  • Coagulation profile: clotting factors, platelet numbers, etc
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are some contraindications for renal biopsy?

A
  • Anaemia / Coagulopathy
  • Oliguria / Anuria / Severe azotaemia
  • Hypertension
  • Urinary obstruction
  • Hydronephrosis, cysts
  • (Peri)renal abscess, pyelonephritis
  • Solitary functioning kidney
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What potential complications can occur with a renal biopsy?

A
  • Haemorrhage (most common)
  • Haematuria
  • Hydronephrosis (obstruction by blood clots)
  • Renal infarction
  • Damage to renal vasculature
  • AV fistula
  • Infection
  • Cyst or haematoma formation
  • Renal fibrosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the methods for renal biopsy?

A
  • Fine Needle Aspirate (FNA): collects cells
  • Tru-cut or Spring-loaded Biopsy instrument 14-18G: Collects tissue
  • Surgical
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the different approaches to the kidney?

A
  • Percutaneous (blind) biopsy (not recommended)
  • Ultrasound-guided biopsy
  • Keyhole biopsy: flank approach
  • Laparoscopic biopsy: requires specific training and equipment
  • Ventral midline celiotomy: most common way
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Where should the needle advance in the kidney when taking a biopsy?

A

Across the cortex only! not towards the hilus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

During surgical approach which structures are moved to expose the kidney?

A

Retraction of the duodenum and descending colon towards the midline exposes the kidney

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is a nephrotomy used for?

A
  • Used to obtain a Wedge biopsy

- Used in removal of nephroliths (nephrolithotomy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Describe nephroliths and their clinical signs

A
  • May be incidental finding
  • Calculi occur more commonly in bladder than kidneys
  • Clinical signs: lumbar/abdominal pain, haematuria, recurrent UTI, azotaemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How are nephroliths treated?

A
  • Medical management
  • Calcium oxalate do not respond to medical management so have to be surgically removed
  • Surgical management: consider referral
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is a ureternephrectomy?

A

Removal of the kidney and associated ureters

17
Q

What are the indications for a ureternephrectomy?

A
  • Trauma
  • Hydronephrosis (ligated ureter?!)
  • Renomegaly/renal masses
  • Management of single ureteral ectopia?
  • Harvest kidney for transplantation
18
Q

What must a patient have to undergo a ureternephrectomy?

A

Functioning other kidney

19
Q

What is the most common renal neoplasia in cats?

A

Lymphoma

20
Q

What is the most common renal neoplasia in dogs?

A

Renal cell carcinoma

21
Q

Describe the history and clinical signs of an animal with renal neoplasia

A
  • Slow onset (weeks-months)
  • Haematuria
  • Weight loss
  • Depression/lethargy
  • Inappetence
  • Pyrexia
  • Lameness
  • Abdominal distention
22
Q

How is renal neoplasia investigated/diagnosed?

A
  • Abdominal palpation
  • Haematology and serum biochemistry
  • Radiography
  • Computed tomography
  • Abdominal ultrasound
  • Biopsy (FNA, Trucut, excisional)
  • CHECK FOR METASTASIS
23
Q

How is renal neoplasia treated?

A
  • Lymphoma: chemotherapy, not surgical disease
  • Unilateral renal neoplasia with no gross metastasis: Ureteronephrectomy
  • Surgery can be challenging due to neovascularization
  • Surgery is palliative until metastases become apparent
24
Q

Describe two congenital abnormalities of the bladder

A
  • Patent urachus: fetal communication between bladder and allantoic sac persists
  • Vesicourachal diverticulum: external opening of urachus closes but blind-ending diverticulum remains open
25
Q

What are the clinical signs of congenital abnormalities of the bladder?

A

Urine leakage, dermatitis, infection

26
Q

What are the indications for cystotomy?

A
  • Removal of calculi (stones)
  • Repair of bladder trauma
  • Biopsy or resection of bladder masses
  • Biopsy of bladder wall
  • Repair of ectopic ureters
27
Q

How is the bladder closed?

A
  • Monofilament suture material
  • Single layer, simple interrupted or simple continuous
  • 2-layer inverting continuous pattern
  • Submucosa is the strength-holding layer
  • Bladder heals quickly: 100% of normal tissue strength in 2-3 weeks
28
Q

The majority of bladder calculi are made of?

A

Struvite or calcium oxalate

29
Q

What are the signs of bladder calculi?

A

Haematuria
Pollakiuria (frequent, abnormal urination during the day)
Stanguria (painful, frequent urination of small volumes)
Dysuria (painful urination)

30
Q

How are bladder calculi diagnosed?

A
  • Haematology, serum biochemistry, urinalysis, urine bacteriology
  • Plain radiography: you may not see urate, cystine, calcium phosphate
  • Pneumocystography
  • Double-contrast cystography
  • Ultrasound
31
Q

What are the causes of bladder rupture?

A
  • Trauma
  • Bladder neoplasia
  • Urethral obstruction by calculi or neoplasia
  • Iatrogenic: cystocentesis, catheterisation, manual expression
32
Q

What are the signs of bladder rupture?

A
  • Haematuria, anuria, dysuria
  • Abdominal bruising
  • Abdominal pain
  • Abdominal distention
  • Depression, vomiting or shock signs
33
Q

How is bladder rupture diagnosed?

A
  • History + clinical examination
  • Absence of urine/haematuria on catheterisation
  • Urethral obstruction at attempted catheterisation
  • Azotaemia, dehydration, metabolic acidosis, hyperkalaemia
  • Abdominocentesis: sample of abdominal free fluid for analysis
  • Abdominal ultrasonography
  • Positive contrast radiography
34
Q

How is bladder rupture managed?

A
  • Small tears heal spontaneously, place indwelling catheter for 1-3 days
  • Fluid therapy + urine drainage:
    • To normalise electrolyte levels, improve hydration + decrease azotaemia
    • Indwelling catheter
  • Exploratory laparotomy: identify and repair defect
35
Q

What is the use of a cystostomy tube?

A

Allows urinary diversion or to avoid bladder distention
Indications
• Bladder or urethral surgery
• Obstructive bladder neck or urethral neoplasia
• Neurogenic bladder atony

36
Q

What is the most common bladder neoplasia in dogs and cats?

A

Transitional cell carcinoma

37
Q

What are the clinical signs of a bladder neplasia?

A
  • Dysuria, haematuria, pollakiuria, systemically ill

- UTI

38
Q

How is a bladder neoplasia diagnosed?

A
  • Haematology, serum biochemistry, urinalysis
  • Ultrasound
  • Double contrast cystography
  • CT + thorax
  • Catheter suction biopsy
  • TCC biopsy: tumour seeding possible
39
Q

How is a bladder neoplasia treated?

A
  • Chemotherapy
  • Non-steroidal anti-inflammatory drugs (NSAIDS)
  • Cystostomy tube
  • Urethral stenting
  • Partial cystectomy: up to 75%, not if trigone affected

Y3 MOD (23 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions