Uroperitoneum

Question 1

What are the three causes of uroperitoneum and the time frame of when they occur?

Answer 1

3-4 days of age: ruptured bladder (#1), urethras defects (rare)

1-2 weeks of age: urachal perforation

Question 2

What are the clinical signs off uroperitoneum?

Answer 2

QAR
Straining
Fluid in body cavities

Question 3

Are colts or fillies more predisposed to uroperitoneum?

Answer 3

Colts

Question 4

How do you diagnose uroperitoneum?

Answer 4

• abdominocentesis >2:1 peritoneal:serum creatinine
• U/S, contrast rads
• bubble gram (sterile saline shaken and placed in bladder during U/S) confirms existence of rent
• Low sodium and chloride
• High potassium = hyperkalemia = emergency
• Dehydration
• metabolic acidosis

Question 5

How should you manage uroperitoneum pre-surgery?

Answer 5

1. SLOW peritoneal drainage (rapid draining can lead to circulatory collapse)
2. IV NaCl (.9% - 2.5%)
3. Stabilize for anesthesia; must get K+ below 6 mEq/L; use dextrose or insulin in complicated cases

Question 6

How can you decrease the potassium levels in a foal with a ruptured bladder?

Answer 6

Best to slowly drain urine from abdomen and give IV fluids
If not enough to bring down K+, can give dextrose or insulin

Question 7

Should you rush into surgery on a uroperitoneum?

Answer 7

NO
Only fools rush in

Question 8

Where are bladder tears most commonly located?

Answer 8

Dorsal aspect of the bladder

Question 9

What factors would make you decide against surgery for a ruptured bladder?

Answer 9

Severely debilitated - poor candidates for general anesthesia
Small tears / no definitive tears seen on cystoscopic exam; manage with medical support and continuous suction drainage of bladder

Question 10

What is the surgical approach for a ruptured bladder?

Answer 10

Midline celiotomy + exploration + cystorrhaphy

Simple continuous appositional pattern of serosa + submucosa
NEVER penetrate mucosa - adhesions will form
Inverting pattern over top
Fill with fluid to pressure test