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CFT II > Exam 3 - Ureteral Obstructions > Flashcards

Exam 3 - Ureteral Obstructions Flashcards

1
Q

why are dogs more amenable to stents for ureteral obstructions than cats?

A

cats have ureters that enter the bladder further distally than dogs, so stents sit very closely if not in their urethra which is painful

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2
Q

what is the kidneys’ immediate response to obstruction?

A

ureteral pressures increase immediately

renal blood flow decreases

pressure in bowman’s capsule goes up & GFR/blood flow decreases

vasoactive mediators are released leading to more vasoconstriction & further decreased blood flow

WBC influx

fibrosis - chronicity -> permanent damage!!!

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3
Q

T/F: time is of the essence when dealing with a patient with blocked ureters

A

true - 5 days in dogs & 4 days in cats if you’re aiming to get them back to normal function

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4
Q

what is the most common cause of ureteral obstructions in dogs & cats? why is this important?

A

ureterolithiasis - calcium oxalate stones

NOT DISSOLVABLE!!!

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5
Q

behind calcium oxalate stones causing ureteral obstruction, what commonly can cause it dogs & cats?

A

dogs - struvite stones

cats - blood calculi/pus balls

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6
Q

what is the normal size of a cat ureter?

A

1 mm

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7
Q

if you have a cat that you palpate a large kidney on, but don’t see any stones on rads, what should you do?

A

do an ultrasound - could be blood calculi causing the obstruction

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8
Q

is bilateral disease associated with ureteral obstruction more common in dogs or cats?

A

cats

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9
Q

what are the indications of when you should intervene for nephrouteroliths?

A

if they obstruct urine flow

if they grow in the face of appropriate therapy

associated with serving as a nidus for infection

associated with serious pain or hematuria

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10
Q

how do circumcaval ureters cause issues in cats?

A

more likely to be seen in cats ~15%

usually the right ureter wraps around the cava, which causes compression over time

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11
Q

what is the best way to diagnose circumcaval ureters in a cat?

A

CT

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12
Q

what is usually seen on physical exam of patients with ureteroliths?

A

asymmetrical kidney palpation & pain

or could also not have any pain

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13
Q

what is the common signalment of animal affected by ureterolithiasis?

A

middle aged to older animals is most common

can happen in young animals

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14
Q

why is it important to do a urine culture for a dog with a ureteral obstruction?

A

50-75% of them will have a positive urine culture!!!! indicates the need for antibiotics

high incidence of concurrent UTI & pyelonephritis

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15
Q

if you palpate asymmetric kidneys on physical exam, what should you suspect?

A

obstructed kidneys!!!!

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16
Q

will an animal be azotemic if they have one of two healthy kidneys become obstructed? why?

A

no - takes a minimum of 75% of renal mass loss to see azotemia

minimum of 60% of functional nephron loss in animals with chronic kidney disease

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17
Q

what clin path abnormalities do you expect to see in a cat with a ureteral obstruction?

A

azotemia

hyperkalemia

hyperphosphatemia

normocytic, normochromic anemia

positive urine culture

hypercalcemia

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18
Q

what clin path abnormalities do you expect to see in a dog with a ureteral obstruction?

A

positive urine culture

azotemia

leukocytosis

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19
Q

what diagnostic imaging is recommended when working up a patient for a ureteral obstruction?

A

combine ultrasound & radiographs

20
Q

in a transverse plane, how big should the pelvic width of the ureter measure in a dog & cat?

A

dogs - up to 2 mm

cats - 1.6 mm

21
Q

what is the normal diameter of the canine ureter? what about the feline ureters?

A

dogs - ranges from 1-3 mm

cats - internal diameter is 0.4 mm & outside diameter of 1 mm

22
Q

what is seen on this ultrasound image of the kidney?

A

dilated renal pelvis

23
Q

what is seen on this ultrasound image of the kidney?

A

hydronephrosis & a stone in the ureter

24
Q

what is seen on this ultrasound image of the ureter?

A

ureteroliths

25
Q

does a normal renal pelvis mean there is no obstruction present?

A

NO!!!

26% of obstructed feline ureters will result in minimal pelvic dilation < 4 mm

26
Q

what are some contraindications for medical management of a patient with ureteroliths?

A

if they are oliguric/anuric

hyperkalemic

progressively getting worse over 24-72 hours

not fluid overloaded

27
Q

what is included in medical management for patients with ureteroliths?

A

iv fluids, a blockers, diuretics, amitriptyline, glucagon, & supportive care

28
Q

T/F: a nephrectomy should be the absolute last resort for treating a ureteral obstruction

A

true

29
Q

what are some surgical options for treating ureteral obstructions?

A

ureterotomy/ureteral resection & anastomosis

ureteral re-implantation

ureteronephrectomy

30
Q

what are the most common surgical options used for treating ureteral obstructions?

A

ureterotomy & reimplantation

31
Q

what are the complications associated with ureterotomy & reimplantation surgery?

A

uroabdomen, site edema, recurrence of obstruction (40%), stricture, & leakage

32
Q

what is extracorporeal shockwave lithotripsy?

A

procedure used to fragment uroliths so that they are small enough to be passed & voided - ultrasound shock waves are used to crush stones

not as effective in cats

33
Q

what is included in a shock wave lithotriptor?

A

energy source for generating the shock waves

focusing device to concentrate the shock wave energy to a focal zone

coupling medium to transmit the shock waves from the generator to the urolith within the patient’s body

imaging system (fluoroscopy & ultrasound) used for positioning the urolith within the focal zone

34
Q

T/F: all common uroliths are amenable to fragmentation by ESWL except for cystine stones

A

true

35
Q

what are the goals of ureteral stenting?

A

divert the urine to bypass the obstruction

passive ureteral dilation

decrease surgical tension

aid extracorporeal shockwave lithotripsy

prevent future obstructions while the stent is in place

36
Q

when is a percutaneous placement of ureteral stent common?

A

common in dogs that have a UCC causing obstruction

37
Q

when do we use a hybrid approach for placing a ureteral stent?

A

generally done for patients that are too small to scope

38
Q

what animals do we use a cystoscopic retrograde placement for a ureteral stent? what about an antegrade approach?

A

retrograde - dogs

antegrade open - cats

39
Q

what is the most common short term ureteral stent complication seen in cats? why?

A

dysuria - they have ureters that enter the bladder very distal, so the stents are very close to the urethra if not in it

40
Q

what are some long term complications associated with ureteral stents?

A

pollakiuria, stent migration, ureteritis, tissue in-growth, chronic hematuria, UTIs, & stent reobstruction

41
Q

T/F: dogs with ureteral stents have fewer complications than cats

A

true

42
Q

what makes up a subcutaneous ureteral bypass?

A

locking loop nephrostomy tube

cystotomy tube at the apex of the bladder

catheters are tunneled under the skin

attach onto a subcutaneous port

permanent, internalized drainage system

43
Q

what is the success rate of SUBS?

A

85-90% survival to discharge

well tolerated by cats long term

44
Q

what are the disadvantages of SUBS?

A

life long management!!!!

current recommendations include 3 month recheck with SUB flush (special HUBER needle, tetra EDTA, required u/s & experience)

45
Q

what are the peri-operative complications associated with SUBS?

A

nephrostomy site leakage, catheter leakage, catheter obstructions/kinks, & blood clot occlusion

46
Q

what are the long term complications associated with SUBS?

A

infections, encrustations, failure to resolve azotemia, kinking, migration, & peritoneal effusion

47
Q

when should you intervene in treatment for a patient with nephroliths?

A

recurrent or persistent UTIs proven or presumed secondary to nephroliths

compromise of renal function worsening with a large stone burden

recurrent or persistent clinical signs

severe hematuria that is renal in origin

CFT II (28 decks)

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