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Year 1/2 > Elimination & Detox 2: Urinary Sx Ruminants > Flashcards

Elimination & Detox 2: Urinary Sx Ruminants Flashcards

1
Q

what is the PIZZLE?

what animal DOES NOT HAVE THIS?

A

URETHRAL PROCESS

BULLS DO NOT HAVE THIS

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2
Q

why should we NOT install a CATHETER RETROGRADE in MALE & FEMALE RUMINANTS?

what should we do INSTEAD?

A

MALE RUMINANTS = SIGMOID FLEXURE makes RETROGRADE CATHETERIZATION VERY DIFFICULT, also URETHRAL DIVERTICULUM

FEMALE RUMINANTS = URETHRAL DIVERTICULUM

better to do CYSTO on RUMINANTS

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3
Q

in EXAMINING THE URINARY SYSTEM of RUMINANTS…

what 2 WAYS can we perform US? which one looks at BLADDER & KIDNEYS best?

what are we looking for in RADIOLOGY?

what 3 things are we looking for in ENDOSCOPY?

A

in US…
1. TRANSCUTANEOUSLY
2. TRANSRECTALLY –> best for BLADDER & KIDNEYS

in RADIOLOGY = looking for OBSTRUCTIVE UROLITHIASIS

in ENDOSCOPY…
1. RULE IN OR OUT URINARY MASS
2. CONGENITAL DEFECT in URINARY TRACT
3. STRICTURE in URETHRA

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4
Q

presenting complaint for UROLITHIASIS generally tends to be….

7 common CLINICAL SIGNS?

this can be diagnosed VIA…

A

presenting complaint for UROLITHIASIS generally tends to be VERY VAGUE

clinical signs?
1. lethargic
2. bruxism (grinding teeth)
3. vocalizations
4. MUSCLE FASCICULATIONS
5. STRAINING POSTURE/STRANGURIA
6. ABDOMINAL DISTENTION
7. COMPLETE ANURIA or URINE DRIPPING

this can be diagnosed VIA A PHONE CALL!

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5
Q

this ruminant is VOCALIZING and maintaining THIS POSITION…

what should be your TOP DIFFERENTIAL?

how would you DESCRIBE this animal with one CLINICAL SIGN?

A

TOP DIFFERENTIAL = OBSTRUCTIVE UROLITHIASIS

CLINICAL SIGNS = STRANGURIA

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6
Q

compared to OTHER ruminants, SHEEP with UROLITHIASIS…

they RARELY…

A

ARE MUCH LESS DEMONSTRATIVE, will just LAY DOWN & ISOLATE

they RARELY VOCALIZE

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7
Q

is CONSTANT DRIPPING of urine ever normal?

A

NO!

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8
Q

what 2 findings on ABDOMINAL PALPATION might we find for UROLITHIASIS?

2 means of palpation?

A

2 urolithiasis findings?
1. DISTENDED, HARD, FIRM BLADDER
2. PULSATING URETHRA

2 means of palpation?
1. TRANSRECTAL (cattle)
2. DIGITAL (small ruminants)

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9
Q

what are 5 CLINICAL SIGNS of RUPTURED BLADDER in RUMINANTS?

these usually manifest WHEN in DZ?

what do we often see on PE? (1 big one, 1 +/-)

A

5 clinical signs?
1. DEPRESSION/RECUMBENCY
2. DEHYDRATION
3. SCLERAL INJECTION
4. ENOPHTHALMIA (sunken eyes)
5. BRADYCARDIA from HYPERKALEMIA

these usually manifest after animal is BLOCKED FOR SEVERAL DAYS

on PE = BILATERAL ABDOMINAL DISTENTION +/- FLUID WAVE

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10
Q

how does a RUPTURED BLADDER usually PRESENT GROSSLY?

A

usually PINPOINT PERFORATIONS in bladder where URINE OOZES OUT OF due to EXTREMELY DISTENDED BLADDER that’s UNDERGONE NECROSIS

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11
Q

if a ruminant is presenting with DEPRESSION & ENOPHTHALMIA, what disease should we suspect?

A

SUSPECT RUPTURED BLADDER

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12
Q

this animal is likely experiencing WHAT disease?

if this is VERY chronic, what might occur?
–> what is a STRONG clinical sign of this?

A

animal likely experiencing URETHRAL RUPTURE

if VERY CHRONIC = FISTULA can develop where URINE ESCAPES OUT OF THE SKIN
–> usually accompanied by STRONG SMELL

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13
Q

URETHRAL RUPTURE

= how does it usually occur?

what often occurs if you touch the prepuce? why?

will the prepuce be hot or cold?

A

= PRESSURE NECROSIS tends to occur at SITE OF OBSTRUCTION & URINE LEAKS into SQ TISSUES of PERINEUM, PREPUCE & VENTRAL ABDOMEN

if you touch the prepuce, usually cause INDENTATIONS called PITTING EDEMA; occurs due to NECROSIS

prepuce should be COLD because NOT WELL VASCULARIZED from EDEMA (NOT INFLAMMATORY)

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14
Q

URETEROLITHIASIS/NEPHROLITHIASIS…

commonality in SMALL RUMINANTS vs. LARGE?

BEFORE offering surgery, what should we do?

A

VERY UNCOMMON in SMALL RUMINANTS, just tends to occur in STEERS

BEFORE offering surgery for this, INVESTIGATE KIDNEY

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15
Q

in UROLITHIASIS in ruminants…

usually see ____ AZOTEMIA

in PROLONGED cases (>___-___ HOURS), can see WHAT 4 electrolyte derangements?

what DIAGNOSTIC TOOL & FINDING can help confirm? give 2 possible parameters

A

usually see POST-RENAL AZOTEMIA

in PROLONGED cases (>24-36 HOURS), can see…
1. HYPERKALEMIA
2. HYPONATREMIA
3. HYPOCHLOREMIA
4. HYPERPHOSPHATEMIA

DIAGNOSTIC TOOL = ABDOMINOCENTESIS

FINDING from ABDOMINOCENTESIS = ABDOMINAL CREATININE:SERUM CREATININE RATIO
–> textbook states 2:1
–> in reality, VERY HIGH 1:1 IS OK TO HELP CONFIRM UROLITHIASIS

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16
Q

US for UROLITHIASIS in ruminants…

often performed trans____ or trans____ (in cattle only)

usually see WHAT finding on the bladder? in SMALL vs. LARGE breeds of SMALL RUMINANTS?

INSIDE the bladder can also see…

A

US often performed transABDOMINALLY or transRECTALLY (in cattle only)

usually see MARKEDLY DISTENDED BLADDER, and in small ruminants…
1. SMALL BREEDS = >5cm
2. LARGE BREEDS = >8cm

INSIDE the bladder can also see ECHOGENIC MATERIAL

17
Q

ID WHERE the lesion that’s CAUSING UROPERITONEUM is

what likely is it?

A

likely UROLITHIASIS

18
Q

we should perform RADIOGRAPHS on EVERY ___ ____ ____

rads can be taken either ____ or in _____ RECUMBENCY

we should make sure to include both the ____ & ____ in our views

if we DO NOT SEE RADIODENSE CALCULI…

A

EVERY OBSTRUCTED SMALL RUMINANT

rads can be taken either STANDING or in LATERAL RECUMBENCY

we should make sure to include both the PERINEUM & PREPUCE in our views

if we DO NOT SEE RADIODENSE CALCULI, DOES NOT RULE OUT UROLITHIASIS, JUST MIGHT NOT HAVE STONES THAT ARE RADIOPAQUE

19
Q

ID what’s obstructing this small ruminant & why

A

CALCIUM CARBONATE STONES, they’re usually VERY RADIOPAQUE

20
Q

when should we use CONTRAST RADIOGRAPHY in SMALL RUMINANTS? (2)

2 ways that we can INJECT CONTRAST?

A

when should we use CONTRAST RADIOGRAPHY in SMALL RUMINANTS?
1. when we suspect a URETHRAL RUPTURE
2. when we suspect URETHRAL OBSTRUCTION that’s caused by NON-RADIOPAQUE UROLITH

how can we inject contrast?
1. RETROGRADE by placing catheter in DISTAL URETHRA (just a little bit)
2. via CYSTOCENTESIS to inject contrast INTO BLADDER & let animal URINATE IT OUT

21
Q

what DIAGNOSTIC method is this?

name TOP & BOTTOM circle findings

A

CONTRAST RADIOGRAPHY

TOP = DISTENDED URETHRA

BOTTOM = CONTRAST EXTRAVASATING OUT

22
Q

ENDOSCOPY in SMALL RUMINANTS…

limitation? (1)

helps to visualize… (2)

A

limitations = hard for SMALL RUMINANTS bc SMALL URETHRA

helps to visualize…
1. STRICTURE
2. CONGENITAL ABNORMALITY

23
Q

TREATMENT OPTIONS for SMALL RUMINANT with OBSTRUCTIVE URETHROLITHIASIS… (3)

which one is usually NON-REWARDING?

what should we WARN the owners about?

A
  1. IMMEDIATE SALVAGE is possible via EUTHANASIA, especially if animal is MARKETED
  2. MEDICAL Tx usually NON-REWARDING, better to just try and AMPUTATE SOME OF URETHRAL PROCESS
  3. SURGICAL Tx has MANY OPTIONS but usually just reserved for PETS

SHOULD WARN OWNERS OF POSSIBLE RECURRENCE because MANY ANIMALS HAVE GENETIC PREDISPOSITION

24
Q

PRE-OP considerations/treatments for URETHROLITHIASIS SURGERY in SMALL RUMINANTS (4)

A
  1. makes sure PROPER FLUID LOAD, can give ISOTONIC FLUID
  2. if HYPERKALEMIA, can give DEXTROSE, SODIUM BICARBONATE or INSULIN to push K INTRACELLULARLY
  3. CYSTOCENTESIS to EVACUATE BLADDER prior to Sx either US-GUIDED or BONNANO CATHETER (left in bladder for 24 hours)
  4. PRUDENT USE of NSAIDs due to NEPHROTOXICITY
25
Q

we should DEFINITELY NOT use NSAIDs if the patient is…

what should we opt for INSTEAD?

A

AZOTEMIC

INSTEAD, opt for OPIOIDS

26
Q

BONNANO CATHETER…

= what is it?

when is it used?

A

= URINARY CATHETER that can be left/safely remains IN BLADDER for 24 HOURS to help STABILIZE METABOLICALLY UNSTABLE PATIENTS

used usually when patients are UNSTABLE & CANNOT UNDERGO IMMEDIATE SURGERY

27
Q

URETHRAL PROCESS AMPUTATION…

this should ONLY be suggested if WHAT 2 THINGS ARE TRUE?

___ is NECESSARY

restraint of animal?

post-op risk?

A

ONLY be suggested if…
1. OBSTRUCTION is AT URETHRAL PROCESS
2. we can REESTABLISH FLOW

SEDATION is NECESSARY

restraint? = animal restrained on VD or LATERAL RECUMBENCY with PELVIS & HOCKS FLEXED to MANIPULATE PENIS OUT OF SHEATH

post-op risk = CAN GET OBSTRUCTED AGAIN SOMEWHERE ELSE

28
Q

ID STONES

A

CALCIUM CARBONATE STONES

29
Q

what is the GOLD STANDARD of TREATMENT for UROLITHIASIS in SMALL RUMINANTS?

A

TUBE CYSTOSTOMY

30
Q

TUBE CYSTOSTOMY…

= used to treat WHAT?

3 pros?

4 cons?

A

= GOLD STANDARD tx for UROLITHIASIS

pros?
1. allows CLEARANCE of CYSTIC CALCULI via NORMOGRADE FLUSHING to remove EVERYTHING IN THE BLADDER
2. PRESERVES NORMAL ANATOMY
3. allows BYPASS OF URINE during POST-OP PERIOD

cons?
1. HIGH COST!
2. LONGER POST-OP care & HOSPITAL STAY
3. MAY REQUIRE SECOND SURGERY
4. DOES NOT PREVENT RECURRENCE

31
Q

TUBE CYSTOSTOMY…

position?

necessary for patient to be under…

6 steps?

A

position = DORSAL RECUMBENCY

necessary for patient to be under GENERAL ANESTHESIA

steps?

  1. make PARAMEDIAN INCISION in CAUDAL ABDOMEN
  2. DECOMPRESS & EVACUATE CONTENTS OF BLADDER
  3. INSERT CATHETER at TRIGONE
  4. REMOVE STONES IN BLADDER & FLUSH NORMOGRADE
  5. +/- can leave a FOLEY CATHETER IN via making SEPARATE STAB INCISION on BLADDER & BODY WALL for CATHETER TO COME OUT OF
  6. INFLATE FOLEY CATHETER to keep it in bladder & suture via PURSE-STRING SUTURE
32
Q

why do we insert a FOLEY CATHETER into TUBE CYSTOSTOMY?

at day 5…

at day 15…

A

BYPASS URINE FLOW for IMMEDIATE POST-OP PERIOD to AVOID STRAINING & INFLAMMATION

day 5 = CLAMP CATHETER for a FEW HOURS AT A TIME to LOOK FOR URINATION

day 15 = CATHETER needs to be OCCLUDED FOR 2 days and GOAT URINATES NORMALLY

33
Q

why do we need to wait 2 WEEKS to REMOVE FOLEY BLADDER from TUBE CYSTOSTOMY?

what are we hoping has happened?

A

we are hoping that an ADHESION has formed between BLADDER & BODY WALL so that WE DO NOT GET UROABDOMEN, and this can ONLY OCCUR AFTER 14-15 DAYS

WE DO NOT WANT TO GO BACK TO SURGERY!

34
Q

6 POSSIBLE COMPLICATIONS from TUBE CYSTOSTOMY?

label as RARE or LESS RARE

A
  1. GA complications (RARE)
  2. URETHRAL RUPTURE from AGGRESSIVE FLUSH, so don’t use syringes any greater than 20 CC (RARE)
  3. POST-OP PERITONITIS or UTI (rarely) (RARE)
  4. IATROGENIC UROABDOMEN when FOLEY CATHETER PULLED TOO SOON (RARE)
  5. CAN’T RESTORE URETHRAL PATENCY at the time of surgery (LESS RARE)
  6. recurrence of UROLITHIASIS (LESS RARE)
35
Q

PERINEAL or PERMANENT URETHROSTOMY…

= what is it?

animal is usually in ___ recumbency

should make a ___ INCISION ____ the penis

A

= CREATING A NEW OPENING to the URETHRA to BYPASS AN OBSTRUCTION, usually at an opening in the PERINEUM (BELOW THE ANUS)

animal is usually in DORSAL recumbency

should make a LINEAR INCISION TOWARDS the penis

36
Q

PERINEAL or PERMANENT URETHROSTOMY…

two pros?

4 cons?

2 RARE complications?

3 COMMON complications?

A

two pros?
1. LOWER COST from SHORTER HOSPITAL STAY
2. VALID OPTION for URETHRAL RUPTURE or if TUBE CYSTOSTOMY has been attempted

4 cons?
1. STRICTURE = VERY LIKELY WITH PU and can cause MST <1 YEAR
2. LOSS OF NATURAL BREEDING
3. RECURRENCE of OBSTRUCTION
4. does NOT allow EVACUATION OF CYSTIC CALCULI (in bladder)

2 RARE complications?
1. GA complications
2. CANNOT RESTORE URETHRAL PATENCY due to PELVIC URETHRAL OBSTRUCTION

3 COMMON complications?
1. POST-OP STRICTURE
2. URINE SCALDING
3. RECURRENCE of UROLITHIASIS

Year 1/2 (139 decks)

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