Elimination & Detox 2: UT Trauma Flashcards
5 causes of UT TRAUMA?
- ABDOMINAL TRAUMA = look for RIB FRACTURES, HEMOPERITONEUM, ETC.
- PELVIC FRACTURES where SHARP EDGES DAMAGE URETHRA
- PENETRATING WOUNDS like BITE WOUNDS
- URINARY CALCULI that can ERODE THROUGH WALL OF URETER or we cause IATROGENIC damage trying to remove in URETHRA
- SURGICAL COMPLICATIONS/IATROGENIC
when asking owners for HISTORY of UT TRAUMA, WHAT should we be ASKING THEM IF THEY’VE SEEN? (4)
- HEMATURIA, DYSURIA or ANURIA?
- ABDOMINAL SWELLING
- ABDOMINAL BRUISING
- HISTORY of PREVIOUS CATHETERIZATION
if an animal has DISTAL URETHRAL INJURY, then WHAT is their LIKELY PE PRESENTATION?
has SKIN around the PERINEAL AREA that’s WEEPY, MOIST & PAINFUL
ID WHERE INJURY IS
Skin around the PERINEUM is WEEPY, MOIST & PAINFUL.
DISTAL URETHRAL INJURY
PERITONEAL FLUID when assessing POTENTIAL UT TRAUMA?
2 values EACH for DOGS & CATS?
we should COMPARE CREATININE & POTASSIUM of ABDOMINAL FLUID to SERUM CREATININE & POTASSIUM!
in DOGS…
1. CREATININE SERUM:EFFUSION should be 1:2
2. POTASSIUM SERUM:EFFUSION should be 1:1.4
in CATS…
1. CREATININE SERUM:EFFUSION should be 1:2
2. POTASSIUM SERUM:EFFUSION should be 1:1.9
what 3 things should we look for on ABDOMINAL RADS for UT TRAUMA?
- ABSENCE of URINARY BLADDER
- LOSS OF ABDOMINAL DETAIL (effusion)
- LOSS of RETROPERITONEAL DETAIL & INCREASED SIZE Of RETROPERITONEAL SPACE
if a patient has CONFIRMED UT TRAUMA, what do we do for INITIAL STABILIZATION? (3)
what 3 ADDITIONAL treatments MIGHT BE NECESSARY? why?
what 2 THINGS should we EVALUATE FOR?
INITIAL STABILIZATION…
1. IV FLUIDS
2. CORRECT ELECTROLYTE & ACID-BASE ABNORMALITIES
3. ANTIBIOTICS
if VERY UNSTABLE, might need these to MAKE THEM A BETTER ANESTHETIC CANDIDATE…
1. DIALYSIS
2. URINARY DIVERSION
3. PERITONEAL DRAINAGE
EVALUATE for…
1. CONCURRENT TRAUMA
2. CARDIAC ARRHYTHMIAS
3 TREATMENT options for HYPERKALEMIA?
an UNCOMMON treatment for METABOLIC ACIDOSIS?
HYPERKALEMIA…
1. IV FLUID THERAPY with ISOTONIC FLUID
2. IV Ca-GLUCONATE at 10%
3. INSULIN + DEXTROSE
METABOLIC ACIDOSIS…
1. SODIUM BICARBONATE
SURGICAL Tx for KIDNEY TRAUMA (3)
- PRIMARY REPAIR = use ABSORBABLE SUTURES for WOUNDS on RENAL CAPSULE
- PARTIAL NEPHRECTOMY = remove PART of a kidney, uncommon
- COMPLETE NEPHRECTOMY = OTHER KIDNEY OK
in a NEPHRECTOMY, we should isolate the RENAL ARTERY down to the ____, and isolate the RENAL VEIN down to the _____
RENAL ARTERY = AORTA
RENAL VEIN = CAUDAL VENA CAVA
2 GOOD IMAGING MODALITIES for UT TRAUMA when we suspect RUPTURE?
- EXCRETORY UROGRAM via CONTRAST RADIOGRAPHY
- ABDOMINAL US
what IMAGING MODALITY is this?
which kidney is ABNORMAL?
this is an EXCRETORY UROGRAM via CONTRAST RADIOGRAPHY
RIGHT KIDNEY ABNORMAL = CONTRAST IS EXTRAVASATING
3 SURGICAL OPTIONS for URETERAL TRAUMA?
- PRIMARY REPAIR with SUTURES
- URETERAL REIMPLANTATION
- NEPHRECTOMY (complete)
ID what DEVICE this is!
what is it USED FOR?
WHEN is it removed?
NEPHROSTOMY TUBE
used to STABILIZE URETER INSTEAD of PLACING STENT
only REMOVE ONCE URETER HAS HEALED
URETERAL TRANSECTION…
= what is it?
process? (4)
how do we MAKE SURE PATIENT ISN’T LEAKING?
= occurs when we REMOVE A PIECE OF DAMAGED URETER and then ANASTOMOSE the TWO HEALTHY ENDS BACK TOGETHER
process?
1. ISOLATE KIDNEY from RETROPERITONEAL ATTACHMENTS & PULL CAUDALLY
- then PULL THE BLADDER CRANIALLY
- TRANSECT URETER & then ANASTOMOSE healthy ends
- PLACE A STENT into URETER to STABILIZE IT
afterwards, can put CONTRAST THROUGH to MAKE SURE PATIENT ISN’T LEAKING
