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Large Animal Surgery > Equine Urogenital Surgery: Urolithiasis & Foals > Flashcards

Equine Urogenital Surgery: Urolithiasis & Foals Flashcards

1
Q

What is the most common type of cystic calculi seen in horses? What is the most common clinical presentation?

A

Type 1 - calcium deposits into yellow, spiculated structures

  • hematuria after exercise
  • stranguria - posturing to urinate without passing urine
  • colic
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2
Q

How are cystic calculi diagnosed?

A
  • rectal palpation - just inside rectum
  • endoscopy
  • U/S - bladder, kidney (nephroliths have high likelihood of recurrence)
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3
Q

What are 3 options for treating cystic calculi in horses?

A
  • surgery - cystotomy, perineal urethrotomy (blocking urethra)
  • mares - manual removal
  • lithotripsy
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4
Q

How are horses prepared for cystotomies? What are 2 options for approach?

A

fast for 24-48 hours to decrease abdominal fill

  1. caudal ventral midline + parapreputial - enter abdomen on midline
  2. parainguinal - cranial edge of inguinal ring
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5
Q

Where is the bladder found in the abdomen? How are cystotomies performed?

A

caudal abdomen/pelvic inlet

  • facilitate exteriorization by distending the bladder with saline and allowing it to empty
  • place stay sutures to stretch the bladder and apply traction
  • enter bladder and gently peel stones off of the mucosa (spicules adhere to mucosa!)
  • lavage the bladder to reduce subsequent stone formation
  • close with a 2 layer inverting pattern - Cushing or Lembert
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6
Q

What do smaller stones most commonly cause? What clinical signs are associated? How are they diagnosed?

A

urethral obstruction –> posturing to urinate with no passage or urine

  • distended bladder on rectal palpation
  • endoscopy
  • palpation
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7
Q

What are 2 indications for perineal urethrotomies?

A
  1. permit urine flow with urethral obstructions or atonic bladders
  2. remove small uroliths - manual, lithotripsy, challenging!
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8
Q

In what 4 ways are horses prepared for perineal urethrotomy? Where is the incision placed?

A
  1. standing sedation
  2. caudal epidural anesthesia + local blocks
  3. evacuate rectum to avoid contamination
  4. pass a urinary catheter into the bladder

incise perineum 4-6 cm below anus and extend distally 6-8 cm below the ischial arch –> dissect to penile body and incise into urethral lumen

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9
Q

What are 3 options for removing uroliths from a perineal urethrotomy?

A
  1. extract manually
  2. endoscopic - pass endoscope through PU into bladder, use basket to remove
  3. lithotripsy - laser through endoscope to break the stones
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10
Q

What is the difference between a temporary and permanent perineal urethrotomy?

A

TEMPORARY - heals by second intention within 2-3 weeks, hematuria for 2 weeks common with incision into corpus spongiosum

PERMANENT - urethrostomy, done for fabulous urolithiasis, suture urethral mucosa to the skin, urine scalding common

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11
Q

What are the major causes of uroperitoneum in foals?

A
  • bladder rupture - common during parturition, dorsal aspect of bladder
  • patent urachus - SQ edema
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12
Q

What signs are associated with uroperitoneum in foals? When is it most commonly seen?

A
  • EARLY - depression, inappetence, straining
  • PROGRESS - colic, abdominal distension, preputial swelling
  • tachycardia, tachypnea, bradycardia, arrhythmia
  • lower volume + straining with urination

first 48 hours of life

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13
Q

What are the 3 most common etiologies of uroperitoneum? In colts?

A
  1. trauma
  2. septic omphalitis
  3. increased abdominal pressure during foaling

narrow pelvis and longer urethra

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14
Q

What are 5 options for diagnosing uroperitoneum?

A
  1. blood chemistry - azotemia
  2. acid/base status - metabolic acidosis
  3. electrolytes - hyperkalemia, hyponatremia, hypochloremia
  4. imaging - contrast radiography, U/S
  5. peritoneal fluid - peritoneal:plasma creatinine >2:1
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15
Q

What ECG findings are indicative of uroperitoneum?

A

hyperkalemia –> peaked T wave, loss of P wave, wide QRS complexes

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16
Q

What 3 medical treatments are recommended for uroperitoneum?

A
  1. correct electrolyte imbalance - 0.9% or 0.45% NaCl, 5% dextrose, calcium gluconate, insulin –> treat hyperkalemia before life-threatening arrhythmias
  2. abdominal drainage - remove urine, peritoneal lavage, must be slow enough to not alter abdominal pressure too fast
  3. urinary catheter
17
Q

What is the treatment of choice for uroperitoneum? What is commonly recommended after?

A

surgical management once patient is stabilized with a serum K <5.5 - good prognosis if otherwise healthy

  • indwelling urinary catheter
  • antibiotics - prophylactic or existing infection
18
Q

What is the urachus? How does it develop?

A

conduit for fetal urine to travel from the bladder to the allantoic cavity

should close at birth –> incomplete closure common with foals –> moist umbilicus, urine stream during urination

19
Q

What are the 3 major causes of patent urachus?

A
  1. congenital malformation
  2. omphalitis
  3. septicemia causes local sepsis in the umbilicus
20
Q

What conservative treatment options are there for patent urachus? What is recommended?

A

chemical cauterization with silver nitrate sticks + 7% iodine dip and antibiotics

surgical - umbilical resection

21
Q

What is omphalophlebitis? What are common clinical signs? How is it diagnosed?

A

umbilical remnant infection

  • heat, swelling, pain
  • ventral edema
  • purulent discharge, fever

U/S of umbilical structures

22
Q

When is surgical treatment recommended for omphalophlepbitis? What is done?

A

severe, non-responsive to medical treatment

umbilical resection

23
Q

How is an umbilical resection performed?

A
  • fusiform incision around umbilicus
  • resect bladder tip and enlarged umbilical vessels
  • oversew and invert urachus to reduce contamination
24
Q

How can a non-reducible umbilical hernia be differentiated from an infection?

A

U/S - may have bowel entrapment

25
Q

How are different types of umbilical hernias treated?

A
  • reducible, <5 cm = usually close spontaneously
  • > 4 months old, >10 cm = surgery, higher risk of stangulation
  • bowel incarceration = emergency surgery
26
Q

What methods of umbilical hernia treatment are no longer recommended?

A

hernia clamps or castration bands –> bowel entrapment causes GI obstruction, peritonitis, and an entercutaneous fistula + if they dislodge, evisceration can occur

27
Q

What approach is used for umbilical hernia surgery?

A
  • dorsal recumbency + general anesthesia
  • fusiform incision traced with the back of the scalpel first
  • be conservative with skin incision - stay close to umbilicus to make closure easier
28
Q

How are scissors used to dissect skin from SQ in umbilical hernia surgery?

A

point curved Metzenbaums toward the skin to reduce the risk of entering the hernial sac, which communicated with the peritoneal cavity

29
Q

What surgical techniques are used for small and large hernias?

A

SMALL - closed, dissect away skin from sac, invest sac into abdomen prior to closure

LARGE (>8 cm or 4 fingers) - open, remove sac to ensure placement of body wall sutures

30
Q

How is the body wall closed following umbilical hernia surgery? What suture is used? How can tension be combated?

A

interrupted pattern

0 or 1 monofilament or braided - PDS, Vicryl

use towel clamps

31
Q

How is the SQ and skin closed following umbilical hernia surgery? What is not used?

A

SQ - 2-0 monofilament

SKIN - 2-0 absorbable monofilament, intradermal or continuous pattern

staples - hard to get out of a foal

32
Q

What is the best option for covering the surgery site of umbilical hernia surgery in foals? What else is used?

A

Elastikon

CM Hernia Belt

Large Animal Surgery (32 decks)

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