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Renal > Urinary Tract Obstruction in Small Animals > Flashcards

Urinary Tract Obstruction in Small Animals Flashcards

1
Q

Where in the UT is the most common place for obstruction? What are the likely causes?

A

Urethra
+ Uroliths
+ Urethral lesions
+ Organ displacement

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2
Q

What can cause UUT obstruction? When do the clinical signs occur?

A

Calculi
Trauma
Clinical signs when bilateral

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3
Q

If calculi are seen on radiographs, how can you confirm they are obstructive?

A

Additional imaging - US, contrast radiography

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4
Q

Give 4 examples of intraurethral causes of obstruction

A

Calculi
Tumours
Inflammation
FB (v rare)

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5
Q

Give 4 examples of extraurethral obstructions…

A

Bladder mass
Pelvic mass
Prostatic disease
Trauma, surgery

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6
Q

What changes happen to the bladder as a result of obstruction?

A

Retroflexion
Displacement
Bladder torsion

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7
Q

What causes LMN urine retention? Where is the lesion found/

A

Cauda equina syndrome
Lumbosacral disease
Vertebral fractures
L5 and caudal

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8
Q

What are the clinical signs of LMN urine retention?

A

Flaccid, overdistended bladder
Easy to express
Urine leakage (esp when picked up)

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9
Q

What can cause UMN retention of urine? Where is the lesion found?

A 
IVDD
Neoplasia
Luxations
Fractures
Cranial to L5
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10
Q

What are the clinical signs of UMN urine retention? How can it be expressed?

A

Firm, tense bladder
Difficult to express
Relaxation of urethral sphincter

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11
Q

Outline functional urethral obstruction (reflex dsynergia)

A

D > C but rare
Pass small spurts of urine, large residual vol
Dysnergia between detrusor contraction and urethral relaxation

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12
Q

Are M or F more likely commonly affected by obstruction?

A

Male

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13
Q

What are the clinical signs of urinary obstruction?

A

Anuria, dysuria, stanguria
Apparent constipation
Vulval/penile bleeding/haematuria
V+

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14
Q

What are the clinical signs of urinary obstruction on PE?

A 
Full bladder
Inability to pass cath
Palpable mass in pelvic region
Abdo pain
Depression
Unproductive straining
Abdo distension
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15
Q

Outline the pathophysiology of urinary obstructions

A

Urine not excreted fully > increase urethral pressure > increased tubular pressure > increased pressure in bowmans capsule > Decreased GFR> reduced renal blood flow > ischaemic nephropathy > permanent nephron loss

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16
Q

How do UT obstruction affect the bladder?

A

Increased pressure in bladder > ureters dont empt properly > ureteral backflow

Ischaemia, oedema, haemorrhage and mucosal sloughing

17
Q

How does urinary obstruction result in system hypovolaemia?

A

Local vasodilation

Fluid loss in V+, faeces, sensible losses

18
Q

What biochemical changes are expected with obstructions? Are these changes reversible?

A 
Azotaemia
Hyperglycaemia
Acidaemia
Hyperphosphataemia
Hypocalaemia
Hyperkalaemia
19
Q

What cardiac effects does hyperkalaemia have?

A

Prolonged PR interval, tall/peaked T waves

Bradycardia

Ventricular arrhythmias

20
Q

What level of hyperkalaemia becomes a life threatening emergency?

A

K 8mEq/L

21
Q

How is hyperK treatment? What is the aim of treatment?

A

IVFT
Ca gluconate
Relieve obstruction
Stabilise the myocardium so condition is no longer life-threatening

22
Q

What are the dis/advantages of decompressive cystocentesis?

A

+ Temporary relief and stabilisation
+ Facilitate catheterisation
+ Risk of infection in cats v low

  • Risk of urine leaking into the abdo cavity -> septic peritonitis
23
Q

Outline how a urinary obstruction might be relieved…

A
  1. Patient is stable GA/sedation
  2. Lubricate catheter
  3. Stay sutures or allis forceps hold back prepuce
  4. Flush well with warm saline
  5. Float catheter into bladder
24
Q

Why shouldn’t ABs be used with an indwelling catheter?

A

Don’t prevent infection and only cause resistence

25
Q

What should you monitor for, following relieving of a urinary obstruction?

A 
Profound diuresis
HypoK
UTI
Detrusor atony
Blood clot
Stricture
26
Q

What drugs may be helpful in relieving urethral obstruction?

A

Smooth muscle relaxants

a-adrenergic antagonists - phenoxybenzamine, prazosin

Skeletal muscle relaxants - dantrolene, diazepam

27
Q

What is the preferred method of managing calculi in M SA? How is it carried out?

A

Retrograde hydropropulsion

Flush urethral calculi back into the bladder then removed buy cystotomy

28
Q

What are the surgical options for management of urethral obstruction?

A

Removal of calculi

Urinary diversion

Uretheral end-to-end anastomosis

Renal (12 decks)

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