Final Flashcards
(291 cards)
1
Q
Review Card: Anatomy of the Kidney
A
Make sure to Preserve the Venous Drainage for the Left Ovarian Vein
2
Q
What is the Arterial and Venous Supply of the Kidney?
A
Kidneys Supplied by a Single Renal Artery that Arises from the Aorta
The Renal Veins empty into the Caudal Vena Cava
3
Q
Surgical Disease of the Kidney Described Below:
Calculi/Stones within the Kidney
41% of Nephroliths are Calcium Oxalate
Can Develop Uremia and Hydronephrosis
Clinical signs- Mainly Asymptomatic
A
Nephrolithiasis
*Calcium Oxalate- No Medical Managment
4
Q
What are the Most Common Nephroliths?
A
Calcium Oxalate
*41% of Nephroliths are Calcium Oxalate
5
Q
What Clinical Signs are Associated with Nephroliths?
A
Absent/Asymptomatic- Most Common
Depression, Anorexia, Hematuria, Pain
*Nephroliths are Commonly Incidental Findings
6
Q
Best way to Diagnose Nephrolithiasis
A
Survey Radiographs
*Most Nephroliths are Radioopaque- Plain Radiographs are normally Diagnostic
*Prior to Surgery perform a Full Check of Renal Function- Excretory Urography, GFR, and Ultrasound
7
Q
What Parameters do you use to Determine the Best Managment for Nephroliths?
A
Type of Calculi
Anatomical Location
Clinical Effects
*Ex. Struvite Calculi can be Managed Medically, while Calcium Oxalate Calculi cannot
8
Q
When is Surgery for Nephroliths Indicated?
A
Obstruction
Infection Associated with Calculi
*In Patients with Asymptomatic Nephrolithiasis, we may just Monitor Renal Function and Manage Medically
9
Q
Name Two Surgical Treatment Options for Nephroliths
A
Nephrolithotomy
Pyelolithotomy
10
Q
Surgery for Nephrolithiasis Described Below:
Ventral Midline Celiotomy
Retract Mesocolon/Mesoduodenum
Isolate Kidney and Vessels
Rumel Tourniquet or Bulldog Vascular Clamp on Isolated Vessels to Temporarily Occlude Venous Supply
Make Sagittal Incision and** **Remove the Stone
Culture Renal Pelvis, Flush Renal Pelvis and Ureter with Heparinized Saline
Catheterize Ureter to Ensure Patency and Submit Stones for Analysis
A
Nephrolithotomy
*Cutting into the Kidney, Opening it and removing the Stones
11
Q
What Instruments can be used to Occlude the Renal Vessels during Nephrolithotomy
A
Rumel Tourniquet
Bulldog Vascular Clamp
12
Q
How do you Close the Surgical Site following Nephrolithotomy
A
Sutureless Closure- Hold for 5 Minutes, Forms Fibrin Seal, Suture Capsule Only with Simple Continuous Pattern
or
Horizontal Mattress Pattern- Through Capsule and Cortex of Kidney
13
Q
How Long can you Occlude the Renal Vessels for during Nephrolithotomy?
A
20 Minutes
*Vascular Clamp Time is 20 minutes! No longer than 20 Minutes or else you will develop Damage to the Kidney
14
Q
Surgery for Nephrolithiasis Described Below:
Can be used to Remove Calculi when Proximal Ureter and Renal Pelvis are Dilated
A
Pyelolithotomy
*Making an Incision into the Renal Pelvis to Remove a Stone
*Have to have Swelling/Dilation for you to have Access to Renal Pelvis
15
Q
What are Advantages of a Pyelolithotomy over a Nephrolithotomy?
A
Pyelolithotomy- Does NOT Require Occlusion of Blood Supply and does NOT Damage Nephrons
*Better to use Pyelolithotomy when Stones are Located in Renal Pelvic Area because it has Advantages over Nephrolithotomy
16
Q
What is Post Operative Managment of a Nephrolithotomy
A
Post op Radiographs- Look for Calculi
Monitor Urine Output, Renal Enzymes/Electrolytes
Provide Diuresis- Helps Maintain Renal Perfusion, Helps Minimize Clot Formation
17
Q
How can you Diagnose Renal Trauma?
A
Contrast Excretory Urography
Ultrasound
18
Q
How do you Treat Minor, Moderate, and Severe Renal Trauma?
A
Minor Trauma (Ex. Bruising)- Conservative Treatment
Moderate Trauma (Ex. Capsular Tears, Bleeding)- Surgical Intervention by Suturing Tears, Hemostatic Agents (Gelfoam), Omentalization (Omental Patching)
Major Trauma (Shattered Cortex and Capsule)- Nephrectomy or Nephroureterectomy
19
Q
What are the Indications for Performing a Nephroureterectomy
A
Severe Infection (Ex. Pyelonephritis)
Severe Trauma
Obstructive Calculi with Persistent Hydronephrosis
Neoplasia
Transplant
*Nephroureterectomy- Removal of the Kidney and Ureter
20
Q
What are the Indications for a Partial Nephrectomy
A
Trauma/Focal Hemorrhage/ Neoplasia in a Patient with CONTRALATERAL Renal Compromise and we want to preserve as much Renal Tissue as Possible
Compromised GFR in Other Kidney
21
Q
What are the Disadvantages of Performing a Partial Nephrectomy over a Nephrouretectomy?
A
Partial Nephrectomy- Higher Incidence of Post Operative Hemorrhage
*Risk of Hemorrhage is MUCH high than Performing a Total Nephrectomy
22
Q
Progressive Dilation of the Renal Pelvis and Atrophy of the Renal Parenchyma
A
Hydronephrosis
23
Q
Clinical Signs of which Kidney Disease:
A
Hydronephrosis
*Kidney will Feel like a Tumor Mass- Palpable Mass
24
Q
How do we Diagnose Hydronephrosis?
A
Abdominal Radiographs
Ultrasound
Excreatory Urogram
25
Treatment for **Hydronephrosis**
**Releave Primary Cause/Obstruction \< 1 week: Complete Resolution**
**Releave Primary Cause/Obstruction \> 4 Week Duration: May Retain 25%**
**Severe Parenchymal Damage (\> 4 Week Duration): Nephroureterectomy**
_\*If its Caught early (\< 1 Week) and you are able to Releave the Primary Obstruction, Often the Kidneys will regain full Function_
26
Treatment for **Pyelonephritis**
**Severe/Non Responsive Cases- Nephrouretectomy**
_\*Typically if we can Treat Pylonephritis Medically or Surgically we will go ahead and do that. Ex. If caused by Obstructive Uropathy (Nephrolithiasis) you will remove the Stone_
27
How is **Giant Kidney Worm (Dioctophyma Renale)** often Diagnosed?
**Urinalysis- Eggs in Urine** (If Caught Early)
**Necropsy-** _Often Diagnosed on Necropsy_
_**\***Once the worm matures it Migrates through the Kidney thus causing Significant Damage of the Cortex and the Medulla. These worms tend to Proliferate and cause damage very Quickly_
28
Treatment for **Giant Kidney Worm (Dioctophyma Renale)**
**Nephrectomy-** _Removal of Affected Kidney_
**Nephrotomy-** _Manually Remove the Worms_
_**\***If Unilateral then remove the one Kidney. If its causing Significant Damage to the Kidney, its best to Remove the Entire Kidney (Nephrectomy)_
29
Most Common **Benign and Malignant Kidney Tumors** in the Dog and Cat
**Benign- _Renal Adenoma_** (Both Dogs and Cats)
**Malignant in Dogs- _Renal Cell Carcinoma_**
**Malignant in Cats- _Lymphosarcoma_**
_\*Most Renal Neoplasia is Aggressive Metastatic Types of Tumors_
30
Most Common **Renal Neoplasia** in the Canine
**Renal Cell Carcinoma**
_**\***Mean Survival Time 6-8 Months_
31
How to Manage **Renal Cell Carcinoma** in Canine
**Nephroureterectomy and Chemotherapy**
_**\***Remove the Kidney and use Chemotherapeutic Protocols_
32
Best way to Diagnose **Renal Cell Carcinoma**
**Renal Biopsy**
33
Most Common **Renal Neoplasia** in the Feline
**Renal Lymphoma (Lymphosarcoma)**
34
Treatment for **Renal Lymphoma** in Felines
**Chemotherapy**
_\*Renal Lymphoma- Not Surgically Treated_
35
**Renal Neoplasia** Described Below:
**_Congenital Neoplasia_**
**_Part of the Developing Kidney_**
_More Common in **YOUNG Dogs and Cats (\< 1 Year)**_
_Mean Survival Time- 6 Months_
**Embryonic Nephroblastoma**
_\*YOUNG Dogs and Cats_
36
How do **Nephroblastoma's** Develop?
**Embryogenesis**
37
Treatment Indicated for **Embryonic Nephroblastoma**
**Nephroureterectomy and Chemotherapy**
_\*However, these tumors are NOT very Amenable to Treatment_
38
**Clinical Signs** of \_\_\_\_\_\_:
**Renal Neosplasia**
_**\***Commonly able to Palpate a Large Mass in the Paralumbar Area_
39
How do you Diagnose **Renal Neoplasia?**
**Abdominal Radiographs**- _Can be Very Diagnostic for Renal Neoplasia_
**Abdominal Ultrasound-** _Even MORE Diagnostic for Renal Neoplasia (Confirms Kidney Mass in 85% of Patients)_
_\*Very Rare that you have to do more advanced Diagnostics than Radiograph or Ultrasound to Diagnose Renal Neoplasia_
40
What Parameters are used to Determine if a **Renal Biopsy** is Indicated?
**Suspected Neoplasia**
**Nephrotic Syndrome**
**Renal Cortex DIsease**
**Non Diagnosed Acute Renal Failure (ARF)**
41
_Contraindications_ of Performing a **Renal Biopsy**
**Coagulopathies**
**Hypertension**
**Severe Chronic Hydronephrosis**
_**\***ALWAYS collect Coagulation Profiles on Patients prior to Renal Biopsy. If the patient is not clotting Properly the Renal Biopsy could be Disasterous_
42
**Kidney Biopsy** Technique Described Below:
**Percutaneous**
_**\***Best for Skinny/Small Dogs and Cats_
43
**Kidney Biopsy** Technique Described Below:
**Ultrasound Guided** _(**_P_**referred Method)_
44
**Kidney Biopsy** Technique Described Below:
**Keyhole**
45
**Kidney Biopsy** Technique Described Below:
**Wedge/Incisional Biopsy**
_**\***Surgical Method of Obtaining a Biopsy- Need to Occlude Vasculature_
**_\*Taking a Larger/Very Good Diagnostic Sample_**
46
Common **Complications/Risks** of Performing **Renal Biopsy**
**Severe Hemorrhage** _(IMPORTANT)_
**Hematuria-** _Resolves in 2-3 days_
**Hydronephrosis**
_**\***Hemorrhage is a HUGE possible Complication- Make sure Patients haven't recently been treated with blood thinners or NSAIDs_
47
**Indications** for ______ in Felines:
**Renal Transplant**
_**\***Mainly used in Chronic Renal Failure Cats or Patients with Acute Irreversible Renal Failure associated with a Toxin_
48
_Contraindications_ to **Renal Transplants**
**Viral Positive (FELV, FIV)**
**Cardiac Disease**
**Neoplasia**
**Fractious**
49
_Special Considerations_ taken for **Renal Transplants**
**Cost** _(Extremely Expensive)_
**Frequent Visits**
**Immunosuppression Therapy**- _LIFELONG_
50
Prognosis for **Renal Transplant** in Felines
**25% of Patients do NOT survive to Discharge (Don't Leave Hospital)**
**Mean Survival Time- 613 Days**
51
Breed, Sex and Clinical Signs of which **Surgical Disease of the Ureter:**
_Breed Predisposition: **Siberian Husky**_
**_Young Female Canines_**
**Clinical Signs:**
**_Incontinence_**
**_Fails to House Train_**
_UTI/Urine Scalding_
**Ectopic Ureter**
**\*Ectopic Ureter:** _Failure of One or Both Ureters to Terminate in the Normal Location_
52
How do you Diagnose **Ectopic Ureter**?
**Excretory Urography (Fluoroscopy)**
**CT**
**Ultrasound**
**Cystoscopy**
_**\***We use a Combination of Diagnostics to Confirm the Presence and Location of Ectopic Ureters_
53
Two Different Classification of **Ectopic Ureters.** Which Classification is the Most Common?
**Extramural:** _Ureter Enters into Neck, Urethra or Vagina_
**Intramural:** _Ureter Enters Normally but Exits Abnormally_ **(MOST COMMON)**
54
Treatment for **Ectopic Ureter**
**Neoureterocystostomy**
_**\***Two Types: Side to Side, End to Side_
55
**Neoureterocystostomy** Technique for Treatment of **Ectopic Ureter** Described Below:
**Side To Side**
_**\***Best to Remove Remnant Ureter that may Contribute to Incontinence_
56
_Prognosis_ Following Treatment for **Ectopic Ureter**
**90% Improvement when add Medications Following Neoureterocystostomy**
57
What are the Two Types of **Ureteroceles**
**Intravesicular (Normal)**
**Ectopic (Neck/Urethra)**
_**\***Ureterocele- Dilation of Distal Ureter due to Persistent Membrane over the Ureteral Oriface where it empties into the Bladder. Persistent Membrane can create Hydroureter or Obstruction_
58
Clinical Signs of **Ureterocele**
**UTI / Incontinence**
**Azotemia** (If Obstruction)
_\*High Incidence of Urinary Tract Infections with Ureteroceles_
59
How do you Diagnose **Ureterocele?**
**IV Urography**
\*_Contrast media will outine the Persistent Membrane- Cobra Head Sign_
60
Treatment for **Ureterocele**
**Intravesicular: _Uretercelectomy_**
**Ectopic: _Neoureterocystostomy with Ureterocelectomy_**
61
What are the _Causes_ of **Ureteral Trauma**
**Iatrogenic (#1 Cause)**
_**\***Most Common Cause- During an Ovariohysterectomy where the Surgeon accidently Clamps Down/Ligates the Ureter_
62
How do you Diagnose **Ureteral Trauma?**
**Uroretroperitoneum or Uroabdomen**
**Radiographs**
**IV Urography**- Localize Lesion
_\*Obviously if there is Urine Leakage into the Abdominal Cavity, there must be a Leaking area at the Level of the Crush Site_
63
What are the _Four Treatment Options_ for **Ureteral Trauma?**
**Nephroureterectomy-** _Removal of Ureter and Kidney_
**Ureteroureterostomy-** _Ureteral Anastomosis_
**Neoureterocystostomy-** _Replant Ureter in Different Location in the Bladder_
**Urinary Diversion-** _Divert Urine from going across the Surgical Site to allow better chance of healing_
_\*Urinary Diversion is usually done in Conjunction with one of the Other Surgical Procedures_
64
Surgical Procedure used to Treat **Ureteral Trauma** Described Below:
_Disadvantages- Extermely Difficult with **High Incidence of Complications**_
**Ureteroureterostomy** (Ureteral Anastomosis)
_**\***Disadvantages: Very Difficult with High Incidence of Complication_
65
_Surgical Procedure_ used to Treat **Ureteral Trauma** Described Below:
**_Catheterize Through Cystotomy_**
_Avoids Engaging Back wall with the Suture_
**_Suture under Magnification_**
**Ureteroureterostomy**
66
What Two Methods are Available for **Urinary Diversion** After _Ureteral Surgery_
**Ureteral Stent**
**Nephrostomy Tube**
67
Method Available for **Urinary Diversion** After _Ureteral Surgery_ Described Below:
**Ureteral Stent**
**_\*Urinary Diversion is Provided after every Surgical Procedure used to Correct Ureteral Trauma in order to Prevent Urine Flow through the Surgical Site_**
_Allows Urinary Diversion to allow the Anastomosis Site to Heal following Ureteroureterostomy (Ureter Anastomosis)_
68
Method Available for **Urinary Diversion** After _Ureteral Surgery_ Described Below:
**Nephrostomy Tube**
_**\***Suture Kidney to the Body Wall and then Feed the Tube Out of the Body wall to Create a Urinary Diversion without any urine going through the Anastamosis Site_
69
What Procedures can be used if you have **Loss of Length** of the Distal or Proximal **Ureter**
**Transureteroureterostomy-** Used When Proximal Ureteral Length is Insufficient to Reach the Bladder. _Bring Segment across Midline and Anastomosis to Other Ureter_
**Renal Descensus**- _Mobilize Kidney and Suture Caudally to Lumbar Musculature_
**Nephrocystopexy**- _Suturing the Kidney to the Cranial Edge of the Bladder_
**Psoas Hitch-** _Fixes the Bladder in a More Cranial Position_
70
Surgical Procedure used when **Proximal Ureteral Length** is Insufficient to Reach the Bladder but Long enough to Cross Midline
**Transureteroureterostomy**
71
_Surgical Procedure_ used when there is **Significant loss of _Distal Ureter_**
**Bladder Wall Flap**
_**\***Lengthening Bladder Tissue so that it can reach the Ureter_
72
Most Common Indication for **Ureteral Surgery**
**Ureterolithiasis**
_**\***Stones within Ureter- **Primarily Calcium Oxalate**_
73
What are the Clinical Signs of **Ureterolithiasis**
**Asymptomatic _(Most Common)_**
**UTI, Hematuria**
**Anorexia, Lethargy, Pain**
_**\***If the Stones are not causing a significant Obstruction Process the patients are commonly Asymptomatic_
74
How do you Diagnose **Ureterolithiasis**
**Plain Radiographs**
_\*Most are Radiopaque Calcium Oxalate_
75
Since Most **Ureterolithiasis** cases are \_\_\_\_\_\_, Medical Dissolution is NOT an Option
**Calcium Oxalate**
**\***_Can only Treat Struvites via Medical Dissolution_
76
**Presurgical Considerations** for \_\_\_\_\_\_\_:
_**Cannot Predict how Long Ureter Obstructed**: 1 Week Obstruction GFR \< 65% **(Cannot Predict how Well Kidney will Recover**)_
_Most Cats have Preexisting Interstitial Nephritis unrelated to Obstruction_
_If Azotemic with Unilateral Obstruction = Bilateral Renal Disease_
**_High Complication Rate with Surgery_**
**Ureterolithiasis**
77
_Treatment Options_ for **Ureterolithiasis**
**Cystotomy and Retrograde Flushing and Removal via Pyelithotomy (_Ideal Procedure)_**
**Ureterotomy-** _Difficult with High Incidence of Leakage/Dehisence_
_**\***If you have a Stone in the Ureter it would be IDEAL to do a Cystotomy Incision, Place a Catheter into the Ureteral Orifice and try to Push the Stone into the Renal Pelvis- Flush Saline and Dislodge the Stone_
78
_Advantages and Disadvantages_ of **Permanent Ureteral**\_\_\_\_\_\_:
**Advantages:**
**_Decreased Morbidity_**
_Shorter Hospitilization_
**_Less Complications_**
**Disadvantages:**
**_Specialized Equipment_**
_Steep Learning Curve_
**Permanent Ureteral Stenting**
_**\***Due to the High Complication Rate with Ureteral Surgery, Ureteral Stenting is becoming more Common_
**_\*Rather than Remove the Actual Stone or Obstruction, you Bypass the Ureteral Obstruction with Permanent Ureteral Stent- Leads to Less Complications_**
**_Indications for Ureteral Stenting- Stone, Tumor, Stricture, Blood Clot_**
79
Method of **Permanent Ureteral Stenting** Described Below:
## Footnote
**_Place Guide Wire into Ureteral Orifice_**
**_Place Catheter over Guide Wire and Inject Contrast Media in order to Visualize Renal Pelvis_**
**_Remove Ureteral Catheter and feed Stent over the Guide Wire and Place the Stent into the Renal Pelvis_**
**Endoscopic Placement**
80
Method of **Permanent Ureteral Stenting** Described Below:
**_Perform Cystotomy Incision and Place Catheter into Renal Pelvis using Fluoroscopy_**
**_Guide Stent into Renal Pelvis_**
**Surgical Stenting**
81
Method of **Permanent Ureteral Stenting** Described Below:
## Footnote
**_Placing one End of Catheter into Kidney (Renal Pelvis)_**
**_Kidney Catheter is Placed onto Shunting Port_**
**_A Seperate Catheter is Placed into the Bladder_**
**_The Opposite End of the Bladder Catheter is Attached to the Shunting Port_**
**SUB (Subcutaneous Ureteral Bypass)**
_**\***Feed Renal Catheter and Bladder Catheter through the Abdominal Wall and connect both of them to the Shunting Port. Secure the Port to the Abdominal Wall_
82
**Review Card: Anatomy of the Bladder**
**_Trigone- Region Between Urethral and Ureteral Openings_**
**Nerve Supply: _Hypogastric Nerve (Sympathetic) and Pelvic Nerve (Parasymphathetic)_**
**Blood Supply: _Caudal Vesicular (Primary), Prostatic/Vaginal Artery_**
83
Types of ______ **Abnormalities:**
## Footnote
**Persistant Urachus**
**Vesicouracheal Diverticulum**
**Urachal Cyst (Rare)**
**Urachal Sinus (Rare)**
**Urachal**
_**\***Urachal- Embryonic Conduit Providing Communication between Bladder and Allantoic Sac that Atrophies at Birth_
**_Persistant Urachus- Persistance of a Tube between the Bladder and Umbilicus_**
84
**Urachal Abnormality** Described Below:
**_Persistance of a Tube between the Bladder and Umbilicus_**
**Clinical Signs:**
**_Urine Dribbling From Umbilicus_**
_**Omphalitis** (Inflammation of Umbilicus)_
_Ventral Abdominal Dermatitis_
_UTI_
**Persistant Urachus**
85
How do you Diagnose **Persistant Urachus**
**Place Contrast In Umbilicus and Take Radiograph**
_**\***You will see Contrast Travel from Umbilicus up into the Bladder_
86
How do you Treat **Persistent Urachus**
**Surgical Removal of Urachal Tube**
87
Most COMMON **Urachal Abnormality**
**Vesicouracheal Diverticulum**
88
**Urachal Abnormality** Described Below:
**_Most Common Urachal Abnormality in Canine Patients_**
**_External Opening at the level of the Umbilicus is Closed while the Internal Opening is Open_**
_Patients with Recurrent Urinary Tract Infections_
**Vesicouracheal Diverticulum**
89
How do you Diagnose **Vesicouracheal Diverticulum**
**Positive Contrast Cystography**
90
Treatment for **Vesicouracheal Diverticulum**
**Partial Cystectomy and Diverticulectomy**
**\***_Remove that section of the Bladder Wall and suture it back together_
91
What are the Causes of **Bladder Rupture**
**Mainly Trauma (HBC)**
**Severe Cystitis**
**Neoplasia**
**Urethral Obstruction**
**Iatrogenic-** _Ex. Catheterization, Cystocentesis_
92
True/False: In Any Case of _Abdominal Trauma_, consider **Bladder Rupture** until you can Rule it out
**True**
_**\***Palpable Bladder and Normal Urination does NOT rule out Bladder Rupture_
93
How do you Diagnose **Bladder Rupture**
**Positive Contrast Urethrocystogram (Most Reliable)-** _Leakage of Contrast Material into Abdomen_
**Abdominocentesis (Confirm Diagnosis)_-_** _Urine in Abdominal Cavity_
_Plain Radiographs: Obscured Serosal Detail, Free Abdominal Fluid, Absence of Bladder_
_Ultrasound: Helps Determine Source of Injury and Visualize Defects in Bladder Wall_
94
When Performing an _Abdominocentesis_ to Confirm **Bladder Rupture,** What do you expect to find with Regards to _Creatinine and Urea Levels_
**Creatinine in Peritoneal Fluid \> Serum Creatinine**
**Urea in Peritoneal Fluid = Serum Urea**
_**\***Once Creatinine in Abdominal Fluid is Higher than Serum Creatinine you have confirmed the presence of Urine in the Abdominal Cavity_
95
How do you Treat **Bladder Rupture**
**Surgical Repair Immediately if Stable-** _Debride Tear and Necrotic Tissue and Close Bladder Wall_
**Omentalize or Serosal Patching-** _Better Seal Bladder Defect_
_\*Make sure to Explore the Entire Abdominal Cavity_
_\*If Patient is Unstable, then Stabilize First with Fluids and Abdominocentesis (Decompress Abdominal Cavity)_
96
What are the Indications for **Tube Cystotomy**
**Any Need for Urinary Diversion-** _**Bladder or Urethral Surgery/Trauma**, Neurological Bladders_
_**\***Often Times we Divert urine with a Tube Cystostomy- Do this Procedure to help Keep the Bladder Decompressed_
97
How to Perform a \_\_\_\_\_\_:
_Ventral Midline Incision_
**_Purse String Suture in Bladder_**
**_Make Stab Incision in Bladder and place 6-16 fr Foley or Mushroom Tip Catheter_**
**_Create Hole in Abdominal Wall and feed Catheter through Hole_**
_Perform Cystopexy- Hold Bladder in place_
**_Attach Collection Bag to End of Catheter to Monitor Urine_**
**Tube Cystostomy**
98
**Potential Complications** for Performing a \_\_\_\_\_\_:
**Tube Cystostomy**
_**\***Patient always has to have an E Collar on whenever you place these Tubes otherwise they will Grab the Tubes and pull them out_
99
_Indications_ for Performing a **Cystopexy**
**Tube Cystostomy**
**Perineal Hernia**
**Urinary Incontinence associated with Pelvic Bladder**
_Cystopexy- Surgical attachment of the urinary bladder to the abdominal wall or to other supporting structures_
_In Patients with Perineal Hernias- the Bladder is one of the Structures that tends to Herniate. Cystopexy helps to prevent the Bladder from Herniating_
100
How to Perform a \_\_\_\_\_\_:
_Cranial Traction of Urinary Bladder_
**_Suture Bladder Wall to Abdominal Wall_**
**_Two Lines of Suture_**
**Cystopexy**
101
Most Common Types of **Cystic Calculi** (Stones in the Bladder)
**Struvite**
**Calcium Oxalate**
_**\***Struvite and Calcium Oxalate account for over 90% of Cystic Calculi_
102
_Clinical Signs_ associated with \_\_\_\_\_\_:
**_Hematuria, Straining and Discomfort_**
**_Palpation of Large Thickened Bladder_**
_Sometimes Palpate Large Calculi_
**_Urinary Tract Infection (76%)_**
**Cystic Calculi**
103
How do you Diagnose **Cystic Calculi**
**Plain Radiographs-** _May see Radiopaque Stones within Bladder (Struvite, Calcium Oxalate). If Stones are Radiolucent (Cystine and Urates) then more Diagnostics are Required_
**Double Contrast Cystography or Ultrasound-** _Equally Effective for Detecting Radiolucent Stones within the Bladder (95% Effective)_
104
What are the **Non-Surgical** Treatment Options for **Cystic Calculi**
**Voiding Hydropropulsion**
**Transurethral Cystoscopy**
**Dietary Modification**
**Electrohydraulic Lithotripsy**
105
**Non-Surgical Treatment** Option for **Cystic Calculi** Described Below:
**_Must be Very Small Calculi (Smaller than Urethral Diameter)_**
_Place Patient under Anesthesia_
**_Inject Saline into the Bladder- Distend Bladder_**
_Hold Upright_
**_Express Bladder_**
**_Re-Radiograph_**
**Voiding Hydropropulsion**
106
**Non-Surgical Treatment** Option for **Cystic Calculi** Described Below:
**_Use of Cystoscope to Remove Small Stones_**
_Stones must be Smaller than the Diameter of the Urethra_
**_Grab Stones and Manually Remove them out of the Bladder_**
**Transurethral Cystoscopy**
107
**Non-Surgical Treatment** Option for **Cystic Calculi** Described Below:
**_ONLY works for Struvite Stones_**
_Cannot be Obstructed_
**Dietary Modification**
**\***_Alter the Diet to help Dissolve the Stones_
_\*Diet Modification DOES NOT work on Calcium Oxalate Stones_
108
**Non-Surgical Treatment** Option for **Cystic Calculi** Described Below:
**_Passage of a Cystoscope_**
**_Electrode Wire and Spark Generator to Break apart Stone_**
**Electrohydraulic Lithotripsy**
109
When is **Surgery** Indicated for **Cystic Calculi**
**Urinary Tract Obstruction**
**No Medical Options**
**Other Retrieval Methods Failed**
110
Most Common **Surgical Procedure** used to Remove **Cystic Calculi**
**Cystotomy**
111
**Surgical Procedure** for **Cystic Calculi** Described below:
_Caudal **Ventral Midline Approach**_
**_Moistened Lap Sponges_**
_Empty Bladder (Compression/Small Needle and Syringe)_
_Place Stay Suture in Lateral Aspect and Apex of Bladder_
**_Make Stab Incision at Apex of Bladder and Extend Incision with Scissors_**
**_Evert Bladder Walls to Allow Full Inspection_**
**_Remove Calculi with Instrument_**
_Pass Urethra Catheter and Flush to Ensure Patency_
**Ventral Cystotomy**
_**\***Ventral Cystotomy Approach is Preferred over Doral Approach_
**_\*Submit Urine, Stones, and Mucosal Tissue for Culture_**
112
What is the **Layer of Strengh** when Closing a **Cystotomy** Incision
**Submucosa**
_**\***Layer of Strength of the Bladder_
113
Following a **Cystotomy**, the Bladder Requires a _Water Tight Closure._
What are the **Common Suture Patterns** used to **Close the Bladder?**
**One or Two Layer Inverting Pattern**- _Cushing Followed by Lembert_
**Simple Continuous in the Submucosa followed by Cushing Pattern**
_**\***Inverting Pattern will Create Fibrin Seal and assist us with Water Tight Closure- Serosa to Serosa Contact Encourages Fibrin Seal_
114
Following **Cystotomy**, after closing the Bladder, make sure to perform a \_\_\_\_\_\_
**Leak Test**
_**\***Compress Neck of Bladder and Inject Saline and look for any leakage at the incision site_
115
What is **Polypoid Cystitis**
**Benign Polyps that Develop within the Mucosa of the Bladder**
_\*Rare Condition that Mimics a Neoplastic Condition_
_When the Polyps rupture the Patients will have Bloody Urine_
116
How do you Diagnose **Polypoid Cystitis**
**Biopsy**
**\***_Biopsy confirms Polypoid Cystitis_
117
Treatment for **Polypoid Cystitis**
**Surgery- Resect Affected Tissue**
_**\***Usually Curative after you Resect the Polyps since it is a Benign Condition_
118
Most Common **Bladder Tumor** in the _Dog_
**Transitional Cell Carcinoma (TCC)**
_\*97% Malignant and has an affinity for the TRIGONE area_
119
Most Common **Bladder Tumor** in the _Cat_
**Transitional Cell Carcinoma**
_**\***Most Common Bladder Tumor in Cats, and the Second most Common Urinary Tract Tumor in Cats_
120
Most Common **Urinary Tract Tumor** in _Cats_
**Renal Lymphoma**
121
How does **Transitional Cell Carcioma (TCC)** differ in the Dog and Cat?
**Most common _Older FEMALE Dogs_**
**Most Common in _Middle Aged MALE Cats_**
Dogs: **_Affinity for TRIGONE area of Bladder_**
Cat: **_Affinity for APEX of Bladder_**
**_\*_**_Felines- More Ammenable for Surgery because the TCC is in the Apex of the Bladder_
_Canine- Less Amenable for Surgery because the TCC is found within the Trigone Area_
**_KNOW THESE DIFFERENCES- On Exam_**
122
_Predisposing Factors_ for ______ in the **Bladder:**
**_Obesity_**
**_Insecticide Exposure_**
**_Herbicide Exposure_**
**_Cyclophosphamide_** _(Anti-Cancer Drug)_
**Transitional Cell Carcinoma (TCC)**
_**\***Carcinogen Exposure- Insecticides and Herbicides. Patients that have been exposed to Insecticides and Herbicides have shown an Increased Incidence of the Development of TCC_
123
_Breed Predisposition_ for **Transitional Cell Carcinoma**
**Older Scottish Terriers**
124
_Physical Exam Findings_ in Patients with \_\_\_\_\_\_:
**Transitional Cell Carcinoma**
_**\***Often we can **Palpate a Large Mass in the Caudal Abdomen in the Area of the Bladder**_
_\*Since there is such High Metastatic Potential you are going to look for Metastatic Disease- Ex. Lymphadenopathy_
125
How do you Diagnose **Transitional Cell Carcinoma?**
**Cystoscopy (Very Diagnostic)-** Can Visualize and Biopsy Mass
**Ultrasound (Very Diagnostic)**- Determines Degree of Bladder Invasiveness, Evaluate Abdomen for Metastatic Disease and LN Involvment
**Bladder Tumor Antigen Test (BTAT)-** _High Risk of False Positives_
_\*30% of Urine Cytology will pick up TCC_
126
Name the _Advantages and Disadvantages_ of the **Bladder Tumor Antigen Test (BTAT)** used to diagnose Transitional Cell Carcinoma
**Advantage**- _Best used as Routine Screening Test for Older Patients_
**Disadvantage**- _High Incidence of FALSE POSITIVES_
_\*Very Poor in Differentiating Patients with Lower Urinary Tract Disease versus Transitional Cell Carcinoma (False Positives)_
127
Treatment for **Transitional Cell Carcinoma (TCC)** of the Bladder
**Combination Protocol- _Chemotherapy and Partial Cystectomy_**
**_\*_**_Chemotherapy and Partial Cystectomy on their Own did not Increase the Mean Survival Time of the Patient. Only in Combination do they Increase the Survival Time_
128
**Urethral Condition** Described Below:
_Most Common Developmental Abnormality of Male Genitalia_
**_Incomplete Formation of Penile Urethra_**
**_Urethral Orifice can occur anywhere along Penis_**
**Hypospadias**
129
Treatment for **Hypospadias**
**If Asymptomatic- _Leave it alone_**
**If Clinical Signs- _Reconstruction Procedure_**
_\*Most of the Time these patients are Asymptomatic and we just leave it alone. Only Perform Surgery if the Patient is developing Urine Scolding and other Clinical Signs_
130
**Protrusion to Urethral Mucosa through Orifice**
**Urethral Prolapse**
_**\***Associated with some form of Straining_
131
Clinical Signs associated with which **Urethral Disorder:**
**_Bleeding from Prepuce_**
**_Licking_**
**_Red-Purple Mass_**
**Urethral Prolapse**
132
**Urethral Prolapse** is most Common in Young Male _____ Dogs
**Brachycephalic**
_**\***Most Urethral Prolapses occur in Brachycephalic Breeds that Strain while Breathing, which leads to the Prolapse_
133
Treatment for **Urethral Prolapse** in _Asymptomatic Patients_
**Reduce with Aid of Large Catheter**
**Place Purse String Suture- Leave for 5 Days**
**\***_Tie Purse String to help Prevent it from Prolapsing again_
134
Two _Adjunctive Treatments_ done in Patients with **Urethral Prolapse**
**Surgical Correction of Airways**
**Castration**
_\*Brachycephalics are more Prone to Urethral Prolapse due to Straining while Breathing. If the Airways are corrected, so that they are not straining to breathe so much then Prolpase will not recur_
135
Treatment for **Urethral Prolapse** in _Symptomatic Patients_
**Urethropexy**- _If Tissue is Viable_
**Resection and Anastomosis**_- Tissue is NOT Viable_
136
What Suture Material is best for **Urethral Surgery**
**Monofilament Absorbable (PDS)**
**\***AVOID Braided Absorbable (Vicryl)
137
What Causes **Urethral Obstruction** in Dogs and Cats
**Mucus Plugs**
**Crystals or Stones**
**Neoplasia**
**Strictures**
_**\***Most common cause of Urethral Obstruction in male Dogs is Calculi_
138
Where is **Urethral Obstruction** Most Common in Male Dogs and Cats?
_Male Dogs:_ **Ischial Arch or Caudal to Os Penis**
_Male Cats:_ **Distal 1/3 of Urethra**
139
How do you Diagnose **Urethral Obstruction**
**Contrast Urethrography**
**Plain Radiographs**- _Radiopaque Calculi, Large Distended Bladder_
140
In Patients with **Urethral Obstruction**, you want to administer _____ right away in order to _Decrease the Urea/BUN Concentrations_
**Fluids**
_**\***Fluids will help to Improve Metabolic Acidosis_
141
_Three Methods_ used to **Temporarily Relieve Urethral Obstruction** in a Dog or Cat due to Calculi
**Catheter**
**Hydropropulsion**
**Cystocentesis**
_**\***Initially try to Relieve the Obstruction Non-Surgically_
142
_Non-Surgical Method_ used in CANINE Patients to **Temporarily Relieve Urethral Obstruction** due to Calculi:
**Retrograde Hydropropulsion**
**\***_Place Catheter as far up the Urethra as possible and attempt to Inject Saline under pressure in order to distend the Urethra in an attempt to Flush the stone back into the Bladder- Much easier to do Surgery on the Bladder rather than the Urethra_
143
Surgical Technique to **Relieve Urethral Obstruction** due to _Calculi_ if **Hydropropulsion was NOT Successful**
**Urethrotomy**
_**\***If Hydropropulsion was Successful the Calculi would be in the Bladder and we would Perform a Cystotomy_
**_If Hydropropulsion was NOT Successful then we must perform a Urethrotomy- Cutting into the Urethra and Removing the Stone at the Location where the Obstruction has occured_**
**_Indications- Calculi that cannot be Hydropropulsed_**
144
Where would you Perform a **Urethrotomy** in _Canine Patients_
**Prescrotal**
_**\***Very Superficial Area with Less Cavernous Tissue_
145
Surgical Technique to **Relieve Urethral Obstruction due to Calculi** Described Below:
**_Place Urethral Catheter_**
_Ventral Midline Incision between Base of Scrotum and Caudal Penis_
_Retract Retractor Penis Muscle_
**_Incise Urethra and Remove Calculi_**
_Flush Urethra_
**Prescrotal Urethrotomy**
_**\***Most Common Surgical Technique used in Canine Patients_
146
Two Available Methods for _Closure_ Following **Prescrotal Urethrotomy**
**4\0 Monofilament Absorbable-** _Suture Urethra Closed_
**Second Intention (Preferred)- Advantage:** _Less Risk of Stricture, **Disadvantage:** Profuse Hemorrhage_
147
Why is **Perineal Urethrotomy** a _Less Preferred_ Surgical Method to **Relieve Urethral Obstruction?**
**Increased Risk of Infection**
**Difficult Procedure**
148
Surgical Formation of a Permanent Opening of the **Urethra** at a New Site
**Urethrostomy**
149
_Preferred Locations_ for **Urethrostomy** in Dogs and Cats
**Canine- Scrotal**
**Feline- Perineal**
_**\***Canine- Scrotal Urethrostomy is Preferred because it is More Superficial, Less Hemorrhage, and Less Urine Scold_
150
In a **Scrotal Urethrostomy,** which Structures should be Draped in your Surgical Field?
**Abdomen**
**Scrotum**
**Prepuce**
151
In a **Scrotal Urethrostomy**, How Long should the Urethral Incision be?
**2.5-4cm Long**
152
In a **Scrotal Urethrostomy,** What is the Most appropriate Suturing Method?
**4\0 Absorbable/Non-Absorbable Monofilament**
**Take Bites at Edge of Cavernous Tissue-** _Avoid Cavernous_
_**\***AVOID Cavernous Tissue- Only Engage Urethral Mucosa and Skin_
153
Complications of a **Scrotal Urethrostomy**
**Hemorrhage**
**Dehiscence**
**Urine Scald**
**Stricture**
**UTI**
154
What is the Disadvantage of a **Canine Prescrotal Urethrostomy**
**Higher Incidence of Urine Scald**
155
When is a **Perineal Urethrostomy** in a _Cat_ Indicated?
**Frequent Obstruction**
**Strictures**
**Trauma**
_**\***Perineal Urethrostomy- Commonly done Procedure in Feline Patients. Usually performed in Cats where Medical Treatment for Recurrent Obstructions (Mucous Plugs or Crystals) isn't Working_
_\*After Multiple Attempts of Medically Preventing Recurrence of Urethral Obstruction, we end up doing this Salvage Procedure of removing part of the Proximal Urethra_
156
What are the Goals of **Perineal Urethrostomy** in Cats?
**Mobilization of Urethra**
**Creation of Wide Urethral Orifice**
157
What _Gland/Area of the Urethra do you dissect to_ when Performing a **Perineal Urethrostomy** in a Cat
**Bulbourethral Gland/Pelvic Urethra**
_\*Dissect to the Level of the Bulbourethral Gland- Anatomical Landmark to know you are within the Pelvic Urethra_
158
When Performing **Perineal Urethrostomy**, how can you check if the Urethral Orifice is Wide Enough?
**Mosquito Hemostat to Hinge**
_**\***To Ensure that you have a Wide enough Opening, take a pair of Mosquito Hemostats and place it into the Urethra and it should and it should reach all the way up to the Hinge Section of the Hemostat_
159
Complications of a **Perineal Urethrostomy** in a _Cat_
**Hemorrhage (Common)**
**Urinary Tract Infection (Common)**
**Stricture**
**Subcutaneous Urine Leakage:** _Improper Suturing_
_**\***Complication Rate- 25%_
160
Creation of a **Urethrostomy** on the _Ventral Body Wall Cranial to the Pubis_
**Antepubic Urethrostomy**
161
_Indications_ for which Type of **Urethrostomy Procedure:**
## Footnote
**_Recurrent Pelvic Urethral Obstruction_**
**_Failed Perineal Urethrostomy that cannot be Revised_**
**Antepubic Urethrostomy**
162
Complications associated with **Antepubic Urethrostomy**
**Urine Scalding-** _Big Problem_
## Footnote
**UTI**
**Incontinence**
163
Clinical Signs of **Urethral** \_\_\_\_\_\_:
**Trauma**
_**\***Most of the TIme with Urethral Trauma the patient will show Straining with Hematuria_
_\*There may be Leakage into Adjacent Subcutaneous Tissue- Urine accumulating and Causing Necrosis of that Tissue_
164
How do you Diagnose **Urethral Trauma**
**Positive Contrast Urethrogram**
165
Treatment for **Urethral Trauma**
**Incomplete or Small Laceration**- _Heal with Urinary Diversion and Urethral Catheter (Conservative Managment)_
**Complete Laceration-** _Anastomosis or Repair with Urinary Diversion_
166
What are the Causes of **Urethral Strictures**
167
Patients with **Urethral Strictures** won't show Clinical Signs until \_\_\_\_\_% of the Urethra is Narrowed
**60%**
168
How do you Diagnose **Urethral Strictures?**
**Cystoscopy-** _See Stricture within Urethra_
## Footnote
**Urethrogram**
169
Treatment for **Urethral Strictures**
**Urethral Dilators**
**Balloon Dilation**
**Resection and Anastomosis** (Severe Strictures)
170
**Review Card: Dental Terminology**
171
**Very Important Anatomic Landmark shown by the Red Line**
**Mucogingival Line**
_**\***Junction between the Gingiva (Soft Tissue of the Oral Cavity that supports the Teeth) and the Oral Mucosa_
172
**Review Card: Dental Anatomy**
173
**The Dentin** of the Tooth is the Dense Body-Like Matrix layer beneath the Enamel and the Cementum. It is a _____ Layer sensitive to Heat or Cold because the _Dentinal Tubules_ allow Indirect Access to the Nerves in the Pulp Chamber
**Porous**
174
**Review Card: Radiographic Anatomy of Tooth**
_Portion of the Pulp that is BELOW the Crown = Root Canal_
_Portion of the Pulp that is ABOVE the Crown = Pulp Chamber_
175
_Only Visible Part_ of the **Periodontium** in a Normal Mouth
**Gingiva**
176
**Potential Space Between Tooth and Gingiva**
**Gingival Sulcus**
177
**Collagenous Connective Tissue Structure Extending from Cementum to Periosteum of the Tooth**
**Periodontal Ligament**
178
_Functions_ of the \_\_\_\_\_\_\_:
**_Attaches Teeth to the Alveolus_**
_**Absorbs Shock** from the Impact of Occlusal Forces and Transmits them to Alveolar Bone_
_Supplies Nutrients to Alveolar Bone and Cementum via Arterioles_
**_Isolates the Tooth from the Surrounding Bone and, IMPORTANTLY, the Osteoclasts that Remodel the Surrounding Bone_**
**Periodontal Ligament**
179
If the ______ Ossifies, due to **Trauma or Excess Vit. D**, then _Osteoclasts can invade the Tooth and Remodel it_ into Brittle Bone Rather than a Flexible Tooth full of Dentinal Tubules. This Causes the Roots to Essentially Disappear and the Crown to Break off since the Tooth Doesn't Flex when it chews on something solid
**Periodontal Ligament**
_**\***Vitamin D is Toxic to the Periodontal Ligament Fibers_
180
**True/False: This is a Mass/Tumor in the Oral Cavity**
**False**
_**\***This is Incisive Papilla- Overlies the Vomeronasal Organ_
181
Perminant Bud Arises from the Deciduous Bud in Utero. Therefore if there is No _____ Tooth, there will be **NO Corresponding Permanent Tooth**
**Deciduous Tooth**
182
Part of the Tooth that is **\< 0.1 mm to 0.6 mm Thick** and that is **NOT Replaced if Damaged**
**Enamel**
183
Part of the Tooth that **Consists of Blood Vessels, Nerves and Connective Tissue**
**Pulp**
_**\***As the Animal Ages the Pulp Chamber becomes Progressively Smaller_
184
Normal ______ Process:
As the Root Lengthens, the Deciduous Tooth will Erupt. Soon after the Tooth is Fully Erupted the Root will Begin to Undergo Resorption. At the Same time the Permanent Tooth Bud starts its development and Erupts as the Deciduous Tooth is Shed
**Eruption**
185
**Review Card: Anatomical Numbering System**
**_Place the Number of the Tooth on the Corresponding Side of the Letter_**
**_As a Superscript if in the Maxilla and a Subscript if in the Mandible_**
_If Deciduous Teeth use Small Case Lette_rs
Ex. Maxillary Canine of Right (C1)
Ex. Second and Third Premolar on Left (2,3P)
**Incisor = I**
**Canine = C**
**Premolar = P**
**Molars = M**
186
**Review Card: Triadan System**
_First Number = Quadrant the Tooth is In_
_Second and Third Number = Number of the Tooth Itself_
**_Canine Incisor is ALWAYS 04_**
**_First Molar is ALWAYS 09_**
_KNOW THE RULE OF 4 AND 9_
Examples:
_Right Maxillary Middle Incisor = 102_
_Left Maxillary Canine = 204_
_Left Mandibular 4th Premolar = 308_
_Right Mandibular 1st Molar = 409_
187
**Dental Disorder** Described Below:
**_Caused by Failure of the Primary Tooth's Root to undergo Resorption_**
**_Cause Displacement of Permanent Teeth that can lead to Orthodontic Problems or Soft Tissue Trauma_**
_Canine Teeth and Incisors Most Commonly_
**Retained Decidious Teeth**
188
_Two Clinical Problems_ that Arise from **Retained Decidious Teeth**
**Malocclusions**
**Periodontal Disease**
189
With **Retained Decidious Teeth**, Permanent Teeth usually Erupt Lingual to the Decidious Teeth. The Primary Exception is the **Maxillary Canine** which Erupts _____ to Its Deciduous Counterpart
**Mesial (Rostral)**
190
Most Common _Malocclusion_ caused by **Retained Decidious Teeth:**
## Footnote
**_Mandibular Adult Canines Erupt LINGUAL to Decidious Canines_**
**Base Narrow Canines**
_**\***Canines have come in Too Far Lingually and they are Impacting on the Soft Tissue entrapped there_
191
Treatment for **Retained Decidous Teeth**
**Extract Decidious Teeth that are Retained**
192
**Dental Disorder** Described Below:
## Footnote
**_"Extra Teeth" most commonly seen in Premolar Area_**
**_Can Interfere with Normal Occlusions, Cause Overcrowding, Malposition, Malocclusion or Incomplete Eruption of Adjacent Teeth_**
**Supernumerary Teeth (Polyodontia)**
193
**Dental Disorder** Described Below:
**_Missing Teeth_**
**_Genetic Defect (Never Developed)_**
**_Premolars are Most Commonly Affected_**
_Predisposed Breeds- Mexican Hairless and Chinese Crested Dogs_
**Adontonia/Hypodontia (Missing Teeth)**
_**\***Rule of Thumb- If Deciduous Tooth is Congenitally Absent, the Adult Tooth will also be missing_
194
**Normal Occlusion** Described Below:
**Scissor Bite**
195
**Class of Malocclusion** Described Below:
## Footnote
**_Malpositioned Teeth_**
**_Jaw Length Normal_**
**Class 1**
_**\***Some Teeth are within an Improper Position_
196
**Class of Malocclusion** Described Below:
## Footnote
**_Mandibular Brachygnathisim_**
**_Upper Jaw is Longer than the Lower Jaw (Parrot Mouth)_**
**Class 2**
_**\***Mandible is too short- Mandibular Brachygnathism_
197
**Class of Malocclusion** Described Below:
## Footnote
**_Mandibular Prognathism_**
**_Mandible is Longer than the Maxilla (Underbite)_**
**Class 3**
\*Ex. Bulldogs
198
**Class 1 Malocclusion** Described Below:
## Footnote
**_Teeth are Misaligned due to too many Teeth (Supernumerary Teeth) or the Jaw is too small for the Normal Number of Teeth_**
**Crowding**
_**\***Not enough room for all the teeth to fit in the normal alignment_
199
Most Common **Class 1 Malocclusion:**
## Footnote
**_Mandibular Adult Canines Erupt LINGUAL to Decidous Canines_**
**Base Narrow Canines**
200
**Class 1 Malocclusion** Described Below:
**_One or More Maxillary Incisors are Displaced Towards the Palate_**
**Anterior Cross Bite**
_**\***The Maxillary Incisors should be Rostral to the Mandibular Incisors_
201
**Class 1 Malocclusion** Described Below:
**_Maxillary Premolars are Lingual to Mandibular Premolars_**
**Posterior Cross Bite**
202
**Class 3 Malocclusion** Described Below:
**_Incisor Crowns Meet Instead of the Mandibular Incisors being Directly Behind the Maxillary Incisors_**
_Considered Prognathism_
**_Leads to Abnormal Wear on Incisors- Attrition_**
**Level Bite**
203
**Malocclusion** Described Below:
## Footnote
**_Elongation of One Half of the Hed so there is Unequal Arch Development_**
**_Midline of the Mandible and Maxilla do NOT Line Up_**
**Wry Mouth**
204
**Treatment for Malocclusions** Described Below:
**_Certain Teeth Extracted or have their Crown Height Reduced to Prevent Trauma to other Teeth or Soft Tissue Structures in the Mouth_**
**Interceptive Orthodontics**
205
Treatment for **Base Narrow Canine Malocclusion:**
## Footnote
**_Acrylic Material Placed Inside the Maxilla_**
**Incline Planes**
206
**Impacted Teeth** can result in _____ Formation and _Should be Extracted_ in most Cases
**Dentigerous Cyst**
207
**Dental Disease** Described Below:
## Footnote
**_Damage to Ameloblasts during Enamal Development or Exposure of Enamel to Corrosive Material_**
**_Enamel Wears Down Over Time_**
**Enamel Hypocalcification/Hypoplasia**
_**\***Overtime the Enamel is worn down and the teeth assume and Irregular Knob Shape with Dentin that stains Brown_
208
**Distemer Virus Infection** or other Diseases that cause **High Fever** during Permanent Tooth Development can cause Generalized or Focal Defects in \_\_\_\_\_
**Enamel**
209
Treatment for **Enamel Hypocalcification/Hypoplasia**
**Focal: Restore Defect with Composite**
**Cap Important Teeth to Prevent Wear**
210
In **Tibetan Terriers**, ______ occurs in addition to **Generalized Enamel Defects**
**Root Abnormalities**
211
**Dental Disease** Described Below:
**_Drug that if Given to Pregnant Bitches and Given to Young Pups when Adult Teeth are Developting will lead to Yellow-Stained Teeth_**
_Dentin is the Affected Layer_
**Tetracycline Staining**
_**\***No Treatment_
212
**Dental Disease** Described Below:
## Footnote
**_Pathologic Wearing due to Contact with Opposing Tooth (Malocclusion)_**
**Attrition**
213
Treatment for **Attrition**
**Orthodontic Correction**
**Crown Reduction**
**Extraction**
214
**Dental Disease** Described Below:
**_Abnormal Contact with Crown Surface by Foreign Object_** _(Ex. Tennis Balls, Cages)_
**Abrasion**
215
**Dental Disease** Described Below:
**_Etiology- Bacteria Produce Organic Acids that, when in the Presence of Carbs, Decalcify Enamel and Dentin_**
_Uncommon due to Scissor Bite, Pointed Crowns, and Diet_
**_Appearance- Brownish Color, Leathery Consistency_**
**Dental Caries (Cavities)**
216
Treatment for **Dental Caries (Cavities)**
**Indirect or Direct Pulp Capping**
**Root Canal**
**Extraction** (Most Common)
_**\***Normally Dental Caries are Severe by the Time they are Reconized. Therefore Most Commonly the Tooth ends up being Extracted_
217
**Dental Disease** Described Below:
## Footnote
**_Infection that Can Result in Endodontic or Periodontic Lesions_**
**Periapical Infection**
_**\***Classic Presentation- Draining Tract at the Medial Apect of the Eye_
218
**Draining Tract** Associated with The Teeth is called a \_\_\_\_\_\_
**Parulis**
_**\***If the Parulis is at the Mucogingival Line- Most Likely to be Caused by Endodontic Disease_
219
**Dental Disease** Described Below:
**_Etiology: Focal Hyperplastic Gingiva in Periodontal Disease_**
_Predisposed Breeds: **Boxers**_
_Can occur with Administration of Drugs- Cyclosporine, Calcium Channel Blockers_
**Gingival Hyperplasia**
220
Treatment for **Gingival Hyperplasia**
**Gingivectomy/Gingivoplasty**
**Post Op Care- Twice Daily Rinses with 0.2% Chlorhexidine Solution**
_**\***Treatment- Remove Excessive Tissue to Return Sulcus Depth to Normal. Try to Recreate Normal Scalloped Contour_
221
**Dental Disease** Described Below:
**_Trauma to the Pulp_**
**_Discoloration of the Tooth- Purple/Grey_**
_May be Reversible- But NOT Often (\< 10%)_
_The Older the Patient the Less Likelihood the Pulp will Survive_
**Pulpitis**
_**\***Trauma to the Pulp has caused Bleeding. Blood Perculates out into the Dentinal Tubules leading to Purple Color of Tooth_
_\*The Younger the Animal, the Greater the Likelyhood the Pulp will Survive_
222
_Treatment_ for **Pulpitis**
**Monitor**- _If Tooth is Still Alive_
**Root Canal or Extraction-** _If Tooth is Dead_
_\*Pink Tooth = Still Alive_
_Grey Tooth = Dead_
223
_Radiographic Findings_ in a Tooth with **Pulpitis**
**Decreased Wall Size**
**Lucency around Apex**
**Apex Resorption**
224
**Tooth Fracture Classification** Described Below:
## Footnote
**_Microfractures in Enamel caused by Heavy Chewing_**
**_Staining of Teeth Often Occurs in Lines_**
**_NO Loss of Structure_**
**Enamel Infraction (Abraction)**
225
**Tooth Fracture Classification** Described Below:
## Footnote
**_Tooth Fracture where the Pulp Chamber is NOT Exposed_**
**Uncomplicated Crown Fracture**
226
**Tooth Fracture Classification** Described Below:
## Footnote
**_Crown Fracture where Pulp is Exposed_**
**Complicated Crown Fracture**
227
Chewing on Hard Objects such as Nylabone can cause **Shearing Forces of the Crown** known as ______ that Extend into the Surface of the Root
**Slab Fractures**
_**\***Slab of the Tooth is Fractured off- **Most Common in Maxillary 4th Premolar**_
228
_Treatment_ for **Uncomplicated Crown and Enamel Fractures**
**Indirect Pulp Capping**
**Crown Restoration**
229
_Treatment_ for **Complicated Fractures**
**Vital Pulpotomy**
**Root Canal**
**Extract Tooth**
**\***_If there is Minimal Periodontal Involvement, the Tooth can be Saved by Performing a Vital Pulpotomy or Root Canal and Placing the Dog on Antibiotics_
_\*Root Canal- Take out all the Contents of the Tooth_
230
**Diagnosis and Treatment of Disease that Affect the Tooth Pulp and Apical Periodontal Tissues**
**Endodontics**
231
_Indications_ for \_\_\_\_\_:
**Endotontics**
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**Endodontic Procedure** Described Below:
**_Maintains a Viable Tooth that will Continue to Mature_**
_Performed after **Acute Pulp Exposure** due to due to Trauma_
**_Patients \< 18 Months Old (Immature Tooth)_**
_80% Initial Success when Performed \< 48 Hours after Pulp Exposure_
**Vital Pulpotomy**
_**\***Removal of the Corroded Portion of the Pulp_
233
**Endodontic Procedure** Described Below:
**_Remove the Exposed and Contaminated Pulp from Crown with Dental Bur_**
**_Gently Flush the Access Site with Sterile Saline_**
**_Apply ProRoot MTA (Mineral Trioxide Aggregate) to Stimulate Dentinal Bridge Formation_**
_Place Intermediate and Surface Restoration_
**_Re-Radiograph at 3, 6, and 12 Months Post Op_**
**Vital Pulpotomy**
234
**Endodontic Procedure** Described Below:
**_Goal is to Remove ALL the Pulp Contents, Disinfect the Pulp Cavity, Create a Seal at the Apex to Trap Remaining Bacteria in the Tooth_**
**_Mature Tooth (\> 24 Months)_**
_Maintains Tooth Function but Tooth is "Dead"_
**Root Canal**
235
**Endodontic Procedure** Described Below:
**_Access Pulp Cavity and Remove Dead or Infected Pulp_**
_Clean and Shape the Canal with Endodontic Files_
**_Flush Canal with Sodium Hypochlorite while Cleaning and Shaping_**
**_Obturate (Fill) the Canal: Seal Apex and Fill the Rest of Canal with Gutta Percha_**
_Radiograph to Confirm Complete Obturation_
_Restore the Surface of the Crown at Fracture_
**Root Canal**
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**Dislocation of a Tooth out of its Alveolus WITHOUT being Totally Avulsed from the Mouth**
**Luxation**
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**The Total Separation of a Tooth from its Alveolus**
**Avulsion**
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For **Luxated/Avlused Tooth:**
Re-Implantation should occur within 30 Minutes of Avulsion. While Awaiting Aplantation the Tooth Should be Kept in a Mixture of Saliva and \_\_\_\_\_
**Milk**
_**\***After 30 Minutes Success goes down Exponentially_
239
Treatement for **Tooth Luxation/Avulsion**
**Re-Seat in Alveolus and then Splint in Place (4 weeks)**
**Perform Root Canal when Splint is Removed if Tooth is Reattached**
_**\***Replace the Avlused Tooth into the Socket and then Place Acrylic Splint. A Root Canal is Performed Later when Reattachment of the Tooth is Verified_
240
**Dental Disease** Described Below:
## Footnote
**_Most Common Disease of Tooth Structure in Domestic Felines_**
**_Osteoclast Resorption is the Predominant Activity_**
**Tooth Resorption**
241
**Type of Tooth Resorption** Described Below:
**Type 1**
242
**Type of Tooth Resorption** Described Below:
**Type 2**
243
**Type of Tooth Resorption** Described Below:
**Type 3**
244
Clinical Signs in Cats with \_\_\_\_\_\_:
**_Very Localized Hyperplastic/Hyperemic Gingiva_**
**_Pain- Dropping Food, "Chattering", Anorexia, Reluctance to have Mouth Examined_**
**Tooth Resorption**
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Treatment for **Tooth Resorption**
**Type 1:** _Entire Tooth should be Extracted_
**Type 2:** _Extract Entire Tooth if Root Structure/Pulp Chamber are Intact. If Not Intact, Amputate Crown and Superficial Root and Leave Ankylosed Part of the Root since its being Reabsorbed anyway_
**Type 3:** _Combination of Above_
246
**Dental Disease** Described Below:
_Etiology: Unknown but Possibly due to Calicivirus_
**_Chronic Non-Responsive Inflammatory Oral Disease Characterized by a Distinct Infiltrate of Plasma Cells and Lymphocytes_**
**_Clinical Signs: Ptyalism, Dysphagia, Anorexia, Severe Marginal Gingivitis_**
**Feline Gingivostomatitis**
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Treatment for **Feline Gingivostomatitis**
**Teeth Extraction- All Caudal Teeth or All Teeth** _(Most Effective)_
**Prophylaxis/Home Care**
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**Dental Disease** Described Below:
**_Noted in Cats \< 9 Months of Age_**
**Clinical Signs:**
_Abundant Plaque and Calculus that Results in Gingivitis, Bone Loss, Gingival Resorption and Pocket Formation_
**Juvenile-Onset Periodontitis**
249
Treatment for **Juvenile-Onset Periodontitis**
**Frequent Prophylaxis and Aggressive Homecare-** _May "Outgrow"_
## Footnote
**Extractions**
250
**Dental Disease** Described Below:
_Severe Inflammation of the Paradental Tissue **(Kissing Lesions)**_
**Clinical Signs:**
**_SEVERE Halitosis (Bad Breath)_**
**_Thick, Cloudy Saliva_**
_Oral Pain and Difficulty Eating_
**Canine Ulcerative Paradental Stomatitis (CUPS)**
251
Treatment for **Canine Ulcerative Paradental Stomatitis (CUPS)**
**Home Care: 1-2x's Daily Brushing**
**Total Mouth Extractions**
252
Study and Treatment of Diseases affecting the **Supporting Structures of the Tooth**
**Periodontics**
253
**Dental Disease** Described Below:
**_Most common Oral Disease_**
_\> 70-85% of Dogs and Cats_
**_#1 Cause of Tooth Loss_**
_More Common due to: Diet, Malocclusion_
**Periodontal Disease**
254
Diseases that Exacerbate **Periodontal Disease:**
**_Neutrophil Dysfunction_**
**_Diabetes Mellitus_**
**_Autoimmune Disease_**
**_Hyperadrenocorticism_**
**_Feline Viral Disease_**- Especially \_\_\_\_\_\_\_
**Calicivirus**
_**\***Calicivirus in Cats can cause Issues within the Oral Cavity_
255
_Three Etiologies_ of **Periodontal Disease**
**Acquired Pellicle (Biofilm)**- _Thin Layer of Salivary Proteins that Form on Surface of Tooth and serves as Site for Bacterial Attachment_
**Plaque**- _Combinatinon of Bacteria, Food, Debris, and Oral Epithelial Cells_
**Calculus**- _Mineralized Plaque Containing Bacteria which Release Endotoxins that Cause Gingivitis_
256
Loosely Adhered ______ **Plaque** causes an Inflammatory Response which Results in Destruction of the Junctional Epithelium and Epithelial Attachment exposing the Periodontium. This in turn creates a **Periodontal Pocket** which allows apical migration of the Bacteria and **Further Loss of the Periodontal Ligament and Alveolar Bone**
**Subgingival Plaque**
257
_Pathophysiology_ of \_\_\_\_\_\_:
## Footnote
**_Gingival Recession_**
**_Destruction of Periodontal Ligament_**
**_Bone Loss_**
**_Mobility_**
**Periodontal Disease**
**\***_Mobility of the Tooth caused by Destruction of Periodontal Ligament_
258
_Clinical Signs_ of \_\_\_\_\_\_\_:
**Periodontal Disease**
_**\***Accumulation of a Lot of Debris on the Surface of the Tooth_
259
Stage of **Periodontal Disease** Shown Below:
**_Gingival Tissue is Firm and Pink or Pigmented_**
_Defined Stipling_
**_Free Gingival has Knife-Like Edge_**
**_Minimal Sulcus Depth: 1-3mm in Dog, 0-1mm in Cats_**
**Stage Zero (Normal)**
260
Stage of **Periodontal Disease** Shown Below:
_Erythema_
_Gums Bleed When Probed_
_Loss of Stipling_
**_Normal Sulcus Depth_**
**_Reversible- With Proper Treatment_**
**Stage 1 (Gingivitis)**
261
Stage of **Periodontal Disease** Shown Below:
_Gums Bleed when Probed_
_Minor Pockets_
_Minimal Bone Loss_
**_Usually NO Mobility_**
**_Periodontitis can be Controlled but NOT Completely Reversed_**
**Stage II (Early Periodontitis)**
_**\***CANNOT be Reversed, Only Controlled_
262
Stage of **Periodontal Disease** Shown Below:
**Stage III (Moderate Periodontitis)**
_**\***Up to about 50% Bone Loss_
263
Stage of **Periodontal Disease** Shown Below:
**Stage IV (Advanced Periodontitis)**
_\* \> 50% Bone Loss, Advanced Bone Mobility_
264
_# 1 Preventative Method_ for **Periodontal Disease**
**Mechanical Abrasion**
_\*Good Home Care_
265
Treatment of **Periodontal Disease**
**Home Care- _Start Daily Tooth Brushing_**
**Thorough Dental Cleaning**
**Dental Diets/Dental Hygeine Chews-** _Help Prevent Accumulation of Plaque and Tartar_
**Antibiotics-** _Clindamycin_
266
True/False: **Antibiotics** can cure **Periodontal Disease**
**False**
_\*Antibiotics DO NOT cure Periodontal Disease_
267
**Dental Instrument** Desribed Below:
_Pointed Tip, Two Cutting Surfaces_
_Work Away from Sulcus_
**_NEVER use Sharp Tip below the Gingival Margin_**
**Scaler**
_**\***ONLY used Supragingivally- Above the Gum Line_
268
**Dental Instrument** Desribed Below:
_**Rounded Tip** and Back with Flat Face_
**_Used for Supra-or Subgingival Calculus Removal and Root Cleaning_**
**Curette**
269
**Dental Instrument** Desribed Below:
**_Probe used to Measure Sulcus Depth_**
**Periodontal Probe**
270
**Dental Instrument** Desribed Below:
## Footnote
**_Considered to be the Best Scaler in Vet Met_**
**_Creates Best Motion for Cleaning_**
**iM3 42-12**
271
**Review Card: Complete Dental Cleaning**
_1. Disinfect the Oral Cavity- Power Spray the Mouth with Chlorohexidine_
_2. Examine the Oral Cavity- Visual Inspection using Magnification. Look and Feel Under Tongue_
_3. Gross Calculus Removal- Hand Scaling_
**_4. Subgingival Calculus Removal- CRITICAL STEP_**
**_5. Missed Calculus Detection- Air from 3 Way Syringe- You can see Inside Pockets this way._** _Residual Calculus will Appear Chalky White_
**_6. Polish- ESSENTIAL STEP_**
_7. Sulcus Irrigation- Flush Polish out of the Sulcus_
**_8. Diagnostics- Periodontal Probing (Measure Sulcus Depth), Charting, Dental Radiographs_**
272
**Review Card: Calculus Index and Gingitivits Index**
273
True/False: Some Degree of **Tooth Mobility** is Normal and is Referred to as **Physiologic Mobility** and Represents the movement of a tooth within the Periodontal Ligament Space
**True**
_**\***Movement in Excess of Physiologic Mobility is Referred to as Pathologic Mobility_
274
Grade that Represents **Severe Mobility** of a Tooth
**3**
275
When Performing a **Complete Dental Cleaning**, _____ are Essential to Identify "Hidden" Lesions and Develop a Treatment Plan
**Dental Radiographs**
276
**Diagnosis based on this Radiograph**
**Periodontal Disease**
277
List the Pathologies seen in this **Radiograph**
278
**Diagnosis based on this Radiograph**
**Periodontal Disease**
279
**Diagnosis based on this Radiograph**
**Periodontal Disease**
280
**Diagnosis based on this Radiograph**
**Feline Buccal Bone Expansion**
281
The Branch of Denstistry that Deals with **Tooth Extraction**
**Exodontics**
282
**Indications** for \_\_\_\_\_\_:
**Exodontics (Tooth Extraction)**
283
Diagnosis based on this **Pre-Extraction Radiograph**
**Dilaceration** (Curved Root Tip)
284
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