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Surgery II > LEC 4 - Urinary Surgery > Flashcards

LEC 4 - Urinary Surgery Flashcards

1
Q

What is the minimum amount of information you should have before going into a urinary surgery?

A

HCT, BUN, electrolytes, creatinine, total protein, albumin, and urine analysis

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2
Q

When is radiology good to use to evaluate the urinary system?

A

Companion animals, equine, and ruminants +/- contrast cystography

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3
Q

What type of contrast should be avoided in radiographs of the bladder?

A

IV contrast

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4
Q

What animals is ultrasound a good method for seeing the bladder?

A

Companion animals, equine, and ruminants

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5
Q

What animals is a rectal exam a good method for analyzing the urinary tract?

A

Equine and cattle

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6
Q

What is a nuclear scintigraphy used for?

A

Renal function in a horse (GFR, renal blood flow, or loss of function)

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7
Q

When can an endoscopy be used to evaluate the urethra?

A

Companion animals, equine, and ruminants

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8
Q

What blood abnormalities are seen with many patients that have CKD?

A

Electrolyte abnormalities

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9
Q

What electrolyte abnormality is of our greatest concern? Why?

A

Hyperkalemia, can predispose the animal to arrhythmias

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10
Q

How should pre-op treatment be handled before a CKD patient goes into surgery

A

Fix the electrolyte abnormalites. Rehydrate over 4 to 6 hours. Administer GI protectants. Blood transfusion if needed. In general stabilize the patient

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11
Q

What drugs should be avoided with CKD patients?

A

alpha 2 agonists, acepromazine, aminoglycosides, tetracyclines, sulfonamides, and polymycin B, and NSAID’s

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12
Q

What are the degrees of nephrotoxicity of the gas anesthestics?

A

Methoxyflurane > Enflurane > Isofularne > Halothane

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13
Q

When does a dog need a blood transfusion?

A

PCV

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14
Q

When does a cat need a blood transfusion?

A

PCV

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15
Q

What is a cystorrhexis?

A

Ruptured bladder

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16
Q

What should be done pre-op for a cystorrhexis?

A

Correct hyperkalemia. Abdominal drainage, and stabilize the patient

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17
Q

What does abdominal drainage in the presence of cystorrhexis do?

A

Helps correct electrolyte imbalance and decrease pressure on teh diaphragm

18
Q

Where in the bladder are ruptures most common?

A

Dorsocranial margin

19
Q

What animal do you most commonly see bladder ruptures?

A

Foals, males

20
Q

What is a diagnostic conformation of a cystorrhexis?

A

Abdominal creatine to serum creatinine. 2:1 is definitive

21
Q

What is a good fluid option for a patient with cystorrhexis?

A

0.9% saline

22
Q

What is the most common approach to urinary surgery?

A

Ventral midline

23
Q

In foals, what surgical approach is used?

A

Vental midline or modified ventral midline. In adult males, paramedian

24
Q

What is the common approach in companion animals for a nephrectomy?

A

Ventral midline

25
Q

What is the approach for a nephrectomy in an adult horse?

A

Standing or lateral recumbency

26
Q

What is the approach for a nephrectomy in a foal?

A

Lateral recumbency

27
Q

How is the right kidney reached in a horse?

A

15th and 17th intercostal space

28
Q

How is the left kidney reached in a horse?

A

Caudal to the 18th rib

29
Q

What type of suture should be used to close the bladder?

A

Monofilament absorbable suture. NEVER USE NON-ABSORBABLE

30
Q

How long does it take the bladder and urethra to regain 100% of its normal tissue strength?

A

2 to 3 weeks

31
Q

How is a cystotomy closed?

A

2 layer closure. 1st layer - simple interrupted with cushing or utrecht as second layer.

32
Q

What type of urine affects the hydrolysis of the suture?

A

Alkaline urine

33
Q

What is the common urolith type in dogs/cats?

A

Struvites, calcium oxalate, urate, silicate, or cystine

34
Q

What animals is a tube cystotomy most often done?

A

Male sheep and goats

35
Q

What are the most common uroliths in a goat/sheep?

A

Calcium apatite or phosphate based calculi

36
Q

When do you remove the catheter from a small ruminant?

A

Once they are urinating normally which could take about 10 to 14 days.

37
Q

When is a tube cystotomy used in small animals?

A

Urine diversion

38
Q

When is a tube cystotomy removed from a small animal?

A

3 to 7 days

39
Q

What is a major component to calculus formation in horses?

A

Urine has a high mucous content

40
Q

What is the proposed pathogenesis of calculus formation in a horse?

A

Imbalance between crystal precipitation and dissolution along with stasis of urine flow couple with damage to the uroepithelium. Local activation of inflammatory and clotting pathways = nidus. Papillary necrosis. Highly alkaline urine favors crystallization of urolith components.

41
Q

How is the diet of a horse change post nephrorectomy?

A

No alfalfa hay and low protein diet

42
Q

What vitamin do horses get post nephrorectomy indefinitely?

A

Vitamin C

Surgery II (6 decks)

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