LEC 4 - Urinary Surgery

Question 1

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

Answer 1

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

Question 2

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

Answer 2

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

Question 3

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

Answer 3

IV contrast

Question 4

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

Answer 4

Companion animals, equine, and ruminants

Question 5

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

Answer 5

Equine and cattle

Question 6

What is a nuclear scintigraphy used for?

Answer 6

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

Question 7

When can an endoscopy be used to evaluate the urethra?

Answer 7

Companion animals, equine, and ruminants

Question 8

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

Answer 8

Electrolyte abnormalities

Question 9

What electrolyte abnormality is of our greatest concern? Why?

Answer 9

Hyperkalemia, can predispose the animal to arrhythmias

Question 10

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

Answer 10

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

Question 11

What drugs should be avoided with CKD patients?

Answer 11

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

Question 12

What are the degrees of nephrotoxicity of the gas anesthestics?

Answer 12

Methoxyflurane > Enflurane > Isofularne > Halothane

Question 13

When does a dog need a blood transfusion?

Answer 13

PCV

Question 14

When does a cat need a blood transfusion?

Answer 14

PCV

Question 15

What is a cystorrhexis?

Answer 15

Ruptured bladder

Question 16

What should be done pre-op for a cystorrhexis?

Answer 16

Correct hyperkalemia. Abdominal drainage, and stabilize the patient

Question 17

What does abdominal drainage in the presence of cystorrhexis do?

Answer 17

Helps correct electrolyte imbalance and decrease pressure on teh diaphragm

Question 18

Where in the bladder are ruptures most common?

Answer 18

Dorsocranial margin

Question 19

What animal do you most commonly see bladder ruptures?

Answer 19

Foals, males

Question 20

What is a diagnostic conformation of a cystorrhexis?

Answer 20

Abdominal creatine to serum creatinine. 2:1 is definitive

Question 21

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

Answer 21

0.9% saline

Question 22

What is the most common approach to urinary surgery?

Answer 22

Ventral midline

Question 23

In foals, what surgical approach is used?

Answer 23

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

Question 24

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

Answer 24

Ventral midline

Question 25

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

Answer 25

Standing or lateral recumbency

Question 26

What is the approach for a nephrectomy in a foal?

Answer 26

Lateral recumbency

Question 27

How is the right kidney reached in a horse?

Answer 27

15th and 17th intercostal space

Question 28

How is the left kidney reached in a horse?

Answer 28

Caudal to the 18th rib

Question 29

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

Answer 29

Monofilament absorbable suture. NEVER USE NON-ABSORBABLE

Question 30

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

Answer 30

2 to 3 weeks

Question 31

How is a cystotomy closed?

Answer 31

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

Question 32

What type of urine affects the hydrolysis of the suture?

Answer 32

Alkaline urine

Question 33

What is the common urolith type in dogs/cats?

Answer 33

Struvites, calcium oxalate, urate, silicate, or cystine

Question 34

What animals is a tube cystotomy most often done?

Answer 34

Male sheep and goats

Question 35

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

Answer 35

Calcium apatite or phosphate based calculi

Question 36

When do you remove the catheter from a small ruminant?

Answer 36

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

Question 37

When is a tube cystotomy used in small animals?

Answer 37

Urine diversion

Question 38

When is a tube cystotomy removed from a small animal?

Answer 38

3 to 7 days

Question 39

What is a major component to calculus formation in horses?

Answer 39

Urine has a high mucous content

Question 40

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

Answer 40

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.

Question 41

How is the diet of a horse change post nephrorectomy?

Answer 41

No alfalfa hay and low protein diet

Question 42

What vitamin do horses get post nephrorectomy indefinitely?

Answer 42

Vitamin C