Term
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Definition
| mineralized material, "stones;" can be found anywhere in the body |
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Term
| Name for the Sx in which a penis is turned into vulva? |
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Definition
| perineal urethrostomy (PU) |
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Term
|
Definition
| a mineralized material or "stone" found somewhere in the urinary system |
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Term
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Definition
| minerals mixed in a matrix of mucus, proteins, and debris; more like a sandy grit than a stone |
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Term
| Where can uroliths be found? |
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Definition
| kidney, bladder, ureter, urethra |
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Term
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Definition
diuresis: to flush out
dialysis: filtering the blood through a machine |
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Term
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Definition
| Feline Urologic Syndrome, now called FLUTD |
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Term
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Definition
| Feline Lower Urinary Tract Disease |
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Term
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Definition
| making an incision into the urethra, usually to remove a urethral stone causing an obstruction |
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Term
| Urethrotomy is done mostly in _____. Why? |
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Definition
male dogs, because:
-smaller diameter urethra
-os penis bone (stones get stuck)
-longer urethra w/bend around pelvis |
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Term
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Definition
| funnel-shaped area where the urethra and 2 ureters attach to the bladder |
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Term
| Common spots for urinary calculi to lodge: |
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Definition
-trigone
-urethral bend
-os penis |
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Term
| Notes on taking urinary "scout rads:" |
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Definition
-show butt
-see bladder, trigone
-extend both femurs |
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Term
| CS of urethral obstruction: |
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Definition
-dysuria, stranguria, hematuria
-hard, large, palpable bladder
-coma and death from ARF and hyperkalemia can occur within 72 hours |
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Term
| How to distinguish cystitis from urethral obstruction: |
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Definition
-still have dys/strang/hemat-uria with cystitis
-but cystitis has small bladder because walls thicken from inflammation |
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Term
| Cystitis occurs more in ____. Why? |
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Definition
females because:
-urethra 1/3 length and wider in females |
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Term
| #1 cause of bladder infections is by what route? |
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Definition
| ascending route (bacteria travels from outside up through urethra) |
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Term
| Fluid of choice for treat urethral obstructions? |
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Definition
| saline, because it has no K (patients with urethral obstructions have hyperkalemia) |
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Term
| What else might you find in a bladder if you see very large stones on scout rads? |
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Definition
| smaller stones in between the large ones |
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Term
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Definition
| 50% water, 50% KY jelly - syringe into urethra via cath, may allow stones to pass |
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Term
| Term for how to push uroliths from urethra back into bladder? |
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Definition
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Term
| How to perform retropulsion? |
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Definition
-rectal pressure to occlude urethra just proximal to stone
-begin squirting solution through cath
-remove rectal pressure, hope stone dislodges |
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Term
| Purpose of applying rectal pressure during retropulsion? |
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Definition
| allow cath to build up pressure before release |
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Term
| Where to make urethrotomy incision? |
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Definition
| caudal to os penis, directly over urethra |
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Term
|
Definition
-surgical prep
-advance urinary cath up to obstruction
-saline, sterile water, or other sterile liquid to flush |
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Term
| What size syringe to use for flushing out a stone during urethrotomy? Technique? |
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Definition
| 60cc - move cath in and out, flush hard |
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Term
| Urethrotomy post-op notes: |
|
Definition
-incision left unsutured
-urination through incision and tip of penis
-bloody urine (Kool-Aid, not ketchup)
-possible bladder atony |
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Term
| What sort of aftercare should a patient receive after urethrotomy? (from PP) |
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Definition
-manually express bladder
-Abx maybe |
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Term
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Definition
| distended bladder, temporary lack of contractions |
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Term
| Name of the muscle that contracts to allow the release of urine? |
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Definition
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Term
| Uroliths should be sent to the lab to test for... |
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Definition
-mineral content
-culture & sensitivity |
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Term
| The size of a zone of inhibition is not indicative of... |
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Definition
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Term
| Define "perineal urethrostomy:" |
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Definition
| creating a permanent opening of the urethra below the anus |
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Term
| Perineal urethrostomy is mostly performed on ___. |
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Definition
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Term
| What should you try before resorting to perineal urethrostomy? |
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Definition
| retropulsion - only do PU Sx when blockages are recurring |
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Term
| Notes on perineal urethrostomy: |
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Definition
-cats: partial amputation of penis
-dogs: penis remains intact
-new urethral hole is bigger
-can result in urine scalding, strictures, and recurrent UTIs |
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Term
|
Definition
| an abnormal narrowing of a bodily passage which may be caused by scar tissue |
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Term
| Possible consequences of perineal urethrostomy? |
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Definition
-urine scalding
-strictures
-recurrent UTIs |
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Term
| How to position a cat for perineal uresthrostomy? |
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Definition
-sternal
-rear end hanging off table
-tail taped up
-urinary cath placed
-purse string suture on anus |
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Term
| Describe the procedure of perineal uresthrostomy from the pictures in the PP: |
|
Definition
-laser cuts around penis
-penis extended, urethra incised (not lasered)
-urethra sutured to skin, penis amputated |
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Term
|
Definition
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|
Term
| Reasons for why a cystotomy may be performed: |
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Definition
| remove uroliths or growths |
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Term
| Sx prep site varies between males and females for what type of Sx? Describe differences. |
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Definition
cystotomy
Male:
-parallel and lateral to penis
-can undermine penis to reach linea alba
-more chance of seroma/hematoma
Female:
-ventral midline
-more caudal than for spay |
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Term
| Do you need to place a urinary catheter for cystotomy? |
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Definition
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Term
|
Definition
| temporary sutures which hold the bladder (in this case) in position outside of the incision |
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Term
|
Definition
-allow frequent urination to prevent bladder distention
-expect urine to be bloody for at least 5 days
-Abx
Diet changes
-Urinary acidifiers for Struvites |
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Term
| Urinary acidifiers are used for ___ stones. |
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Definition
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Term
| Examples of urinary acidifiers: |
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Definition
-methionine (tabs, gel) is an AA
-ammonium compounds |
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Term
| #1 type of urolith in vet med? |
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Definition
| struvite - in alkaline, high pH urine |
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Term
| Rarely do cats and dogs have ___ stones, but rather ___. |
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Definition
| rarely kidney, rather bladder |
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Term
| Describe the formation of a urolith: |
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Definition
| -central nidus coated with layers of minerals and bacteria |
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Term
| Are Abx given after removal of uroliths if urine is sterile? Why or why not? |
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Definition
| Yes, always, even if urine sterile. Nidus of stone tends to have bacteria |
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Term
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Definition
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Term
| __% of all stones in vet med are ___. |
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Definition
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Term
| Double contrast studies are helpful to visualize ____ stones. |
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Definition
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Term
| Breed predilections for stones: |
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Definition
Schnauzers - Struvite
Dalmation - Urates |
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Term
| Stones of ___ size are hard to view on rads. |
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Definition
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Term
| What do we check for in UA of patients with stones? |
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Definition
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Term
| How to administer contrast materials for a double contrast study? |
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Definition
-air, then dye
(otherwise there are many confusing bubbles) |
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Term
| Ideal gas to use for double contrast studies: |
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Definition
| CO2, but room okay (just more risk of embolism) |
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Term
| What type of catheter should you use for double contrast cystogram? |
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Definition
| Foley- has bubble so air can't escape |
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Term
| Other names for Struvite: |
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Definition
-triple phosphate
-ammonium phosphate
-Mg ammonium PO3 |
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Term
|
Definition
-acidify urine 6-6.3
-s/d <6mo, then c/d |
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Term
| Breed/Sex/pH/Diet/Tx/Etc for Struvite stones: |
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Definition
-Schnauzer
-80% female dogs
-forms in alkaline urine
-s/d < 6 mo, then c/d (want low magnesium phosphate)
-medical Tx
-radiopaque
-80% all stones = Struvite |
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Term
| Breed/Sex/pH/Diet/Tx/Etc for Calcium Oxalate stones: |
|
Definition
-Burmese, Persian, Himalayan cats
- > 70% male dogs
-acidic
-u/d or c/d multi
-surgical Tx
-radiopaque |
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Term
| Breed/Sex/pH/Diet/Tx/Etc for Urate stones: |
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Definition
-Dalmations
-males
-acidic
-u/d to treat, low protein and allopurinol to prevent
-medical Tx
-radiopaque OR radiolucent (low density)
-can be caused by liver shunts |
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Term
| Breed/Sex/pH/Diet/Tx/Etc for Silicate stones: |
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Definition
-no breed predilection
-90% male
-acidic
-u/d, prevent from eating sand/dirt
-surgical Tx
-radiopaque |
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Term
| Breed/Sex/pH/Diet/Tx/Etc Cystine stones: |
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Definition
-no breed predilections
-90% male
-acidic
-u/d
-medical
- may or may not be radolucent |
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Term
| Burmese, Persian, and Himalayan cats are more prone to ____ stones. |
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Definition
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|
Term
| What stone primarily affects female dogs? What percentage of these stones are found in female dogs? |
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Definition
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|
Term
| Stone/s in alkaline urine: |
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Definition
|
|
Term
|
Definition
(all but struvite)
-calcium oxalate
-urate
-silicate
-cystine |
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Term
| Stones that can be treated medically: |
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Definition
|
|
Term
| Stones that are radiopaque: |
|
Definition
-struvite
-calcium oxalate
-silicate
-sometimes urate |
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|
Term
|
Definition
|
|
Term
| Diet to prevent future struvite stones? |
|
Definition
| c/d (low magnesium phosphate) |
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|
Term
| Stone prevented by u/d or c/d multi? |
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Definition
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|
Term
| > 70% of ____ stones are found in male dogs. |
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Definition
|
|
Term
| Diet used to treat or prevent urate stones: |
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Definition
| u/d (prevent: low protein, allopurinol) |
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Term
| Of the stones covered in the class, most are found in (pH) of urine? |
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Definition
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Term
| Stone that can be radiolucent or radiopaque? |
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Definition
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|
Term
| 90% of ___ stones affect males, and they require surgical removal. |
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Definition
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|
Term
| 90% of ___ stones affect males, and they can be treated medically. |
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Definition
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|
Term
| U/d can be used to treat what stone/s? |
|
Definition
-calcium oxalate
-urate
-silicate
-cystine |
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Term
| What stone is + or - radiolucent? |
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Definition
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Term
| Contributing factors to FLUTD: |
|
Definition
-urine pH (alkaline)
-cat's weight (obese)
-water intake (really concentrated urine)
-Mg content of food, not ash content (too much Mg) |
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Term
| What sex is more likely to get FLUTD? |
|
Definition
|
|
Term
| Where in the UT do male cats tend to get plugged? |
|
Definition
| distal penis because it's a reverse megaphone shape |
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|
Term
| What can you do as a tech to Tx a blocked male cat? |
|
Definition
-manually compress tip of penis
-H2O2 with caution
-Go-Juice
-Tritop as lube (has steroid)
-suture cath in place with tape wings
-0.2cc lidocaine in urinary cath to decrease urethral spasms
-retrograde hydropulsion |
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|
Term
| Avoid sedating a blocked cat with what drugs and why? |
|
Definition
-ketamine: urethral muscle constriction
-barbiturates: lingers a long time
-alpha-2 agonists like Dex/Xyla: diuretic effect, makes urine faster (bad if still blocked) |
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|
Term
| What drugs does Dr. Costa use to sedate a blocked cat? |
|
Definition
| none, but said you could mask them down with Iso or Sevo |
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|
Term
| Why is closed urinary collection better than open? |
|
Definition
-less messy for cage and for animal
-prevent urine scald
-can monitor urine output |
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|
Term
| Normal urinary output in cats: |
|
Definition
|
|
Term
| How will diuresis affect output and SG? |
|
Definition
| increase output, decrease SG |
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|
Term
| Does FLUTD usually involve an infection? |
|
Definition
| No, FLUTD urine is usually sterile |
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