Tobias Everything > Bladder > Flashcards

Bladder Flashcards

(37 cards)

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1
Q

Where do the lateral ligaments attach?
What structures run within them?

A
  • Attach to the pelvic walls
  • Distal ureter and umbilical artery on each side
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2
Q

Where is the trigone?

A

Internal region of the bladder between the ureteral opening and the urethral opening at the bladder neck

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3
Q

What is responsible for voluntary control of micturition?

A
  • Pudendal nerve control of striated urethral muscle
  • Direct cortical innervation of the pontine micturition centre
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4
Q

How long does it take for bladder mucosa to heal?
How long for full-thickness defects to reach full strength?

A
  • Mucosa fully heads in 5 days
  • Full thickness strength in 14-21 days
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5
Q

What suture materials are most appropriate for use in the bladder?
What organism disintegrated all tested sutures by day 7?

A
  • Polydioxanone and polyglyconate
  • Proteus mirabilis
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6
Q

What ABx are a reasonable choice for periop antibiosis in the face of a UTI?

A
  • Amoxiclav
  • 3rd gen cephalosporin
  • Enrofloxacin
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7
Q

What effects does azotaemia have on anaesthesia and surgery?

A
  • Significant impact on animals ability to tolerate anaesthesia due to alterations of pharmacokinetics of, and sensitivty to, drugs
  • Interferes with platelet function
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8
Q

What are the effects of hyperkalaemia?

A
  • Bradycardia
  • Arrhythmias
  • Potentiates the cardiodepressant effects of anaesthetic drugs
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9
Q

List some factors which may help to predict what type or urolith is present

A
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10
Q

List the options for contrast radiographs for the work-up of suspected urolithiasis

A
  • Cystogram
  • Retrograde cystourethrogram
  • Double contract cystogram
  • Intravenous urogram
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11
Q

What is the reported rate or uroabdomen after cystotomy?

A

less than 1.5%

Haematuria and dysuria in 37-50%

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12
Q

What cause bladder regeneration after cystectomy?

A
  • Mucosal regeneration, synthesis and remodelling of scar tissue
  • Hypertrophy and proliferation of smooth muscle
  • Distention of remaining bladder wall

Regenerating cells arise from the epithelium of the terminal ureters and urethra (trigone)

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13
Q

How much bladder can be removed in dogs?

A
  • 30-40% - all dogs regained baseline bladder capacity by 10m
  • More than 90% - Still had 72% decrease in capacity by 9m
  • 40-70% excised in 11 dogs, 2 had persistant pollakiuria
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14
Q

List options for reconstructions when most or all of the bladder required excision

A
  • Seromuscular colonic augmentation
  • Ileocystoplasty
  • Total cystectomy with urinary diversion to colon (not recommended, high morbidity)
  • TOtal cystectomy with diversion to prepuce or vagina
  • Porcine SIS
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15
Q

What approaches can be used for cystostomy tube placement?

A
  • Ventral midline
  • Minimally invasive inguinal approach
  • Laparoscopic
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16
Q

What % of patients with cystostomy tubes develop complications?

Study These Flashcards
A

49%
Inadvertnent removal, displacement, chewing, breakage of mushroom tip on removal, fistula formation, urine leakage, rectal prolapse etc

17
Q

List the 2 broad options for cystopexy

Study These Flashcards
A
  • Tube cystostomy
  • Incisional cystopexy (3 rows of 6 simple interrupted sutures with 3-0 polypropylene)
18
Q

What is a patent urachus?

Study These Flashcards
A

Foetal communication between urinary bladder and allantoic cas persists, resulting in urine being discharged through urachal tube and exiting abdomen at the umbilicus

19
Q

What is a congenital vesicourachal diverticulum?

Study These Flashcards
A

The external opening of the urachus closes but a blind-ending diverticulum remains at the bladder apex

20
Q

What are the physiologic effects of uroabdomen?

Study These Flashcards
A
  • Azotaemia
  • Dehydration
  • Metabolic acidosis
  • Hyperkalaemia
  • Death within 47-90hr
21
Q

How can you perform peritoneal dialysis in a patient with uroabdomen?

Study These Flashcards
A
  • Place an indwelling abdominal drain
  • Instill 20ml/kg warmed isotonic fluid
  • Leave in situ for 45 minutes and then drain
  • Can be repeated hourly
22
Q

What are the most common calculi in dogs and cats?

Study These Flashcards
A
  • Struvite (magnesium ammonium phosphate)
  • Calcium oxalate
23
Q

What % of dogs with a negative urine culture will have a positive culture from the urolith, mucosal biopsy or both?

24
Q

Which uroliths are not amenable to dissolution and therefore requir removal?

Study These Flashcards
A
  • Calcium oxalate
  • Silicate
25
List methods for retrieval of uroliths
- Catheter-assisted retrieval - Transurethral cystoscopic retrieval - Voiding hydropulsion (fully voided in 15/21) - Lithotripsy (Ho:YAG) - Laparoscopic assisted or percutaneous cystotomy - Surgical cystotomy
26
What is the rate of incomplete removal of cystoliths at cystotomy?
20%
27
What minimised urine spillage during a minimally invasive laparoscope-assisted cystotomy?
- Packing swabs around the bladder - Using a purse string suture - Trochar with a diaphragm
28
What recommendations can be made to reduce recurrence?
- Increased water intake - Elimination of obesity - Appropriate diet or medical therapy
29
What are the recurrence rates of various uroliths?
Struvite - 21% dogs - 2.7% cats - UTI management, acidifying diet Calcium oxalate - 50% in dogs within 3 yr - 7% cats Urate - 33% dogs - 13% cats Cysteine - 47% dogs - diet, 2-MPG Silicate - 12% dogs
30
What is polypoid cystitis? What disease can it resemble?
- An uncommon nonneoplastic inflammatory disease - Can resemble TCC but is typically located in cranioventral aspect of bladder
31
List surgical options for polypoid cystitis
- Partial cystectomy - Submucosal resection - Excisional mucosal biopsy using a clamp placed across the base - Resection using laparoscope-assisted cystoscopy
32
What is the most common bladder neoplasia in dogs and cats? What breeds are overrepresented?
TCC Overrepresented: - Airedale terriers - Beagles - Shelties - Collies - Scottish terriers
33
List factors which may be associated with the development of TCC
- Female - Obesity - Older topical insecticides - Phenoxy herbicides - Nitrosamine exposure - Cyclophosphamide - Living in highly industrial area
34
In what % of cases does it effect both the bladder and urethra? Prostate?
- Bladder and urethra in 56% - Prostate in 29% of male dogs
35
What % of TCC will have metastatised to the LNs and to the lungs?
- LN 16% at diagnosis, 40% at necropsy - Thoracic: 14% at diagnosis, 49% at necropsy
36
What Tx is associated with the best results for TCC?
Recieving multiple different treatment protocols over the course of their disease (leads to control of TCC growth in 75% with a MST of 1yr) - Response monitored every 4-8 weeks - Different treatment instituted if cancer progresses or unacceptable toxicity occurs
37
What % of stents will relieve urinary obstruction in the face of TCC? And cause urinary incontinence?
- over 95% relieve obstruction - 26-39% urinary incontinence - MST 78d
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