Chapter 64 - Diagnostic Techniques and Principles of Urinary Tract Surgery

Question 1

1. What is the primary rule out for hematuria following exercise?

Answer 1

• Cystolithiasis

Question 2

2. What are symptoms of chronic renal failure in uremic horses? (5)

Answer 2

• Decreased body condition
• Intermittent decreased appetite
• Excessive dental tarter
• Mild ventral edema
• “fishy” or uremic odor of the oral cavity and skin

Question 3

3. ______ palpation should be included as part of a complete physical exam of all horses with suspected urinary tract disease

Answer 3

• Rectal

Question 4

4. Why might a larger cystolith be missed on rectal palpation?

Answer 4

• Dysuria and pollakiuria frequently result in a small bladder that may be entirely within the pelvic canal, the bladder and disc-shaped cystolith are best palpated with the hand inserted only wrist deep into the rectum.

Question 5

5. T/F – The bladder of a normal horse should be easily expressed from manual pressure during rectal palpation.

Answer 5

• False, it is nearly impossible to express urine from a horse with a normal urethral sphincter during rectal palpation

Question 6

6. Horses with large, atonic bladders are much more likely to develop what condition? (May be mistaken for a cystolith)

Answer 6

• Sabulous cystitis

Question 7

7. Why might a bladder be more tubular in shape and unable to be freely manipulated?

Answer 7

• If a bladder apex remains adhered to the umbilicus

Question 8

9. ______ is the lesion associated with NSAID nephropathy.

Answer 8

• Medullary crest necrosis

Question 8

8. Ureters are generally not palpable unless they are _____ or ______

Answer 8

• Enlarged
• Obstructed

Question 9

10. What are the most rewarding and cost effect imaging techniques for the urinary tract?

Answer 9

• Ultrasonography and endoscopy

Question 10

11. Retrograde contrast radiographic studies can be used in foals to help identify what 3 conditions?

Answer 10

• Ruptured bladder
• ectopic ureter
• urorectal fistula

Question 11

12. What is the best way to image the right kidney and where is the best place to image?

Answer 11

• Transabdominal ultrasound via the dorsolateral extent of the last 2 or 3 intercostal spaces

Question 12

13. What is the best way to image the left kidney and where is the best place to image?

Answer 12

• Via the last 2 intercostal spaces or via the paralumbar fossa.

Question 13

14. T/F: With transabdominal ultrasound evaluations, in acute kidney injury, the kidneys appear small, and with chronic kidney disease the kidneys appear normal to enlarged.

Answer 13

• False, in AKI kidneys are normal to enlarged and in CKD they appear small

Question 14

15. How can calculi in the renal pelvis be differentiated from normally echogenic areas of the renal pelvis on ultrasound evaluation?

Answer 14

• Because they cast an acoustic shadow

Question 15

16. In horses, where is the best location of the ultrasound to obtain ultrasound images of the bladder, urethra, and ureters?

Answer 15

• Transrectal US

Question 16

17. T/F: in horses, the urine is rich in crystals and mucus, and appears as homogenous, echogenic fluid that can be made to swirl by manipulating the bladder.

Answer 16

• False, an inhomogenous fluid

Question 17

18. Cystic calculi can typically be imaged with transrectal ultrasound. The calculi appear _______ and produce _______.

Answer 17

• highly echogenic
• acoustic shadowing

Question 18

19. Endoscopic examination of the equine urinary tract is a useful tool. The ideal flexible endoscope should have an outer diameter of _______ or less and be a minimum length of ________.

Answer 18

• 12mm
• 1m

Question 19

20. Normal distal urethral mucosa of male equines is pale pink with ______ (direction) folds.

Answer 19

• longitudinal

Question 20

21. The paired bulbourethral gland duct openings are seen along the _______ aspect of the pelvic portion of the urethra.

Answer 20

• dorsal

Question 21

22. With suspicions of urethral rent, the ______ aspect of the urethra should be closely examined at the level of the _______ to assess for _________.

Answer 21

• Caudal
• ischial arch
• fistulous tracts communicating with the corpus spongiosum penis

Question 22

23. What can be a site of postejaculation hemorrhage in stallions?

Answer 22

• The joint openings of the ductus deferens and seminal vesicle ducts on the colliculus seminalis

Question 23

24. A small amount of urine should pass from each ureteral opening approximately once every ____-____s.

Answer 23

• 30-60s

Question 24

25. T/F: Radiography is useful to evaluate the urinary tract of foals, miniature horses, adult horses, and small ruminant species?

Answer 24

- False, it is not useful in evaluation of adult horses

Question 25

26. T/F: Struvite calculi are radio-opaque and visible on radiographs where as calcium carbonate calculi are radiolucent on radiographs.

Answer 25

- False, calcium carbonate should be radiopaque