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Urolithiasis - Coggle Diagram
Urolithiasis
treatments from specialists
basket retrieval
laser lithotripsy
extracorporeal lithotripsy
percutaneous cystolithotomy
cystoscopic assisted cystotomy
subcutaneous bypass device for urethral obstruction
uroliths
solid aggregates of mineral and non-mineral crystalloids
form when urine oversaturated with crytallogenic precursors
form from
biogenic material
drug metabolites
amino acids
around foreign substances
anatomy
nidus
area of obvious initiation of urolith growth
not necessarily the geometric center
body
major portion
focus of preventative measure if no nidus
shell
outer concentric lamination
surface
incomplete outer lamination
predicting urolith composition
rad appearance
breed and gender
urinalysis
serum chem
diagnosis
medical imaging
rads
US
both may be needed
:forbidden:
pass urinary catheter
bladder palpation
when to dissolve vs procedure
obstructive
urohydropropulsion
if anima can be lifted into vertical position
stones small enough to pas through urethra
steps
anesthetize
attach 3 way stopcock to end of urinary catheter
fill bladder
LRS or normal saline
can occlude vulva/urethra with finger~
position patient vertically
stones accumulate at the neck of the bladder
agitate bladder
rarely needed
dislodges more uroliths
express bladder
flush repeatedly
repeat steps 2-6
medical imaging
cystotomy
dissolve
struvites in bladder for cats
+/- dog struvites, limited success
infection associated is not ideal for dissolution
cysteine
urate
xanthine
when to culture urine
diagnosing infection-induced struvites
not quantitative from bladder cystocentesis
location verification
urethrolith
should be retrohydropulsed
heavy sedation, general anesthesia, local anesthesia
success depends on adequate relaxation of the urethra
decompress urinary bladder
uroliths cannot be flushed back into an over-distended urinary bladder
use 22g 1.5in needle attached to IV extension tubing
3-way stopcock
large volume syringe to remove urine
lubricate around uretroliths
fill 1 12ml syringe w 5ml of saline
fill 1 12ml syringe with lubricant
attach both to 3 way stop cock
mix contents of both syringes by empyting one into the other several times
insert urethral catheter
inject 3-8ml of the mix
insert catheter
large bore flexible catheter
do not insert such that the tip is proximal to urethrolith
occlude pelvic urethra
gloved hand into rectum, press ventrally
occlude distal urethra
w moistened gauze sponge, compress distal urethra around catheter
force fluid through catheter forcefully
fill a syringe w/ sterile isotonic 0.5 - 4ml depending on animal size
attach syringe to catheter
empty syringe forcefully
relieve occlusion of pelvic urethra
once urethra dilates, remocal pelvic urethra pressure
continue flushing
dissolution ineffective
when to castrate
inherited cystine urolythiasis