This document summarizes a study evaluating 47 cats with critical urogenital disorders causing abdominal pain. Feline urologic syndrome (FUS) was diagnosed in 18 cats, urinary bladder rupture in 2 cats, polycystic kidney disease in 1 cat, uterine rupture in 1 cat, and closed cervix pyometra in 25 cats. Diagnosis was based on clinical signs, radiography, ultrasonography, bloodwork, and urinalysis. Cats received fluid therapy, antibiotics, and analgesics. Surgical interventions like cystostomy, cystorrhaphy, percutaneous cyst aspiration, and ovariohysterectomy were performed. Most cats recovered well with prompt diagnosis and treatment, though one cat with F
CE Title: Gastrointestinal Bleeding Scintigraphy: Changing the Paradigm
Presented at the Annual Meeting of the Society of Nuclear Medicine and Molecular Imaging, held in Denver, CO on Tuesday, June 13, 2017, 8:00 AM–9:30 AM
Educational Objectives
Upon completion of this activity, the participant will be able to:
1. Interpret GIBS images, planar and SPECT/CT.
2. Compare GIBS with available diagnostic tests used in GI bleeding, including GIB-CTA, endoscopy, etc.
3. Implement the best practice technique for GIBS, based on the revised SNMMI guideline document.
This document provides information about urodynamic evaluation of voiding dysfunction. It discusses the history of urodynamics, aims, equipment used including catheters, flowmeters and EMG equipment. It describes how to conduct urodynamic evaluations including uroflowmetry, cystometrogram, and considerations for filling rate and medium. Key points covered are the indications for urodynamics, preparation of patients, types of equipment and how to interpret uroflow curves and cystometrogram measurements.
This study aimed to evaluate the protective effects of zofenopril on intestinal ischemia-reperfusion injury using a rat model. Rats were divided into five groups: sham surgery, ischemia only, ischemia-reperfusion, ischemia-reperfusion with zofenopril pretreatment, and zofenopril only. Biochemical markers of oxidative stress and apoptosis were measured in intestinal tissue samples. Histopathological examination and immunohistochemical staining for caspase-3 was also performed. Results showed that ischemia-reperfusion caused intestinal damage including mucosal destruction and cell apoptosis. Zofenopril pretreatment reduced oxidative stress markers and inhibited apoptosis, protecting against ischemia-reperfusion injury on histological and biochemical evaluation. The
Timing of surgery in mild biliary pancreatitisAravind TK
This study aimed to determine the optimal timing of cholecystectomy for patients with mild to moderate acute biliary pancreatitis. It was a prospective randomized controlled study conducted at a hospital in Malaysia between 2013-2014. 82 patients were randomly assigned to either early cholecystectomy within the index admission (n=38) or delayed cholecystectomy after 6 weeks (n=34). The study found significantly fewer recurrent biliary events like pain and infection in the early group compared to delayed group, with no significant difference in complication rates. The study concluded that for mild to moderate acute biliary pancreatitis, early laparoscopic cholecystectomy reduces risk of recurrence without increasing operative risks.
This document provides an overview of abdominal, hematologic, gynecologic, genitourinary, and renal emergencies. It begins with introducing the case study of a 67-year-old woman experiencing abdominal pain and discusses the chief complaint and physical exam. It then provides introductions to different types of emergencies and outlines abdominal structures and functions. The majority of the document focuses on acute abdominal pain, describing causes like peritonitis, appendicitis, and pancreatitis. It discusses signs and symptoms of different conditions that can cause acute abdominal pain.
Peritonectomy is a surgical technique used to treat advanced ovarian cancer that aims to remove all visible tumor from the peritoneal cavity. A study was conducted on peritonectomies performed at the Queensland Centre for Gynaecological Cancer to evaluate the safety and outcomes. The results showed that peritonectomy can debulk tumor down to less than 2cm in size, with smaller residuals associated with better survival rates. However, going from 2cm or less to no visible tumor takes significantly more time and expertise. Patient selection remains a challenge, but modified peritonectomy appears to be a viable option for some advanced ovarian and primary peritoneal cancer cases. Training future surgeons in these complex procedures is important to improving patient outcomes.
CE Title: Gastrointestinal Bleeding Scintigraphy: Changing the Paradigm
Presented at the Annual Meeting of the Society of Nuclear Medicine and Molecular Imaging, held in Denver, CO on Tuesday, June 13, 2017, 8:00 AM–9:30 AM
Educational Objectives
Upon completion of this activity, the participant will be able to:
1. Interpret GIBS images, planar and SPECT/CT.
2. Compare GIBS with available diagnostic tests used in GI bleeding, including GIB-CTA, endoscopy, etc.
3. Implement the best practice technique for GIBS, based on the revised SNMMI guideline document.
This document provides information about urodynamic evaluation of voiding dysfunction. It discusses the history of urodynamics, aims, equipment used including catheters, flowmeters and EMG equipment. It describes how to conduct urodynamic evaluations including uroflowmetry, cystometrogram, and considerations for filling rate and medium. Key points covered are the indications for urodynamics, preparation of patients, types of equipment and how to interpret uroflow curves and cystometrogram measurements.
This study aimed to evaluate the protective effects of zofenopril on intestinal ischemia-reperfusion injury using a rat model. Rats were divided into five groups: sham surgery, ischemia only, ischemia-reperfusion, ischemia-reperfusion with zofenopril pretreatment, and zofenopril only. Biochemical markers of oxidative stress and apoptosis were measured in intestinal tissue samples. Histopathological examination and immunohistochemical staining for caspase-3 was also performed. Results showed that ischemia-reperfusion caused intestinal damage including mucosal destruction and cell apoptosis. Zofenopril pretreatment reduced oxidative stress markers and inhibited apoptosis, protecting against ischemia-reperfusion injury on histological and biochemical evaluation. The
Timing of surgery in mild biliary pancreatitisAravind TK
This study aimed to determine the optimal timing of cholecystectomy for patients with mild to moderate acute biliary pancreatitis. It was a prospective randomized controlled study conducted at a hospital in Malaysia between 2013-2014. 82 patients were randomly assigned to either early cholecystectomy within the index admission (n=38) or delayed cholecystectomy after 6 weeks (n=34). The study found significantly fewer recurrent biliary events like pain and infection in the early group compared to delayed group, with no significant difference in complication rates. The study concluded that for mild to moderate acute biliary pancreatitis, early laparoscopic cholecystectomy reduces risk of recurrence without increasing operative risks.
This document provides an overview of abdominal, hematologic, gynecologic, genitourinary, and renal emergencies. It begins with introducing the case study of a 67-year-old woman experiencing abdominal pain and discusses the chief complaint and physical exam. It then provides introductions to different types of emergencies and outlines abdominal structures and functions. The majority of the document focuses on acute abdominal pain, describing causes like peritonitis, appendicitis, and pancreatitis. It discusses signs and symptoms of different conditions that can cause acute abdominal pain.
Peritonectomy is a surgical technique used to treat advanced ovarian cancer that aims to remove all visible tumor from the peritoneal cavity. A study was conducted on peritonectomies performed at the Queensland Centre for Gynaecological Cancer to evaluate the safety and outcomes. The results showed that peritonectomy can debulk tumor down to less than 2cm in size, with smaller residuals associated with better survival rates. However, going from 2cm or less to no visible tumor takes significantly more time and expertise. Patient selection remains a challenge, but modified peritonectomy appears to be a viable option for some advanced ovarian and primary peritoneal cancer cases. Training future surgeons in these complex procedures is important to improving patient outcomes.
This document describes the renogram procedure. It provides details on:
- The radiopharmaceuticals used, including 99mTc-DTPA, 99mTc-MAG3, and 99mTc-DMSA
- How the procedure is performed, including patient preparation, image acquisition, and time-activity curve analysis
- The roles of the radiopharmaceuticals in evaluating renal blood flow, glomerular filtration rate, and renal handling and excretion
- Factors that can affect the procedure such as hydration, medications, and kidney positioning
The document discusses the history and development of damage control resuscitation for trauma patients. It describes how 50 years ago there was little systematic resuscitation for civilian injuries, but that the development of trauma systems in the 1970s helped ensure patients were within 15-20 minutes of care. The key aspects of damage control resuscitation are outlined, including controlling hemorrhage, contamination and completing temporary repairs in the operating room, followed by resuscitation in the ICU and later definitive repairs. REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta) is also discussed as a technique for hemorrhage control in the emergency room.
This document outlines principles of trauma laparotomy and damage control surgery. It discusses relevant anatomy, indications for laparotomy following penetrating or blunt trauma, and the operative sequence including access, exploration, hemorrhage control, and damage control or definitive repair. It provides details on approaches and management of injuries to various abdominal organs. The goal is to control hemorrhage and contamination while optimizing the patient's physiology for subsequent definitive care.
This case study presents a 26-year-old woman who was admitted to the hospital after a car accident with multiple pelvic and femoral fractures. Imaging showed a peri-hepatic collection that was initially thought to be a hematoma. However, the patient's decreasing urine output and cystography revealing a bladder rupture led to the diagnosis of a peri-hepatic urinoma caused by a bladder injury. Catheterization was sufficient treatment and helped the bladder heal before the patient returned to Hungary for orthopedic procedures.
Abstract—Hydatid cyst disease is a zoonotic disease caused by the larval stage of Echinococcus granulosus and Echinococcus Multilocularis. In human beings, apart from involving the liver and lungs commonly, it also affects other organs like brain, kidney and spleen. Rupture of Hydatid cyst into abdominal cavity causes disseminated abdominal hydatidosis which is a rare complication. Here this rare case was presenting as a 48 years old female patient of disseminated intra-abdominal hydatidosis. Disseminated abdominal hydatidosis occurs secondary to traumatic or surgical rupture of a hepatic cyst. Ultrasonography or Computed Tomography findings are helpful in making a definitive diagnosis. For localized hydatid cysts in liver or lungs, the management of choice is preferably surgical while the treatment for disseminated intra-abdominal hydatidosis remains medical. Albendazole is the treatment of choice for disseminated abdominal hydatidosis.
This document summarizes traditional perioperative care practices and proposes evidence-based alternatives as part of an enhanced recovery after surgery (ERAS) protocol. It discusses replacing traditional practices like preoperative starvation, high stress levels during surgery, and excessive intravenous fluid administration with a multi-modal intervention approach including carbohydrate loading before surgery, limiting or avoiding premedication, effective pain relief through regional anesthesia, early mobilization, and goal-directed fluid therapy to improve outcomes.
This study analyzed 200 critically ill surgical and trauma patients in Pakistan to determine the frequency and risk factors of abdominal compartment syndrome (ACS). The key findings were:
- 6 patients (3% of the study population) developed ACS. The most significant risk factors for ACS included severe peritonitis, severe gut edema, systemic inflammatory response syndrome, and tense ascites.
- Patients who developed ACS had multiple organ dysfunction and high mortality - 5 of the 6 patients with ACS died during their hospital stay, an 80% in-hospital mortality rate.
- Early identification of at-risk patients and monitoring of intra-abdominal pressure could help detect ACS earlier to improve outcomes. However,
Fast-track or Enhanced Recovery After Surgery (ERAS) programs aim to reduce surgical stress and speed recovery through a multimodal approach. ERAS was pioneered by Henrik Kehlet in 1995 through laparoscopic colon resections with early feeding, mobilization, and discharge by postoperative day 2-3. ERAS utilizes a multidisciplinary team to implement protocols like preoperative carbohydrate drinks, short-acting anesthesia, epidurals, early feeding and mobilization, and discharge when criteria are met to reduce recovery time from major surgery. ERAS benefits even fragile elderly patients and makes more efficient use of healthcare resources without expensive infrastructure changes.
This document provides information about urine analysis performed by the Department of Urology at GRH and KMC in Chennai, India. It discusses the history of urine analysis from early observations of color and odor to modern quantitative tests. It outlines the moderators and their qualifications. It also describes proper procedures for urine specimen collection, transport, preservation, and analysis, including macroscopic examination, chemical dipstick analysis, microscopy, culture, and cytology. Key factors that can affect urine such as volume, color, turbidity, and specific gravity are explained.
Medical nutrition therapy status post whipple procedureValerie Agyeman
SG, a 72-year-old female, underwent a Whipple procedure for pancreatic adenocarcinoma. She experienced significant weight loss pre-operatively and nutritional complications post-operatively including delayed gastric emptying and electrolyte abnormalities. The registered dietitian's nutrition diagnoses included malnutrition, unintentional weight loss, and altered GI function. The RD prescribed a carbohydrate-controlled diet and thickened liquids, provided nutrition education, and collaborated with other providers to optimize SG's recovery.
Damage Control Laparotomy - an evidence based approachYasser Abbas
Dr. Yasser Abbas outlines the concept of damage control surgery, which involves temporarily controlling bleeding and contamination through techniques like packing and temporary abdominal closure, to allow time for resuscitation before definitive repair. Damage control is indicated for patients who are hemodynamically unstable, coagulopathic, acidotic, or hypothermic and involves three phases - initial surgery to control bleeding, ICU resuscitation to correct physiological derangements, and a second surgery for definitive repair once stabilized. The goal of damage control is to prevent the "lethal triad" of acidosis, coagulopathy, and hypothermia in order to improve survival rates.
This document discusses antibiotic prophylaxis in urological surgery. It provides guidelines for use of antibiotic prophylaxis for different urological procedures based on the invasiveness of the procedure and patient risk factors. Procedures like transrectal ultrasound-guided prostate biopsy and TURP require antibiotic prophylaxis due to the higher risk of infection. Less invasive procedures like cystoscopy only require prophylaxis for high-risk patients. The document recommends use of quinolones, ampicillin, vancomycin, or gentamicin as prophylactic antibiotics based on patient allergy history.
The document discusses the Enhanced Recovery After Surgery (ERAS) protocol. ERAS aims to optimize patient care and recovery through a multidisciplinary, evidence-based approach. It challenges traditional practices like prolonged preoperative fasting and use of drains. The ERAS protocol incorporates recommendations across the preoperative, intraoperative and postoperative periods. This includes carbohydrate loading, minimal fasting, optimized fluid management, multimodal analgesia, early nutrition and mobilization to reduce complications and length of stay while improving outcomes.
Endoscopy plays a crucial role in managing upper gastrointestinal bleeding by allowing diagnosis, risk assessment, and delivery of therapy. Recent guidelines recommend early risk scoring using the Glasgow-Blatchford Score and endoscopy within 24 hours. New endoscopic therapies like Hemospray and over-the-scope clips show promise in achieving hemostasis, though more data is needed. Achieving hemostasis can be challenging, and failed endoscopic hemostasis requires intervention like radiology, surgery, or stents.
Fluid resuscitation is an important part of treating acute pancreatitis. Early resuscitation within the first 24 hours is most effective. Lactated Ringer's solution is preferred over normal saline as it is more pH balanced and reduces inflammation. The goal is to resuscitate at a rate of 5-10 ml/kg/hour to a total of 2500-4000 ml in the first 24 hours. Response should be monitored using clinical goals like heart rate, blood pressure, urine output and biomarkers like CRP and hematocrit to guide further fluid administration. Early resuscitation with Lactated Ringer's reduces complications and mortality in acute pancreatitis.
This document provides information on upper urinary tract infections from the Department of Urology at Govt Royapettah Hospital and Kilpauk Medical College in Chennai, India. It defines upper urinary tract infections and various related conditions like pyelonephritis, renal abscesses, perinephric abscesses, and pyonephrosis. It discusses the pathogenesis, clinical presentation, diagnostic evaluation, and management of these conditions. Key pathogenic bacteria are outlined and imaging findings for various infections are described. Treatment involves antibiotic therapy and sometimes drainage or nephrectomy.
The document discusses damage control surgery for abdominal trauma. It describes how multiple trauma patients often die from the metabolic triad of coagulopathy, acidosis, and hypothermia rather than surgical complications. Damage control surgery aims to control bleeding, prevent contamination, and protect organs in an abbreviated first operation, leaving the abdomen temporarily open. This is followed by intensive care to reverse metabolic failure and a planned second operation once the patient is stabilized.
The document outlines the Enhanced Recovery After Surgery (ERAS) protocol. ERAS aims to reduce surgical stress, accelerate recovery through a multimodal approach. Key elements of ERAS include pre-admission counseling and nutrition optimization, minimizing preoperative fasting through carbohydrate loading, selective bowel preparation if needed, thoracic epidural anesthesia, early feeding and mobilization, and multimodal pain control to avoid opioid use and ileus. The goal is to minimize length of stay through evidence-based perioperative optimization.
Rupture of urinary bladder in large animals copy (2)Vinkit Patanjal
Uroperitoneum, or the leakage of urine into the abdominal cavity, is most commonly caused by rupture of the urinary bladder in cattle and horses. Bladder rupture typically occurs secondary to urinary tract obstruction from urolithiasis or stones. Clinical signs include abdominal distension, pain, and odor of urine from the breath. Diagnosis involves abdominal ultrasound to detect free fluid in the abdomen, as well as laboratory analysis of abdominal fluid. Definitive treatment requires surgical exploration and closure of any bladder tears. Post-operative care includes antibiotics and monitoring to ensure proper urination and prevent recurrence.
This document describes the renogram procedure. It provides details on:
- The radiopharmaceuticals used, including 99mTc-DTPA, 99mTc-MAG3, and 99mTc-DMSA
- How the procedure is performed, including patient preparation, image acquisition, and time-activity curve analysis
- The roles of the radiopharmaceuticals in evaluating renal blood flow, glomerular filtration rate, and renal handling and excretion
- Factors that can affect the procedure such as hydration, medications, and kidney positioning
The document discusses the history and development of damage control resuscitation for trauma patients. It describes how 50 years ago there was little systematic resuscitation for civilian injuries, but that the development of trauma systems in the 1970s helped ensure patients were within 15-20 minutes of care. The key aspects of damage control resuscitation are outlined, including controlling hemorrhage, contamination and completing temporary repairs in the operating room, followed by resuscitation in the ICU and later definitive repairs. REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta) is also discussed as a technique for hemorrhage control in the emergency room.
This document outlines principles of trauma laparotomy and damage control surgery. It discusses relevant anatomy, indications for laparotomy following penetrating or blunt trauma, and the operative sequence including access, exploration, hemorrhage control, and damage control or definitive repair. It provides details on approaches and management of injuries to various abdominal organs. The goal is to control hemorrhage and contamination while optimizing the patient's physiology for subsequent definitive care.
This case study presents a 26-year-old woman who was admitted to the hospital after a car accident with multiple pelvic and femoral fractures. Imaging showed a peri-hepatic collection that was initially thought to be a hematoma. However, the patient's decreasing urine output and cystography revealing a bladder rupture led to the diagnosis of a peri-hepatic urinoma caused by a bladder injury. Catheterization was sufficient treatment and helped the bladder heal before the patient returned to Hungary for orthopedic procedures.
Abstract—Hydatid cyst disease is a zoonotic disease caused by the larval stage of Echinococcus granulosus and Echinococcus Multilocularis. In human beings, apart from involving the liver and lungs commonly, it also affects other organs like brain, kidney and spleen. Rupture of Hydatid cyst into abdominal cavity causes disseminated abdominal hydatidosis which is a rare complication. Here this rare case was presenting as a 48 years old female patient of disseminated intra-abdominal hydatidosis. Disseminated abdominal hydatidosis occurs secondary to traumatic or surgical rupture of a hepatic cyst. Ultrasonography or Computed Tomography findings are helpful in making a definitive diagnosis. For localized hydatid cysts in liver or lungs, the management of choice is preferably surgical while the treatment for disseminated intra-abdominal hydatidosis remains medical. Albendazole is the treatment of choice for disseminated abdominal hydatidosis.
This document summarizes traditional perioperative care practices and proposes evidence-based alternatives as part of an enhanced recovery after surgery (ERAS) protocol. It discusses replacing traditional practices like preoperative starvation, high stress levels during surgery, and excessive intravenous fluid administration with a multi-modal intervention approach including carbohydrate loading before surgery, limiting or avoiding premedication, effective pain relief through regional anesthesia, early mobilization, and goal-directed fluid therapy to improve outcomes.
This study analyzed 200 critically ill surgical and trauma patients in Pakistan to determine the frequency and risk factors of abdominal compartment syndrome (ACS). The key findings were:
- 6 patients (3% of the study population) developed ACS. The most significant risk factors for ACS included severe peritonitis, severe gut edema, systemic inflammatory response syndrome, and tense ascites.
- Patients who developed ACS had multiple organ dysfunction and high mortality - 5 of the 6 patients with ACS died during their hospital stay, an 80% in-hospital mortality rate.
- Early identification of at-risk patients and monitoring of intra-abdominal pressure could help detect ACS earlier to improve outcomes. However,
Fast-track or Enhanced Recovery After Surgery (ERAS) programs aim to reduce surgical stress and speed recovery through a multimodal approach. ERAS was pioneered by Henrik Kehlet in 1995 through laparoscopic colon resections with early feeding, mobilization, and discharge by postoperative day 2-3. ERAS utilizes a multidisciplinary team to implement protocols like preoperative carbohydrate drinks, short-acting anesthesia, epidurals, early feeding and mobilization, and discharge when criteria are met to reduce recovery time from major surgery. ERAS benefits even fragile elderly patients and makes more efficient use of healthcare resources without expensive infrastructure changes.
This document provides information about urine analysis performed by the Department of Urology at GRH and KMC in Chennai, India. It discusses the history of urine analysis from early observations of color and odor to modern quantitative tests. It outlines the moderators and their qualifications. It also describes proper procedures for urine specimen collection, transport, preservation, and analysis, including macroscopic examination, chemical dipstick analysis, microscopy, culture, and cytology. Key factors that can affect urine such as volume, color, turbidity, and specific gravity are explained.
Medical nutrition therapy status post whipple procedureValerie Agyeman
SG, a 72-year-old female, underwent a Whipple procedure for pancreatic adenocarcinoma. She experienced significant weight loss pre-operatively and nutritional complications post-operatively including delayed gastric emptying and electrolyte abnormalities. The registered dietitian's nutrition diagnoses included malnutrition, unintentional weight loss, and altered GI function. The RD prescribed a carbohydrate-controlled diet and thickened liquids, provided nutrition education, and collaborated with other providers to optimize SG's recovery.
Damage Control Laparotomy - an evidence based approachYasser Abbas
Dr. Yasser Abbas outlines the concept of damage control surgery, which involves temporarily controlling bleeding and contamination through techniques like packing and temporary abdominal closure, to allow time for resuscitation before definitive repair. Damage control is indicated for patients who are hemodynamically unstable, coagulopathic, acidotic, or hypothermic and involves three phases - initial surgery to control bleeding, ICU resuscitation to correct physiological derangements, and a second surgery for definitive repair once stabilized. The goal of damage control is to prevent the "lethal triad" of acidosis, coagulopathy, and hypothermia in order to improve survival rates.
This document discusses antibiotic prophylaxis in urological surgery. It provides guidelines for use of antibiotic prophylaxis for different urological procedures based on the invasiveness of the procedure and patient risk factors. Procedures like transrectal ultrasound-guided prostate biopsy and TURP require antibiotic prophylaxis due to the higher risk of infection. Less invasive procedures like cystoscopy only require prophylaxis for high-risk patients. The document recommends use of quinolones, ampicillin, vancomycin, or gentamicin as prophylactic antibiotics based on patient allergy history.
The document discusses the Enhanced Recovery After Surgery (ERAS) protocol. ERAS aims to optimize patient care and recovery through a multidisciplinary, evidence-based approach. It challenges traditional practices like prolonged preoperative fasting and use of drains. The ERAS protocol incorporates recommendations across the preoperative, intraoperative and postoperative periods. This includes carbohydrate loading, minimal fasting, optimized fluid management, multimodal analgesia, early nutrition and mobilization to reduce complications and length of stay while improving outcomes.
Endoscopy plays a crucial role in managing upper gastrointestinal bleeding by allowing diagnosis, risk assessment, and delivery of therapy. Recent guidelines recommend early risk scoring using the Glasgow-Blatchford Score and endoscopy within 24 hours. New endoscopic therapies like Hemospray and over-the-scope clips show promise in achieving hemostasis, though more data is needed. Achieving hemostasis can be challenging, and failed endoscopic hemostasis requires intervention like radiology, surgery, or stents.
Fluid resuscitation is an important part of treating acute pancreatitis. Early resuscitation within the first 24 hours is most effective. Lactated Ringer's solution is preferred over normal saline as it is more pH balanced and reduces inflammation. The goal is to resuscitate at a rate of 5-10 ml/kg/hour to a total of 2500-4000 ml in the first 24 hours. Response should be monitored using clinical goals like heart rate, blood pressure, urine output and biomarkers like CRP and hematocrit to guide further fluid administration. Early resuscitation with Lactated Ringer's reduces complications and mortality in acute pancreatitis.
This document provides information on upper urinary tract infections from the Department of Urology at Govt Royapettah Hospital and Kilpauk Medical College in Chennai, India. It defines upper urinary tract infections and various related conditions like pyelonephritis, renal abscesses, perinephric abscesses, and pyonephrosis. It discusses the pathogenesis, clinical presentation, diagnostic evaluation, and management of these conditions. Key pathogenic bacteria are outlined and imaging findings for various infections are described. Treatment involves antibiotic therapy and sometimes drainage or nephrectomy.
The document discusses damage control surgery for abdominal trauma. It describes how multiple trauma patients often die from the metabolic triad of coagulopathy, acidosis, and hypothermia rather than surgical complications. Damage control surgery aims to control bleeding, prevent contamination, and protect organs in an abbreviated first operation, leaving the abdomen temporarily open. This is followed by intensive care to reverse metabolic failure and a planned second operation once the patient is stabilized.
The document outlines the Enhanced Recovery After Surgery (ERAS) protocol. ERAS aims to reduce surgical stress, accelerate recovery through a multimodal approach. Key elements of ERAS include pre-admission counseling and nutrition optimization, minimizing preoperative fasting through carbohydrate loading, selective bowel preparation if needed, thoracic epidural anesthesia, early feeding and mobilization, and multimodal pain control to avoid opioid use and ileus. The goal is to minimize length of stay through evidence-based perioperative optimization.
Rupture of urinary bladder in large animals copy (2)Vinkit Patanjal
Uroperitoneum, or the leakage of urine into the abdominal cavity, is most commonly caused by rupture of the urinary bladder in cattle and horses. Bladder rupture typically occurs secondary to urinary tract obstruction from urolithiasis or stones. Clinical signs include abdominal distension, pain, and odor of urine from the breath. Diagnosis involves abdominal ultrasound to detect free fluid in the abdomen, as well as laboratory analysis of abdominal fluid. Definitive treatment requires surgical exploration and closure of any bladder tears. Post-operative care includes antibiotics and monitoring to ensure proper urination and prevent recurrence.
This document discusses urinary tract injuries that can occur during laparoscopic gynecological surgery. It notes that bladder injury is the most common major complication. Prevention strategies include catheterization before trocar insertion, using the lowest effective power for electrosurgery, and identifying bladder boundaries. Injuries may be recognized intraoperatively through direct visualization, cystoscopy, or instilling dye. Postoperative recognition involves symptoms like pain and hematuria. Management often involves laparoscopic repair by a gynecologist or urologist to avoid additional morbidity of laparotomy.
Urolithiasis, or bladder stones, is a common nutritional disorder in ruminants caused by an imbalance in minerals like calcium, phosphorus, and magnesium in the diet. When cattle, sheep, and goats consume grain-heavy rations instead of their normal forage, it can cause stones to form in the bladder or urethra. Clinical signs include difficulty urinating, abdominal pain, and swelling. Left untreated, the blockage can cause the bladder or urethra to rupture, resulting in uremia and death. Veterinarians may use medications to relax the bladder or flush out stones, or surgery to remove blockages or create bypasses. Proper mineral balance in the diet and
The document provides guidance on caring for cows before, during, and after calving. It discusses isolating cows that are close to calving, monitoring for signs that calving is imminent, and what to do during each stage of the calving process. It also covers caring for the newborn calf, ensuring it receives colostrum, and general feeding and health practices for mother and calf in the days and weeks after birth.
Este documento describe la peritonitis, clasificándola en primaria, secundaria y terciaria. La peritonitis secundaria incluye la aguda espontánea, posquirúrgica y postraumática, siendo la bacteria más común E. coli. El cuadro clínico incluye dolor abdominal, distensión y fiebre. El tratamiento requiere control quirúrgico del foco, antibióticos y soporte en UCI. La laparoscopía es una opción para el tratamiento de la peritonitis secundaria a apendicitis
This document discusses the acute abdomen, including its definition, common causes, symptoms, and physical examination findings. An acute abdomen is any sudden abdominal disorder requiring urgent operation. Common causes include appendicitis, cholecystitis, pancreatitis, and bowel obstructions. The history should clarify the location, onset, character, and relieving/aggravating factors of pain. The physical exam involves a full examination with focus on signs confirming or ruling out differential diagnoses.
The document discusses reading strategies for identifying causes and effects in nonfiction texts. It defines causes as why something happened and effects as the result. Key strategies include identifying clue words like "because" and "as a result of" and understanding that effects can form chains where one leads to another. Examples are provided to illustrate identifying explicit and implicit cause-effect relationships.
This document provides an overview of toxicology and related topics. It defines toxicology as the study of poisons and their sources, properties, mechanisms of toxicity, toxic effects, detection, clinical manifestations, and management. It describes different types of toxic agents and mechanisms of toxicity. It also discusses factors that affect the action of poisons, including dose, route of exposure, and individual susceptibility. Analytical toxicology methods for qualitative and quantitative analysis are summarized, including chromatography techniques and immunoassays. The key steps and factors in the mechanism of toxicity, from delivery to the target site to repair or dysfunction, are outlined.
This study evaluated 59 cats that underwent perineal urethrostomy surgery for feline lower urinary tract disease (FLUTD) at a university veterinary clinic. Early complications within 4 weeks of surgery occurred in 25.4% of cats, most commonly urethral stricture formation. Late complications after at least 4 months included recurring urinary tract infections in 28.2% of cats. Despite frequent complications, 32.2% of cats had no long-term issues, though recurring FLUTD symptoms still occurred in 23% of cats. Overall, the surgery provided a good quality of life for most cats, according to their owners.
This retrospective study evaluated 26 dogs that underwent fluoroscopic wire-guided nasojejunal tube placement between 2006 and 2010. The primary diagnosis in 60% of dogs was pancreatitis. The technique involved passing a wire through the nose and stomach to guide placement of a feeding tube in the jejunum. Transpyloric passage was achieved in 92.3% of dogs and jejunal access in 78.2% overall. Success at jejunal placement improved over time, with 100% success in the later half of the study. Complications included mild bleeding in 2 dogs and tube migration in 2 dogs due to sneezing. The median feeding duration was 3.3 days. This technique provides a minimally invasive
A clinical study of intussusception in childreniosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Comparison of Ondansetron and Granisetron for Prevention of Nausea and Vomiti...Apollo Hospitals
The most common and distressing symptoms, which follow anaesthesia and surgery, are pain and emesis. The consequences of PONV are physical, surgical and anesthetic complications for patients as well as financial implications for the hospitals or institutions. Sometimes nausea and vomiting may be more distressing especially after minor and ambulatory surgery, delaying the hospital discharge. Laparoscopic surgery is one condition, where risk of PONV is particularly pronounced due to pneumo-peritoneum causing stimulation of mechanoreceptors in the gut. In spite of plenty of anti-emetic drugs available no single drug is 100% effective in prevention of PNV and combination therapy has got a lot of side effects.
This document provides guidelines for the prevention and management of puerperal sepsis. It defines puerperal sepsis and puerperal infections, noting that sepsis is a significant cause of maternal mortality. Prevention efforts should begin in the antenatal period by screening and treating infections. During delivery, strict sterile procedures and minimizing unnecessary interventions can reduce risk. For management, early identification and resuscitation are critical, including intravenous antibiotics, fluids, oxygen and monitoring vital signs. Patients with severe sepsis should be transferred urgently to specialist care for further treatment and intensive monitoring. The guidelines cover investigations, treatments and interventions for non-specialist and specialist hospital settings.
Acute glomerulonephritis is an inflammation of the glomeruli in the kidneys that is usually caused by a bacterial infection or injury. It involves the immune system fighting off an infection which leads to scar tissue formation. Common causes include post-streptococcal infections and other primary glomerular diseases. Diagnostic tests include urine analysis, kidney function tests, kidney biopsy, and imaging tests. Nursing care focuses on monitoring for complications, managing symptoms, and providing education.
Retained Products of Conception (RPOC) occur in 1 % of cases. Clinical features of 41 women diagnosed of RPOC by hysteroscopy, to establish the best time-lapse of an expectant management after an office hysteroscopy avoiding an operative hysteroscopy to permit a spontaneous expulsion, were analyzed. There were no differences between patients who suffered a spontaneous expulsion or those in whom a persistence of RPOC was observed at time of surgical removal in terms of age, gravidity, prior uterine surgeries, uterine alterations, type and time of pregnancy termination and ultrasonographic characteristics. There was a higher rate of spontaneous expulsion after 4 weeks from the office hysteroscopy compared with those where the surgical removal was performed up to 4 weeks after the diagnosis (p-value 0.011).
This document discusses the use of intravesical hyaluronic acid (HA) instillations for various conditions of the urinary bladder including cystitis. It summarizes several studies that found HA instillations were well-tolerated and significantly reduced symptoms of cystitis like pain, urgency and frequency. It also decreased the risk of urinary tract infections and radiation-induced cystitis. One study found 85% of patients with interstitial cystitis/painful bladder syndrome experienced improvement in symptoms and 55% had minimal or no symptoms after HA treatment. HA instillations may allow for complete symptom reversal or cure in some cystitis patients.
Uretero-Enteric Anastomosis Stricture after Urinary Diversion; Detailed Analy...JohnJulie1
To report the lessons we have learned in the management of uretero-enteric anastomosis stricture (UEAS) in a tertiary urology center over a decade of experience.
Uretero-Enteric Anastomosis Stricture after Urinary Diversion; Detailed Analy...NainaAnon
To report the lessons we have learned in the management of uretero-enteric anastomosis stricture (UEAS) in a tertiary urology center over a decade of experience.
Sepsis and septic shock are life-threatening medical emergencies in obstetric patients that require immediate treatment and resuscitation. Risk factors include underlying maternal conditions and obstetric interventions. Early detection and treatment within an hour is critical and involves administering IV fluids and broad-spectrum antibiotics while measuring lactate levels and stabilizing vital signs. Complications can include hemorrhage, endotoxic shock, acute renal failure, and ARDS. Prevention focuses on optimizing family planning, enforcing safe abortion practices, and administering prophylactic antibiotics in certain high-risk situations.
This study compared the efficacy and safety of single versus multiple instillations of povidone iodine and urographin as a sclerosing agent for the treatment of chyluria. The study involved 54 patients randomized into single or multiple instillation groups. Results found no significant difference in chyluria recurrence rates or disease-free duration between groups. Both approaches achieved over 85% success rates with minimal adverse effects. The study concluded that a single instillation protocol is as effective as multiple instillations but is more cost-effective due to a shorter hospital stay.
Assessment of Ureteroscopy During Pregnancy.docx4934bk
Ureteroscopy can be performed safely during pregnancy to diagnose and treat ureteral stones. The summary is:
1) Ureteroscopy allows direct visualization of the ureter and extraction or fragmentation of stones without the risks of radiation exposure, as compared to other imaging modalities.
2) In a study of 15 pregnant patients who underwent ureteroscopy, stones were successfully removed or fragmented and all pregnancies resulted in full-term deliveries without complications.
3) Ureteroscopy during pregnancy can be performed safely under sedation rather than general anesthesia using thin ureteroscopes, with close obstetric monitoring.
This document discusses several radiopharmaceutical techniques for imaging the gastrointestinal tract, including detecting gastrointestinal bleeding, Meckel's diverticulum, inflammatory bowel disease, and neuroendocrine tumors. Scintigraphy using radiolabeled red blood cells or colloids can help locate the source of gastrointestinal bleeding when endoscopy is inconclusive. Meckel's diverticulum can be identified by detecting ectopic gastric mucosa using technetium pertechnetate imaging. White blood cell scintigraphy with indium or technetium can demonstrate inflammatory bowel disease. Somatostatin receptor scintigraphy using indium-labeled octreotide is useful for detecting and staging neuroendocrine tumors such as carcinoid tumors.
Liver trauma is an important cause of morbidity and mortality in Pakistan. This study analyzed 113 patients who underwent surgery for liver trauma at a teaching hospital from 2003-2010. Most patients were young males injured in road traffic accidents. Over 80% presented with low blood pressure and over half had other organ injuries as well. The majority had grade I or II liver injuries. The most common surgery was packing the liver with abdominal packing. Post-operative complications occurred in nearly a quarter of patients, with an in-hospital mortality rate of 9.7%. Liver trauma predominantly affects young males and improved emergency response is needed to reduce complications.
This case report describes a male cat that presented with urethral obstruction and severe azotemia. After catheterization relieved the obstruction, the cat experienced a rapid decrease in blood urea nitrogen and developed neurologic signs including seizures, similar to dialysis disequilibrium syndrome. The cat was treated with hypertonic saline boluses and infusion, and his neurologic signs resolved within 48 hours. This report suggests that similar osmotic injury can occur after rapid resolution of azotemia from urethral obstruction in cats. Practitioners should be aware of this potential complication of postobstructive treatment.
This 3-sentence summary provides the key details from the document:
This clinical trial in northern Cameroon assessed the safety and efficacy of a new polyvalent antivenom called FAV-Africa, which is composed of highly purified F(ab)2 fragments. Forty-six patients received intravenous injections of FAV-Africa for treatment of snake envenomations, and all patients were clinically cured with no serious adverse reactions observed. The results confirm the safety of FAV-Africa and its effectiveness for treating snake envenomations in sub-Saharan Africa.
A RETROSPECTIVE ANALYSIS IN TERTIARY HOSPITAL FOR SURGICAL SITE INFECTIONS AF...indexPub
Objectives: to know about percentage of patients getting wound infection and commonly grown bacteria in emergency laparotomy incisions. Summary: Surgical site infections are very high in developing countries. Infections at surgical sites leads to delayed discharge from hospital increased cost of treatment to either government or patient themselves.
This document provides an overview of the management of enterocutaneous fistulas. It discusses the history, classification, etiology, pathophysiology, clinical presentation, investigation, management phases including stabilization, decision making, treatment, and prevention of enterocutaneous fistulas. The management involves correcting fluid and electrolyte imbalances, providing nutritional support, controlling sepsis, making a decision on definitive therapy after 4-6 weeks if not closing spontaneously, and surgical treatment when needed.
Similar to Critical urogenital disorders causing abdominal pain in intact cats (20)
This study evaluated a diagnostic model to detect aflatoxicosis outbreaks in sheep. The model compared a suspected aflatoxicosis herd (ASH) to a control herd (CH). Several parameters were measured including mortality, clinical signs, feed aflatoxin levels, blood tests, organ aflatoxin residues, and histopathology. Significant differences were found between the ASH and CH for most parameters, allowing the model to distinguish between herds. The diagnostic model shows potential for adoption in national surveillance programs to detect aflatoxicosis in sheep.
Third-degree Rectovestibular Lacerations in mares and mare donkeysProf.Dr. Gamal Karrouf
Six mares and a she donkey suffering from third-degree rectovestibular lacerations during difficult births were admitted to a veterinary clinic. Surgical correction was performed 5-7 weeks later through a single-stage repair using interrupted vertical mattress sutures of polydioxanone. Primary healing of the reconstructed rectovestibular shelves and perineal bodies occurred in six animals, though one mare developed anal sphincter incompetence and another a rectovestibular fistula due to post-operative straining.
The document describes 4 figures showing cases of guttural pouch tympany and empyema in various equine patients. Figure 10 shows a stallion with unilateral tympany that was relieved by decompressing the unaffected side. Figure 11 depicts a donkey with bilateral tympany treated via a modified Whitehouse technique removing septum tissue. Figure 12 shows a foal with bilateral distension drained through a stab incision. Figure 13 portrays unilateral empyema drained using a modified Whitehouse approach in standing position with catheter irrigation, resolving all signs.
- Arthrodesis, or surgical fusion of a joint, is commonly performed on the proximal interphalangeal (PIP or pastern) joint in horses to treat osteoarthritis, fractures, or other injuries when conservative treatments have failed.
- Surgical techniques for PIP joint arthrodesis typically involve removing articular cartilage from the bone ends, drilling holes in the subchondral bone, and using internal fixation like lag screws or a T-plate followed by cast immobilization to promote fusion.
- Arthrodesis aims to eliminate joint motion and relieve pain, allowing horses to return to work despite losing use of one joint. When performed on the PIP joint, it provides a functional outcome in
The umbilicus is the remnant of the fetal maternal connection . In the developing fetus , the various component structures of the umbilical cord pass through the ventral abdominal wall . These comprise the umbilical vein which leads to the liver , paired umbilical arteries which arise from the iliac arteries as well as the urachus which passes to the bladder.
This document summarizes a study on the surgical management of certain ano-rectal conditions in farm animals. A total of 65 cases were examined between 2003-2006, including congenital defects like atresia ani (24 cases), acquired conditions like rectal prolapse (15 cases), and rare cases of anus vaginalis. Surgical techniques are described for reconstructing the anal opening in atresia ani and repairing rectal prolapse. Early surgical correction of atresia ani is important for animal survival. Histopathology was used to diagnose neoplastic masses. The most common condition was atresia ani, especially in lambs and calves.
Ringbone is a condition characterized by excessive bone growth in the pastern or coffin joint of a horse. It is caused by stress or injury to the tendons and ligaments in the pastern area. High ringbone occurs higher up on the pastern bone and is easier to see, while low ringbone occurs closer to the hoof and may cause more severe lameness initially. Treatment focuses on reducing inflammation, alleviating pain, and improving hoof balance and support through shoeing. Shockwave therapy and other techniques can help promote healing and slow the progression of ringbone.
The document describes a study of 65 cases of benign and malignant neoplasms in ruminants over a 3 year period. The neoplasms included 2 fibromas, 1 fibromatous epulis, 1 fibroadenoma, 4 fibropapillomas, 25 cutaneous papillomas, 8 keratoacanthomas, 2 fibrosarcomas, 21 squamous cell carcinomas, and 1 lymphosarcoma. The neoplasms were surgically treated and followed up for 4-6 months. The study aimed to describe the gross and histopathological features of various ruminant neoplasms and determine which cases were suitable for surgical treatment.
1. Hernias are protrusions of abdominal contents through openings or weaknesses in the abdominal wall. They can be classified by location (e.g. umbilical, inguinal), contents (e.g. bowel, omentum, bladder), and reducibility.
2. Umbilical hernias occur through the umbilicus, and may be congenital or develop from straining. Ventral hernias develop through other parts of the abdominal wall, often from trauma.
3. Treatment involves reducing the hernia contents and repairing the abdominal wall defect surgically, usually with sutures or mesh. Postoperative management focuses on rest and reduced feeding to aid healing.
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involves immediate intravenous hydration and initiation ultrasonography was performed using Shenzhen Mindray
of antibiotic therapy. After patient stabilization, (DP-2200vet, PR China) with 5, 7.5 and 10 MHz linear
ovariohysterectomy is the treatment of choice [18]. transducer. Venous blood samples were obtained before
UtR is a potentially catastrophic event during the treatment to evaluate complete blood count. Serum
peri-parturient period by which the integrity of the samples were used to evaluate creatinine, blood urea
myometrial wall is breached mostly due to trauma, uterine nitrogen (BUN) and potassium levels. As well, urine
torsion, uterine epithelium defects, fetal or maternal samples were collected by cystocentesis under
dystocia, fetal overload or careless obstetrics procedures ultrasonographic guidance for complete urinalysis.
[19-21]. Treatment consists of ovariohysterectomy,
removal of the fetuses, fluid replacement and antibiotic Anesthesia: Animals were pre-medicated with diazepam
therapy [22]. (0.2-0.5 mg/kg/IV) and inducted by combination of
The current work aimed to diagnose and evaluate a diazepam (0.5 mg/kg/IV) and Ketamine Hcl(Ketamine,
series of cats suffered from critical urogenital problems Sigma-Tec, Egypt) in a dose of 5 - 10 mg/kg.
causing abdominal pain, as well as highlighting the
important aspects of medical and surgical interventions of Feline Urologic Syndrome (n=18):
such cases.
MATERIALS AND METHODS were performed in 17/18 cats according to Osborne et al.
Animals: Forty seven cats; 21 Shiraz, 22 Siamese and 4 15/18 cats [24, 25].
Egyptian Mau (20 male and 27 female) were diagnosed
with urogenital disorders associated with abdominal pain. Urinary bladder rupture (n=2)
They were admitted between March 2011 to April 2014 to
Mansoura Veterinary Teaching Hospital of the faculty of A fenestrated silicone tube catheter for peritoneal
veterinary medicine, Egypt. Diagnostic investigations dialysis was inserted under the effect of diazepam and
included history, clinical signs, cardiovascular and lidocaine Hcl [26]. A urine-collecting bag was connected
respiratory monitoring, radiography, abdominal to the free end of the catheter and a Fucidin antibiotic
ultrasonography, urinalysis, hematology and biochemical ointment (Fusidic acid 2%, Leo pharma, Denmark) with
analysis. sterile gauze was placed over the entry site before placing
Animal Resuscitation: Immediately after admission, cats its normal potassium, creatinine and blood urea nitrogen
were received either normal saline 0.9% or lactated levels, surgical repair of the bladder was performed by
Ringer’s solution in a rate of 30-40 ml/kg/hr. One-third of identification of the ruptured site, debriding of its edges
the calculated volume was administered rapidly, then the and routine closure of the defect using coated vicryl no.
patient’s perfusion parameters as heart rate, capillary refill 2/0.
time, blood pressure and urine output were monitored.
The rest of the volume was given slowly until Polycystic kidney (n=1)
aforementioned parameters regained to its normality.
Additionally, all cats received Ephedrine HCL (Ephedrine, In bilateral PKD, percutaneous aspiration of the cysts
CID, Egypt; 0.1 mg/kg), Metoclopramide HCL (Primperan, under ultrasonographic guidance was performed.
Sanofi Aventis, Egypt; 0.2 mg/kg), Cefotaxime Na
(Cefotax, EPICO, Egypt; 20-80 mg/kg), Diazepam Uterine rupture (n=1)
(Neuril, Egypt; 0.4-0.8 mg/kg), Lidocaine (Debocaine,
El-Debiky, Egypt; 2 mg/kg/h) and Butorphanol A 10 month-old domestic short-haired cat weighed
(Alvegesic, CP pharma, Germany; 0.1-0.2 mg/kg). about 2 kg was presented. Exploratory laparotomy was
Diagnostic Procedures: Heart rate (HR), pulse quality, Peritoneal lavage with warm isotonic saline at 200ml/kg
respiratory rate (RR), end tidal Co2 (EtCO2) and patient [27] and hysterectomy was done.
side oxygen saturation (SpO2) were examined regularly by
patient monitor (M69S user's manual, China). Abdominal Cervix pyometra (n=25)
Cystocentesis and retrograde urohydropropulsion
[23]. In addition to tube cystostomy that performed in
a sterile abdominal wrap. After the patient was regained
performed for removal of two extra-uterine dead feti.
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Cats were surgically treated by hysterectomy RESULTS
according to Tobias, 2010 [24].
Histopathological Examination: One cat with obstructed
FUS was died on arrival and samples from (kidneys,
ureters, urinary bladder and urethra) were fixed in neutral
buffered formalin 10%. Histopathological processing was
performed acc. to Bancroff et al. [28].
Follow up after Surgical Intervention: Cats received
maintenance doseof IV normal saline 0.9% (44 ml/kg/24h),
Primperan (0.1-0.5 mg/kg/8h) and Cefotax (20-80
mg/kg/12h). Alvegesic (0.1–0.2 mg/kg/6-8h) was used in
cats with FUS, PKD and UBR, while Ketoprofen (Ketofan,
Amriya, Egypt; 2.2 mg/kg/24h) was used in cases of
pyometra and UtR.
In Cats with FUS: Cats received diazepam (0.4-0.8
mg/kg/12h), vitamin K (Amri-K/Amriya, Egypt; 1mg/kg
once daily), ascorbic acid (CebionEff, Amoun/Merk,
Egypt, 200 mg/cat/day), ammonium chloride (Broncholase
syrup, Memphis, Egypt; 700mg/cat/day) and prazosin
(Minipress1mg tablets, Pfizer, Egypt; 0.5 mg/kg /once
daily). The urine in the bag was removed three times a
day. Urinary bladder flashing was performed using sterile
normal saline daily. Normal micturation was tested by
temporary tying the catheter which allowing its removal.
Cat with PKD: The cat had a dietary restriction of
phosphorus, sodium and protein. She received antiemetic
famotidine (Peptofam10, Gelatin, Egypt; 1
mg/kg/day/orally), anti-hypertensive enalapril (Enalapril
5, Octoberpharma, Egypt; 1 mg/kg/ day/orally), intestinal
aluminum based phosphorus binders lanthanum
carbonate (Fosrenol, shire, Egypt; 80 mg/kg/day/orally)
and vitamin B12 (Neuroton/ Amoun, Egypt; 250
ug/cat/IM/once a week). He received Omega-3 fatty acids
(Super omega, Mjestic, Egypt; 500 mg
DHA/EPA/cat/day/orally) and beta-carotene
(Oxidrex, Rexcel/Techno, Egypt; 2.1 mg/kg/orally/ daily).
These medications were continued for 3 months.
Forty seven cats with various types of urogenital
disorders causing abdominal pain were included in this
study. Age, gender and body weight of the diagnosed
cases were depicted in Table 1.
Results of Clinical Examination: Cases were admitted to
the clinic within different time ranged from 24 h to three
weeks after first appearance of clinical signs. Depression,
dehydration, polydipsia, dysphagia, vomiting, abdominal
distention and abdominal pain were the main features in
the cats.
Five cats with FUS that admitted within 24- 36 h and
nineteen cat with CP (one week) showed signs of
tachycardia (220- 240 beats/m), tachypnea (40-50
breath/m), normal rose mucous membrane color, normal
SpO2 (92-94%) and EtCO2 (33-34), rapid capillary refill time
(CRT; 1-1.5 s) and bounding pulses.
Thirteen cats of FUS that admitted within three days,
two cases of UBR (24-36h), In six cats with CP that
admitted within (2-3weeks) and a cat with UtR (48h) and
a case of PKD (2 weeks) showed signs of pale mucous
membranes, prolonged CRT (2-3 s, weak peripheral pulses
and hypothermia, bradycardia (80-92 beats/m), slow
shallow respiration (18-21breaths/m) and decreased both
SpO2 to an average of 90% and EtCO2 around 32 mmHg.
FUS suffered cats showed signs of dysuria 2/18
(11%), anuria 16/18 (89%, hematuria was found in 10 cats)
and licking of the perineal region 18/18 (100%). The tip of
the penis was swollen and dark red to purple in color and
the urinary bladders were palpable and distended in all
FUS cases. Cases with UBR showed anuria and thrilling
with abdominal ballottement, abdominal paracentesis
elicited presence of free urine in the peritoneal cavity.
Polyuria and diarrhea were observed in cats with CP and
PKD while in the cat with UtR, the main feature was
offensive bloody vaginal discharge.
Results of Animals' Resuscitation: All animals received
the whole fluid therapy volume, where 37 cats (78.7%)
regainedor close to normal health parameters. While 10
Table 1: Incidence, age, gender and body weight of cats suffered abdominal pain
Gender
--------------------------------
Case categories Number of cases/ 47 (%) Age (mean) years Male female Body weight (mean) kg
FUS 18/ 47 (38%) 1 - 7 (3) 18 - 6.0-9.5 (7)
UBR 2/47 (4%) 2 and 4 1 1 6.9 and 8.3
PKD 1/47 (2%) 3 1 - 7.50
CP 25/47 (53%) 2-5 (3) - 25 5.0 - 12 (9.5)
UtR 1/47 (2%) 10 month - 1 3
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Fig. 1: (a, b) Showing ultrasonography of FUS. a)Longitudinal sonogram of the urinary bladder of a 3-year-old male
Shiraz cat. There were cystic calculi. The urine is heteroechoic with shadowing mineralized dependent sediment.
Irregular shaped blood clots appeared as non-shadowing medium to mildly hyperechoic that adhered to the
bladder wall. b) Transverse sonogram of the left kidney in a 2-year-old male Siamese cat with a history of anuria
of 2 days duration. There is moderate hydronephrosis with uniformly dilated hypoechogenic renal pelvis
(Arrows). c) Showing ultrasonography of (UBR) with presence of anechoic fluid in the peritoneal space. Ileus
was diagnosed as a distention of intestinal loops and the lumen filled with echogenic fluid (Arrow). d) Showing
a transverse sonogram of the left kidney that replaced by large (White arrow) and small size (Black arrow)
hypoechoic cysts. Note that these cysts are non-communicating ruling out hydronephrosis.
cats (21.3%) (FUS=8, UBR=1 and PKD=1) were severe hyperechoic irregular/amorphous shaped blood clots were
hyperkalemic with hypotension and bradycardia. adhered to the bladder wall. Uniformly dilated
They additionally received constant-rate infusion of 10% hypoechogenic renal pelvis was observed in 2/16 (12.5%)
calcium gluconate (0.5–1.0 ml/kg), regular insulin(0.1–0.25 of complete obstructed cases which indicate mild to
U/kg), 25% dextrose (1–2 g/U of insulin) and Sodium moderate hydronephrosis, Figure 1 (A, B).
bicarbonate (1–2 mEq/kg) slowly over 20 mins. They took In cats with UBR, ultrasonography showed anechoic
about 12(n=7)-24(n=3) hours to regain their normal health fluid accumulation in the peritoneal space dissecting
parameters. between organs. Ileus was diagnosed in a Shiraz cat as a
Results of Ultrasonographical Examinations: Cats with with echogenic fluid, Figure 1 (C).
FUS showed fully distended urinary bladders and In PKD case, renal ultrasound showed renomegaly of
heteroechoic urine, with focal, dependent, hyperechoic, both kidneys with an irregular outline and presence of
curvilinear echogenicity calculi which changed position varied size anechoic, smooth margined cysts in the renal
as patient position changes. Shadowing mineralized tissue. These cysts eroded the normal renal architecture
dependent sediment was present. Mild to medium and showed distal acoustic enhancement, Figure 1 (D).
local distention of intestinal loops and the lumen filled
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Fig. 2: A transverse sonogram of a cat with closed pyometra. a) The uterus was enlarged with multiple circular structures
containing hypoechogenic material. b) The exteriorization of large uterus filled with fluctuating materials.
Table 2: Showed urine, hematological and biochemical analysis of cats (n=47) with urogenital disorders causing abdominal pain
Laboratory FUS UBR PKD Pyometra UtR
examination n = 18 n= 2 n= 1 n= 25 n= 1
USG 1.070 - 1.090 - 1.010 < 1.020 -
Proteinuria +ve (n= 16) - +ve -ve -
Glucosuria +ve (n= 1) - -ve -ve -
hematuria +ve (n= 16) - -ve +ve trace -
Potassium (mEq/L) <7 (n=12)
>7 (n=8) 5.8 and 7.6 8.2 - -
BUN (mg/dl) 35-160 39 and 54 79 - 25
Creatinine (mg/dl) 1.9 -3.2 2.2 and 2.9 3.2 - 1.1
PCV (%) 55.6-69.8 56.8 and 61.1% 58.3% 63.7-69.9 62.1%
Albumin (g/dl) - 4.1 and 4.3 - 1.8-2.2 1.9
In CP, abdominal ultrasound showed an enlarged from 1.070 to 1.090. Proteinuria was observed in 16/18
multiple circular structures containing hypoechoic (88.9%) and glucosuria in 1/18 (5%). Calcium oxalate
material. The endometrium was thickened with crystals were verified in all cases of obstructed
hyperechoic areas of varying size. Proliferative changes urolithiasis 16/18 in a huge number that covered the field
were visualized, Figure 2. and in trace amount in FIC cases 2/18 (11.1%).
In UtR, abdominal ultrasound showed free gases Hyperkalemia (6 to7.5 mEq/L) was observed in 8/18 (44%).
appeared as hyperechoic structures with comet-tail Both blood urea nitrogen (BUN) and creatinine levels
artifacts immediately adjacent to the inner margin of the were ranged in 35-160 mg/dl and 1.9-3.2 mg/dl,
abdominal wall. Two echogenic fetal bone skeletons were respectively in all cases. All cases showed increased PCV
seen extra-uterine beside the stomach in cranial region in (55.6-69.8%).
the abdominal cavity. There were echogenic particles In UBR cases, hyperkalemia (5.8 and 6.2 mEq/ L),
oscillating in the abdominal fluid with strands of increased BUN (39 and 54 mg/dl), increased creatinine
hyperechoic tags of fibrin. (2.2 and 2.9 mg/dl), increased PCV (56.8 and 61.1%) and
Results of Urine, Hematological and Biochemical In all CP cases leukocytosis, neutrophilia with shift to
Analysis Were Depicted in Table 2: Urinalysis of FUS left, hypoalbuminemia (1.8-2.2 g/dl) and increased PCV
validated cloudy and bloody urine where RBCs were (63.7-69.9%) were observed. Five cats had normocytic and
ranged from 5-10 cells to over hundreds that masked the normochromic anemia.Low USG < 1.020 was the main
analytic film. The urine specific gravity (USG) was ranged feature in urinalysis.
hyperalbuminemia (4.1 and 4.3g/dl) were observed.
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Fig. 3: a) Showing a stream of hematuria after retrograde urohydropropulsion in a cat. b) PM of the dead cat with
obstructive urolithiasis. Notice that the urethra filled with sand like materials that occluded it completely.
Fig. 4: Kidney with adenocarcinoma. a) Malignant cell adenocarcinoma with hyperchromatic, vesicular nuclei with
tendency to form acini (HE, X 10). b) Kidney showing severe vacculation in renal tubular epithelium with
dissolution of renal glomeruli (HE, X 10). c) Kidney showing cystic dilatation of renal tubules with atrophy of
renal tubular epithelium (HE, X 10). d) Urinary bladder showing cystitis with sever congestion and
lymphohistocytic infiltration with edema in submucosa beside necrosis in epithelium (HE, X 10).
In the case of PKD, non-regenerative normocytic cystocentesis (Figure3, A), while 15/18 cases (83%)
normochromic anemia, increased PCV (58.3%), increased underwent tube cystostomy and recovered completely
creatinine (3.2 mg/ dl) and BUN (79 mg/dl) were observed within 7 to 10 days.
with Hypokalemia (3mEq/L). Urinalysis revealed low USG A Shiraz cat with a history of 5 days anuria and 3
(1.010). times trials of cystocentesis; was died on arrival. PM
In case of UtR, hematology revealed leukocytosis examination revealed uroabdomen and a fully distended
(15.8 10X3/mm ), neutrophilia, normochromic normocytic urinary bladder with presence of huge amount of3
anemia and increased PCV (62.1%). Biochemical tests yellowish crystals filled the urinary bladder and
revealed hyperproteinemia (9.3 g/dl), hypoalbuminemia completely occluded the urethra (Figure 3, B).
(2.2g/dL), normal levels of creatinine 1.1 mg/dl and BUN Histopathological examination showed severe renal
25 mg/dl. degenerative changes and cystic dilatation of renal
Intervention: FUS suffered cats, 17/18 showed complete atypia and basophilic nuclei, with formation of acini
recovery as; 2/18 (12%) had FIC were recovered using replacing renal tissue were observed which directed the
multiple retrograde urohydropropulsion with diagnosis toward adenocaecinoma (Figure 4).
tubular epithelium. Also malignant cells with cellular
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Fig. 5: Uterine rupture in a cat. a) Exteriorization of the dead fetus from the abdominal cavity. b)The seat of rupture in
the uterine body.
After tube cystostomy, the urine in the collecting bag DISCUSSION
gradually changed from bloody color to clear straw yellow
within 3- 4 days. Among 16 obstructed cats, three cats Urogenital disorders causing acute abdomen is a
showed reluctant bloody urine continued from 3 -5 days challenging task, as the differential diagnosis of acute
necessitate multiple doses of vitamin K. Cats showed abdominal pain includes an enormous spectrum of
trials for normal micturition within 5- 8 days. After catheter disorders, ranging from life-threatening diseases to
removal, uroabdomen was diagnosed in 2/15 (13%) cats, benign self-limiting conditions [3]. It is often associated
which needed further cystorrhaphy. Stranguria and with cardiovascular shock secondary to the underlying
pollakiuria were observed in the first few days after disease. The associated cardiovascular shock should be
catheter removal. recognized immediately and addressed emergently as
The two cats of UBR restored their normal physical, increased morbidity is associated with prolonged shock
biochemical parameters and intestinal movement up to and subsequent tissue hypoxia. Those diseases carrying
two days after peritoneal dialysis catheterization. The two a grave prognosis are readily treatable with aggressive
cases showed complete recovery after cystorrhaphy and intervention, including fluid resuscitation, pain control
regaining normal urination. and often, exploratory laparotomy [29].
After ovario-hystrectomy of the pyometra-suffering In the present study 47 cats were suffered urogenital
queens, the excised uteri, appeared enlarged and disorders (FUS (18), UBR(2), PKD (1), CP(25)and UtR(1))
distended with purulent materials (Figure 2). All queens causing abdominal pain and they were managed
showed complete recovery. according to the classification of Tello [30]; non-surgical,
The cat with PKD was died after three months from that treated medically with supportive care and analgesia
admission. (Two cases of FIC and a case of PKD); urgent cases
A Shiraz cat with a history of 24 h first parturition, required surgical intervention after previous stabilization
oxytocin and prostaglandin treatment trials and massive for a period up to 12 hours (Obstructed urolithiasis, UBR
instrumental misuse during vaginal labor was underwent and CP suffered cats), while critical,(As in case UtR) that
exploratory laparotomy that revealed fetid odor and required emergent immediate surgery following a few
presence of bloody uterine fluid within the abdominal hours of cardiovascular stabilization as rapid deterioration
cavity. Uterine body rupture was identified and two dead may occur if surgical intervention is delayed.
feti were located cranially within the abdominal cavity, Patients were present with significant cardiovascular
Figure 5. The cat was died immediately at the end of the abnormalities and showed different clinical signs, this can
operation. be postulated to the cause and time frame of intervention
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as the animal may present in one of three broad stages of The first line for management of FUS suffered cats
shock: compensatory, early decompensatory and terminal
decompensatory [31, 32].
Analgesia is an important element in the treatment of
patients with acute abdomen [31]. Efforts were directed in
this study towards minimizing pain while ensuring normal
cardio-respiratory parameters. Although butorphanol has
a relatively less analgesic potency and much shorter
duration of action, it was the cornerstone for analgesia of
the recorded cases. As non-steroidal anti-inflammatory
drugs have, a potential to exacerbate gastrointestinal
ulceration and renal perfusion in hypertensive patient
[33, 34], ketoporfen was only used in non-uremic cats (CP
and UtR cases).
In the present study, safe anesthesia for cats was
conducted by a low dose of diazepam and ketamine
combination to maintain cardiac function. This was
coincided with the results obtained by Herold et al. [35]
as most anesthetic drugs depress cardiovascular and
respiratory function in a dose related manner. Therefore,
drugs with minimal depressant effect should be
importantly usedin low doses and in combination.
Diazepam cause minimal cardiovascular depression,
rarely cause hypotension, provides some narcosis, good
muscle relaxation and no analgesia [36]. While ketamine as
a sole anesthetic agent in critical ill patient has a direct
depressant effects resulting in poor contractility,
decreased cardiac output and respiratory depression
[31, 34].
Cats were suffered signs of shock, so they received
IV normal saline and empirical therapy with cafotaxime.
Once hypovolemia and decreased tissue perfusion to
abdominal viscera are present, compromise of the
intestinal wall, can lead to translocation of intra-luminal
bacteria and can predispose patients to septicemia and/or
endotoxemia. Decreased venous return and portal
hypertension are additional concerns during shock
[2, 31]. As vomiting was one of important clinical signs in
cats in this study; metaclopramide was used as
recommended by Dye [37].
Eighteen out of forty-seven cats suffered FUS, two
cats (11%) showed FIC with dysuria without obstruction
and 16/18 (89%) showed obstructive urolithiasis. While
Gerber et al. [38] recorded 24 (53%) idiopathic obstruction
without urolithiasis, 13 cats (29%) urolithiasis and eight
cats (18%) with urethral plug. These differences can be
postulated to that Gerber et al. [38] performed their work
mainly on neutered cats 39/45 and to the great differences
in diets, environmental conditions and the culture of the
owner.
was retrograde urohydropropulsion in addition to the
empirical treatment. Cystocentesis was performed before
retrograde urohydropropulsion to prevent bladder
rupture, allow excretory renal function to resume and
assist in dislodging the urethral plug [39]. In retrograde
urohydropropulsion a stream of urine was obtained by
increasing the intra-cystic pressure with physician hand
compression while using the uretheral catheter. This was
enough for treatment of two cases with FIC while re-
obstruction was observed in the remaining cats with
obstructive urolithiasis (15/18). The prolonged
obstruction of the lower urinary tract produces increased
pressure in the bladder and urethra proximal to the
obstruction and this damages the wall, likely through the
hypoxic damage caused by pressure induced
reduction in the blood flow and disrupt tight
junctions between detrusor myocytes that
manifested clinically as post-obstructive detrusor
atony. In most patients, this is transient and resolves
clinically if the bladder is kept empty, unless, permanent
detrusor dysfunction occur [9, 40]. Generally, the initial
bouts of IC resolve within 7 days with or without
treatment [4].
Severe hyperkalemia ( 8mmol/l) was observed in 2 /16
(12.5%) cats suffered obstructed urolithiasis as recorded
by Lee & Drobatz [8]. While BUN was increased in all cats
suffered FUS. This was explained by Gerber [41] as post-
renal azotemia develops about 24 hours after the
obstruction of the urethra.
Tube cystostomy was operated in 15 cats diagnosed
with obstructive urolithiasis. Thirteen of them were
completely cured and returned to normal urine voiding
within 5-8 days and no recurrence for 12-18 months
follow-up. The other two cases were complicated with
uroabdomen after removal of the catheter and cured after
cystorrhaphy. This outcome were not the same as
obtained by Gerber et al. [38] during their study on
neutered cats with idiopathic cystitis and urethral
obstruction, as 8/44 cats were died after treatment with
urethral catheterization, indewelling catheter, perineal
urethrostomy and cystotomy.
One cat with complete urethral obstruction for 72
hours was euthanized. This was assumed due to renal
failure, uremia as well as the presence of adenocarcinoma.
Pre-renal azotemia develops as an adaptive response to
any cause of reduced renal perfusion [33]. Complete
urethral obstruction until death may be less than 72 hours
[9].
9. Global Veterinaria, 13 (5): 906-917, 2014
914
Uroabdomen in cats was diagnosed in two cases 2/47 improved renal blood flow. While calcium gluconate does
(4%) due to blunt trauma according to owner allay in not alter serum [K+], but mitigates cardiotoxicity by
addition to two cases as complication after tube permitting cardiac cell membrane depolarization in the face
cystostomy removal during this study. Causes of bladder of severe hyperkalemia [45].
rupture and uroperitoneum in dogs and cats that recorded Cats with UBR restored their normal physical,
by Stafford and Bartges [42], were urinary tract biochemical parameters and intestinal movement up
obstruction, traumatic bladder expression or to two days after peritoneal dialysis catheterization.
catheterization, neoplasia and postoperative leakage They showed complete recovery after cystorrhaphy and
following abdominal or urogenital surgery. regaining normal urination. Stafford and Bartges [42],
Uroabdomen results in profound dehydration, life- considered uroabdomen as a medical emergency, not a
threatening hyperkalemia, severe azotemia, chemical surgical emergency need acute management involves
peritonitis and metabolic acidosis over the subsequent 24 stabilization, treatment of hyperkalemia, Urinary diversion
to 48 hours [13]. This explained the severity of the clinical and, in some cases, peritoneal dialysis are necessary to
signs that observed on the two cats with UBR. Mayhew stabilize the patient until life-threatening conditions
& Holt [43], clarified the pathophysiology of the resolve. Once the patient is stable for anesthesia, surgical
abnormalities is multi-factorial; urine is hyperosmolar repair, when indicated is performed.
compared with extracellular fluid (ECF). Theseresults in The case of PKD was diagnosed accurately using
creating a concentration gradient across the peritoneum renal ultrasound [15] with sensitivity and specificity of
from the ECF to the abdominal cavity, thus worsen the 91% and 100%, respectively, when performed in cats older
condition. than 36 weeks of age. Ultrasound of both kidneys showed
Diagnosis of uroabdomen in the present study was renomegaly and the cysts seated in both renal cortex and
based on animal history (Trauma), clinical signs medulla, vary in size and typically replace the normal renal
(Vomiting, abdominal distention and pain and parenchyma that affect the normal renal function [15, 16].
ballottement), biochemical analysis (Increased potassium, The biochemical analysis confirmed the ultrasonographic
BUN and creatinine levels) and mainly abdominal results as uremia and hyperkalemia were observed that
ultrasonography that detect the presence of fluid in the indicated renal failure. The treatment after stabilization
abdominal cavity. Tag and Day [44], confirmed the was based on percutenous aspiration of the cysts under
diagnosis of uroabdomen by measuring potassium and ultrasound guidance to relieve pain [46] and received the
creatinine concentrations. A ratio of the creatinine medical therapy that used with chronic renal failure to
concentration in the effusion to serum creatinine above maintain hydration, nutritional status and treating clinical
2:1 is diagnostic for uroperitoneum. A ratio of the signs associated with uremia [15]. Although that the
potassium concentration in the effusion to serum death was occur after three months because cysts
potassium above 1.9:1 in cats is diagnostic for aspiration alone is inefficient as cysts will re-accumulate
uroperitoneum. Urea is too soluble, so BUN cannot be fluid due to an active chloride transport process. Elzinga
used in the diagnosis of uroabdomen. et al. [47] recommended cyst decompression surgery as
Ileus was detected in a case of UBR as a complication it is much better results in excellent improvement in renal
of uroabdomenas urine accumulates in the peritoneal function as well as effective, lasting pain relief up to 80%
space, chemical peritonitis ensues; if the peritonitis is of patients were pain free at 12 months postoperatively
sterile, it is not immediately life threatening but will cause and 62% at 24 months after surgery.
abdominal pain and ileus [43]. Peritonitis results in an Closed pyometra constitute the high percent among
increased loss of albumin into the abdominal cavity, the admitted cases 25/47 (53%) although Wiebe and
leading to decreased oncotic pressure, which also Howard [48], mentioned that CP in cats is less common,
contributes to abdominal effusion [13]. likely because they are induced ovulators with more
In the present study, ten cats (8 with FUS, one with limited progesterone exposure. There were no definite
UBR and one with PKD) with hyperkalemia received causes for this high percent except that cat has a season
additional therapy for treatment of hyperkalemia, as usually about twice a year and undergoes all the hormonal
recommended by Tag and Day [44], to evade cardiac changes associated with pregnancy whether she is
conduction disturbances. Moderate hyperkalemia (Serum pregnant or not. Thus increase the incidence to make
[K+] <7.0 mEq/L) will often resolve using normal saline infection with each cycle with age [17, 18]. In addition, the
due to hemodilution and increased excretion from cause for this high percent may be due to the haphazard
10. Global Veterinaria, 13 (5): 906-917, 2014
915
injections by non-veterinarian with some hormones to 2. Franks, J.N. and L.M. Howe, 2000.
stop seasons or for treatment of other conditions.
Treatment of pyometra typically based on immediate
patient stabilization, antibiotic therapy and
ovariohysterectomy with good prognosis. CP requires
more immediate surgical intervention, following
stabilization, because drainage of the infected uterus is
not occurring [2].
Uterine rupture was diagnosed in this study in one
cat with a percent of 2%. Diagnosis of uterine rupture is
made through the animal’s history, clinical signs,
laboratory tests, abdominal ultrasound and radiography,
but a definitive diagnosis was accurate after exploratory
laparotomy. Animal history showed erroneous oxytocin
and prostaglandin administration and massive manually
assisted whelping [19, 20].
Normocytic normochromic anemia in the cat with UtR
can be explained by blood loss subsequent to uterine
rupture and passage of red blood cells into the uterine
lumen by diapedis. Hyperproteinemia was resulting from
dehydration or increased synthesis of acute phase
proteins and antibodies in response to bacterial infection
and inflammation. Hypoalbunemia was due to a lack of
protein ingestion consequent to anorexia as a result of
decreased liver synthesis of albumin, hemorrhages,
protein loss due to peripheral edema caused by vasculitis
or compensation to maintain osmotic pressure caused by
increased globulins [21, 49, 50].
Although treatment of the case with UtR consisted of
fluid replacement, antibiotic therapy, ovariohysterectomy,
removal of the fetuses as recommended by Linde
Forsberg [22], animal was died after surgery. This can be
postulated to intestinal compression, severe adhesions,
septic peritonitis and hemorrhage [51].
CONCLUSIONS
It was concluded that rapid resuscitation, prompt
diagnosis and accurate treatment are the corner stone for
management of urogenital disorders causing abdominal
pain in cats with good prognosis. Tube cystostomy is a
successful method for treatment of refractory cases of
obstructed FUS cases without recurrence. Hyperkalemia
should be concerned in cases with FUS, uroabdomen and
polycystic kidney.
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