Employee Training Urogenital and Reproductive Emergencies VETE 4326: CA Emergency and Critical Care Sarra Borne Lord - February 24, 2014

Urogenital Emergencies

Normal Anatomy: Urogenital and Reproductive System

Urogenital Emergencies Feline Idiopathic Cystitis with Obstruction  Synonyms:  Feline lower urinary tract disease (FLUTD)  Feline urological syndrome (FUS)  Feline interstitial cystitis (FIC)  “The pathophysiology of FIC is multifactorial and involves complex interactions between anatomic, hormonal and environmental factors” (Aguirre & Darling, 2012)

Urogenital Emergencies Feline Idiopathic Cystitis with Obstruction Presentation  “Urinary obstruction is the inability of urine to flow normally from the body” (Battaglia, 2001)  Most common causes are urolithiasis (stones) or debris plugs.  Usually affects male cats, females rarely get obstructed due to a shorter urethra and larger lumen.  Presentation includes dysuria. pollakiuria, stranguria, and hematuria. More general clinical signs include anorexia, vomiting, restlessness, frequent licking of the genital area, and signs of pain.  Owners may mistake the signs and think the cat is constipated. Diagnosis  A large, painful, firm urinary bladder can be felt on palpation if there is a complete obstruction.  The tip of the penis may be discolored and there may be a urethral plug  Biochemistry may show azotemia, hyperkalemia, hyperphosphatemia, and metabolic acidosis.  The large bladder and any associated calculi can be visualized on survey films.

Urogenital Emergencies Feline Idiopathic Cystitis with Obstruction Treatment  IV catheter and isotonic crystalloid fluids  Relieve the obstruction by passing a catheter  Urine culture  Urine collection set  E-collar  Supportive care  If all else fails, urethrostomy

Reproductive Emergency

Normal Reproductive Anatomy of the Dog

Reproductive Emergency Pyometra Presentation  Infection of the uterus  Middle-aged or older intact female most common  Open or closed  Open – most common owner complaint is purulent vaginal discharge  Closed or open – vomiting, diarrhea, lethargy, polyuria, polydipsia, anorexia  HISTORY! Diagnosis  Laboratory findings are not specific to pyometra. Patients may have a neutrophilia or neutropenia with a left shift. Signs of dehydration or kidney dysfunction may be apparent on biochem panel and urinalysis.  Radiograph may show displacement of the bowel and a tubular opacity in the abdomen  Ultrasound is the preferred method for diagnosis

Reproductive Emergency Pyometra Pyometra surgery on a Chihuahua. Treatment  IV catheter and isotonic crystalloid fluids.  Broad spectrum antibiotics  Surgical removal of the uterus (ovariohysterectomy)  Culture of uterine contents  Medical management (not recommended)

Reproductive Emergency Paraphimosis  Pariphimosis is the inability to retract the penis into the prepuce  Pariphimisis may be caused by a small preputial opening, trauma, a constricting band of hair or other foreign object  The exposed penis will become edematous, and eventually dry and painful.  Self-trauma exacerbates the condition

Reproductive Emergency Paraphimosis Diagnosis  History: The owner notices that the penis has been protruding for a long period of time.  The penis may be swollen or discolored  The dog may be constantly licking at its genital area  A band of hair, string or other foreign object may be observed Treatment  Painful, will require sedation or anesthesia  Gently rinse the penis to remove debris  Apply cold packs and a hyperosmotic agent (Dextrose 50%) topically  Remove any foreign objects (hair, string, etc)  Lubricate heavily, debride necrotic tissue and attempt replacement  Surgery may be required

Reproductive Emergency Paraphimosis Home Management  Elizabethan collar  Sanitary clip  Observe urination  Topical ointments  Restrict activity  Good to guarded prognosis

References Aguirre, A., & Darling, T. (Eds.). (2012). Urinary and renal diseases. Small animal internal medicine for veterinary technicians and nurses (pp ). Ames. IA: Wiley Blackwell. Battaglia, A. M. (2001). Small animal emergency and critical care: A manual for the veterinary technician. Philadelphia, PA: W.B. Saunders. Dennis, J., & Hamm, B. L. (2012). Canine pyometra: Early recognition and diagnosis. Retrieved from diagnosis?id=&pageID=1&sk=&date= Dennis, J., & Hamm, B. L. (2012). Surgical and medical treatment of pyometra. Retrieved from Norkus, C. L. (Ed.) (2012). Veterinary technician’s manual for small animal emergency and critical care. Ames, IA: Wiley-Blackwell. Selected topics in canine and feline emergency medicine (Vol 2). (2010). Paris: Diffo Print Italia.