1. Chapter 9 Urogenital Anatomy & Emergency ANGELA CULP LVT SMALL ANIMAL EMERGENCY AND CRITICAL CARE

2. Chapter 9 Urogenital Anatomy & Emergency  In this chapter we will be discussing the anatomy of the urogenital system.  We will also discuss a true urinary emergency, what signs to look for, diagnostics and a treatment plan.

3. Renal Anatomy - Location  The kidneys lie retroperitoneal in both the dog and cat.  They are sheltered along the back and are surrounded by adipose tissue.  The Renal Fascia holds the kidneys in place  The right kidney can be found positioned slightly cranial to the left kidney in all species.  Upon palpation the kidneys in the cat are easily moved and have more movement, whereas the dogs kidneys are more affixed.  An appropriate sized kidney (radiographically) is considered 2.5-3 times the length of the animals own L2 vertebrae. (Norkus, 2012)

4. Gross Anatomy  In both dogs and cats you will find 2 layers : The Cortex (Outer) and the Medulla (Inner).  The kidney is considered “unilobar” or one lobe.  In a dog the kidney has another structure called the Renal Pelvis, (a large collecting channel for urine that terminates at the ureter) and a Fibrous Capsule that surrounds the entire kidney.  In the cat the anatomy is found to be quite similar except for a Serosal Capsule, (nothing like the Fibrous Capsule in the dog). (Norkus, 2012) Figure 1.Commander. (2015). Anatomy of the Kidney. Tangient LLC. http://images.tutorvista.com

5. Renal Blood Supply  The caudal aorta branches to the 2 renal arteries and each of these go towards a kidney.  The renal arteries branch into several interlobar arteries > then into smaller arterioles > then into capillaries to provide the kidney tissue its needed blood.  When the blood is used the capillary beds terminate the cells at the beginning of the venous circulation provided as small venules and finish at the renal vein, this then flows into the caudal vena cava. (Norkus, 2012)

6. Microscopic Anatomy  The structural and functional unit of the kidney is the nephron that is a multi cellular structure composed of several distinct areas with its own function.  The nephron is composed of the bowman’s capsule, glomerus, proximal tubule, loop of henle and distal tubule.  Within the kidneys are multiples of nephrons. The dogs kidney holds 415,000 nephrons and the cats kidney holds 190,000 nephrons.  Nephrons connect to the collecting tubules that eventually deposit urine into the renal pelvis for delivery to the bladder via the ureters. (Norkus, 2012)

7. Microscopic Anatomy  The two principle features of the Nephron: Glomerus and the Bowman’s Capsule.  The Glomerus is a capillary bed that is fed by the afferent arteriole that arises from the renal artery. Blood enters the Glomerus, circulates and exits through the efferent arteriole. The efferent arteriole continues to supply blood to the nephron and then carries away solutes and water from the tubules.  The Bowman’s Capsule is a hollow structure that surrounds the Glomerus.  The Bowman’s space next takes the debris to the lumen of the proximal tubule. This then goes into the Loop of Henle, then through the distal tubule and finishes at the collecting duct. (Norkus, 2012)

8. Microscopic Anatomy Figure 2.Cummings, B. (2004). Urinary Physiology. Pearson Education Inc.

9. Anatomy of Urine Output  At the end of the renal pelvis the urine is deposited into the ureters.  From each of the kidneys a ureter brings the urine to the bladder.  Once the urine is collected into the bladder, the animal will expel the urine out of the urethra. (Norkus, 2012) Fig 3. Commander. (2015). The Urinary System. Tangient LLC. http://images.tutorvista.com.

10. Renal Emergency Postrenal Azotemia  Postrenal Azotemia occurs when there is an impendent to the flow of urine out of the body.  Most common urethral obstruction in the veterinary medicine:  Urethral obstruction of the male cat; AKA blocked tom, Ruptured Urethra, Urinary blockage from neoplasia in the urethra, Bladder or surrounding disease and Uroloths.  Urinary trauma; when a patient is involved in an accident it is best to check for urethral trauma. This can lead to leakage into the hind legs and inguinal area and lead to surgery. (Norkus, 2012)  (FLUTD) Feline Lower Urinary Tract Disease which is a collection of conditions that can affect the bladder and urethra of cats. (Cornell University College, 2014) Figure 4.Hardy, S. (2011.). Orange Cat. Flickr, a Yahoo company. Flickr, Garment District.

11. Complaints/ In clinic signs  Owners may call give complaints that the animal may seem constipated. Other complaints include urinating outside of the litter box, excessive grooming of genitals, vocalizing, having hematuria or dysuria. With any of the complaints it is best to get the animal in and not delay treatment.  In the clinic upon primary exam you may find:  a moderate to large hard bladder.  a ruptured bladder that wont be able to be palpated.  maybe cardiovascular unstable secondary to fluid deficits and metabolic derangements. (Norkus, 2012)

12. Diagnostics  Diagnostics include gathering bloodwork of a:  PCV/ TP  Blood Glucose  BUN  Venous Blood Gas  Electrolytes  and Radiographs.  (Norkus, 2012)

13. Treatment  Cats with urethral obstruction should be treated as emergencies when presented. In particular, cats that have been obstructed 48 hours or more may be severely ill and require crisis management.  A thorough assessment of the cat’s condition should be made before attempting to relieve the obstruction. Provide a rectal exam and radiograph to determine trauma, stones or masses.  Placement of an IV catheter with a isotonic crystalloid fluid should be the first procedure in order to administer fluids and medication.  Analgesia should be provided at the earliest opportunity. Appropriate agents include buprenorphine and hydromorphone. Midazolam (0.2 mg/kg, IM) may help with anxiety associated with pain and distress. Make sure you obtain blood work prior to treatment.  In some situations a cystocentis can provide some relief but in most circumstances you will need to place a urinary catheter to expel the urine in the bladder. (Susan Little, 2015)

14. References American Heritage® Dictionary of the English Language, Fifth Edition. (2011). Retrieved February 27 2015 from http://www.thefreedictionary.com Cornell University College. (2014). Cornell Feline Health Center. Retrieved from http://www.vet.cornell.edu/FHC/health_resources/UrinaryConcerns.cfm Norkus, C. (2012). Veterinary Technicians Manual for Small Animal and Critical Care. Danvers: Wiley-Blackwell. Susan Little, D. D. (2015). Management of Urethral Obstruction in Male Cats. Retrieved from http://drsusanlittle.net Figure 1.Commander. (2015). Anatomy of the Kidney. Tangient LLC. http://images.tutorvista.com Figure 2.Cummings, B. (2004). Urinary Physiology. Pearson Education Inc. Figure 3.Commander. (2015). The Urinary System. Tangient LLC. http://images.tutorvista.com. Figure 4.Hardy, S. (2011). Orange Cat. Flickr, a Yahoo company. Flickr, Garment District.

15. Chapter 15 Reproductive Emergencies ANGELA CULP LVT SMALL ANIMAL EMERGENCY AND CRITICAL CARE

16. Chapter 15 Reproductive Emergencies  In this chapter we will discuss anatomy of both the male and female species.  We will also address some of the emergencies that you will see and what to do incase of that situation.

17. Female Reproductive Anatomy  The female genital tract consists of the vulva, vagina, cervix, uterus, oviducts, and ovaries, as well as the mammary glands found on the chest and abdomen.  The oviducts are small tubes that connect the ovaries to the uterus.  The end of the uterus is called the cervix. It separates the uterus from the vagina and provides a barrier against infection.  The vagina, a muscular tube that extends from the cervix to the outside, is connected to the vulva, which is the external opening of the female genitals.  Oviducts are associated with each ovary.  (The Merck Manuals, 2011)

18. Female Reproductive Anatomy Figure 1. Manuals, M. (2011). The reproductive system of the female cat. Merck Sharp & Dohme Corp.

19. Female Reproductive Emergency - Uterine Prolapse  Presented with a mass – like substance in the vagina. It is either one or both uterine horns that will prolapse.  Timeline of occurrence:  during parturition or shortly after, usually as the cervix is open.  Treatment:  Sedation or anesthesia needed for treatment and pain relief.  Clean the prolapsed portion with 0.9% saline and lubricate with a water based lubricant.  Reduce the uterus manually with a hyperosmotic agent to reduce the tissue edema.  50% dextrose  Following the reduction with Oxytocin that should be given intramuscular (5-10 u). This helps with the involution of the uterus.  If unable to reduce the uterus surgical intervention may be needed.  (Norkus, 2012)

20. Female Reproductive Emergency - Uterine Prolapse Figure 3.Bodurova, K. (2015). Prolapsed uterus in a cat. Veterinary ECC Small Talk. http://www.veteccsmalltalk.com/images

21. Male Reproductive Anatomy  The genital tract provides a pathway for semen, which contains the sperm cells.  The epididymis connects the testicle to the ductus deferens, which carries ejaculated sperm to the urethra.  Sperm mature and are stored in the epididymis.  The accessory sex glands, such as the prostate, create the fluid portion of semen.  (The Merck Manuals, 2011)

22. Male Reproductive Anatomy Figure 2.Manuals, M. (2011). The reproductive system of the male cat. Merck Sharp & Dohme Corp.

23. Male Reproductive Emergency - Paraphimosis  A condition in which the penis is unable to retract into the prepuce; less likely to happen in a feline.  Presented with or without penile strangulation or entrapment.  The penis becomes enlarged and swollen to the point that it is unable to retract into the prepuce. Usually associated with erection or coitus.  Will also present with agitation, pain and trying to lick or bite at penis. Penis is dry due to the exposure and loss of natural lubrication.  Prone to injury or will collect debris in this state.  (Norkus, 2012)

24. Male Reproductive Emergency - Paraphimosis  Treatment :  Sedation for initial treatment is usually needed.  Clean the exposed penis  Retract penis back into normal position of the prepuce.  Drugs needed:  Hyperosmolar 50% dextrose to reduce the edema  Water soluble lubricant  Anti- inflammatory drugs  Continue at home with a triple antibiotic and monitor consistent retraction.  If conservative treatment fails surgical correction may be necessary.  If left untreated urethral obstruction can occur.  (Norkus, 2012)

25. Male Reproductive Emergency - Paraphimosis Figure 4.Vets, T. P. (2015). Paraphimosis in dogs. Asiahomes Internet. Toa Payoh Vets Clinical Research.

26. References  Figure 1. Manuals, M. (2011). The reproductive system of the female cat. Merck Sharp & Dohme Corp.  Figure 2.Manuals, M. (2011). The reproductive system of the male cat. Merck Sharp & Dohme Corp  Figure 3.Bodurova, K. (2015). Prolapsed uterus in a cat. Veterinary ECC Small Talk. http://www.veteccsmalltalk.com/images  Figure 4.Vets, T. P. (2015). Paraphimosis in dogs. Asiahomes Internet. Toa Payoh Vets Clinical Research.  Norkus, C. (2012). Veterinary Technicians Manual for Small Animal and Critical Care. Danvers: Wiley-Blackwell.  The Merck Manuals. (2011, July). Merck Manuals. Retrieved from http://www.merckmanuals.com/pethealth/cat_disorders_and_diseases/rep roductive_disorders_of_cats/the_gonads_and_genital_tract_of_cats.html