Challenging Urinary Cases to Improve Your Diagnostic and Therapeutic Skills 复杂的泌尿系统病例分析 : 帮助您提高诊断和治疗技术

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1 Challenging Urinary Cases to Improve Your Diagnostic and Therapeutic Skills 复杂的泌尿系统病例分析 : 帮助您提高诊断和治疗技术

2 CANADA 加拿大

12 CASE #1 病例 1

13 Skye: 4 yr, F/s, Siberian Husky Skye: 4 岁, 母 / 绝育西伯利亚爱斯基摩犬

14 Skye: 4 yr, F/s, Siberian Husky Skye: 4 岁, 母 / 绝育西伯利亚爱斯基摩犬 Presenting Problems: During the first snow fall in Minnesota, the owner noticed red urine. History: The owner has also noticed progressive lethargy 问题表现 : 明尼苏达第一场雪时, 主人发现尿呈红色 ; 主人也注意到它逐渐变得嗜睡

15 Skye: 4 yr, F/s, Siberian Husky Skye: 4 岁, 母 / 绝育西伯利亚爱斯基摩犬 Presenting Problems: During the first snow fall in Minnesota, the owner noticed red urine. History: The owner has also noticed progressive lethargy Physical Exam: Temp=104 F=40 C, P=140 bpm, R=36 bpm, Abdominal palpation=unremarkable 问题表现 : 明尼苏达第一场雪时, 主人发现尿呈红色 ; 主人也注意到它逐渐变得嗜睡体检 : 体温 40 摄氏度, 心率 140 次 / 分, 呼吸 36 次 / 分, 腹部触诊无明显异常

17 Can you localize the hematuria? 你能确定出血位置吗? A. Urethra 尿道 B. Bladder 膀胱 C. Kidney 肾 D. Not the urinary tract 非泌尿系统

18 The next step to best manage Skye? 接下来首要做什么? A. Administer Antibiotics 使用抗生素 B. Culture the urine 尿液培养 C. Submit a CBC 全血细胞计数 D. Ultrasound the abdomen 腹部超声检查

22 The best therapy for Skye s disease is? 最好的治疗方法是? A. Ivermectin to kill the larvae 使用伊维菌素杀死幼虫 A. Immiticide (melarsomine hydrochloride) to kill the adults 美拉索明杀死成虫 B. Surgery 手术 C. Antibiotics 抗生素

25 URETER What is Skye s diagnosis? 诊断结果是?

26 Vena Cava Syndrome 腔静脉压迫综合症

27 URETER What would have been the outcome if only antibiotics were administered to correct hematuria? 如果只使用抗生素来纠正血尿会导致什么后果?

28 Confirming & Localizing Hematuria 确定血尿来源 Urinalysis 尿液分析 (red, brown or black Urine) ( 红, 棕或黑色尿液 ) Occult Blood 潜血 (dipstick 尿检试纸 ) + (hemoglobin/myoglobin) ( 血红蛋白 / 肌红蛋白 ) - Dyes, Food, Drugs 色素, 食物, 药物 Urine Sediment: #RBC 尿沉渣 : 红细胞数量 + - Hemoglobinemia/uria or myoglobinemia/urina 血红蛋白尿或肌红蛋白尿 Hemorrhage (Urinary/Genital Tract ) 泌尿 / 生殖系统出血 Local Disease 局部疾病 (infection, inflammation, neoplasia, trauma) ( 感染, 炎症, 肿瘤, 外伤 ) Generalized Disease 系统性疾病 (coagulation abnormality, thrombocytopenia) ( 凝血障碍, 血小板减少 )

30 Red urine can result from lower urinary tract disease, upper urinary tract disease, or non-urinary tract disorders. To localize disease interpret occult hemoglobin in relation to urine sediment analysis, the color of the serum, and the clinical context of the patient. 红色尿液可能来自于上下尿路疾病或非尿路系统疾病确定出血位置需要综合分析尿潜血与尿沉渣结果, 血清颜色和病患临床表现

31 CASE #2 病例 2

32 Buddha: 5-year, M/n DLH cat Buddha: 5 岁, 公 / 绝育本土长毛猫 Presenting Concern : Straining to urinate Inappropriate urination Duration = 5 months Obtained from a veterinary clinic were the owner works Current Treatments: None 问题表现 : 排尿困难, 排尿异常, 已持续 5 个月, 该猫领养于主人就职的动物诊所目前治疗情况 : 无

33 KEY POINT 关键点 Medical imaging and a urinalysis should be performed on all cats with Lower Urinary Tract Disease. 所有患有下尿路疾病的猫都需要影像检查和尿检

35 Now What? 现在怎么做?

37 What diagnostic test would you select next? 你接下来会选择做什么检查? A. Abdominal radiograph 腹部 X 光检查 B. Abdominal ultrasonography 腹部超声检查 C. Contrast urethrocystography 尿道膀胱造影 D. Cystoscopy 膀胱镜检查

38 Where would you localize Buddha s disease? 你觉得病灶是哪里? A. Kidney 肾 B. Bladder 膀胱 C. Urethra 尿道 D. Perineum 会阴

41 Where would you localize Buddha s disease? 你觉得病灶是哪里? A. Kidney 肾 B. Bladder 膀胱 C. Urethra 尿道 D. Perineum 会阴

42 What diagnostic test would you select next? 你接下来会选择做什么检查? A. Repeat the abdominal radiograph 重复腹部 X 光检查 B. Abdominal ultrasonography 腹部超声检查 C. Contrast urethrocystography 尿道膀胱造影 D. Cystoscopy 膀胱镜检查

44 WHY? 原因?

45 Unobstructing Male Cats The S.A.F.E. Method 疏通公猫尿道阻塞 :S.A.F.E. 方法

46 The Stabilize before you anesthetize 麻醉前保定病患 A. F. E. Method

Prevalence of Life-Threatening Abnormalities 有生命危险的异常情况分布趋势 (223 cats with urethral obstruction) 16% 12% 12% 6% 39% (223 只尿道阻塞的猫 ) Hypothermia (<100 o F) 低体温

47 Prevalence of Life-Threatening Abnormalities 有生命危险的异常情况分布趋势 (223 cats with urethral obstruction) 16% 12% 12% 6% 39% (223 只尿道阻塞的猫 ) Hypothermia (<100 o F) 低体温 Acidemia (ph <7.2) 酸血症 Bradycardia (<149 bpm) 心动过缓 Hyperkalemia (> 8mmol/L) 血钾过高 Hypocalcemia (< 0.8mmol/L) 血钙过低 Lee, et al. J Vet Emerg Crit Care. 2003;13:

48 Re-establishing Tissue Perfusion 重新建立组织灌注 Volume 容量 Force 力量 (Cardiac Output 心脏输出 ) Uremia 尿毒症 Hypothermia 低体温 Hyperkalemia 血钾过高 Acidemia 酸血症 Hypocalcemia 血钙过低

49 IS CYSTOCENTESIS SAFE? 膀胱穿刺是否安全?

50 对于膀胱穿刺我们非常谨慎, 因为膀胱壁会损伤, 尿液可能从损伤处流到腹腔

51 猫的尿腹膜炎 Cause 导致猫的尿腹膜炎的主要原因 1. Abdominal trauma 腹部外伤 - 59% 2. Urethral catheterization 尿道插管 - 32% 3. Bladder expression 挤压排尿 - 9% JAAHA 1998;34:315

52 Managing Urethral Obstruction: Decompressive Cystocentesis 治疗尿道阻塞 : 减压性膀胱穿刺 BENEFITS 好处 üappropriate sample for UA & culture 获得尿检和培养的尿液样本 üreduce discomfort 减少不适 üreduce biochemical consequences of obstruction 减少阻塞造成的不良生化后果 üdecreased resistance to retrograde flushing 降低逆行冲洗阻力 RISKS 风险 üextravasation of urine 尿液外渗 üinjure bladder 膀胱损伤 übladder rupture (?) 膀胱破裂 (?)

53 IS CYSTOCENTESIS SAFE? 膀胱穿刺是否安全?

57 The Stabilize before you anesthetize Accurate diagnosis 准确诊断 F. E. Method

58 What is the most common test to diagnose urethra obstruction? 确诊尿道阻塞的最常用方法是什么?

59 UNOBSTRUCT FIRST, RADIOGRAPH SECOND? 首先解除阻塞, 接下来用 X 光片?

62 Case 1 病例 1 Case 2 病例 2

68 KEY POINT 关键点 Medical imaging should be performed to verify and localize urethral obstruction prior to catheterization. 插管前应使用医学影像确定阻塞位置

72 The Stabilize before you anesthetize Accurate diagnosis Flush, don t force Extend the penis caudally 顺着阴茎向后延伸 Method

81 1. Select tests that correlate with the location of disease. 选择与阻塞位置相对应的检查 2. Remember to question owners, not only about previous diseases, but also about previous treatments that can cause disease. 记得向主人多问问题, 不仅是关于宠物病史, 也包括当时如何治疗的, 因为治疗也可能导致疾病

82 CASE #3 病例 3

86 CASE #4 病例 4

87 Max is an 11 year old Cat with chronic hematuria. What should I do? Max 是一只 11 岁的猫, 患有慢性血尿应该怎么办?

88 Is surgery indicated? 是否需要手术?

89 Is surgery indicated? 是否需要手术?

90 Is surgery indicated? 是否需要手术?

91 What would you select? 应该选择什么? A. Surgery Is 进行手术 surgery indicated? B. No Surgery 不进行手术

92 Is surgery indicated? 是否需要手术?

94 When evaluating radiographs, always use a systematic approach. 评估 X 光片时, 要用系统性的评估方法

95 Max: 9-year, Dalmatian 9 岁, 达尔玛西亚犬 Presenting Concern: Straining to urinate History: Slightly weak in the hind legs Max urinates normally most of the time, but when they come home after work, it takes him a long time to urinate or he squats without any urine voiding 问题表现 : 排尿困难病史 : 后肢无力, 程度轻微 ; 大部分时间 Max 排尿正常, 但主人下班回到家后, 它需要很长的时间完成排尿, 或者做出排尿动作但没有尿液排出

100 Which way will the air move? 空气向哪边移动? A B

101

102 A large bladder is at a mechanical disadvantage to empty itself. Do not let bladder get very over distended and expect them to function properly. 从力学角度讲, 充盈的膀胱不利于它的排空不要让膀胱过度充盈, 也不要期望过度充盈的膀胱能正常工作

UTI (Urinary Tract Infection) - Traditional Chinese

UTI (Urinary Tract Infection) Urinary tract infection, also called UTI, is an infection of the bladder or kidneys. Urethra Kidney Ureters Bladder Vagina Kidney Ureters Bladder Urethra Penis Causes UTI