rupture of urinary bladder in large animals copy (2)

VINKIT DHIMAN

(L-2008-V-68-B)

(BVSc & A.H.)

Most common source of uroperitoneum.

Common problem in cattle. Urolithiasis in males is the underlying cause in the majority of cases, however, cystorrhexis has been reported in yearling heifers.

Rupture of the bladder is usually on the dorsal aspect; it may consist of multiple holes or of single large tear.

Occurs secondary to urethral urolithiasis.

Steers in feedlots are commonly affected groups.

Can occurs in neonatal foals.

Also occurs in foaling mares.

-Urolithiasis with subsequent urinary tract obstruction.

-Abd. Trauma.

-Susequent manipulation of fetus.

-In prgnant females:- obstruction of pelvic urethra by fetus during prolonged dystocia may leads to U.B.rupture.

-During parturition.

-It may be of 2 types:-

1) Traumatic rupture.

2) Spontaneous rupture.

Favoured by distension of organ and violent contusion of abd. Wall.

By falling on projecting body.

Feet of fetus during parturition.

Urethral obstruction by calculus or a stricture.

Seen most often in ox.

Pain suddenly subsides and patient seems relieved.

Temporary improvement in attitude.

Animal resumes eating.

Bilaterally symmetrical progressive abd. distension with free fluid.

Dehydration.

Depression.

Anorexia.

Expired air exhales an odour of urine.

P/R:-palpably flaccid bladder.

History and clinical signs.

Laboratory findings:-

-includes evaluation of serum and peritoneal fluid.

Ultrasonography.

Radiography-not in cattle and horse.

Endoscopy.

Serum electrolyte abnormalities:-

Hyponatremia.

Hypochloremia.

Hyperkalemia &

Occasionaly metabolic alkalosis in foals.

Increased creatinine levels.

-Abdominocentesis-18 gauge needle.

-Clear to slightly turbid & clear to yellow in colour.

-Heating-odour of ammonia.

-Peritoneal:serum creatinine ratio:-

-2:1 or greater

-Peritoneal : serum K ratio:-

-2.7:1 is a consistent finding in bladder rupture in preruminant calves.

-Identification of CaC03 crystals-unique to adult horse.

Greatest value.

Large volume of echogenic fluid.

Very small bladder surrounded by excessive peritoneal fluid.

U/S contrast studies with injection of air or agitated saline-gas echoes confirm a leak.

Another procedure to confirm uroperitoneum.

Sterile dye soln. is infused.

Demonstration of dye in P.F. indicates a hole in lower urinary tract.

To determine the extent of tear.

Endoscope should be properly disinfected.

Antibiotics should be administered if endoscopy is performed.

As a rule is useless.

Initial treatment involves resolving urine outflow obstruction, which is the primary cause of bladder rupture.

Immediate surgery should be done as the animal may die within 4-5 days if left as such.

Definitive treatment of urinary bladder rupture requires laparotomy and closure of rents in the bladder wall.

Correct acid-base electrolyte abnormalities before surgery:- For this-Administer 0.9%saline solution with 5% glucose i/v.

Remove abdominal fluid before anaesthesia.

Urethral catheterization is done before surgery.

It is the repair of urinary bladder.

It has been reported that dorsal rupture of U.B. heal spontaneously if urethral catheter is placed.

Ventral bladder tears usually requires surgery and are approached by ventral flank region.

Can also be done in standing position through left paralumbar fossa.

Should be performed when animal`s condition is stabilized.

After incision bladder is exposed and tear should be identified.

Edge of the tear should be then debrided to prevent further complication.

Tear is closed in 2 layers:-

-simple continuous pattern

-inverting pattern.

. To avoid providing a nidus for additional calculi

formation, suture material should not penetrate the bladder lumen.

Maintain the animal on systemic antibiotics for at least 5 days after surgery.

Observe the animal regularly to ensure that urination is normal, and modify the diet to prevent additional calculi formation.

Recurrence of urine leakage after surgery is relatively common because the bladder wall has been weakened.

Can be minimized by carefull debridement of tear site before its closure.

Adhesions are formed.