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43 Cards in this Set
- Front
- Back
Location of kidney:
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right: below dorsal extent of last 2 to 3 ribs and first lumbar transverse process; left: caudal to the right
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Size of kidney:
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6-7 inches long, 6 inches wide, 2-2.5 inches height, left kidney is not as wide
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Vascular supply to kidney:
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renal arteries branching from aorta, accessory renal arteries from caudal mesenteric, testicular, ovarian, or deep circumflex iliac arteries
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Size of ureters:
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2-3 inches in diameter, 28 inches long
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Function of ureter:
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muscular tubes that induce contraction to move bolus of urine from renal pelvis to bladder
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Functional unit of kidney:
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nephron
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Innervation of kidney:
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sympathetic nerves from aorticorenal and renal ganglia
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Receptors of kidney vasculature:
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alpha & beta adrenergic, dopaminergic
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Innervation of ureters:
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alpha 1 and beta 2 adrenergic receptors
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Congenital disorders of ureters:
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ectopic ureter, ureteral defects or tears, vascular anomalies to urinary tract
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When do ectopic ureters develop?
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Ureteric bud (metanephric duct) fails to be incorporated into the urogenital sinus or fails to migrate cranially to bladder neck or when mesonephric duct fails to regress
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Locations of ectopic ureters:
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with ureteric bud failure, open near urethral papilla in females and colliculus seminalis in males; with mesonephric duct failure, open anywhere in the vagina, cervix or uterus
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Clinical sign of ectopic ureter:
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urinary incontinence
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Diagnosis of ectopic ureter:
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visual examination, endoscopic examination +/- IV administration of phenol red dye, contrast studies, CT, MRI
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Surgical treatment of ectopic ureter:
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ureterocystotomy (reimplantation of ectopic ureter into bladder), unilateral nephrectomy if preferred
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What needs to be determined before surgical correction of ectopic ureter?
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Whether it is bilateral or unilateral, if there is UTI present
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Term for ureter defect or tears:
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ureterorrhexis
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What results from ureter defects?
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Retroperitoneal accumulation of urine or uroperitoneum
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Treatment of ureter defects:
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suturing defect around indwelling catheter, unilateral nephrectomy
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Acquired renal or ureteral disorders:
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calculi, pyelonephritis, ureterorrhexis, neoplasia
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Treatment of renal & ureteral calculi:
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if disease is unilateral, unilateral nephrectomy
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Treatment of pyelonephritis:
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if disease is unilateral, unilateral nephrectomy
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What should be determined before performing nephrectomy for pyelonephritis?
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Absence of azotemia and absence of bacteria in unaffected ureter
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Most common renal neoplasia:
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renal cell carcinoma
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Treatment of renal neoplasia:
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if unilateral, unilateral nephrectomy
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Disadvantage of nephrectomy for renal neoplasia:
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disease is likely to be metastatic and large size of neoplastic kidney is difficult to remove without complications
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Approaches to nephrectomy:
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open (right: 16th or 17th rib resection, 16th or 15th ICS; left: 17th or 18th rib resection, dorsal flank; foal: caudal VMC), laparoscopic, hand-assisted laparoscopic
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Most common approach to nephrectomy:
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17th rib resection
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Describe rib resection nephrectomy:
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incision made over rib to periosteum, periosteum elevated circumferentially, rib resected 2-5 cm distal to costovertebral articulation and disarticulated at costochondral junction, medial periosteum incised, self retaining retractors inserted, kidney mobilized by digital blunt dissection, ureterovascular pedicle isolated, artery, vein, ureter double ligated, kidney removed, ureter mobilized, ligated as far distal as possible, transected, penrose or closed suction drain place prior to closure
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Portal location for laparoscopic nephrectomy:
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between 17th & 18th rib at ventral border of TC, ½ way between 18th rib and dorsocranial border of TC and 8 cm distal
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Order of ligation for laparoscopic nephrectomy:
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artery, vein, ureter
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Complications of laparoscopic nephrectomy:
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pneumothorax, hemorrhage from accessory renal arteries
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Disadvantages of laparoscopic nephrectomy:
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technically challenging
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Describe hand assisted laparoscopic nephrectomy:
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incision made in PLF with modified grid, scope portal made dorsal to open incision, combination of hand and laparoscopic dissection to free kidney, renal artery and vein double ligated with 1 hand ties, vessels transected, kidney exteriorized, ureter double ligated and transected
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Complications of hand assisted laparoscopic nephrectomy:
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hemorrhage from accessory renal arteries
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Benefits of hand assisted laparoscopic nephrectomy:
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tactile sensation for dissection, hand retraction, smaller incision, no GA
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Describe nephrotomy:
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approach as for open nephrectomy, kidney mobilized, incision made to exposed collecting system, obstructions removed, parenchymal pressed together, renal capsule closed with simple continuous pattern
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Indications for ureterotomy:
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calculi
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Approaches for ureterotomy:
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flank laparotomy+/- endoscopic guidance
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Removal of ureteral calculi:
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primary incision of ureter to remove, endoscopic guided dislodgement through ureter
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Complication of kidney or ureter surgery:
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pneumothorax if through a flank approach and penetration of crura of diaphragm, hemorrhage, infection
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Complication of kidney or ureter surgery:
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pneumothorax if through a flank approach and penetration of crura of diaphragm, hemorrhage, infection
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Ruminant nephrectomy:
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PLF approach just caudal to last rib (13th) for right, mid-PLF for left, blunt dissection of kidney, ligation of artery, vein, ureter, remove kidney; standing for cattle, lateral recumbency for small ruminants
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