胃腸疾病大小15.2g等多個文件-02腎衰專題19.4排尿困難

Nephrology

DysuriaArianeDr.med.vet.,DACVIMVetsuisseFacultyUniversityofBerneSmallAnimalInternalMedicine

ESAVSShanghaiSignsoftheLowerUrinary下 癥Dysuria排 difficult,abnormal排 ，異Pollakiuria頻異地排±失

frequenturinationofurineslowandpainfulbloodinthe consciousandvoluntaryurinationinabnormalplaces uncontrolledlossofurine無法控制尿排 阻Dysuria-Differential排 －鑒別診Inflammation/infection尿肌 detrusor尿肌尿肌張力和 detrusor尿肌張力和

排 －鑒別診斷和相象情Defecationproblems(obstipation…)排便問題（便秘…）Orthopedicproblems(pain…)矯形外科問題（疼痛…）PU/PD多尿/多飲(+associatedsphincter與擴(kuò)約肌張力減弱Anuria無GeneralHistory病 / 腹瀉/便BesurethatitisstranguriaandNOT須確定是痛性尿淋漓而不是便秘/排Back 背部 藥ABchemotherapy, 抗生素、化療 多尿/多UrinaryHistory排尿 持續(xù)時Persistentvs 持續(xù)性vs間歇Urinarysigns(lowerurinarytract)排尿癥狀（下 血Pollakisuria 排 痛性尿淋 異地排 尿 失 edUTI’s先前記錄PhysicalExamination體格檢NeurologicExam神經(jīng)學(xué)GaitProprioceptivedeficits本體感受Perinealreflex(LMNreflex)&bulbocavernosus反射（下運(yùn)動神經(jīng)反射）& 肌反Perinealandpudendal 和陰神sphincterconstrictionandtail肛擴(kuò)約肌收縮和尾UrologicExam尿液檢Watchanimalurinate觀察動物dysuria,hematuria排 、血Incontinence尿失UrgencyCatheterize 導(dǎo)功能性vs解剖性阻largevs 多vsExtrude 擠Vaginal 檢Evaluate 評價形Case病例1“Minnie13yearoldF/Sterrier13歲雌性絕 Presentedtotheveterinaryschoolwitha3monthhistoryofstranguriaOwnerhashadsinceaGeneral 病glandabscess3yearsago三年 腺膿Otherwise 余無明顯異Urinary 頻

排尿Mild 輕度排No 無血UTI3monthsagoandrespondedtoAmoxi/clav. Stranguriacontinueddespitefurthertx盡管進(jìn)一步治療，痛性尿淋漓仍持續(xù)存Physical 體格檢Brightalert 機(jī)靈、警覺、靈T=38.4;HRWNL,RR體溫=38.4心率處于正常范圍呼吸處于正常范圍Pulses=strongandsynchronous脈搏=強(qiáng)且同步Abdomen:WNLexceptforlarge,tense Lymphnodes: ：正Urinary 檢Rectalexam:3cmmass,thick“bumpy” Vaginalexam:smallmass Noattemptatcatheterization未嘗試插管Urination排 尿頻 Moderatesizebladderafterattemptedto動物試圖自主排尿后 中度大Problem 問題列 尿頻 Vaginal 腫Inabilitytoemptythe 不能排Historical 病Localization:Urethral定位 疾DifferentialDiagnoses鑒別Physicalurethral Urethral 腫Malignantepithelialtumors(TCCorsquamouscell惡性上皮腫瘤（移行細(xì)胞癌或鱗狀細(xì)胞癌 平滑Proliferativeurethritis(granulomatous增生 炎（肉芽腫 炎SuggestedDiagnostics推薦CBCbiochemicalprofileAbdominalultrasoundThoracicradiographs

Traumatic Cystostoscopyand Traumatic 損傷性+/-fenestrationsin Insertuntilyoufeelthelesionand“rub”thecatheterbackandforth;aspiratesimultaneouslyTraumaticCatheterization損傷性ProliferativeUrethritis增生 “Granulomatousurethritis”肉 Inflammationwithraised炎癥，伴有組織凸淋巴細(xì)胞漿細(xì)胞性或反復(fù)Canlooklike外觀似腫TreatmentforProliferative增生 炎的治非類固醇性抗e.g.piroxicam,meloxicam?,Steroids類固e.g ProliferativeUrethritis增生 Beforetreatment治療 Followup復(fù)查Markedimprovementin24Normalisationwithin1 Case2:Dalmatian,fs,4大麥町，雌性絕育，4Severeurinarysinceadoptedfromshelter自從領(lǐng)養(yǎng)后嚴(yán)重尿失禁SevereskinlesionsonUrinaryIncontinenceDifferential

acquired獲得Manxcat spinalinjury脊柱受傷 pulledtail non- ectopic post-spay pelvicbladde

AnatomicAbnormalities解剖異Anatomic 解剖EctopicPelvic

骨 Bladder/urethralhypoplasia AnatomicAbnormalities解剖異Ectopicureters輸尿管異Usuallyyoung(<1year)at就診通常較年青（＜1歲Female Siberianhuskies,Labradorretrievers,Goldenretrievers,西伯利亞哈士奇、拉布拉多犬、金 、其Unilateral(67%)orbilateral(33%);92%bilateralinone PracticalapproachforEU可疑輸尿管異位的 r檢 的結(jié) 尿液Evaluatespecific 評 多尿/ 沉Urine 尿培Onestudy→66%hadpositive一研究→66%的培養(yǎng)結(jié)UrethralPressureSurgerydoesnotcureall手術(shù)不能治愈所有Mayhavecomponentof可能 性肌肉擴(kuò)約肌閉鎖不全的因Mayrequiremedsafter術(shù)后可能需要藥物OtherImaging其它影Especiallyimportant要UrodynamicTesting尿動力學(xué)試Attemptedurethralpressureprofile(UPP)continuallycatheterizedthe嘗 壓力剖析圖，但仍進(jìn)行異位輸尿管插Warnedownerthatsurgicalcorrectionalonemaynotresultincompleteresolutionofurinary告誡主人手術(shù)單獨無法