胃肠疾病大小15.2g等多个文件-02肾衰专题19.4排尿困难

Nephrology

DysuriaArianeDr.med.vet.,DACVIMVetsuisseFacultyUniversityofBerneSmallAnimalInternalMedicine

ESAVSShanghaiSignsoftheLowerUrinary下 症Dysuria排 difficult,abnormal排 ，异Pollakiuria频异地排±失

frequenturinationofurineslowandpainfulbloodinthe consciousandvoluntaryurinationinabnormalplaces uncontrolledlossofurine无法控制尿排 阻Dysuria-Differential排 －鉴别诊Inflammation/infection尿肌 detrusor尿肌尿肌张力和 detrusor尿肌张力和

排 －鉴别诊断和相象情Defecationproblems(obstipation…)排便问题（便秘…）Orthopedicproblems(pain…)矫形外科问题（疼痛…）PU/PD多尿/多饮(+associatedsphincter与扩约肌张力减弱Anuria无GeneralHistory病 / 腹泻/便BesurethatitisstranguriaandNOT须确定是痛性尿淋漓而不是便秘/排Back 背部 药ABchemotherapy, 抗生素、化疗 多尿/多UrinaryHistory排尿 持续时Persistentvs 持续性vs间歇Urinarysigns(lowerurinarytract)排尿症状（下 血Pollakisuria 排 痛性尿淋 异地排 尿 失 edUTI’s先前记录PhysicalExamination体格检NeurologicExam神经学GaitProprioceptivedeficits本体感受Perinealreflex(LMNreflex)&bulbocavernosus反射（下运动神经反射）& 肌反Perinealandpudendal 和阴神sphincterconstrictionandtail肛扩约肌收缩和尾UrologicExam尿液检Watchanimalurinate观察动物dysuria,hematuria排 、血Incontinence尿失UrgencyCatheterize 导功能性vs解剖性阻largevs 多vsExtrude 挤Vaginal 检Evaluate 评价形Case病例1“Minnie13yearoldF/Sterrier13岁雌性绝 Presentedtotheveterinaryschoolwitha3monthhistoryofstranguriaOwnerhashadsinceaGeneral 病glandabscess3yearsago三年 腺脓Otherwise 余无明显异Urinary 频

排尿Mild 轻度排No 无血UTI3monthsagoandrespondedtoAmoxi/clav. Stranguriacontinueddespitefurthertx尽管进一步治疗，痛性尿淋漓仍持续存Physical 体格检Brightalert 机灵、警觉、灵T=38.4;HRWNL,RR体温=38.4心率处于正常范围呼吸处于正常范围Pulses=strongandsynchronous脉搏=强且同步Abdomen:WNLexceptforlarge,tense Lymphnodes: ：正Urinary 检Rectalexam:3cmmass,thick“bumpy” Vaginalexam:smallmass Noattemptatcatheterization未尝试插管Urination排 尿频 Moderatesizebladderafterattemptedto动物试图自主排尿后 中度大Problem 问题列 尿频 Vaginal 肿Inabilitytoemptythe 不能排Historical 病Localization:Urethral定位 疾DifferentialDiagnoses鉴别Physicalurethral Urethral 肿Malignantepithelialtumors(TCCorsquamouscell恶性上皮肿瘤（移行细胞癌或鳞状细胞癌 平滑Proliferativeurethritis(granulomatous增生 炎（肉芽肿 炎SuggestedDiagnostics推荐CBCbiochemicalprofileAbdominalultrasoundThoracicradiographs

Traumatic Cystostoscopyand Traumatic 损伤性+/-fenestrationsin Insertuntilyoufeelthelesionand“rub”thecatheterbackandforth;aspiratesimultaneouslyTraumaticCatheterization损伤性ProliferativeUrethritis增生 “Granulomatousurethritis”肉 Inflammationwithraised炎症，伴有组织凸淋巴细胞浆细胞性或反复Canlooklike外观似肿TreatmentforProliferative增生 炎的治非类固醇性抗e.g.piroxicam,meloxicam?,Steroids类固e.g ProliferativeUrethritis增生 Beforetreatment治疗 Followup复查Markedimprovementin24Normalisationwithin1 Case2:Dalmatian,fs,4大麦町，雌性绝育，4Severeurinarysinceadoptedfromshelter自从领养后严重尿失禁SevereskinlesionsonUrinaryIncontinenceDifferential

acquired获得Manxcat spinalinjury脊柱受伤 pulledtail non- ectopic post-spay pelvicbladde

AnatomicAbnormalities解剖异Anatomic 解剖EctopicPelvic

骨 Bladder/urethralhypoplasia AnatomicAbnormalities解剖异Ectopicureters输尿管异Usuallyyoung(<1year)at就诊通常较年青（＜1岁Female Siberianhuskies,Labradorretrievers,Goldenretrievers,西伯利亚哈士奇、拉布拉多犬、金 、其Unilateral(67%)orbilateral(33%);92%bilateralinone PracticalapproachforEU可疑输尿管异位的 r检 的结 尿液Evaluatespecific 评 多尿/ 沉Urine 尿培Onestudy→66%hadpositive一研究→66%的培养结UrethralPressureSurgerydoesnotcureall手术不能治愈所有Mayhavecomponentof可能 性肌肉扩约肌闭锁不全的因Mayrequiremedsafter术后可能需要药物OtherImaging其它影Especiallyimportant要UrodynamicTesting尿动力学试Attemptedurethralpressureprofile(UPP)continuallycatheterizedthe尝 压力剖析图，但仍进行异位输尿管插Warnedownerthatsurgicalcorrectionalonemaynotresultincompleteresolutionofurinary告诫主人手术单独无法