RESUMO
BACKGROUND: Literature on the laboratory diagnosis of uroperitoneum is scarce, and it is mostly based on the biochemical findings of cavitary fluid and serum. Cell count and protein concentrations measurements are rarely used and available studies on this subject are based on a relatively small cohort of individuals. OBJECTIVES: We aimed to use a large sample pool of dogs to establish cutoff points for biochemical analytes in cavitary fluids and serum for the diagnosis of uroperitoneum. We also sought to evaluate the general classification of these cavitary fluids. METHODS: In a retrospective and prospective study, 180 canine abdominal effusion cases were evaluated, 30 of which were uroperitoneum (uroperitoneum group, UG) and 150 with other etiologies (non-uroperitoneum group, NUG). RESULTS: The results showed that 83.3% of UG and 12.7% of NUG abdominal fluid cases were not classified as transudates or exudates. The use of specific cutoffs for fluid creatinine concentrations (≥2.1 mg/dL) and fluid:serum creatinine ratios (Cf: Cs ≥ 1.25) in these unclassified effusions resulted in an accuracy of 99.0% for the laboratory diagnosis of uroperitoneum. CONCLUSIONS: The adoption of a new set of criteria and cutoffs based on the combination of parameters such as TP, TNCC, fluid creatinine and Cf: Cs improves the diagnosis of uroperitoneum in dogs.
Assuntos
Doenças do Cão , Derrame Pleural , Animais , Técnicas de Laboratório Clínico/veterinária , Doenças do Cão/diagnóstico , Cães , Exsudatos e Transudatos , Humanos , Derrame Pleural/veterinária , Estudos Prospectivos , Estudos RetrospectivosRESUMO
CASE SUMMARY: A 9-year-old neutered male domestic shorthair cat was presented for evaluation of severe hemodynamic collapse and suspected lower urinary tract disease. On admission, severe metabolic acidosis, hyperkalemia and azotemia, and electrocardiographic findings consistent with cardiotoxicity were identified. The diagnosis of uroabdomen was made based on abdominal fluid to plasma concentration ratios of creatinine and potassium. A central line catheter was placed percutaneously into the abdomen for peritoneal drainage and used for peritoneal dialysis as a bridge to surgery. Retrograde contrast cystography confirmed rupture of the urinary bladder. Point-of-care ultrasound of the chest postoperatively revealed the presence of mild pleural effusion. Echocardiography was then performed showing no evidence of cardiac disease. Pleural fluid analysis revealed a transudate with a creatinine ratio of 2.38 ([Creatinine]pleural fluid/[Creatinine]plasma), consistent with the diagnosis of urothorax. The cat recovered uneventfully from surgery and was monitored for signs of respiratory distress during the rest of its stay in hospital. The cat was discharged 4 days later and the pleural effusion resolved without further medical intervention. RELEVANCE AND NOVEL INFORMATION: There is limited information on the causes of urothorax and uroabdomen management of feline patients. Pleural effusion is a complication observed in critically ill cats secondary to fluid overload, underlying cardiomyopathy, primary thoracic pathology or a combination of these. To our knowledge, this is the first report of urothorax in a cat secondary to non-traumatic uroabdomen. Careful monitoring of respiratory signs consistent with pleural space disease is recommended in cases of uroabdomen.
RESUMO
A ruptura uretral iatrogênica geralmente é uma intercorrência secundária à passagem forçada de sondas rígidas durante a tentativa de desobstrução uretral; procedimento este realizado como forma de eliminação imediata da urina em casos de retenção aguda. Pacientes obstruídos podem manifestar sinais de injúria renal aguda, sendo necessário o pronto restabelecimento do fluxo urinário. O presente estudo tem como objetivo demonstrar o uso de uma técnica de cistostomia temporária em felino com ruptura de uretra, feito a partir da inserção de uma sonda tipo Foley na região ventral da bexiga e fixação desta à parede abdominal para que a urina pudesse ser conduzida ao meio externo.(AU)
The iatrogenic urethral rupture is usually an intercurrence secondary to the forced passage of rigid tubes during the urethral clearance attempt; procedure that is performed as a means of immediate elimination of urine in cases of acute retention. Obstructed patients may show signs of acute kidney injury, requiring prompt restoration of urinary flow. The present study aims to demonstrate the use of a temporary cystostomy technique in feline with rupture of the urethra, made from the insertion of a Foley type probe in the ventral region of the bladder and fixation of it to the abdominal wall so that the urine could be conducted to the external environment.(AU)
La ruptura uretral iatrogénica suele ser una intercurrencia secundaria al paso forzado de tubos rígidos durante el intento de aclaramiento uretral; procedimiento que se realizó como un medio de eliminación inmediata de orina en casos de retención aguda. Los pacientes obstruidos pueden mostrar signos de lesión renal aguda, lo que requiere una pronta restauración del flujo urinario. El presente estudio tiene como objetivo demostrar el uso de una técnica de cistostomía temporal en felinos con ruptura de la uretra, realizada mediante la inserción de una sonda tipo Foley en la región ventral de la vejiga y su fijación a la pared abdominal para que la orina pueda ser conducida al ambiente externo.(AU)
Assuntos
Animais , Gatos , Cistostomia/métodos , Cistostomia/veterinária , Uretra/lesões , Doença Iatrogênica/veterinária , Obstrução do Colo da Bexiga Urinária/veterináriaRESUMO
A ruptura uretral iatrogênica geralmente é uma intercorrência secundária à passagem forçada de sondas rígidas durante a tentativa de desobstrução uretral; procedimento este realizado como forma de eliminação imediata da urina em casos de retenção aguda. Pacientes obstruídos podem manifestar sinais de injúria renal aguda, sendo necessário o pronto restabelecimento do fluxo urinário. O presente estudo tem como objetivo demonstrar o uso de uma técnica de cistostomia temporária em felino com ruptura de uretra, feito a partir da inserção de uma sonda tipo Foley na região ventral da bexiga e fixação desta à parede abdominal para que a urina pudesse ser conduzida ao meio externo.
The iatrogenic urethral rupture is usually an intercurrence secondary to the forced passage of rigid tubes during the urethral clearance attempt; procedure that is performed as a means of immediate elimination of urine in cases of acute retention. Obstructed patients may show signs of acute kidney injury, requiring prompt restoration of urinary flow. The present study aims to demonstrate the use of a temporary cystostomy technique in feline with rupture of the urethra, made from the insertion of a Foley type probe in the ventral region of the bladder and fixation of it to the abdominal wall so that the urine could be conducted to the external environment.
La ruptura uretral iatrogénica suele ser una intercurrencia secundaria al paso forzado de tubos rígidos durante el intento de aclaramiento uretral; procedimiento que se realizó como un medio de eliminación inmediata de orina en casos de retención aguda. Los pacientes obstruidos pueden mostrar signos de lesión renal aguda, lo que requiere una pronta restauración del flujo urinario. El presente estudio tiene como objetivo demostrar el uso de una técnica de cistostomía temporal en felinos con ruptura de la uretra, realizada mediante la inserción de una sonda tipo Foley en la región ventral de la vejiga y su fijación a la pared abdominal para que la orina pueda ser conducida al ambiente externo.