1、尿石癥UrolithiasisPrepared by: Dr. Terry Hunt Translated by Dr. Fu Xiaoping病因/發(fā)病機(jī)理 Cause & Pathogenesis通常發(fā)生于閹割牛Disease of castrated males 膀胱結(jié)石-Calculi form in bladder nidus of bladder cells, minerals and bacteria通過尿道平滑結(jié)石易通過，但不規(guī)則形狀結(jié)石被卡住后易阻塞尿道Pass into urethra smooth calculi pass but irregular shaped are

2、 trapped and cause urethral obstruction危險(xiǎn)因素Risk Factors高精料日糧High concentrate rations草酸鹽含量高的植物Plants high in oxalates飲水少Low water intake閹割Castration 臨床癥狀Clinical Findings3個(gè)綜合癥狀Three syndromes尿道阻塞Urethral obstruction廢食、心跳快Off feed and elevated heart rate排尿緊張尿道有規(guī)律波動(dòng)Straining to pass urine urethra pulsa

3、ting絞痛/疝痛踢腹、尾顫、蹬地Colic feet stamping, kicking at belly and tail twitching粉紅色尿液排出Maybe dribbling of blood tinged urine若完全堵塞，毛干燥If complete obstruction, dry preputial hair直腸觸診漲大的膀胱May palpate enlarged bladder by rectal exam尿道破裂Urethral rupture動(dòng)物開始吃食、無絞痛、緊張Animal begins to eat, no colic and no strainin

4、g腹部多水-陰莖周圍的腹部區(qū)域增大Water belly swelling of ventral abdomen around penis腹部水腫，氣味如尿Appears to be ventral edema but smells like urine腹部脫落Sloughing of ventral skin膀胱破裂Ruptured bladder臨床癥狀暫時(shí)減輕數(shù)天Temporary relief of clinical signs for a few days尿毒癥、消沉、食欲減退Uremia, depression and anorexia腹部含有大量尿液梨形且波動(dòng)Abdomen fi

5、lls with urine pear shaped and fluid wave直檢，瘤胃小，腹部大On rectal exam, rumen is small even though abdomen is large觸摸不到膀胱Unable to palpate bladder毛干燥Dry preputial hair診斷Diagnosis依據(jù)病史、臨床癥狀Based on history, clinical signs腫脹程度和腹部滴水Aspiration of swelling and peritoneal tap鑒別診斷Differential Diagnosis膀胱炎血尿Cysti

6、tis bloody urine腎盂腎炎血尿Pyelonephritis bloody urine急性腸梗阻疝痛或膨脹Acute intestinal obstruction colic and distention球蟲病-Coccidiosis - straining皮下水腫Subcutaneous edema充血性心力衰竭腹水Congestive heart failure - ascites實(shí)驗(yàn)室和病理學(xué)診斷Laboratory and Pathology加熱液體可聞到尿樣嗅味May have to warm up fluid to smell like urine治療Treatment

7、尿道阻塞Urethral Obstruction 早期選擇屠宰Slaughter is an early option抗痙攣藥-氨丙嗪Antispasmodic drugs aminopromazine 粉碎石頭Crush stones at sigmoid flexure of penis陰莖手術(shù)Penile Amputation尿道破裂Urethral Rupture陰莖手術(shù)Penile amputation通過腹部切口排出皮下積尿Drain subcutaneous urine by ventral lacerations膀胱破裂Ruptured Bladder會(huì)陰部尿道手術(shù)Perine

8、al Urethrostomy用套管針排出腹部尿液Drain urine from abdomen by trochar陰莖切除手術(shù)Penile Amputation麻醉Anesthesia腰椎膜外麻醉Clip for epidural第二、三腰椎內(nèi)3 ml 3 ml into C2 C3 space皮膚準(zhǔn)備Skin PreparationClip triple scrub and paint perineal area (midline an area 15 cm * 30 cm)手術(shù)Surgery手術(shù)時(shí)動(dòng)物站立Surgery is generally done on the standin

9、g animal在肛門到陰囊基部下方5cm處的皮膚中線做15cm 切口Full thickness 15 cm midline skin incision starting 5 cm below the anus to base of scrotum鈍性分離陰莖Bluntly dissect down to penis抓住陰莖、并將陰莖從切口處拉出Grasp penis & pull penis out through incision 節(jié)扎陰莖海棉體Ligate Corpus Cavernosum (CC) of penis切除末梢到節(jié)扎處Amputate distal to ligatur

10、e在切口處固定尿道（）Fix urethra in the incision site (suture from skin through CC out skin on other side back through skin, through CC and through skin).將尿道縫合到切口皮膚邊緣Splay urethra suturing to skin edges (urethra is on the dorsal aspect of the penis)縫合皮膚確保尿不流入切口處Suture skin closed insuring that urine does not

11、run into the incision site 背部Dorsal 陰莖Penis 尿道urethra 皮膚切口Skin incision Corpus cavernosum預(yù)后情況Prognosis取決于阻塞持續(xù)時(shí)間、阻塞程度或尿毒癥的情況Depends on the duration of obstruction and degree or uremia后遺癥Sequelae腹膜炎Peritonitis尿毒癥導(dǎo)致死亡Uremia resulting in death腹部皮膚脫落Sloughing of skin on belly尿道表面粗糙化導(dǎo)致阻塞Granulation of urethra leading to obstruction膀胱沒能治愈Failure of bladder to heal預(yù)防Prevention & Control延期閹割Delay castration避免日糧中磷酸鹽含量過高Avoid excess phosphorus in ration (Ca:P 2:1)維持大量飲水（加入鹽至日糧的4%），冬天用熱處理的水Mainta