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Describe the location of the bladder in dogs and cats.
- canine- may be partially intra-pelvic
- feline- should always be intra-abdominal
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What are reasons for lack of visualization of the urinary bladder on rads? (3)
- lack of distention
- superimposition of intestines
- decreased abdominal serosal detail
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Describe the use of compression to visualize the bladder.
- compress laterally in front of hind legs
- move intestines out of the way
- decreases thickness of the patient--> less scatter
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What are causes of decreased opacity of the bladder? (2)
- iatrogenic (cysto)
- emphysematous cystitis
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What are causes of increased opacity of the bladder? (3)
- calculi
- sand-like material
- dystrophic mineralization (mass- neoplasia, granulomatous disease, bladder wall itself)
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What types of calculi are radiopaque? (3)
- silica
- calcium oxalate
- triple phosphate
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What are the radiolucent calculi? (2)
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What are general indications for contrast cystography? (4)
- dysuria
- pollakiuria
- hematuria
- changes on survey radiographs
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What types of contrast is used in contrast cystography?
- positive- iodinated
- negative- CO2 or NO
- double- iodinated plus CO2 or NO
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What views are required for contrast cystography?
- lateral
- VD
- ventral left- dorsal right oblique
- ventral right- dorsal left oblique
- [obliques are the get the bladder off the spine so we can see it better]
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What is the rule of thumb for how much contrast to instill in the bladder during a cystogram?
stop when the bladder palpates distended and/or feel bak pressure on syringe plunger (don't rupture the bladder!)
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General indications for a POSITIVE contrast cystogram? (3)
- locate the bladder (when not seen on surveys)
- bladder tears
- abnormal communications with bladder and ureters/ other organs
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What are indications for a DOUBLE contrast cystogram? (2)
- intra-luminal filling defects
- bladder wall lesions
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What is the techniques for double contrast cystogram?
- small amount of iodinated contrast, roll patient to disperse contrast
- then put in negative contrast to blow up the bladder
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What are potential complications of cystography? (3)
- catheterization- trauma, bacterial introduction, kinking catheter
- intramural/ subserosal accumulation of contrast
- gas embolus (if gross hematuria is present)- this is why we don't use room air
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What are some mucosal changes that might be seen on cystogram? (3)
- irregularity (may be normal if incompletely distended bladder)
- mucosal proliferation d/t cystitis
- ulceration
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How might bladder wall thickening due to neoplasia appear on cystogram? (3)
- intra-mural filling defects
- smooth or irregular mucosal surface
- usually near the trigone
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How might bladder wall thickening due to cystitis appear on cystogram? (2)
- smooth or irregular mucosal surface
- usually at apex
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How do you know you're probably looking at gas bubbles on a cytogram and not calculi? (4)
- bubbles are drawn to the edge of the contrast pool
- well-defined filling defects
- smoothly margined
- will deform margins if next to each other
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How do calculi appear on cystogram? (4)
- centrally located in contrast pool (unless adhered to bladder wall)
- well-defined filling defects
- smooth or irregular margins
- radiolucent when surrounded by positive contrast (regardless of initial opacity on survey radiographs)
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How do blood clots appear on cystogram? (2)
- filling defectsthat are poorly defined
- irregular margins
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Describe the technique for bladder US.
highest frequency possible (may be lower in large dogs)
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How does emphysematous cystitis appear on US?
diffuse reverberation artifact originating from bladder wall causing shadow all over the entire screen- NOT HELPFUL, go to rads
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What is side lobe artifact and how do you make sure it's artifact and not pathology?
- created by echo off nearby colon
- look at longitudinal and transverse planes and see if it's still there
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What is the psuedosluge artifact on US and how do you ensure its artifact?
- volume averaging of ventral aspect of the badder, making it look thicker
- US is catching parts of the curve of the bladder
- turn the probe transversely
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How do calculi appear on US?
calculi are echogenic, MOVEABLE structures (rarely, stuck to bladder wall)
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How might chronic cystitis appear on US?
- wall thickening usually cranioventrally
- may be smooth or irregular
- DDx neoplasia
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