Part 46

Pelvic calculi or concretions are often (in cattle and swine) mere scales lying in chalices. They may fill the whole pelvis and send branching processes into chalices.

Causes. They are attributed to phosphaturia, lithæmia or uric acid diathesis, oxaluria, etc. In cattle they are associated with dry feeding and are common on all magnesian limestone soils. There are usually catarrh of the kidney and the presence of bacterial ferments and colloids (pus, albumen, etc.). (Sharing and Ord.) Calculi or gravel is preceded by renal catarrh, but this is aggravated by the crystalline deposit. Bacteria act also in producing NH_{3}O, which instantly precipitates ammonio-magnesian phosphate. Retention of urine greatly favors the precipitation.

Symptoms. A white or brownish yellow deposit in the last urine discharged collects on the floor. Cloudy urine. Passage of crystals—round—or angular. Colic. Lameness in one or both hind limbs. Arched back. Sensitive loins. Pain paroxysmal. Attempts to urinate. Little passed but often with drops of blood. Sudden relief when the calculus enters the bladder.

Retained in the kidney it may cause no suffering in meat producing animals, but in horses it usually causes stiffness or lameness especially under violent effort. Also hematuria; blood globules are found in the deposit when placed under the microscope. There may be sepsis and specially cloudy offensive urine.

Diagnosis: May be confounded with renal tuberculosis, or sarcoma or oxaluria. Examine for bacillus, small cells, or oxalate of lime or oxalic acid.

Prophylaxis. In the early stages give succulent, watery food, ensilage, roots, potatoes, spring grass, and water ad libitum.

Treatment. Salt may tempt the patient to drink. Nitro-muriatic acid is a solvent and antiseptic. Or alkalies with salicylate of soda. Also tonics. Quiet pain by morphia and other anodynes. Use piperazine.

These failing, an operation on the kidney may be considered.

HYDRO-NEPHROSIS.

A common result of calculus or other obstruction, causing increasing pressure of urine in the pelvis and absorption of the parenchyma, and finally leaving a mere urinous sac.

RENAL TUMORS.

1. Non-malignant: Fibroma. Lipoma. Angioma. Adenoma. Papilloma. 2. Malignant: Sarcoma. Carcinoma.

RENAL PARASITES.

Echinococcus: Herbivora, Omnivora. Bilharzia Crassa: Egyptian cattle. Strongylus Gigas: Horse, ox, dog, man. (Cysticercus Tenuicollis: Ruminants: Pig). Tænia serrata: Dog. Pelvis. Sclerostoma equinum: (renal arteries, kidney pelvis), soliped. Stephanurus dentatus: Pig, (pus cavities). Trichosoma plicata: (Urinary bladder), dog. T. felis: (Cat), bladder. Indetermined embryos: Kidneys, dog; small tumors. Cytodites nudus: Kidneys; hens. Œstrus, (Gast. Hemorrhoidalis): Bladder walls: horse. Mucorimyces: Kidneys; dog. Coccidia: Kidney, Horse, dog, goose.

INJURIES OF THE URETERS.

Lesions by bullets, arrows, stabs, bruises and lacerations in parturition, treads, wheels, tumors, ulcers, calculi, tubercles, parasites. Course. Pathology: transverse division may cause hydronephrosis, or septic peritonitis. Symptoms: uncertain, traumatism, bloody urine, arched, stiff, tender loins, straining, recumbency, groaning in turning or rising, rectal palpation of distended ureter, of ascitic fluid, pitting on pressure of loin, flank or groin, liquid drawn through a cannula is urinous, urine still discharged by normal channel. Crystals in urine, worm ova. Treatment: compresses, fomentations, sinapisms, anodynes, balsams, antispasmodics, extraction of calculus, lateral implantation of urethra.

From their deep and protected position it might be plausibly concluded that the ureters were secure against every kind of traumatism. This however, is not the case, since in both man and animals they have been known to have been injured by bullet wounds, arrow wounds, and stab wounds of various kinds. In dystokia with laceration of the womb, vagina or bladder the ureter is liable to be injured. By blows and kicks it may even be ruptured or torn across, and also by sudden and severe mechanical compression of the abdomen as when run over by a wagon or trodden on by a horse, ox, or other large animal. Tumors of various kinds may grow in, or press upon the ureter, ulcers with thick indurated margins or base may obstruct the passage, or calculi, or worms may block and give rise to overdistension and even rupture. Kopp describes obstruction by multiple calculi with saccular dilation in front, close to the kidney in a cow. Cadiot records cases of thickening of the mucosa by numerous cysts as small as hempseed. Intra-abdominal tumors of the spermatic cord have been known to block the passage. Again tubercles have formed on the urethra, and polypi on the trigonum vesicæ have blocked the ureter and produced all the evil consequences of calculus, parasites, etc.

Course. The progress of the disease will vary greatly according to the nature of the lesion. With complete rupture of the ureter the urine as a rule escapes into the peritoneal cavity. If the urine is aseptic this may not lead to serious results and the edges of the wound cicatrizing, the urine is imprisoned in the ureter and pelvis of the kidney, and leads to final atrophy of the kidney and hydronephrosis. When on the other hand infecting matter escapes with the urine, as in perforating ulcer, tubercle, glanders, cancer, infective catarrh of the kidneys or ureter, such infection is brought in contact with the whole peritoneal surface, where secondary infections follow. In cases associated with penetrating wounds, wounds resulting from dystokia, calculus or parasitic obstruction, similar infection is to be dreaded.

The symptoms are by no means clear, unless the injury result from external traumatism, or when it can be detected by rectal exploration. There may be blood staining of the urine, stiffness of the loins, lameness in one hind limb, tenderness of the lumbar vertebræ and of their transverse processes on pinching, frequent straining to pass urine, a disposition to remain recumbent, pain and groaning when rising, or when turned in a narrow circle. Under rectal examination the blocked ureter may sometimes be recognized, its cystic end shrunken and empty, up to the seat of obstruction, and its renal end, from the hypersensitive seat of obstruction forward, full, rounded, elastic and firm. If the ureter has been ruptured, it may be impossible to distinguish it, but the presence of urine free in the peritoneum may be detected through the rectum as it may often be through the abdominal walls. Sometimes the urine infiltrates the subperitoneal connective tissue, and forms a pasty swelling on the loin or flank. In either case a hollow needle inserted will draw off a liquid having an urinous odor. That this urine has escaped in front of the bladder may be safely inferred from the continued discharge of urine by the urethra and by the absence of cystic swelling, heat and tenderness. If the kidney can be reached by rectal exploration it is felt to be firm and resistent up to the period of rupture of the ureter.

In case of obstruction by calculus, crystals and even small calculi may be passed in the urine, there is usually a history of previous attacks of renal colic, and the suffering is manifestly extreme. In case of worms (strongylus gigas) the use of the centrifuge on the urine, may possibly secure in the sediment specimens of its ova. The existence of tumors or tubercles can usually be clearly made out.

Treatment will be as varied as the lesion. Simple ureteritis may be met by wet compresses, sinapisms, and internally by balsams and anodynes. Calculi and parasites may be passed with some aid perhaps from fomentations, antispasmodics, and diluents. Obstinate cases can only be successfully met by surgical interference. The resulting wounds in the ureter, like ruptures, perforating ulcers and strictures may be met by Van Hook’s “lateral implantation”: the divided cystic end of the ureter is ligatured and on the cystic side of the ligature a longitudinal incision is made, large enough to admit the divided extremity of the renal portion, and through each of the two sides of this last a fine ligature is passed; these ligatures are then passed into the lumen of the cystic portion of the ureter through its longitudinal incision and brought outward through its walls; next the renal end is inserted into the incision in the cystic end and the two are firmly sewed together by the two ligatures. When a small portion of an ureter must be excised it may sometimes be possible to save a valuable animal by such an expedient.

In some cases of rupture into the vagina or uterus an available fistula may sometimes be established into one of these.

URETERITIS.

From wounds, calculus, parasites, infection, injuries in parturition. Symptoms: in wounds of ureter. Course: danger of infection of kidney or bladder. Treatment: for calculus, antispasmodics, anodynes, fomentations, for parasites arsenious acid, for catarrhal conditions, balsams, buchu, salicylates, etc. Operation. Uretero-vaginal fistula.

This may arise from the passage of a rough calculus, from wounds of the ureter sustained in kicks and blows or by being run over by wheels (dogs, cats), it may be due to the blocking of the tube by a parasite such as strongylus gigas, echinococcus, etc., or it may be the result of extension of an infectious inflammation backward from the kidney or forward from the bladder. Again it may be the result of a lesion of the ureter in cases of dystokia.

The symptoms are obscure but there is likely to be frequent straining and passage of urine, tenderness of the loins, all the more significant if confined to one side, lameness or halting on the corresponding hind limb, and on examination through the rectum the swollen and tender cord representing the ureter may be recognizable. In case of calculus or other obstruction the ureter may be felt to be swollen, elastic and tender back to a slight nodular, painful, firm swelling at the seat of obstruction.

Course. In all such cases there is always danger of inflammation (infections or otherwise) of the kidney with degeneration and loss of structure and function, the organ being reduced to a simple urinous cyst (hydronephrosis). In some cases, however, the obstruction (calculus, parasite) may escape into the bladder and a recovery follow. Slight infections, too, may improve and advance to complete convalescence.

Treatment will depend much on the causative factor: Calculus must be treated by anodyne antispasmodics, and fomentations, and in case of relief by measures calculated to prevent its formation anew: parasites may be treated by arsenious acid, oil of turpentine, and other parasiticides which are secreted by the kidneys: catarrhal and infected conditions may be met by balsams, buchu, salicyclic acid and even peppers. In case of calculus which does not give promise of passing, even a surgical operation may be thought of, especially in the smaller house animals.