Page 134 - BSAVA Guide to Pain Management in Small Animal Practice

7 | Abdominal pain

VetBooks.ir e ex p e Pyelonephritis

yelonephritis results from infection of the
renal pelvis and can progress to acute
idney in ury in oth dogs and cats. t
typically arises from ascending infection
from the lower urinary tract however, a
haematogenous origin is possi le. acterial
endocarditis, discospondylitis and pyometra
are recognized predisposing conditions for
pyelonephritis. ain can result from
in ammation ut also following stretching of
the renal capsule when renomegaly
develops igure . .

HISTORY AND PRESENTATION This female dog was repeatedly
stretching while in the home environment
prior to presentation, having shown increased
ogs and cats with systemically drinking and urination in the previous days.
compromised immunity (hyper-
adrenocorticism, diabetes mellitus), chronic
kidney disease or vesico ureteral re ux are TREATMENT
more predisposed to developing
pyelonephritis. In acute disease, animals Once diagnosed, initial treatment with
present with severe systemic illness alongside intravenous antibiotics and uid therapy is
uraemia and possibly sepsis, whereas chronic imperative. Analgesia should be administered
disease can be insidious with slowly especially during the intensive management
progressive azotaemia and renal failure. phase in acute presentations. Options could
include opioids, lidocaine infusions and
CLINICAL SIGNS AND SIGNS OF PAIN paracetamol intravenously. Some would avoid
ketamine as this is 1 renally excreted. he
Abdominal or renal pain, sometimes use of non steroidal anti in ammatory drugs
misinterpreted as back pain, is identi ed in is generally avoided because of the potential
acute cases. ogs can occasionally for worsening renal function. Opioids
demonstrate the ‘prayer position’ with renal administered by the epidural route have
pain. Palpation of the kidneys, particularly if generally not been used due to the risk of
enlarged, can elicit a pain response. Animals urine retention. However, recent studies have
can present as cases of pyrexia of unknown uestioned the importance of this. Antibiotics
origin. In chronic cases, the clinical signs can should continue for at least 6 8 weeks with
be subtle and non speci c. regular urine culture monitoring.

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