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SA DX & TX II > Exam 4 - Feline Interstitial Cystitis > Flashcards

Exam 4 - Feline Interstitial Cystitis Flashcards

1
Q

what is FLUTD?

A

feline lower urinary tract disease - signs associated with lower urinary tract disease (stranguria, pollakiuria, dysuria, hematuria, & pyuria) due to many underlying etiologies

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2
Q

what is FIC?

A

feline idiopathic cystitis - syndrome resulting in lower urinary tract signs caused by complex interactions between the urinary bladder, nervous system, adrenals, husbandry practices, & cat’s environment

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3
Q

what are some examples of causes of lower urinary tract disease in cats?

A

FIC, UTI, urolithiasis, urethral plugs, urinary tract neoplasia, trauma, stricture, anatomic defects, neurological defects, & behavioral disorders

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4
Q

how is FIC diagnosed?

A

diagnosis of exclusion!!!

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5
Q

what are the characteristics of FIC?

A

signs of lower urinary tract dysfunction & clinical signs in other organ systems

waxing & waning signs associated with stressful events

resolution of signs following effective environmental enrichment

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6
Q

what is the most common cause of lower urinary tract signs in cats?

A

FIC

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7
Q

what is the cause of FIC?

A

etiology is unknown!! proposed that the mucous layer containing glycosaminoglycans & glycoproteins is disrupted (the layer that normally provides a barrier for the urothelium) so cats with FIC have a decreased concentration of urinary glycosaminoglycans

when a susceptible cat is housed in a deficient environment, FIC is more likely to occur

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8
Q

what nerves provide sensory innervation to the bladder? how does this relate to FIC?

A

pelvic & hypogastric nerves with neurons in the submucosa

release of substance P from the neurons can result in vasodilation, release of inflammatory mediators, & contraction of smooth muscle

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9
Q

how can decreased urine volume & frequency be a cause of FIC?

A

increases contact time of highly concentrated urine with the uroepithelium

decreased water intake may result from reluctance to drink water, confinement, impaired mobility, or intercat aggression

decreased urination may result from litter box preference, dirty boxes, confinement, or intercat aggression

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10
Q

how does stress contribute to FIC?

A

plays an integral role in FIC

FIC cats have an altered HPA axis characterized by exaggerated catecholamine release & blunted cortisol response

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11
Q

what are some examples of how may a cat with FIC present to your clinic?

A

non-obstructive self-limiting disease

frequent recurring episodes

chronic persistent episodes

urethral obstruction

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12
Q

what signalment of cats are commonly affected by FIC?

A

middle aged (2-7 years old) cats have an increased risk, neutered/overweight cats, being housed indoors, & high levels of stress

in cats <1 year old - UTI or urolithiasis more likely

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13
Q

what is the most common sign of urinary obstruction in cats?

A

non-productive straining in the litter box +/- vocalization

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14
Q

T/F: episodes of FIC often resolve within 7 days with or without treatment

A

true

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15
Q

why do you need to inquire about previous episodes of lower urinary tract signs if you have a cat presenting with stranguria?

A

recurrence rate of FIC episodes is up to 45% in 6 months in male cats with obstructive uropathy

39% within 12 months in cats with non-obstructive uropathy

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16
Q

what may be seen on physical exam in a cat with FIC?

A

bladder may feel small & thickened

if urethral obstruction - bladder will feel turgid, enlarged, & painful, patient may be dehydrated or volume depleted, & may be tachycardic due to pain or bradycardic due to hyperkalemia

after a long standing obstruction - bladder can rupture

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17
Q

why do you need to be careful when evaluating a urine dipstick on a cat?

A

the dipstick will yield false positives for leukocytes in cats - look at the sediment

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18
Q

when should you do a urine culture for a cat with FIC?

A

sample by cystocentesis

should be performed if there is pyuria/bacteriuria, recurrence of clinical signs, evidence of chronic kidney disease, prior urinary catheterization, or perineal urethrostomy

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19
Q

why is efficacy of therapy complicated when managing a cat with FIC?

A

clinical signs usually resolve after 1-7 days

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20
Q

what is management of FIC aimed at?

A

reducing rate of recurring signs, reducing severity & duration of signs, & reducing the risk or urethral obstruction

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21
Q

what is your first line therapy for all cats with FIC?

A

stress reduction!!!!!

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22
Q

how is environmental enrichment used for managing cats with FIC?

A

very important for indoor cats - enhance interactions with owners & predictability of interactions

minimize conflict - belled collars on cats in the home & potentially separate cats

add resources to the home - toys, food & water sites, etc

gradual changes

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23
Q

how is litter box management done for cats with FIC?

A

aimed at promoting frequent urination & decreasing stress - at least one box is uncovered & all boxes placed in easily accessible quiet locations

of litter boxes = # of cats + 1

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24
Q

what kind of litter do cats prefer?

A

clumping, sand like litter

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25
Q

how is feline facial pheromone used for stress management in cats with FIC?

A

nonvolatile molecules that influence social & reproductive behavior

shown to decrease stress in cats during hospital visits

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26
Q

how is diet management part of treating FIC in cats?

A

consider if a diet change would be too stressful!!! transition will need to take place gradually over weeks to months

allow cat to self select by placing new food in a different container beside the current food

increase their water intake - canned food diets, adding broth to dry food

27
Q

what is the current standing on using anti-inflammatory drugs for treating FIC?

A

no difference in rate of recurrent urethral obstruction or recovery from clinical signs in cats with FIC treated with meloxicam vs a placebo

prednisolone not effective in reducing severity or duration of FIC signs

28
Q

what cats are more commonly affected by urethral obstructions? why?

A

male cats - narrow urethra

29
Q

what usually causes urethral obstructions in male cats?

A

urethral plug - composed of protein matrix with some WBC/RBC

less commonly due to a stone (tumors & strictures rarely cause obstruction)

30
Q

what is seen on physical exam of a blocked tom? what parameters do you need to get?

A

bladder is enlarged, turgid, & painful & tip of the penis is often discolored

vital parameters & blood pressure

if obstruction has been present > 48 hours, patient will be SEVERELY ILL

31
Q

what should make up the immediate medical therapy for a patient with a urethral obstruction?

A

establish iv access - need to start isotonic crystalloids/bolus shock dose if needed, & correct % dehydration over 12-24 hours + maintenance

stat data collection - pcv, total protein, electrolytes, venous blood gas, & ecg (monitoring for sinus bradycardia - ventricular tachycardia & arrest may follow)

extended database - collected when possible based on patient stability (urinalysis & culture collected once obstruction is alleviated)

may need to do a decompressive cystocentesis

32
Q

how is a decompressive cystocentesis done? what are the risks?

A

use a 25 or 22 G over the needle catheter with a 3 way stop cock & large syringe to perform a single cystsocentesis to remove as much urine as possible to reduce pressure in the bladder & increase GFR

extravasation of urine, trauma to the bladder wall, possible collapse (thought to be a vagal response)

33
Q

what is the purpose of giving calcium gluconate to a blocked tom?

A

decreases cardiac membrane potential threshold - cardiac protectant!

does not decrease serum potassium levels - need to monitor an ecg during infusion (0.5-1.0 ml/kg IV over 2-5 minutes)

34
Q

how is regular insulin & dextrose fluids used to manage hyperkalemia in a blocked tom? how is it done?

A

insulin shifts potassium & glucose intracellularly

0.25-0.5 U/kg IV regular insulin & then 0.5-1.0 ml/kg of 50% dextrose IV

dilute dextrose in saline 1:4 then begin a 2.5% dextrose CRI monitoring bg & potassium every hour to start

35
Q

how is albuterol or terbutaline used for treating hyperkalemia in a blocked tom?

A

beta-2 mediated stimulation of Na-K-ATPase pump moves potassium intracellularly

36
Q

what are contraindications for giving bicarb to a blocked tom when needing to treat hyperkalemia?

A

encephalopathy, liver disease, or hyperosmolarity

37
Q

T/F: it is okay to give calcium gluconate & sodium bicarbonate at the same time to a blocked cat with hyperkalemia

A

false - don’t do this

38
Q

when would you give sodium bicarbonate to a blocked tom with hyperkalemia? how would you give it? what does it do?

A

if pH < 7.2 or CO2 < 12 mmol/L - HCO3 = weight X (12-patient HCO3) X 0.3 & give half the dose IV over 5 minutes & repeat if needed

helps to shift potassium intracellularly in exchange for hydrogen ions

39
Q

what are your sedation & analgesia options for blocked toms?

A

butorphanol IV +/- midazolam
ketamine IV with diazepam IV/midazolam IM
propofol +/- isoflurane

40
Q

how should a blocked tom be unblocked?

A

sterile procedure when placing ucath (wear sterile gloves) & apply sterile lube to the tip of the catheter

clean penis/prepuce with povidine/iodine

obstruction is alleviated via hydropulsion with saline & only gentle pressure should be applied to the catheter

41
Q

how is a male dog that is blocked from a urolith unblocked?

A

patient positioned in lateral recumbency with the penis extruded

use urohydropulsion through a red rubber catheter to try & propel the stone back into the bladder so that a cystotomy can be done instead of a urethrotomy

after obstruction is alleviated, collect urine from the catheter for urinalysis

empty the urinary bladder

42
Q

how is a tom cat blocked by a urethral plug unblocked?

A

position cat in dorsal recumbency at the edge of the table & massage the tip of the penis gently to remove any distal plugs

extrude the penis & extend it parallel to the spine to stretch out the flexure in the distal urethra

use an open ended tomcat catheter, a 12 mL syringe, & saline to hydropulse

can add lube/lidocaine into the saline

43
Q

what kind of indwelling catheter options do you have?

A

needs to be soft & flexible

red rubber, slippery sam, or foley catheter for dogs

44
Q

how is an indwelling catheter placed?

A

measure the length of it to be passed to avoid forming a knot on itself

suture it in using a tape butterfly & attach the catheter to a closed collection system

usually leave it in for 48 hours - this allows the bladder to remain empty & recover from detrusor atony, lets urethral swelling decrease, & provides access if a re-obstruction occurs

45
Q

what is the benefit of using a closed collection system after placing an indwelling urinary catheter?

A

slows the rate of ascending bacterial infections

allows detection of obstruction of the urinary catheter

allows measurement of urine output - post-obstructive diuresis is common

46
Q

what is the most important thing to do after unblocking a cat?

A

PUT AN E COLLAR ON THEM

47
Q

what monitoring management is done after unblocking a cat?

A

check urine output every 4 hours & adjust fluid rate as needed to compensate for the post-obstructive diuresis - if urine isn’t flowing, check the line for patency with sterile saline & palpate the bladder

48
Q

what medical management is needed after unblocking a cat?

A

buprenorphine or other analgesia

+/- alpha-adrenergic antagonists to manage urethral spasm (prazosin)

avoid abx when ucath is in place because it will predispose them to developing a resistant urinary tract infection

potassium supplement as needed

urine should be clear with little sediment before the catheter is removed!!!!

49
Q

after removing a urinary catheter, what should you consider if the cat is unable to void urine?

A

re-obstruction due to urethral inflammation or urethral plug/clot

re-obstruction by a stone (obtain rads if not previously done)

urethral spasm

urethral strictures do not develop until 7+ days after urethral trauma has occurred

50
Q

after removing a urinary catheter, what should you expect to be going on if the cat is able to void urine?

A

signs of UTIs will persist as expected for several days

client must closely monitor at home for signs of re-obstruction

manage them the same as FIC

51
Q

T/F: 45% of cats reobstruct either soon after being unblocked or within 6 months

A

true

52
Q

when may you pursue an elective perineal urethrostomy? what are the risks?

A

may be done in a male cat with a high risk of recurrent re-obstruction

doesn’t decrease the risk of clinical signs due to FIC - increases susceptibility to UTIs

53
Q

T/F: FIC is considered to be a neuroendocrine disorder & not a primary bladder disease

A

true

54
Q

what are the risk factors for cats developing FIC?

A

middle aged, overweight, indoor only, living with another cat with conflict, fed a dry diet exclusively, & equal sex distribution

55
Q

is there any association with risk of developing FIC with the age of neutering?

A

nope

56
Q

what are the 2 components of the stress response of FIC?

A

exaggerated sympathetic nervous system - increased norepinephrine

blunted HPA axis - less cortisol

57
Q

what is MEMO?

A

multimodal environmental modification

litter box management, synthetic facial pheromone, escape areas

58
Q

what crystals are commonly found in urethral plugs?

A

struvite

59
Q

what are the big consequences of urethral obstruction?

A

azotemia, pain, hyperkalemia, & acidosis

60
Q

what causes pre-renal azotemia? what about post-renal?

A

pre-renal: marked decrease in renal blood flow (dehydration)

post-renal: AKI, obstruction of urine outflow from the kidney

61
Q

if you see this on an ecg of a blocked tom, what are you concerned about?

A

hyperkalemia!!! causing bradycardia & increased resting membrane potential

62
Q

what is seen on ecg commonly in patients with hyperkalemia?

A

long p-r interval, prolonged QRS, tall t wave

may even lose p waves

63
Q

when is an indwelling urinary catheter indicated?

A

if the patient needs time for inflammation to reduce

maintains a patent urethra

keeps the bladder empty

64
Q

how long do strictures take to form after urethral trauma?

A

7+ days

SA DX & TX II (62 decks)

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