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CAEM Pt. 2 > Feline Idiopathic Cystitis & Blocked Cats > Flashcards

Feline Idiopathic Cystitis & Blocked Cats Flashcards

1
Q

What is FLUTD and FUS?

A
  • FLUTD = feline lower urinary tract disease
  • FUS = feline urologic syndrome
    + Clinical signs associated with irritative voiding in cats
    *Describes clinical signs, not necessarily the cause
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2
Q

Most common disease, in cats < 10 yr old, presenting with signs of FLUTD

A

1) Idiopathic cystitis
2) Urolithiasis or urethral plug
3) Other = anatomic abnormality, behavioral, UTI (< 1%), neoplasia

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3
Q

Most common disease, in cats > 10 yr old, presenting with signs of FLUTD

A

1) UTI (> 50%)

2) Idiopathic cystitis (5%)

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4
Q

What is feline idiopathic cystitis?

A

Diagnosis of exclusion when FLUTD signs are present and other diagnoses are ruled out

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5
Q

What causes feline idiopathic cystitis?

A

Neurogenic inflammation with vascular leaking = bladder wall edema and RBC diapedesis, brought on by environmental stressors

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6
Q

What is the most common sign associated with feline idiopathic cystitis?

A

Inappropriate elimination

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7
Q

What is the timeline of resolution with FIC?

A

90% will resolve within 5-7 days, with or without therapy

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8
Q

Risk factors for FIC

A
  • Indoor cat
  • Obese
  • Eats dry food
  • Easily stressed or nervous
  • Living in a multi-cat household
  • Decreased water intake
  • Changes in environment
  • Possibly genetics
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9
Q

Pathology behind FIC

A

> Disorder that links the urinary bladder, CNS, adrenal glands, and environmental stressors

  • Damage to either the urothelium or glycoaminocoside layer = allows urine to permeate and irritate the underlying tissue
  • Irritation results in SNS activation = release of inflammatory mediators = neurogenic inflammation
  • Results in further urothelial damage and activates sensory fibers = perpetuates
  • Deficient adrenocortical response = continual activation of hypothal-adrenocortical axis and SNS

*Starts with anything that can activate the SNS

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10
Q

Common signalments with FIC

A
  • Occurs most commonly between 2-7 years old
  • Both males and females
  • Persians are overrepresented
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11
Q

Clinical signs of feline idiopathic cystitis

A 
\+ Pollakuria
\+ Inappropriate elimination
\+ Stranguria
\+ Hematuria
\+ Vocalization
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12
Q

Diagnosis of FIC

A

> Diagnosis of exclusion

1) GOOD HISTORY - looking for risk factors
2) PE = small and painful abdomen
3) CBC, chem, imaging, U/A, culture = rule out uroliths, UTI, neoplasia

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13
Q

What do we commonly see in cats with FIC, on urinalysis?

A

> Hematuria and proteinuria

- USG, pH and crystalluria are only mildly helpful

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14
Q

What do we need to remember with refrigeration of urine?

A

Can precipitate out and increase the finding of crystals in samples

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15
Q

When do we culture urine in cats we suspect with FIC? (2)

A

1) < 10 years old, USG < 1.045, and there’s > 5 WBC’s in sediment
2) > 10 years old, USG < 1.045, history of FLUTD

  • Also = if azotemic, has had a perineal urethrostomy or recent catheterization
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16
Q

Who do we perform CBC and chem screenings on? (4)

A
  • Obstructed cats (electrolyte abnormalities)
  • Recurrent FLUTD animals
  • Systemic signs = vomiting, fever, anorexia
  • > 10 years old
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17
Q

What can radiographs see when it comes to uroliths?

A

Radio-opague stones > 3 mm

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18
Q

What advantage does U/S have over radiography with detecting uroliths?

A

Can see both radio-opague and radiolucent stones, masses, anatomic abnormalities, and thickening of the urinary bladder

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19
Q

Is antibiotic therapy indicated in FIC cases?

A

NO

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20
Q

Main treatment for FIC (3)

A

1) Analgesia - treat pain and reduce SNS tone
2) Sedation = help break the SNS cycle
3) Environmental cleaning = so they don’t keep urinating in the same spots
* For 5-7 days

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21
Q

What things do you do to prevent FIC recurrence?

A

1) Litterbox management - have enough spread apart, uncovered, frequently cleaned, different substrates
2) Increase water intake = fountains, canned food, salt the food
3) Decrease conflict - establish safe havens
4) Promote natural behaviors = toys, catnip, environmental enrichment
5) Increase available space - horizontally or vertically
6) Synthetic pheromones
7) Amitryiptyline if MEMO doesn’t work

22
Q

Correlation of FIC recurrence and age

A

FIC decreases in frequency and severity with age

23
Q

How long until urinary obstruction can be damaging to an animal’s health?

A

3-5 days

24
Q

Where is the most common site of obstruction in cats?

A

Urethra, esp the penile urethra

25
Q

Top three causes for feline uroliths

A

1) Idiopathic urethral obstruction (general inflammation)
2) Urolithiasis
3) Urethral plugs

  • Others = increased urethral tone w/ neuro dysfunction, neoplasia, strictures, iatrogenic, etc.
26
Q

Cause of urethral plugs

A

Thought to be a consequence of FIC = result of inflammation, edema, urethral spasm –> formation from mucoproteins, cellular debris, and embedded minerals

*Inflammation and edema, even after urethral plug has been removed = can contribute to obstruction

27
Q

Common signalment of blocked cats

A

Commonly male cats, present at any age (median = 4.7 yrs)

28
Q

Common clinical signs of blocked cats

A 
\+ Stranguria
\+ Dysuria
\+ Vocalizing
\+ Lethargy and anorexia
\+ Vomiting
\+ Excessive licking of the perineal area
29
Q

What does the bladder feel like on palpation in blocked cats?

A

Full, turgid, painful

30
Q

PE/clinical signs of a ER blocked cat case

A 
\+ Collapse
\+ Shock
\+ Depression
\+ Tachypnea
\+ Bradycardia (due to hyperkalemia)
\+ Weak pulses
\+ Hypothermia due to poor cardiac output
31
Q

Chem panel and lyte abnormalities with blocked cats

A
  • Azotemia = high BUN and creatinine (1/3 of cats)
  • Hyperphosphotemia
  • Hyperkalemia = muscle weakness, bradycardia
  • Low serum bicarb = inability to excrete H+ and uremic acids
  • Hypocalcemia = complexing with P
32
Q

True or false = magnitude of the increases of BUN, creatinine, and phosphorus are prognostic indicators for blocked cats

A

FALSE - high values can be reduced to normal, even with timely therapy

33
Q

ECG findings of blocked cats (3)

A

1) Tall, peaked T waves
2) Prolonged PR interval and QRS complexes
3) Decreased amplitude, increased width, to disappearance of P waves (atrial standstill)

34
Q

Diagnostics for blocked cats (5)

A
  • PE = general demeanor, heart rate, bladder size
  • Chemistry and lyte values
  • ECG
  • U/A and urine culture (UTI’s unlikely, unless recently catheterized)
  • AFTER PATIENT HAS STABILIZED = Imaging = radiographs
    +/- CBC = in older cats, if showing systemic signs
35
Q

What must always occur first with blocked cats?

A

STABILIZE THE PATIENT - address hypovolemia, acidemia, lyte imbalances, and blockage (anuria or oliguria)

36
Q

Treatment of hyperkalemia

A

1) IV fluids for diuresis
2) Ca++ gluconate = cardio-protectant (TRANSIENT, only lasts for 1 hour)
3) Decrease K+ levels = insulin+dextrose, bicarbonate

37
Q

When don’t we use bicarb in blocked cats?

A

In hypocalcemic patients = exacerbates the problem

38
Q

Treatment of hypocalcemia

A

Ca++ gluconate - but rarely necessary

39
Q

Treatment of acidosis

A
  • IV fluids and unobstructing the patient should suffice

- Bicarb in very severely affected patients

40
Q

What may help relieve the obstruction in cats?

A

Sedation = relax urethra and allow plugs to pass before catheterization, Ex: midazolam and butorphanol

41
Q

What should you do if you palpate a very large bladder in a blocked cat?

A

Decompressive cystocentesis = pressure release to decrease risk of bladder rupture, decrease back pressure on kidney so they can produce urine

42
Q

What must occur with anesthesia to successfully unblock the cat?

A

Achieve COMPLETE urethral relaxation = ketamine, midazolam + propofol or inhalant anesthesia

43
Q

How do we physically unblock the cat?

A
  • Have full relaxation
  • Extrude the penis fully = straighten the sigmoid flexure
  • Pass a rigid catheter with fluid to try and push the obstruction to the urinary bladder
  • Pass a soft catheter for long-term bladder drainage and measure volume
  • Place an E-collar

*DO NOT FORCE THE CATHETER AGAINST RESISTANCE

44
Q

Causes for catheter resistance placement (7)

A

1) Haven’t fully extended the penis
2) Urethral plug or urolith obstructing
3) Urethral tear
4) Inadequate relaxation and urethral spasm

Less common:

5) Urethral stricture
6) Severe urethritis
7) Extraluminal compression

45
Q

When do we remove urinary catheters? (3)

A

> For as little time as possible

1) Azotemia resolves
2) Urine is a normal color and consistency
3) After the post-obstructive diuresis has occurred

46
Q

What causes the post-obstructive diuresis?

A

Occurs secondary to the retention of osmotically active solutes and the relieving of the back pressure on the kidney

*Lasts for about as long as the azotemia does

47
Q

Why is monitoring the post-obstructive diuresis important?

A

If you don’t keep up with fluids during that time, it can lead to a life threatening hypovolemia and hypokalemia

48
Q

Things to be monitoring post-obstruction (3)

A

1) Azotemia
2) Lyte values - esp K+
3) Urine output

49
Q

Drugs we can use to relax the urethra

A

Alpha blockers = acepromazone, PRAZOSIN, phenoxybenzamine

*AVOID the use of antibiotics, steroids, and NSAID’s

50
Q

Complications of blocked cats (7)

A

1) Persistent urethral obstruction
2) UTI secondary to catheterization
3) Catheter induced trauma (urethral tears)
4) Urethral stricture
5) Bladder rupture
6) Urinary bladder atony and incontinence
7) Kidney injury

51
Q

What do we recommend with cats who chronically re-obstruct?

A

Perineal urethrostomy surgery

CAEM Pt. 2 (27 decks)

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