Feline Urinary Diseases

Question 1

What are the most important questions where dx LUT dz in cats?

Answer 1

Frequency: dysuria ( norm 1-3x / day)
Volume: frequent and large= kidney dz, large = NOT LUT)
Location: painful* (mult. places), behavior (random and mult. times in one place)

Question 2

Dysuria without obstruction

Answer 2

Small bladder
↑ frequency, ↓ volume
Urinating in multiple locations

Question 3

Differentials for dysuria without obstruction

Answer 3

Idiopathic cystitis
Uroliths
Infection or neoplasia

Question 4

Dx dysuria without obstruction

Answer 4

Urinalysis, Rads/ US
+/- cx, contrast rads
CBC may be normal

Question 5

How to tx dysuria without obstruction

Answer 5

Fluid therapy

Question 6

Dysuria with obstruction

Answer 6

Large bladder
↑ frequency, ↓ volume
Urinating in multiple locations

Question 7

Differentials for dysuria with obstruction

Answer 7

Plug
Urethroliths
Spasm
Stricture and clots

Question 8

Dx dysuria with obstruction

Answer 8

Survey rads + urinalysis (dz in urethra)
+/- special imaging, cx and Bld profile

Question 9

How to tx dysuria with obstruction

Answer 9

Cardiovascular stabilization (restoring volume depletion and correct imbalances)
Bladder decompression
Alleviate obstruction (urethral hydropropulsion)

Question 10

Inappropriate urination without dysuria

Answer 10

Frequency and normal volume
Selected location
Normal bladder size

Question 11

Differentials for inappropriate urination without dysuria

Answer 11

Behavior with underlying cause
Idopathic, uroliths, infections

Question 12

Dx inappropriate urination without dysuria

Answer 12

Urinalysis, rads/ US
+/- cx and contrast rads

Question 13

How to tx inappropriate urination without dysuria

Answer 13

Behavioral modification
Eliminate concurrent dz

Question 14

Urinary incontinence

Answer 14

Frequency constant/ intermittent
↓ volume
Location (wet from lying down and not positioning)
Large bladder (neuro or obstruction)

Question 15

Dx urinary incontinence

Answer 15

Neuro exam, US or surgery rads (spine)
+/- contrast rads, cx

Question 16

How to tx urinary incontinence

Answer 16

Primary: correct anatomic abnormality
Manage/ eliminate concurrent dz

Question 17

Idiopathic cystitis

Answer 17

Activates stress responses system → enhanced sympathetic activity → ↑ outflow to urinary bladder → ↑ permeability and sensitivity to bladder → NS transfers pain back to brain (causing further stress)

Question 18

Bladder down hypothesis (idiopathic cystitis)

Answer 18

Congenital (pandora syndrome)
Affects the bladder and other systems (GI)
Can’t handle the stress

Question 19

Tx acute idiopathic cystitis

Answer 19

Bupren
NSAIDs or acepromazine (manages pain)

Question 20

Tx for recurrent episodes to idiopathic cystitis

Answer 20

Multimodal therapeutic food (prescription)
SOAR (safe, odor, appropriate, active play and resource rich - environment)

Question 21

Most common comorbididites for idiopathic cystitis

Answer 21

Aggression, ↑ body weight and struvite crystalluria

Question 22

T/F: Struvite uroliths are caused by infection like dogs

Answer 22

FALSE (not caused by infection)

Question 23

Standard of care for struvite stones in cats

Answer 23

Stone dissolution (3w) with therapeutic food
Cystotomy (80% successful, not cat friendly)

Question 24

Stones in cats

Answer 24

Struvite → CaOX (upper stones) → pruine → compound → mixed

Question 25

What is the most common stone in Egyptian Mau?

Answer 25

Urate

Question 26

Unobstructing a cat

Answer 26

Stabilize before anesthesia Accurate dx Flush, don't force Extend penis caudally

Question 27

What shouldn't you do when evaluating a cat for obstruction

Answer 27

EXPRESS BLADDER (most common test done) and 3rd most common way to rupture the bladder

Question 28

What causes cat obstructions

Answer 28

Stones, mass, plug, FB, extraluminal compression

Question 29

Main goals for unobstructing the cat

Answer 29

Re-establish tissue perfusion: 1. Replace volume (IV) - if dehydrated 2. Decompressive cystocentesis

Question 30

When should a decompressive cytocentesis be done when unobstructing a cat?

Answer 30

If↓ cardiac output due to hypothermia, uremia, acdemia, hypocalcemia

Question 31

Benefits of decompressive cytocentesis

Answer 31

Reduce bladder pain Reduce biochemical consequences ↓ resistance to retrograde flushing if you occlude urethra Appropriate sample for UA and cx

Question 32

What is the right way to dx a cat obstruction

Answer 32

Medical imaging (done before placing a catheter)

Question 33

How to obstruct the cat

Answer 33

1. Anesthesia (not dexmed) 2. Flush urethra to clear obstruction 3. Place indwelling catheter 4. Moisten gauze spongue

Question 34

How long should the catheter be in for different obstructions?

Answer 34

1. Idiopathic (1-2dy) 2. Crystalline matrix plugs (1-2d) 3. correction of azotemia (1-2d) 4. Blood clot (1-4d) 5. Promote recovery of detrusor atony (3-7d) 6. Promote urothelial repair (3-7d)