Feline Urinary Diseases Flashcards
What are the most important questions where dx LUT dz in cats?
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)
Dysuria without obstruction
Small bladder
↑ frequency, ↓ volume
Urinating in multiple locations
Differentials for dysuria without obstruction
Idiopathic cystitis
Uroliths
Infection or neoplasia
Dx dysuria without obstruction
Urinalysis, Rads/ US
+/- cx, contrast rads
CBC may be normal
How to tx dysuria without obstruction
Fluid therapy
Dysuria with obstruction
Large bladder
↑ frequency, ↓ volume
Urinating in multiple locations
Differentials for dysuria with obstruction
Plug
Urethroliths
Spasm
Stricture and clots
Dx dysuria with obstruction
Survey rads + urinalysis (dz in urethra)
+/- special imaging, cx and Bld profile
How to tx dysuria with obstruction
Cardiovascular stabilization (restoring volume depletion and correct imbalances)
Bladder decompression
Alleviate obstruction (urethral hydropropulsion)
Inappropriate urination without dysuria
Frequency and normal volume
Selected location
Normal bladder size
Differentials for inappropriate urination without dysuria
Behavior with underlying cause
Idopathic, uroliths, infections
Dx inappropriate urination without dysuria
Urinalysis, rads/ US
+/- cx and contrast rads
How to tx inappropriate urination without dysuria
Behavioral modification
Eliminate concurrent dz
Urinary incontinence
Frequency constant/ intermittent
↓ volume
Location (wet from lying down and not positioning)
Large bladder (neuro or obstruction)
Dx urinary incontinence
Neuro exam, US or surgery rads (spine)
+/- contrast rads, cx
How to tx urinary incontinence
Primary: correct anatomic abnormality
Manage/ eliminate concurrent dz
Idiopathic cystitis
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)
Bladder down hypothesis (idiopathic cystitis)
Congenital (pandora syndrome)
Affects the bladder and other systems (GI)
Can’t handle the stress
Tx acute idiopathic cystitis
Bupren
NSAIDs or acepromazine (manages pain)
Tx for recurrent episodes to idiopathic cystitis
Multimodal therapeutic food (prescription)
SOAR (safe, odor, appropriate, active play and resource rich - environment)
Most common comorbididites for idiopathic cystitis
Aggression, ↑ body weight and struvite crystalluria
T/F: Struvite uroliths are caused by infection like dogs
FALSE (not caused by infection)
Standard of care for struvite stones in cats
Stone dissolution (3w) with therapeutic food
Cystotomy (80% successful, not cat friendly)
Stones in cats
Struvite → CaOX (upper stones) → pruine → compound → mixed
What is the most common stone in Egyptian Mau?
Urate
Unobstructing a cat
Stabilize before anesthesia
Accurate dx
Flush, don’t force
Extend penis caudally
What shouldn’t you do when evaluating a cat for obstruction
EXPRESS BLADDER (most common test done) and 3rd most common way to rupture the bladder
What causes cat obstructions
Stones, mass, plug, FB, extraluminal compression
Main goals for unobstructing the cat
Re-establish tissue perfusion:
1. Replace volume (IV) - if dehydrated
2. Decompressive cystocentesis
When should a decompressive cytocentesis be done when unobstructing a cat?
If↓ cardiac output due to hypothermia, uremia, acdemia, hypocalcemia
Benefits of decompressive cytocentesis
Reduce bladder pain
Reduce biochemical consequences
↓ resistance to retrograde flushing if you occlude urethra
Appropriate sample for UA and cx
What is the right way to dx a cat obstruction
Medical imaging (done before placing a catheter)
How to obstruct the cat
- Anesthesia (not dexmed)
- Flush urethra to clear obstruction
- Place indwelling catheter
- Moisten gauze spongue
How long should the catheter be in for different obstructions?
- Idiopathic (1-2dy)
- Crystalline matrix plugs (1-2d)
- correction of azotemia (1-2d)
- Blood clot (1-4d)
- Promote recovery of detrusor atony (3-7d)
- Promote urothelial repair (3-7d)
