FIC Flashcards
What type of patient does FIC describe?
a cat with clinical signs indicative of Dz associated with lower UT
CS of FIC
hematuria
dysuria
stranguira
Hx of getting in/out of litterbox frequently, straining to urinate, production of very little to no urine
What are the different types of categories for FIC?
idiopathic vs secondary to bacterial cystitis/neoplasia, uroliths
obstructive vs non-obstructive
Why do we see the clinical signs we see with FIC?
Inflamed bladder –> edema and pain within bladder wall –> irritation and contraction of detrusor muscle –> stranguria and dysuria
Inflammation and damage to local blood vessels within wall of bladder –> hematuria
Typical course of FIC
self-limiting and resolves in 10-14 days regardless of meds given
if obstructive, requires immediate intervention for survival but doesn’t change time course of Dz
How does urethral obstruction affect the body and how might this result in clinical signs?
Inability to eliminate urine –> hampers kidney’s efforts to filter blood of toxins, electrolytes, and other substances –> quick increase of urea, creatinine, phosphorus, and potassium concentrations in blood
Increased potassium can lead to serious cardiac dysfunction & circulatory instability & hypovolemia Rising toxins can lead to circulatory instability and hypovolemia
If complete obstruction, anorexia, vomiting, lethargy, weakness, collapse
List and describe two main therapeutic strategies for obstructive FIC.
IVF
- P usually unstable and will require meds
- P usually needs to be sedated for catheter placement
- supports management of circulatory disturbances
Placement of Urinary Catheter
-re-establishes urine flow
What does the body begin to eliminate from the blood after urine flow is re-established?
BUN CRE phosphorus potassium other toxins
What condition may develop due to hyperkalemia
heart conditions
What are risk factors that are present even after reliving the obstruction?
acute renal failure
hypokalemia
dehydration secondary to post-obstructive diuresis
What does placement of an indwelling catheter allow for?
- allows for time for the inflammation and urethral spasms secondary to the obstruction to subsite
- ensure urethral patency
What does the use of a collection system allow?
- continue evaluation of kidney function (if sudden drop in amount, may be suffering from kidney failure)
- ability to quantify urine output (eval for kidney failure and detection of diuresis)
- monitor for presence of blood cells, blood clots, crystals, and proteinaceous material within urine
How often should a CBC and biochem panel be done?
q24-36hr post urethral obstruction
What things are checked for on the CBC/Chem?
resolution of…
- secondary hemoconcentration
- azotemia
- hyperphophatemia
- hyperkalemia
start of…
-hypokalemia
When should hemoconcentration resolve?
as the P is rehydrated
when should azotemia and hyperphosphatemia resolve?
over 1-2 days
When should hyperkalemia resolve?
within 24hrs of reliving blockage
Why can hypokalemia develop? What can you do about it?
due to post-obstructive diuresis & not eating well b/c potassium is being lost from the kidneys and not being replaced thru food
supplement IVF with potassium chloride
What are 2 things that are done after removing the urinary cathter?
- monitor for signs of re-obstruction (could be urethral spasms or actual reobstruction)
- follow up UA to make sure no bacteria was introduced to bladder
When is a patient usually discharged?
able to pass urine
able to eat/drink normally
List risk factors for FIC development
sedentary lifestyle
neuter status
obesity
increased crystals/protein in highly concentrated urine with acidic/basic pH
Ways to manage increased crystals/protein in highly concentrated urine with acidic/basic pH
- increase water intake (canned food, adding water/juice from tuna/salmon)
- litterbox maintenance to prevent P from holding urine (clean it frequently, add or remove a lid, alter type of litter)
- dietary manipulation to correct pH (won’t work if P presents with ideal pH of 6.5)
Ways to manage sedentary lifestyle
interactive play/feeding
Ways to manage obesity
caloric restriction
exercise
What is the surgical option for FIC management?
Perineal Urethrostomy (PU) -reroutes the urethra, bypassing the penile urethra, in a way that it becomes wider
Pros of Perineal Urethrostomy Sx
decreased chance for obstruction
