Is It Incontinent? Flashcards
Panther
Breed: DSH
Age: 6 years
Entire male
Panther’s owner, Mr Scott, has started to work longer hours at a busy legal firm. Mr Scott has noticed that although Panther uses his litter tray, he also persistently urinates up the side of the sofa. Mr Scott has tried shouting at Panther when he catches him in the act, and this appears to have made the problem worse. Panther’s behaviour as he urinates is standing in a rigid position, tail raised upright and quivering, backed up to the surface, squirting a stream of urine. Mr Scott lives in rented accommodation and is concerned that if Panther continues to eliminate around the house, then Panther will have to be re-homed. Panther is kept indoors during the day when Mr Scott is at work,
•Construct a differential diagnosis. Mark your most likely choice with an asterix
•Select appropriate diagnostic tests to distinguish between the things on your differential diagnosis list.
•Develop a management strategy for your most likely differential (including drug choices and advice to the client on long term outcome)
•Construct a differential diagnosis. Mark your most likely choice with an Asterix
–Behavioural * - boredom and anxiety
–Idiopathic cystitis
•Select appropriate diagnostic tests to distinguish between the things on your differential diagnosis list.
–Urinalysis and sediment analysis
•Develop a management strategy for your most likely differential (including drug choices and advice to the client on long term outcome)
–Castration
–Feliway
–Meloxicam
–Let the cat out in the day
–Don’t shout at the cat
–Avoid triggers of seeing other cats outside
–Enzyme cleaner for the sofa
–Don’t feed stray cats or other cats in the communication
–Use foil n the urine target spots
–Provide a kitty urinal – up turned litter tray as somewhere he can go
–Enrichment to prevent boredom e.g. toys.
Ms Thomas and Mr Campbell have owned Inx (3yo DSH neutered male) and Lara (3yo DSH spayed female) since they were kittens. Spike (5yo neutered) arrived in the household 1 month ago, he belonged to a friend who has moved into a flat that does not allow pets. The couple are concerned that the cats do not appear to be getting on. Spike is aggressive towards Inx, and Lara constantly hides in the airing cupboard. The cats have an open litter box in the hallway, however Ms Thomas tells you that she often has to remove faeces from various rooms of the house. Ms Thomas and Mr Campbell are very keen to restore peace in the household before the arrival of their first child in 3 months time. Currently the cats do not have outdoor access as the owners are worried that one of the cats may run away!
•Construct a differential diagnosis. Mark your most likely choice with an asterix
•Select appropriate diagnostic tests to distinguish between the things on your differential diagnosis list.
•Develop a management strategy for your most likely differential (including drug choices and advice to the client on long term outcome)
•Construct a differential diagnosis. Mark your most likely choice with an Asterix
–Behavioural – stress due to change in house, dislikes litter tray
–Change in routine and environment
–Pain
•Select appropriate diagnostic tests to distinguish between the things on your differential diagnosis list.
–General clinical exam to rule out pain
•Develop a management strategy for your most likely differential (including drug choices and advice to the client on long term outcome)
–Allow outside access – eliminate
–Feliway
–More litter trays
–Litter trays should be in less of an open space
–Try different litter box substrate
–Food bowls
–Clean regularly
–See how long it goes on for
–Note: Toxoplasmosis risk in litter tray
Molly
Breed: DSH
Age: 15 years
Spayed female
Molly has stopped using her litter box and defecates and urinates on the floor surrounding the box. Molly’s owner, Mrs Maybury, tells you that the elimination problem started a couple of months ago and has gradually got worse.
•Construct a differential diagnosis. Mark your most likely choice with an asterix
•Select appropriate diagnostic tests to distinguish between the things on your differential diagnosis list.
•Develop a management strategy for your most likely differential (including drug choices and advice to the client on long term outcome)
•Construct a differential diagnosis. Mark your most likely choice with an Asterix
–Arthritis – unable to get in litter box
–She is an old cat which increases the chances of her loosing her bladder tone.
–Obesity
–Behaviour
•Select appropriate diagnostic tests to distinguish between the things on your differential diagnosis list.
–Palpation/manual expression? How easy is this done
–Full clinical exam and joint manipulation
–Radiographs
•Develop a management strategy for your most likely differential (including drug choices and advice to the client on long term outcome)
–Meloxicam for any pain
–May be beneficial to place more litter trays around the house in case she cannot get to the litter tray ‘in time’
–Have litter trays which aren’t do high to get into
–Let her out to urine/defecate
Tumeric ….. #BANTER
Lola
Breed: Glen of Imaal Terrier
Age: 7 years
Spayed female
Mr Stokes has noticed in the morning that when Lola wakes up, the coat around her hind quarters is damp and smells strongly of urine. The skin around her perineum looks raw, and her coat is matted. Lola goes to the toilet normally, but sometimes she doesn’t seem to know she is urinating and “leaves a puddle” where she has been lying.
•Construct a differential diagnosis. Mark your most likely choice with an asterix
•Select appropriate diagnostic tests to distinguish between the things on your differential diagnosis list.
•Develop a management strategy for your most likely differential (including drug choices and advice to the client on long term outcome)
•Construct a differential diagnosis. Mark your most likely choice with an Asterix
–Sphincter mechanism incontinence – urination can occur when lying down due to pressure
–Ectopic ureter – should have been picked up younger
–Secondary infection ascending
•Select appropriate diagnostic tests to distinguish between the things on your differential diagnosis list.
–Full radiographs and contrast, Ultrasound to confirm emptying into bladder
–Uro dynamic testing – test the urethral pressure
•Develop a management strategy for your most likely differential (including drug choices and advice to the client on long term outcome)
Medical treatment - Aims to increase sphincter tone
- Α- adrenergic agonists
- Sympathomimetic – phenylpropanolamine
- Exogenous oestrogens
- Dogs with congenital SMI, not this case, should not be spayed before their first season and shouldn’t be given exogenous oestrogens
- Surgical treatment
- Increasing urethral resistance
- Peri-urethral surgical slings
- Intra- urethral bulking agents
- Increasing bladder neck length – bladder neck reconstruction
Relocating bladder from an intra-pelvic position to an intra-abdominal position – colposuspension – pull bladder forward – stretch urethra – increase urethral tone (lowest risk of complications)
Beafy
Breed: Cairn terrier
Age: 8 years
Entire male
Beafy is owned by Dr Stanley. Beafy is kept shut in the kitchen over night. Dr Stanley tells you that in the mornings the kitchen floor is soaked with urine. Dr Stanley asks for your advice on how to train Beafy to “keep his legs crossed” over night. Dr Stanley has also noticed that Beafy appears to be constantly drinking and is very hungry all the time but is losing weight.
•Construct a differential diagnosis. Mark your most likely choice with an asterix
•Select appropriate diagnostic tests to distinguish between the things on your differential diagnosis list.
•Develop a management strategy for your most likely differential (including drug choices and advice to the client on long term outcome)
•Construct a differential diagnosis. Mark your most likely choice with an Asterix
–Diabetes Mellitus
–Cushings
–CKD
–Behavioural – boredorm
•Select appropriate diagnostic tests to distinguish between the things on your differential diagnosis list.
–Urinalysis – glucose
–Blood – haematology and biochemistry
•Develop a management strategy for your most likely differential (including drug choices and advice to the client on long term outcome)
–Diabetes - insulin
Penny
Breed: Border collie
Age: 15 weeks
Female
Presentation
Penny is owned by the Moss family. Unfortunately, the Moss family are considering re-homing Penny because she keeps eliminating around the house. Mrs Moss says that Penny knows she is urinating.
•Construct a differential diagnosis. Mark your most likely choice with an asterix
•Select appropriate diagnostic tests to distinguish between the things on your differential diagnosis list.
•Develop a management strategy for your most likely differential (including drug choices and advice to the client on long term outcome)
Construct a differential diagnosis. Mark your most likely choice with an Asterix
Inadequate training – behaviour
Urinary incontinence
Ectopic ureters
Select appropriate diagnostic tests to distinguish between the things on your differential diagnosis list.
- Plain and contrast radiograph
- Ultrasound
- Urodynamics
Develop a management strategy for your most likely differential (including drug choices and advice to the client on long term outcome)
•Training needed and strict behaviour/disciplines
Marley
Breed: pure bred silver persian
Age: 6 years
Neutered male
Mrs Burns has owned Marley since he was a kitten. Marley is kept predominantly indoors, although she occasionally takes him out in the garden on a lead. Until last week, Marley has reliably used his litter tray. Marley was found urinating in the bath and there were some red spots in his urine. Mrs Burns also owns a 5 year old female tabby. There are two litter boxes in the house, both are of the enclosed variety.
•Construct a differential diagnosis. Mark your most likely choice with an asterix
•Select appropriate diagnostic tests to distinguish between the things on your differential diagnosis list.
•Develop a management strategy for your most likely differential (including drug choices and advice to the client on long term outcome)
- Construct a differential diagnosis. Mark your most likely choice with an Asterix
- Feline lower urinary tract disease
- Causes of non-obstructive FLUTD:
- N on-obstructive idiopathic cystitis - 65%
- Bladder stones - 15%
- Anatomical defects/cancer/other - 10%
- Behavioural problems - <10%
- Bacterial infection - <2%
- Causes of obstructive FLUTD:
- Obstuctive idiopathic cystitis - 29%
- Urethral plug - 59%
- Bladder stones - 10%
- Bladder stones and bacterial infection – 2%
- Kidney disease, such as nephritis, cystic kidney disease, neoplasia, infection
- Ureter disease
- Select appropriate diagnostic tests to distinguish between the things on your differential diagnosis list.
- Blood test to identify any systemic disease
- Perform urinalysis to detect any abnormalities in urine – e.g. bacteria, crystals, casts, cells
- Imaging to identify any blockages
- Treat any identifiable causes
- Non-obstructive FLUTD is normally self limiting and resolves itself
- Develop a management strategy for your most likely differential (including drug choices and advice to the client on long term outcome)
–Meloxicam – NSAIDs for inflammatory and pain relief.
Kidney diets (can then also use phosphate binders)
Breed: Dachshund
Age: 6 years
Female
Batty has been in your hospital for 4 weeks recovering from surgery for a prolapsed disc. She is able to stand with some assistance but is still “knuckling” on her hind feet when she attempts to walk. She has no anal tone and the nurses have been expressing her bladder four times a day and evacuating her bowels once a day during her hospitalisation. Her owners are very keen to take her home. What advice are you going to give them on her home care?
- Teach the O how to manual express?
- Probably best to leave the dog in the care of the hospital to reduce the risks
- Only vets can enter a cavity so cannot get them to enter the colon
