Lower urinary emergencies (Allen) Flashcards
1
Q
Three common emergencies
A
- Blocked cat
- urethral obstruction in a dog
- uroabdomen
2
Q
Common causes
A
- uroliths
- FIC
- urethral stricture
- neoplasia
3
Q
hypothermia, bradycardia
A
probs hyperkalemic too
-spiked P waves on EKG
4
Q
Why do blocked cats die?
A
- hyperkalemia
- hypovolemia
- metabolic acidosis
5
Q
Initial tests blocked cat
A
IV cath
electrolytes
renal values
6
Q
less acidosis with what fluid
A
LRS
7
Q
Cold cats
A
peripheral alpha 2 receptors don’t respond
-BP won’t rise unless warm
8
Q
Signs of trouble
A
- hyperkalemia (> 7.5 - 8 mmol/L)
- dull mentation or recumbency
- hypothermia
- bradycardia
- EKG changes
- bradycardia
- absent p waves
- large T waves
- sine wave appearance - this thing has K of 9 and gonna die
9
Q
drugs that lower K
test question
A
- Insulin
- Sodium bicarb
- Terbutaline
*Calcium gluconate does not change K
10
Q
treating hyperkalemia
A
- fluid, fluid, fluid
- calcium gluconate: 1 ml/kg
- dextrose: 1 ml/kg (dilute 1:3 to avoid raging phlebitis)
- Insulin with dextrose (1 unit with dextrose)
- sodium bicarb (1mcg/kg = 1 ml/kg)
- Terbutaline (0.01 mg/kg) - shifts Na for K
11
Q
hyperkalemia tx
- isotonic crystalloids
- dextrose and insulin
- albuterol or terbutaline
- sodium bicarb
- Establishment of urine output
A
- isotonic crystalloids
- MOA: dilution
- onset: immediate
- complication: volume overload
- dextrose and insulin
- MOA: shifts K intracelularly with glucose
- onset: 20 min
- complication: hypoglycemia
- albuterol or terbutaline
- MOA: stimulates Na, K atpase pump
- onset: 30 min
- complications: tachycardia
- sodium bicarb
- MOA: exchange for H
- onset: 30 min
- complications: paradoxical CNS acidosis
- establishment of urine out
- MOA: excretion
- onset: immediately
- complications: bladder rupture, urethral tear
12
Q
Sedation options
A
- Stable
- ketamine/midazolam/buprenorphine
- not intubated
- Midazolam/buprenorphine/propofol/inhalent
- intubated
- avoid ketamine if murmers
- ketamine/midazolam/buprenorphine
- Sick
- no sedation
- Sacrococcygeal block
- Benzodiazepine/buprenorphine alone
- if more sedation required consider a low dose of opioids or ketamine
13
Q
Unblocking
A
- Open ended tom cat catheter
- extrude penis then pull prepuce over cather to straighten S shape
- If resistance
- flush while passing
- gently twist
- gently apply pressure to bladder while passing and flushing
- empty bladder
- flush while removing cath
- replace with red rubber/slippery sam cath
- suture to skin surrounding prepuce
14
Q
Post unblocking care
A
- Analgesia
- buprenorphine: 0.01-0.02 mg/kg q6-8
- NO NSAIDS
- u cath care q6h
- hourly urine for first few hours
15
Q
Fluids after unblocking
A
- sometime needs lots of fluids
- If no/little urine output then trouble shoot cath
- if ok try fluid bolus 50-100 mls
- Until blodwork returns exceed outs with ins
- May need more than 60ml/hr
16
Q
Post obstructive diuresis
A
- Medullary washout
- osmotic diuresis
- pressure necrosis
- ADH resistance
- watch for hypokalemia
17
Q
fluids post blocking (24-36 hours)
A
- Once bloodwork normal
- slowly taper fluids
- leave catheter in place 24-48 hours min
- u cath care q6hrs
- e-collar
18
Q
Other workup
A
- abdominal imaging
- usually rads
- older cats
- Urine C/S
- UA for crystals
- Routine bloodwork
19
Q
which cases are surgical?
A
- Repeat offenders
- PU surgery
- If there are stones
- retropulse to bladder then cysto
- If you can’t unblock them
- temporary cystostomy tube
- surgical
- percutaneous
- cystocentesis
- risk of leakage/rupture
- emergency PU
- temporary cystostomy tube
20
Q
To go home
A
- Address underlying prob
- FIC
- inc water intake
- less stress
- feliway
- antidepressants
- Urinary crystals
- urinary diets
- Urethral spasm
- Prazosin: 0.5mg/cat BID
- FIC
21
Q
Urinary obstruction
Canine
A
- HX
- inappropriate urination in house
- straining to defecate
- constipated
- vomiting
- leathargy
- genital licking
- Signalment
- midlle-aged to older (2-10)
- no sex predilection: males get UO more
- Breed
- mini schnauzer
- yorkie
- dalmation
- english bulldog
- black russian terrier
22
Q
Shunts like to get
A
stones
-urates
23
Q
PE
Canine urethral obstruction
A
- Tense, painful, large bladder
- Stranguria
- Dehydration
- Palpable stones on rectal
24
Q
Canine UO management
A
- Stabilization similar to FUO, sedate or GenAnes
- Unblock
- polypropylene catheter
- urohydropulsion
- emergent laser lithotripsy
- cystostomy tube
- sx
25
Canine UO management
* Definitive tx
* surgery: open/laparoscopic
* Lithotripsy
* Prognosis
* usually good
* Prevention
* water intake
* diet
26
Uroabdomen
* causes
* bladder rupture
* trauma, overdistension, aggressive bladder palpation, cystocentesis, surgical
* intrapelvic urethral rupture/tear
* trauma, catheter placement
* Urethra rupture
* trauma, iatrogenic
27
Uroabdomen presentation
* Lethargic
* vomiting
* dehydrated
* abdominal distension
* abdominal pain (chemical peritonitis)
* can have
* severe metabolic acidosis
* hyperkalemia
* hypovolemia
28
Uroabdomen diagnosis
* Abdominocentesis
* creatinine 2:1 (abd:blood)
* potassium 1.4:1 (abd:blood)
* cytology
* save for C/S
* urosepsis
29
Uroabdomen treatment
* Stabilize
* fix electrolytes, fluid resuscitate, analgesia
* Drain urine from body cavities
* fenestrated large bore catheter and sterile collection system
* percutaneous trasabdominal drainage catheter
* pigtail catheter
* percutaneous nephrostomy tube in ureteral injury and unstable
30
Uroabdomen
Post stabilization
* Place urinary catheter
* Monitor for AKI
* Contrast study to find leak
* Surgery to repair defect once stable
* Prognosis
* depends on underlying dz, severity of illness, concurrent probs
31
To KNOW
* recognize, triage, stabilize, and treat blocked cats
* hyperkalemia treatment
* troubleshooting empty urine bag
* management of UO in dog
* breeds predisposed to urates
* diagnosis/stabilzation uroabdomen
