MAX FIC Flashcards
if we have a dysuric cat with unproductive straining, what test should we run?
> Emergency bloodwork
* Packed cell volume
* Total solids
* Glucose
* Lactate
* Electrolytes
* Blood smear evaluation
* +/-iCa, Urea and Creat
> Blood pressure
Patient Triage of Dysuric Cats
- important questions to ask, tests to answer these?
- How stable is the cat?
- Is it potentially obstructed?
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* Physical examination (if patient stable)
> Hydration status, etc.
* If unproductive straining (potential obstruction)
> Emergency bloodwork
> blood pressure
* Point of Care Ultrasound (POCUS)
> Free fluid in the abdomen?
> Bladder size?
with dysuric cat ultrasound, we see a bladder. does this rule out a tear?
presence of bladder DOES NOT rule out a tear
Feline Urologic Syndrome “Feline idiopathic cystitis”
- clinical signs
Lower urinary tract clinical signs
* Pollakiuria
* Stranguria
* Hematuria
* +/- stranguria
Feline Urologic Syndrome “Feline idiopathic cystitis”
- how common?
4-10% of all feline admissions
Feline Urologic Syndrome “Feline idiopathic cystitis”
- what kind of obstructions can we see?
Partial or complete urethral obstruction
* 65-90%: Urethral plug & urethral spasm
* 10-35%: Stones
* Rare: Strictures, urethral trauma, blood clots, neoplasia
« Stress » or « Idiopathic » Cystitis Pathogenesis?
- Neurohumoral theory
- Imbalance between sympathetic nervous system
and hypothalamic-pituitary-adrenal axis - Impaired blood flow and release of inflammatory mediators
- Causing edema, smooth muscle spasm, and pain within the lower urinary tract
- Urethral smooth muscle dysfunction and urethral inflammation
Predispostion for Feline Urologic Syndrome
- Young male cats (obstruction)
- Overweight cats
- Inactivity
- 2-6 year old
- Dry food; less digestible; high Mg content * Pedigreed ?
- Longhair cat ?
- Multicat households ?
Feline Urologic Syndrome “Feline idiopathic cystitis”
- Major Complaints and Clinical Signs for partial or no obstruction vs complete obstruction
Partial or no obstruction:
* Urinary signs
* Still U+
* No systemic signs
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Complete Obstruction:
* Urinary signs and systemic signs (anorexia, lethargy, vomiting)
* Unproductive straining
* Big bladder
* +/- Fractious cat
* No urination for >12 hours
Feline Urologic Syndrome “Feline idiopathic cystitis”
- Diagnostic tests for partial or no obstruction vs complete obstruction
Partial or no obstruction:
* Urinalysis
* Point of care ultrasound
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Complete Obstruction:
* Blood work
* Urinalysis +/- culture
* Point of care ultrasound
* Radiographs
Feline Urologic Syndrome “Feline idiopathic cystitis”
- how often do we find the cause?
No cause found in 54-79% cats
CASE:
Max, 5 y old DLH
Pollakiuria, hematuria, straining
*Normal energy
*Good appetite, no vomiting
*Normal vitals
*BCS 7/9
*Bladder not palpable
*Soft abdomen
*Purring in arms
*POCUS: small bladder, no free fluid
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* Stable
*Normal energy
*No systemic signs
*Productive straining
*Bladder not palpable
*No obstruction
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What can we do?
- Pollakiuric++++
> Collection of urine impossible - Oral buprenorphine
- No antibiotics
- Monitoring at home
“Feline idiopathic cystitis”
Management of Unobstructed Cat
- how many cases resolve? how fast?
- what is the usual therapy?
Resolution of clinical signs within 2 to 3 days in 85% cats spontaneously
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Analgesic therapy
* Oral buprenorphine or
* Butorphanol or
* Fentanyl patch
* NSAIDS (questionable)
> NSAID can be bad for kidneys
“Feline idiopathic cystitis”
Environment Alterations
- “MEMO “ : Multimodal Environmental MOdification
- Obtaining a thorough environmental history
- Several litter boxes
- Increase water consumption
> several sources of fresh water, automatic dispensers, broth
“Feline idiopathic cystitis”
- diet
- Canned diet - wet food better than dry
- Hill’s® Diet® c/d® Multicare Urinary
- Royal Canin Urinary S/O calm
- Weight loss program
“Feline idiopathic cystitis”
- pheromone options
- Feliway reduces anxiety of cats * Spray and room diffusers
Medical Management Idiopathic Cystitis? how fast do they work?
Numerous agents tried (see Textbook for doses)
* Antibiotics, tranquilizers, anticholinergics, antispasmodics, anti-
inflammatory drugs tried for idiopathic cystitis in cats
* No controlled studies
* More recently glycosamminoglycans, amitriptyline, NSAIDs
* Antispasmodics: propantheline and oxybutynin
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* Can take longer than 1 week to see improvement
* If fails, drug should be tapered over 1 to 2 weeks
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> 70% cats with idiopathic cystitis responded to placebo treatments
idiopathic cystitis response to placebo
> 70% cats with idiopathic cystitis responded to placebo treatments
Prognosis
Non-obstructed idiopathic cystitis
- Fair to good
- Rarely life threatening
Management of Obstructed Cat idiopathic cystitis
- Hospitalisation
- Analgesia
> Full opioid (methadone), maropitant
> NSAIDs should be avoided at presentation (acute) - Fluid therapy
> Restoration of renal perfusion
> Dilute plasma potassium - Monitor electrolytes and renal profile
- Priority: stabilise and anesthetize patient
> Urinary catheterization
> Soft 3.5 to 5F catheter, strict aseptic technique
should we take radiographs for obstructed idiopathic cystitis?
TAKE RADIOGRAPHS
Could be obstructed with a stone!!
ultrasound use for idiopathic cystitis
- Evaluation of thickness of bladder wall and contours
- Detection of uroliths or mass?
- Major limitations
> Inability to evaluate distal urethra
does successful catheterization rule out urethroliths?
- Successful catheterization DOES NOT rule out urethroliths!!!
- → possible reobstruction after catheter removal if not checked
Contrast Urethrography
- how do we do it? what is its use?
- Contrast instilled with enough pressure in the catheter
- +/- double contrast cystogram
> Stones?
> Soft tissue lesions? - Only contrast urography and rectal exam can evaluate the distal 2/3 of the urethra
idiopathic cystitis
Urinalysis and Urine Culture? when do we do them? why?
Urinalysis:
* Recommended in all cats if possible
* Crystals?
* Signs of infection?
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Urine culture:
* Infection = rare, except in all cats or when multiple recent catheterization
Decompressive cystocentesis prior to catheter placement?
Decompressive cystocentesis advantages
- Allows immediate relief of pressure within the urinary tract
- More rapid resolution of glomerular filtration rate
- Increased comfort
- Minimal sedation
- Uncontaminated urine for tests
- ↓back pressure against the obstruction→ facilitates catheterization
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Best: cystocentesis on sedated or anesthetized patient
Decompressive cystocentesis prior to catheter placement?
disadvantages
- Risk of tearing or rupturing the bladder
- Distended bladder
> More friable
> Greater risk of uroabdomen or hemoabdomen
> Vagovagal collapse (can be fatal)
→Sedation or anesthesia required + 2 people to do cysto
Decompressive cystocentesis or no? when to do it?
- If catheterization not possible
- If money constraint and alternative to euthanasia
- Warn owners about the risks
<><> - Uroabdomen less than ideal BUT preferable to ongoing obstruction and hyperkaliemia in a cat that is unable to be catheterized
