Obstruction

Question 1

Acute unilateral ureteral obstruction

Answer 1

Clinically silent, potentially transient

Question 2

Acute bilateral ureteral obstruction

Answer 2

Painful, azotemia, oliguria/anuria, severe signs

Question 3

Big kidney/little kidney

Answer 3

Renal asymmetry, pain, azotemia
Little—past unilateral —> fibrotic end-stage
Big—hypertrophied, obstructed (acutely)

Question 4

Bilateral CKD w/ concomitant ureteral obstruction

Answer 4

Most guarded px

Sudden obstruction causes decompensation + promotes onset of overt uremia

Question 5

Best way to dx a ureteral obstruction?

Answer 5

Antegrade pyelography/CT

W/ contrast—less invasive

Question 6

Best way to tx a ureteral obstruction?

Answer 6

Ureteral stents—standard of care
Medical management:
Mannitol if oliguric
Prazosin + amitryptilline (relaxants)

Question 7

How to dx urethral obstruction

Answer 7

Male cat (usually), enlarged bladder, difficult to express, urinary urgency
UPC for px!
Collect urine in EDTA tube

Question 8

How to tx urethral obstruction

Answer 8

HyperK—Ca gluconate (protect heart), insulin + dextrose
Relieve obstruction—retrograde, cath, cysto
Pain + antispasmodics—prazosin/phenoxybenzamine
Stents if mass blocking
Perineal urethrostomy if persistent obstruction/stricture

Question 9

What is the most common infection in non-obstructed LUTD?

Answer 9

E.coli. G+ cocci second most common

Question 10

What route is the most common for an infection?

Answer 10

Ascending

Question 11

How do you tx an uncomplicated infection?

Answer 11

Amoxicillin, cephalosporin

Question 12

How do you tx a complicated infection?

Answer 12

Culture is necessary!

Question 13

What’s a reinfection?

Answer 13

Different bacteria, 7 days after last course

Question 14

What’s a superinfection?

Answer 14

Different bacteria, at the same time (7 days after starting)

Question 15

What’s a relapse?

Answer 15

Same bacteria, 7 days after last course

Question 16

What do you do if there is a relapse infection?

Answer 16

Find the source!

Minimum database, rads, u/s of bladder

Question 17

How do you tx a recurring UTI?

Answer 17

Prophylactic (last resort) 30-50% original dose, nitrofuraotin

Question 18

What do you treat a multiple drug resistant E.coli infection with?

Answer 18

Fosfomycin (monurol)

Question 19

What is Feline Lower Urinary Tract Dz?

Answer 19

Aka feline idiopathic UTD? Idiopathic cystitis?

Question 20

How do you dx feline interstitial cystitis?

Answer 20

CYSTOSCOPY gold standard!

Question 21

What causes FLUTD?

Answer 21

Stress—behavioral

Question 22

How do you tx FLUTD?

Answer 22

Environmental enrichment is the only EBM shown to be beneficial