SA Internal Med

Question 1

Predominant stone types in cats

Answer 1

• Ca Oxalate (most common)
• Struvite

Struvites are sterile in cats, can be dissolved with diet in 2-4 w
CaOx need to be removed surgically

Distinguish with radiographic appearance

Question 2

Surgical options for stone removal in male vs female cats

Answer 2

Male (long and narrow urethra) = cystotomy

Female = voiding urohydropulsion, transurethral lithotripsy

Question 3

How common are stones in the urethra in cats?

Answer 3

10% of cases

Pass catheter (must straighten urethra in male cats) and inject saline/contrast to push the stone in the bladder, then remove surgically

Question 4

Type of Upper UT stone in cats

Answer 4

Ca Oxalate (98% of the time)

Question 5

What is the Little Kidney Big Kidney Syndrome in cats?

Answer 5

A nephrolith obstructs a ureter unilaterally -> kidney shrinks over time. The other kidney gets bigger due to high urine load and if it also becomes obstructed => cat is blocked and hyperkalemic -> emergency

Question 6

Medical management of UUT stones in cats

Answer 6

• diuresis (IVTF, mannitol)
• amitriptyline, alpha blockers (prazosin) -> relax smooth muscle
• analgesia

Not effective in majority of cases

Question 7

Surgical management of UUT stones in cats

Answer 7

• Sub Ureteral Bypass (beware of kinking and UTIs)

- ureteric stent (not done anymore, many complications)

Question 8

biomarkers of Cushings in bloodwork

Answer 8

• stress leukogram
• ALP»ALT
• hypercholesterolemia
• hyperglycemia? cortisol antagonizes insolin

Question 9

Why would you do urinalysis in a dog with suspected Cushings?

Answer 9

66% of cushings dogs have UTIs

Will find high pH (over 8)

Question 10

What is the best treatment option for dogs with AD cushings?

Answer 10

Surgical removal of adrenal

Question 11

What adverse effects can trilostane have?

Answer 11

• treatment failure

- spike in ACTH -> increase adrenal blood flow -> adrenal hemorrhage -> addisons

Question 12

What would you do if a PDH dog is not responding to trilostane treatment?

Answer 12

• consider giving trilostane BID
• hypophysectomy
• bilateral adrenalectomy

Question 13

What is the best way to check for trilostane treatment efficacy?

Answer 13

• blood biomarkers (absence of stress leuko, normal ALP, normal Na and K)
• resolution of clinical signs (PUPD, polyphagia, decreased activity, appearance)