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Emergency > Urethral obstruction - Cat > Flashcards

Urethral obstruction - Cat Flashcards

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1
Q

______ is most common life threatening complication of UO

A

Hyperkalemia

↑ K ➙ ↓ depolarisation of ❤ ➙ ↓ HR(<140 bpm) & asystole

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2
Q

Urethral obstruction is reported in ____% of all Cats with FLUTD

A

30-60%

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3
Q

Uremia occurs in ____ hours of acute, complete UO

A

24-48​ hr

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4
Q

Etiology of UO?

A
  1. Physical obstruction:
    • mucous plug
    • Urolith
    • Stricture
    • Neoplasia
  2. Mechanical obstruction by:
    • Urethral spasm
    • Edema
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5
Q

Signalment for UO?

A
  • Male Cats are predisposed
    • Rare in females
  • More common in adults
    • Mean age around 4 yr
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6
Q

UO is not seen in female cats.

T/F

A

False

very rarely seen

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7
Q

UO is commonly seen in young cats i.e. <1 yr age.

T/F

A

False

Mostly in adults i.e. ~4 y

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8
Q

Tell about HR and Temperature in a UO Cat?

A

Mostly HR and Temp is ↓

  • HR:
    • Only ~6% have moderate bradycardia i.e 100-140
    • Only ~5% have severe bradycardia i.e. < 100
  • Temp:
    • ~ 50% have normal temp
    • ~ 40% are hypothermic
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9
Q

how long after UO are systemic signs seen such as vomit, anorexia, lethargy ?

A

>24 hr of UO

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10
Q

link of HR & body temp. with Hyperkalemia?

A

combo of <140 bpm HR & < 96.6 F has a 98% predictive value for serum K levels of >8 mEq/L

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11
Q

Diagnostics for UO?

A
  • CBC/Chem/UA
  • Abdominal imaging

Address critical metabolic abnormalities before getting XRAY

Evaluate ECG in any cat with UO

(even if no bradycardia)

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12
Q

CBC/Chem findings in a UO cat?

A
  • CBC:
    • +/- ↑ WBC
  • Chemistry:
    • +/- Azotemia
    • +/- ↑ [P, glucose, K]
    • +/- ↓ [Na, Ca, serum bicarbonate, venous pH]
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13
Q

UA findings in a Cat with UO?

A
  • +/- [RBC, protein, glucose, bacteria, pyuria, casts, crystals]
    • Concurrent bacterial UTI is uncommon
  • Azotemia is pretty common
    • Can be pre-renal, renal or post-renal
  • USG varies
    • Usually > 1.030
    • Can ↓ if prolonged UO
      • Due to concurrent tubular dysfunction
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14
Q

Is Bacterial UTI common in cat with UO?

A

No

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15
Q

USG of urine in a cat with UO?

A
  • Usually > 1.030
    • Can ↓ if prolonged UO
      • Due to concurrent tubular dysfunction
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16
Q

how many AXR views to take in a UO cat?

A

3 views

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17
Q

what does it mean if you see “decreased serosal detail” in AXR?

A

More likely due to ↑ UB permeability

&

less likely UB rupture

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18
Q

Benifits of AUS over AXR for a suspected UO cat?

A
  • Identify small uroliths (more sensitive)
  • Search for MASSES (bladder or urethral)
  • Free fluid
    • If present +/- = Urinary tract rupture
    • Sometimes can see with AXR too
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19
Q

ECG is not necessary to hook in a suspected UO cat.

T/F

A

False

Evaluate ECG in any cat with UO (even if no bradycardia)

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20
Q

ECG findings in a cat with Hyperkalemia?

A
  • Prolonged PR interval
  • ↓ or absent P waves
  • Widened QRS complexes
  • Short QT intervals
  • Tall T waves
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21
Q

1st step in Rx of a UO cat?

A

IV catheter → Fluid therapy immediately

(can & should absolutely begin before unblocking)

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22
Q

if CV collapse, how to do resuscitation?

A

10 ml/kg IV BES over 15 min ➙ check EOR, if not met 10 ml/kg IV BES over 15 min ➙ check EOR, if not met 2.5-5 ml/kg IV HTS over 5 min

**Give HS over >5 min

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23
Q

How to measure EOR?

A
  • check mentation
  • check MM and CRT
  • check RR and HR and BP
  • Check Temp
    *
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24
Q

EOR stands for

A

End point of Resuscitation

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25
Q

EOR

MM & CRT?

A

pink & <2 sec

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26
Q

EOR

HR,RR,BP

A

HR = 180-220

RR=20-40

SBP=>100

MAP=>80-100

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27
Q

which fluid to use for fluid therapy?

A

BES preferred over NS

(LRS, normsol-R,plasmalyte A,pHyLyte)

** SAFE NOT TO USE NS

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28
Q

components of fluid therapy for UO cat?

A
  • Resuscitate if CV collapse until EOR met
  • then maintain dose based on dehydration% + maintainance requirements
29
Q

2nd step after putting IV catheter and fluid therapy?

A

Treat Hyperkalemia if present

30
Q

tell about treatment of hyperkalemia in UO?

A
  • Vast majority have < 6 mmol/L & can be Rx solely ith IVF
  • measures needed if >6 mmol/L and or ECG abnormalities
31
Q

Rx for Hyperkalemia if <6 mmmol/L and no ECG changes?

A

IVF may be sufficient

32
Q

Rx for hyperkalemia if >6 mmol/L & ECG changes?

A
  • Calcium gluconate
    • start with it to buy some time
  • Insulin + Dextrose
    • start with these after calcium gluconate
33
Q

When to use Calcium gluconate in a hyperkalemic cat?

A

if K > 6 mmol/L and/or ECG changes (bradycardia or arrhythmias)

34
Q

Dose of Calcium gluconate(10%)?

A

50-100 mg/kg given slowly IV

0.5-1 ml/kg BW over 10-15 min

~ 3 ml for a cat

** MONITOR ECG while giving it ; DOA ~ 20-30 min

35
Q

which insulin to use in Hyperkalemia treatment?

A

Regular Insulin

36
Q

Dose of Insulin & Dextrose for Hyperkalemia treatment?

A

Insulin 0.2 U/kg IV (or 1 U/Cat) ➙ 50% Dextrose (1 ml/kg) IV diluted 1:10

  • Onset of 2-5 min
  • Dextrose should always be given after insulin to prevent hypoglycemia
    • +/- → add dextrose to IV fluids to create 1.25% solution
37
Q

you can give only Insulin without Dextrose for ↑ K Rx.

T/F

A

False

Dextose must be given post insulin in all cases to avoid hypoglycemia

38
Q

Dose of insulin in hyperkalemia treatment?

A

0.25 U/kg

~1 U for a 5 kg cat

39
Q

Dose of Dextrose in Hyperkalemia cat?

A

Initially, give 50% Dextrose bolus

@ 1 ml/kg (diluted 1:10)

+/- Later, give fluids containing 1.25% dextrose

40
Q

How to make 1.25% dextrose solution with 1 L BES bag?

A

M1V1=M2V2

50% X V1= 1.25% X 1000

V1= 1.25 X1000/50

V1= 25 ml

Discard 25 ml from 1 L BES bag & add 25 ml 50% dextrose in it to make it a 1.25 % solution

41
Q

What to do after resolving Hyperkalemia if present?

A

relieve catherisation & promote diuresis

which is most effective way to Rx hyperkalemia

42
Q

Is anesthesia needed to unblock a cat?

A

Heavy sedation or anesthesia needed

except in compromised patients (in which you cant use anesthesia; such as hyperkalemic cats )

43
Q

Important points regarding Anesthesia/sedation in a blocked cat?

A
  • No other surgical procedures should be undertaken until following resolved:
    • electrolyte abnormalities
    • fluid deficits
    • azotemia
  • Anesthesia or chemical restrain contraindicated if >8 mEq/L of Pottasium
44
Q

How to unblock a cat if you cannot sedate/anesthetize i.e. compromised or hyperkalemic (mostly >8 mEq/L)?

A
  • can do catheterisation with infilteration of 0.5 ml of 2% lidocaine into urethra
    • It becomes desensitized in 2-3 min
  • Sacrococcygeal epidural analegia +/- light IV or IM chemical restrain
45
Q

When to consider indwelling catheters?

A
  • If catheterization to relieve the initial obstruction was difficult
  • Severely ill cats
  • Weak urine stream after relief of obstruction
  • where a large amount of crystalline debris remains in the bladder even after repeated flushing
46
Q

Indwelling urinary catheters are typically left in place for how long?

A

24-72 hours

47
Q

Best initial unblocking catheter?

A

Tomcat catheter/ Polypropylene

  • other options:
    • Olive tipped catherers
    • 20-22 gauge over the needle catherers
      • WITHOUT NEEDLE
48
Q

indwelling catheter options after unblocking?

A
  • Red rubber/poly vinyl
  • Slippery Sams/Polytetrafluoroethylene
  • MILA TomCat / polyurethane

**DON’T USE TOMCAT

49
Q

which size catheter to use?

A

3.5

Higher chances of reobstruction with 5 Fr

50
Q

when to do cystocentesis?

A

Perform ASAP in Cats with VERY LARGE BLADDERs & prior to anesthesia for urethral catheter placement

51
Q

in which cases in PU recommended?

A
  • If recurrent UO despite medical management
  • Urethral strictures or neoplasia
  • Significant penile or urethral trauma
52
Q

5 steps in post-obstructive supportive care?

A
  1. +/- Antibiotiics
  2. Fuids
  3. Analgesics/sedatives
  4. +/- Urethral relaxants/anti-spasmodics
  5. +/- Rx Detrusor atony therapy
53
Q

When do we need Abs in a unblocked cat?

A

Don’t need unless UTI is confirmed based on UC

**Incidence of UTI is low with FLUTD but Cats might develop UTI in association with catheterization

54
Q

when should Urine C/S be done?

A

Recommended to get Urine C/S at catheter removal

OR

Can also get Urine for C/S at 7-10 days post discharge

55
Q

Should we start antibiotics before catheter removal if indicated based on Urine C/S?

A

Recommended to withhold Antibiotics until catheter removal

** Except if sepsis or signs of pyelonephritis

56
Q

when is fluid therapy recommended post unblocked?

A

To resolve any post-obstructive diuresis

57
Q

Define post-obstructive diuresis?

A

urine output >2 ml/kg/hr within 6 hrs after relief of UO

Urine production can be as high as 100-150 ml/hr

  • tailor fluid therapy accordingly
    • Can taper once normal urine production restored
  • Monitor K levels too & supplement it as needed
    • +/- → ↓ K & ↓ Ca
  • May last upto 3.5 days
    • Educate client
58
Q

Best Analgesics post unblocking?

A

Multimodal approach is best i.e. opioid + gabapentin

  • Example:
    • Buprenorphine @ 0.01 mg/kg PO q8h
    • Gabapentin @ 5 mg/kg PO q8h
  • other Options:
    • Buprenorphine
    • CRI fentanyl
    • Acepromazine
      • May also provide urethral relaxation
59
Q

Dose of buprenorphine and gabapentin for analgesia?

A

Buprenorphine

@ 0.01 mg/kg PO q8h

Gabapentin

@ 5 mg/kg PO q8h

60
Q

Why do we use Urethral relaxants/anti-spasmodics and do we use them in all cases?

A

Because Urethral spasm & irritation actually contributes to urethral obstruction

Use is common in post-obstructive period

but we don’t know how much benefit they provide

61
Q

Options for Urethral relaxants/antispasmodics in an unblocked cat?

A
  • Alpha-1 antagonists
    • Acepromazine
    • Phenoxybenzamine
    • Prazosin
  • Diazepam
62
Q

Most commonly used and recommend urethral relaxant/antispasmodic post unblocking?

A

Prazosin

63
Q

GK about Prazosin

taken from PLUMBS

A
  • Alpha-1 blocker
  • may be useful for :
    • adjunctive treatment of CHF
    • systemic hypertension, or pulmonary hypertension in dogs
  • Also used to reduce sympathetic tone to treat functional urethral obstruction in dogs & cats
  • Caution: CKD or preexisting hypotensive conditions
64
Q

Dose of prazosin as an uretheral relaxant in cat?

A

0.25-0.5 mg/cat PO q24h

Typically 7-10 days

Superior to phenoxybenzamine based on studies

65
Q

Prazosin is ____ mg/cat PO q24h

A

0.25-0.5

66
Q

Tell about Detrusor atony post unblocking a cat?

A
  • can occur following bladder overdistension
  • Keep the bladder small by using indwelling catheter or manual expression of bladder during days immediately following relief of UO
    • ONLY IF EXPRESSION IS NOT TOO DIFFICULT & URETHRAL RESISTANCE IS LOW
67
Q

what to monitor“during hospitalisation/while catheter is in” post unblocking?

A
  • Electrolytes & renal values
    • q12-24h
    • following relief
  • Monitor fluid intake & out take
    • to assess for post operative diuresis
68
Q

How often to monitor electrolytes & renal values post unblocking?

A

q12-24h

If no significant improvement within 24 hr , could be possibility of Renal failure or Uroabdomen​

Emergency (9 decks)

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