Urethral obstruction - Cat Flashcards
1
Q
______ is most common life threatening complication of UO
A
Hyperkalemia
↑ K ➙ ↓ depolarisation of ❤ ➙ ↓ HR(<140 bpm) & asystole
2
Q
Urethral obstruction is reported in ____% of all Cats with FLUTD
A
30-60%
3
Q
Uremia occurs in ____ hours of acute, complete UO
A
24-48 hr
4
Q
Etiology of UO?
A
-
Physical obstruction:
- mucous plug
- Urolith
- Stricture
- Neoplasia
-
Mechanical obstruction by:
- Urethral spasm
- Edema
5
Q
Signalment for UO?
A
-
Male Cats are predisposed
- Rare in females
- More common in adults
- Mean age around 4 yr
6
Q
UO is not seen in female cats.
T/F
A
False
very rarely seen
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
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
9
Q
how long after UO are systemic signs seen such as vomit, anorexia, lethargy ?
A
>24 hr of UO
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
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)
12
Q
CBC/Chem findings in a UO cat?
A
-
CBC:
- +/- ↑ WBC
-
Chemistry:
- +/- Azotemia
- +/- ↑ [P, glucose, K]
- +/- ↓ [Na, Ca, serum bicarbonate, venous pH]
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
14
Q
Is Bacterial UTI common in cat with UO?
A
No
15
Q
USG of urine in a cat with UO?
A
- Usually > 1.030
- Can ↓ if prolonged UO
- Due to concurrent tubular dysfunction
- Can ↓ if prolonged UO
16
Q
how many AXR views to take in a UO cat?
A
3 views
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
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
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)
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
21
Q
1st step in Rx of a UO cat? Choose from below options
A. IV catheter and IV fluids
B. Unblock
A
IV catheter → Fluid therapy immediately
(can & should absolutely begin before unblocking)
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
23
Q
How to measure EOR?
A
- check mentation
- check MM and CRT
- check RR and HR and BP
- Check Temp
*
24
Q
EOR stands for
A
End point of Resuscitation
25
EOR
MM & CRT?
pink & \<2 sec
26
EOR
HR,RR,BP
HR = 180-220
RR=20-40
SBP=\>100
MAP=\>80-100
27
which fluid to use for fluid therapy?
**BES preferred over NS**
(**LRS, normsol-R,plasmalyte A,pHyLyte**)
\*\* SAFE NOT TO USE NS
28
components of fluid therapy for UO cat?
* Resuscitate if CV collapse until EOR met
* then maintain dose based on dehydration% + maintainance requirements
29
2nd step after putting IV catheter and fluid therapy?
Treat Hyperkalemia if present
30
tell about treatment of hyperkalemia in UO?
* Vast majority have \< 6 mmol/L & can be Rx solely ith IVF
* measures needed if \>6 mmol/L and or ECG abnormalities
31
Rx for Hyperkalemia if \<6 mmmol/L and no ECG changes?
IVF may be sufficient
32
Rx for hyperkalemia if \>6 mmol/L & ECG changes?
* Calcium gluconate
* start with it to buy some time
* Insulin + Dextrose
* start with these after calcium gluconate
33
When to use Calcium gluconate in a hyperkalemic cat?
if K \> 6 mmol/L and/or ECG changes (bradycardia or arrhythmias)
34
Dose of Calcium gluconate(10%)?
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
which insulin to use in Hyperkalemia treatment?
**Regular** Insulin
36
Dose of **Insulin** & **Dextrose** for Hyperkalemia treatment?
**Insulin 0.25 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
you can give only Insulin without Dextrose for ↑ K Rx.
T/F
**False**
Dextose must be given post insulin in all cases to avoid hypoglycemia
38
Dose of insulin in hyperkalemia treatment?
**0.25 U/kg**
~1 U for a 5 kg cat
39
Dose of Dextrose in Hyperkalemia cat?
Initially, give 50% Dextrose bolus
@ **1 ml/kg** (diluted 1:10)
+/- Later, give fluids containing **1.25% dextrose**
40
How to make 1.25% dextrose solution with 1 L BES bag?
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
What to do after resolving Hyperkalemia if present?
**relieve catherisation & promote diuresis**
which is most effective way to Rx hyperkalemia
42
Is anesthesia needed to unblock a cat?
**Heavy sedation or anesthesia** needed
except in compromised patients (in which you cant use anesthesia; such as hyperkalemic cats )
43
Important points regarding Anesthesia/sedation in a blocked cat?
* 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
How to unblock a cat if you cannot sedate/anesthetize i.e. compromised or hyperkalemic (mostly \>8 mEq/L)?
* 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
When to consider indwelling catheters?
* 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
Indwelling urinary catheters are typically left in place for how long?
**24-72 hours**
47
Best initial unblocking catheter?
**Tomcat** catheter/ Polypropylene
* other options:
* Olive tipped catherers
* **20-22** gauge over the needle catherers
* WITHOUT NEEDLE
48
indwelling catheter options after unblocking?
* **Red rubber**/poly vinyl
* **Slippery Sams**/Polytetrafluoroethylene
* **MILA TomCat** / polyurethane
***\*\*DON’T USE TOMCAT***
49
which size catheter to use?
**3.5**
Higher chances of reobstruction with 5 Fr
50
when to do cystocentesis?
Perform ASAP in Cats with VERY LARGE BLADDERs & prior to anesthesia for urethral catheter placement
51
in which cases in PU recommended?
* If **recurrent UO** despite medical management
* Urethral **strictures or neoplasia**
* **Significant** penile or urethral **trauma**
52
5 steps in post-obstructive supportive care?
1. +/- Antibiotiics
2. Fuids
3. Analgesics/sedatives
4. +/- Urethral relaxants/anti-spasmodics
5. +/- Rx Detrusor atony therapy
53
When do we need Abs in a unblocked cat?
**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
when should Urine C/S be done?
Recommended to get Urine C/S **at catheter removal**
OR
Can also get Urine for C/S at **7-10 days post discharge**
55
Should we start antibiotics before catheter removal if indicated based on Urine C/S?
Recommended to withhold Antibiotics until catheter removal
\*\* Except if **sepsis** or signs of **pyelonephritis**
56
when is fluid therapy recommended post unblocked?
To resolve any **post-obstructive diuresis**
57
Define **post-obstructive diuresis**?
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
Best Analgesics post unblocking?
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
Dose of buprenorphine and gabapentin for analgesia?
Buprenorphine
@ **0.01** mg/kg PO q8h
Gabapentin
@ **5** mg/kg PO q8h
60
Why do we use **Urethral relaxants/anti-spasmodics** and do we use them in all cases?
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
Options for Urethral relaxants/antispasmodics in an unblocked cat?
* Alpha-1 antagonists
* Acepromazine
* Phenoxybenzamine
* Prazosin
* Diazepam
62
Most commonly used and recommend urethral relaxant/antispasmodic post unblocking?
**Prazosin**
63
GK about Prazosin
taken from PLUMBS
* 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
Dose of **prazosin** as an uretheral relaxant in cat?
**0.25-0.5** mg/cat PO q24h
Typically **7-10 days**
*Superior to phenoxybenzamine based on studies*
65
Prazosin is ____ mg/cat PO q24h
**0.25-0.5**
66
Tell about **_Detrusor atony_** post unblocking a cat?
* 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
what to **monitor**"_during hospitalisation/while catheter is in_" post unblocking?
* **Electrolytes & renal values**
* **q12-24h**
* following relief
* **Monitor fluid intake & out take**
* to assess for post operative diuresis
68
How often to monitor electrolytes & renal values post unblocking?
**q12-24h**
If no significant improvement within 24 hr , could be possibility of **_Renal failure or Uroabdomen_**
