Dogs and Cats 19 Flashcards
abnormal urination important history questions
- Any changes to drinking or eating habits
- Passing normal faeces
- Change to frequency or volume of urine
- Straining to toilet urine or faeces
- Urine a normal stream
- Is there an apparent pain
- Any difficulties in urinating
- Does the pet know when it is urinating
- Is there bed wetting -> think urinary incontinence
- Is there any dribbling of urine -> ectopic ureters
- Abnormal colour, blood, smell
- Urinating in abnormal places
- When was this first noticed
- Any changes since first noticed
Abnormal urination what are the 3 main things and how should be able to distinguish
Thorough physical examination and history
After this should be able to distinguish underlying problem
- Incontinence
- Difficulty in urinating
- Behavioural
Dog urinary incontinence what is it and causes
- Loss of voluntary control of micturition, usually observed as involuntary urine leakage Causes of incontinence - Neurologic - Storage dysfunction - Urethral disorders - Anatomic - Retention - Mix of all of the above
Urethral sphincter mechanism incontinence signalment and risk factors
- May affect more than 20% of female dogs
- Middle age to older
- Medium to large breed
Risk factors - Neutering: does the age this is done change the outcome
- Conformational characteristics -> bladder neck position, urethral length, vaginal abnormalities
- Obesity
- Large to medium breed
- Early tail docking
Urethral sphincter mechanism incontinence general history, physical exam findings
History
- Bed wetting
- Urine dribbling - generally more ectopic ureters not really this
- Normal drinking and urinating pattern
- Smell -> urinary incontinence or anal gland
- Excess licking vulval area
Clinical examination
- Usually unremarkable
- Can observe urine scalding, perineal and ventral dermatitis
- Smelly
Urethral sphincter mechanism incontinence diagnosis
1) Urinalysis
○ Specifically checking USG and sediment
§ Could be PU/PD -> due to underlying cause
§ Sediment for UTI -> would expect other clinical signs
○ Collecting the urine
§ Soup ladel work well -> free catch is fine as not doing culture and sensitivity
2) imaging
3) surgery
Urethral sphincter mechanism incontinence treatment an combinations
- As the aetiology is believed to be multifactorial often treatment involves combination of drugs and or surgery
- Normal starting point is to discuss medical options and let the owners decide
- Drugs
○ Most commonly used are oestrogens and sympathomimetic/alpha adrenergic receptor agonists
1. strillbestrol
2. incurin
3. propalin (phenylpropanolamine) - PERFERRED
2) Other drugs
§ Alpha-adrenergic agonist - Sudafed (pseudoephedrine) not so easy to obtain now
§ GnrH agonists and antihistamines - Can be worse in the summer -> some only need to medicate in summer
What drugs used for Urethral sphincter mechanism incontinence, price, how effective and side effects, which is preferred
1) Strilbestrol (Diethylstilbestrol) 1mg tablets
□ Cheap - approx. 30c per tablet
□ Effective in 60-70% of dogs
□ Rare side effect is irreversible bone marrow suppression
2) Incurin (oestriol) 1mg tables
□ Mild price range - approx $1.80 per tablet -> $50 a month
□ Response rates to 82% have been reported
□ At higher dose end, swollen mammary glands and vulva have been noted, plus attractiveness to male dogs
3) Propalin (phenylpropanolamine HCL) - sympathomimetic
□ Liquid - more expensive, a 100ml bottle is approx $100, which lasts a 25kg dog around 6 weeks
□ Response rate of 90% have been reported
□ Can be associated with restlessness and hypertension
□ PREFERRED MEDICATION
Cats inappropriate urination what need to do first, presentation and 2 things need to establish
- The most common urinary problem is inappropriate urination
- The first step is to work out is it urination or spraying?
○ Both socially unacceptable
Presentation - Often urinate in different locations
- Notice blood within the urine
Two things to establish
1. Is the cat well in itself and still passing urine -> if urethral plus is suspected this is an emergency
2. Work out the underlying cause
What are the 5 main causes of inappropriate urination in cats
- Idiopathic -> most common cause
○ Urinalysis is unremarkable expect for blood - Crystalluria -> in Australia mostly struvite crystals
- Infectious -> cystitis - not that common
- Neoplastic - older cats
- Behavioural - stress induced
What are the 4 main things need to do in a case of cat inappropriate urination and what not do
1) Pain relief -> the cats are sore
○ One off injection of meloxicam 0.3mg/kg/sc
- Antibiotics NOT INDICATED
2) Collect urine -> ideally via cystocentesis but often have no urine in their bladder
○ Hospitalise to collect - not always best, or if owners feel that can get urine at home this is a better option
○ Collecting at home
§ Clean dry litter tray with non-absorbent material - polystyrene or a commercial production
§ Once collected must be analysed ASAP
§ Free following urine - not urine absorbed in the litter
3) Urinalysis
○ Result will dictate treatment
○ Further investigation may be required, that treatment can be lifelong and warm signs of a blocked cat as this is an emergency
4) In all cases it is important to encourage drinking - so wet food, water fountains
for kidneys what need to assess in radiograph or ultrasound
- Size (dog kidney: aorta ratio, cat 3.0-4.3cm), shape, margination, echogenicity, echotexture, corticomedullary definition, presence of mineralisation
Renal pelvis dilation when normal, what are some causes and when indication of obstruction in radiograph
- Renal pelvic dilation is seen in clinically normal dogs and cats
- Overlap between normal, diuresis, pyelonephritis, renal insufficiency, obstruction
- Pelvic width >13mm always indicated obstruction
○ Always important to look at in conjugation with blood, history and urinalysis
○ Should follow uretra -> if dilated can follow with ultrasound - NOT NORMAL
renal degeneration how assess on radiograph
- Assess corticomedullary definition
○ Decreased
○ Margins often irregular - Can result in renal mineralisation
Differentials for changes in renal echogenicity during ultrasound and differentiating
- Nothing is specific BUT DOESN’T MATTER FOR THE MANAGEMENT OF THE PATIENT unless ruling in or out neoplasia
○ Only way to find is the fine needle aspirate and biopsy - risk of haemorrhage and as above doesn’t change management - DON’T WORRY ABOUT - Kidney can appear normal sonographically even if diseased
- DIFFERENTIALS
○ Increase cortical echogenicity +/- loss of CM definition
○ Glomerular or interstitial nephritis
○ Acute tubular necrosis
○ Pyelonephritis
○ Leptospirosis
○ End stage renal disease
○ fat cats - especially male -> if everything else is normal put it down to this
assessing ureters using diagnostic imaging what use and how useful
- Excretory urograms on the left -able to see where ureters attach to bladder
- These days if possible do CT -> easier to see where the go within
- Ultrasound -> will see when dilated, also will be able to see waves of peristalsis if trying to work against an obstruction
what urinary calculi what important to assess in radiographs
- Need to include the caudal urethra within abdominal radiograph - can have a urinary calculi within - common place is at the os penis
for bladder on ultrasound what is important to assess and common findings
- For bladder assess
○ Degree of distention, wall thickness, urine echogenicity, presence of mineralisation - calculi, cystitis, neoplasia especially around neck of bladder (urothelial or transition cell carcinoma)
What occurs with caculi in the bladder with patient positioning and therefore how diagnose
Dorsal recumbency - dorsal wall
left lateral recumbency - calculus on left
right lateral recumbency - on the right
CALCULUS HAS MOVED WITH THE POISONING -> how to confirm it is a movable thing (blot clot of calculi) within not a mass
○ Sometimes blood clot is not moveable
excretory urography what need to do for preparation and technique
- ENEMA
- GA
- Catheter
- Survey rads
- Iodine 880mg/kg - need large bolus of contrast
- Rapid injection
- Take rads
what is the main excretory urography technique used to look at the bladder and other for urethra
Vaginourethrocystogram -> Use foley catheter - able to see bladder, vagina and urethra
urethra - urethrogram
what are some common findings seen when ultrasounding the prostate
1) benign prostate hypertrophy
2) protstatic cysts
3) prostatic mineralisation
define dysuria, stranguira, haematuria, cystitis, pollakiruia, urinary incontinence and urolith
- Dysuria – difficulty and pain passing urine
- Stranguria – straining to pass urine
- Haematuria – blood in the urine
- Cystitis – inflammation of the urinary bladder
- Pollakiuria – increased frequency of urination
- Urinary incontinence – inability to control urination
- Urolith = stone
What is FLUTD, what also known as, how common and what is NOT a cause
- Feline lower urinary tract disease
- Group of disease of feline urinary bladder and urethra
- Also known as: Feline urologic syndrome (FUS), Feline idiopathic cystitis (FIC)
- Accounts for 5-10% of feline consultations
FLUTD is not a diagnosis, but a syndrome
What is not a cause - Urinary crystals
○ Common incidental finding
What is hte main cause of FLUTH and other causes (how common and more common in males or females)
- Idiopathic FLUTD (unknown) - most common
Other 33-50% of cases - Bladder stones (uroliths) -> 15-23% of cases, females > males
- Urethral blockage (obstruction) -> 20% of cases, males > females
- Bacterial Urinary tract infection -> 1-5% of cases, rare, unless cats >10 years
- Congenital or acquired urinary abnormalities -> Urethral scar (stricutre) at previous urethral stone
- Urinary tract trauma -> 1-2% of cases
- Urinary cancer (neoplasia) -> 1-2% of cases
- Nerve / spinal disorders (neurological)
Idiopathic FLUTD (iFLUTD) how many cases, when age rare in and likely causes
- Most common cause ○ 55-64% of cases - = Feline idiopathic cystitis - Rare in cats > 10 years of age - Multiple factors likely responsible Causes of iFLUTD - Viral / bacterial infections - Autoimmune - Leaky internal bladder lining ○ Increased permeability -> exposure of bladder wall to urinary toxins -> pain & inflammation - Urinary toxins - Stress - Mast cell mediated inflammation
What are the main risk factors for FLUTD
- Obesity - not using litter tray as much
- Indoor confinement - no going outside to void
- Sedentary lifestyle
- High number of rainy days
- Diet changes - increase stress
- Major public holidays - change to cat routine - stress
- Changes to home population / routine / moving
- Litter tray changes - change in number, not enough
- Inadequate litter trays
- Stress, nervous, fearful, aggressive behaviour
- Multi-cat households
- Historical gastrointestinal disease
- Dry food diets
- Frequent / ad lib feeding
what are some common presentations for FLUDT
- Haematuria
- Stranguria
- Pollakiuria
- Inappropriate urination (periuria)
- Dysuria
- Unable to urinate
- Licking at penis / vulva
- Crying
- Painful
- Hiding
- Anorexia
- Depression
- Reduced interaction
Regardless of causes, cats with FLUTD will manifest with similar signs!
What is the typical signalment and history of a non obstructed FLUTD
○ Young to middle aged
○ Any breed, Persians may be at increased risk
○ Male or female
○ Typically 2 - 6 years of age
§ Rare in cats < 1 year and > 10 years
○ Acute onset, short duration (3-7 days) of LUT signs - self resolve
○ Usually otherwise well
○ Repeat episodes at unpredictable intervals
§ Generally less frequent and severe with age
what is the typical signalment and history for obstructed FLUTD
○ Usually male - longer and more narrow
○ Life threatening emergency
○ Distended painful bladder - unless ruptured
○ Unable to urinate
○ Progress to weakness, vomiting, low heart rates (bradycardia) - hyperkalaemic
○ Coma and death within 2-4 days
What are the 7 main things to do in the work-up for a FLUTD case and why
- Why do we do this? -> CAUSES ARE DIFFERENT AND TREATMENT AND MANAGEMENT IS DIFFERENT
1. History
○ Previous episodes, treatment, response, risk factors
2. Physical examination
3. Urinalysis
○ Urine specific gravity, dipstick, and urine sediment
§ Typically in FLUTD well concentrated, red cells (haematuria), acidic - idiopathic
4. Survey Abdominal imaging
○ Radiographs
○ abdominal ultrasound
5. +/- Urine culture
○ Cats over 10 years or those with white cells (pyuria) or bacteria (bacteriuria)
○ Via cystocentesis for aerobic culture
6. Laboratory testing - if systemically unwell
○ Haematology and biochemistry
○ Coagulation testing - if believe there is bleeding
7. Contrast radiology - rarely done now
with diagnostic imaging to diagnose FLUTD what are the 2 main modalities used and why
1) Radiographs § Need to take the entire peritoneal space - INCLUDE THE MALE URETHRA § To check for uroliths/plugs □ § Be sure to include entire perineum § Only radiopaque uroliths visible 2) Abdominal ultrasound § Useful, non-invasive § Evaluate kidney and bladder □ Kidney § Check for □ Uroliths – radiolucent and radiopaque □ Mass lesions □ Bright (echogenic) urine sediment □ Bladder wall changes - thickness and irregular § Best when bladder distended § Can’t evaluate entire urethra § Don’t usually see ureters
in terms of diagnosing FLUTD how use contrast radiography, what find
○ Contrast cystourethrography § Radiolucent uroliths § Uroliths < 3 mm - cannot see on radiographs normally § Anatomical abnormalities § Neoplasia § Bladder wall thickenings § Mucosal irregularities § Anatomical irregularities □ Vesicoureteral reflux - urine flow retrograde into kidneys □ Vesicourachal diverticulum 1) Positive contrast urethrocystogram 2) double contrast cystogram - filling defects
In a generally well cat with FLUTD how diagnose and 2 main definitive treatments
Therefore if generally well cat
- History, Urinalysis and imaging to ensure no rupture or blockage -> IDIOPATHIC -> go to non-specific treatment
Treatment
1. Biopsy - Cystoscopy - only in females!
○ Visualisation of inflammation and damage
○ Remove of the uroliths or break them down
○ Histopathology
§ Ulceration, oedema, dilated blood vessels, haemorrhage, mast cell infiltration
○ Bacterial culture
2. Surgery
○ Usually not required
§ Not specific
§ Degree of changes not related to clinical severity
what doesn’t work for treating non obstructed FLUTD
○ Prednisolone
○ Chloramphenicol
○ Propantheline
○ SC fluids
○ Intravesicular (into bladder lumen) lidocaine
○ Short term amitriptyline
○ Pentosan polysulfate sodium (Cartrophen)*
What are the 8 things can do in the treatment of non obstructed FLUTD and what not give
1) pain releif
2) relaxants - in MORE SEVERE CASES
3) sedation if anxious
4) anti-anxiety medication - thinking behavioural
5) good hydration - IMPORTANT - keep bladder distended to reduce pain, dilute urine to reduce risk of obstruction
6) diet - C/D
Antibiotics - contraindication UNLESS proven infection
In terms of pain relief for FLUTD what use for how long and what need to ensure
○ 3-5 days
○ Prevent increased intensity of pain perception
○ No EMB trials!
○ Opioids
§ Urethral relaxation
§ Buprenorphine, tramdol, fentanyl patches
○ NSAIDs
§ E.g. Metacam (Meloxicam)
§ Must be hydrated / eating / normal kidney function
§ Reduce inflammation
what relaxants to use in FLUDT and when use
IN MORE SEVERE CASES or recurrence ○ Urethral smooth muscle relaxants § Phenoxybenzamine ○ Urethral skeletal muscle relaxants § Dantrium / prazosin § Care with IV diazapam (hepatoxic)
Anti-anxiety medication what is the main one to use with FLUDT and which other can use, when use and results in
○ Amitriptyline
§ For chronic forms of FLUTD (not acute setting)
□ Consider if > 1 episode
□ Several weeks for effect
§ Anti-depressant
□ Also pain relief, reduce spasm and inflammation
§ SID PO before bed
§ Adverse effects
§ Required monitoring
§ Reduces signs in ~ 60% of cats
○ Analog of feline facial pheromone - feliway
§ Increased grooming and intake in hospitalised cats
§ Trend* towards fewer days of cystitis, less episodes and reduced negative behaviors
Diet therapy in FLUDT treatment what use, what does it do
proven to reduce severity and frequency
○ Increased Omega 3 fatty acid
§ Reduce inflammation
○ High plant based proteins -> Increased urine pH
○ Further increased if high Mg and P diet
§ -> Struvite crystals, plugs, uroliths
○ Diets reformulated in 80’s -> Less plant proteins, Mg, P -> acidic urine -> Less obstructed FLUTD
§ No therapeutic advantage of such diets in cats with non-obstructed FLUTD in the acute setting
§ “Might” reduce the risk of a potential urethral obstruction
□ Vs. Cost, stress, diet change, oxalate stones (not for young, CRD)
○ Salt supplementation - generally not needed to do
§ Increase water intake -> urine output & Ca output in healthy cats
