Feline Idiopathic Cystitis & Blocked Cats Flashcards

(51 cards)

1
Q

What is FLUTD and FUS?

A
  • FLUTD = feline lower urinary tract disease
  • FUS = feline urologic syndrome
    + Clinical signs associated with irritative voiding in cats
    *Describes clinical signs, not necessarily the cause
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2
Q

Most common disease, in cats < 10 yr old, presenting with signs of FLUTD

A

1) Idiopathic cystitis
2) Urolithiasis or urethral plug
3) Other = anatomic abnormality, behavioral, UTI (< 1%), neoplasia

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3
Q

Most common disease, in cats > 10 yr old, presenting with signs of FLUTD

A

1) UTI (> 50%)

2) Idiopathic cystitis (5%)

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4
Q

What is feline idiopathic cystitis?

A

Diagnosis of exclusion when FLUTD signs are present and other diagnoses are ruled out

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5
Q

What causes feline idiopathic cystitis?

A

Neurogenic inflammation with vascular leaking = bladder wall edema and RBC diapedesis, brought on by environmental stressors

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6
Q

What is the most common sign associated with feline idiopathic cystitis?

A

Inappropriate elimination

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7
Q

What is the timeline of resolution with FIC?

A

90% will resolve within 5-7 days, with or without therapy

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8
Q

Risk factors for FIC

A
  • Indoor cat
  • Obese
  • Eats dry food
  • Easily stressed or nervous
  • Living in a multi-cat household
  • Decreased water intake
  • Changes in environment
  • Possibly genetics
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9
Q

Pathology behind FIC

A

> Disorder that links the urinary bladder, CNS, adrenal glands, and environmental stressors

  • Damage to either the urothelium or glycoaminocoside layer = allows urine to permeate and irritate the underlying tissue
  • Irritation results in SNS activation = release of inflammatory mediators = neurogenic inflammation
  • Results in further urothelial damage and activates sensory fibers = perpetuates
  • Deficient adrenocortical response = continual activation of hypothal-adrenocortical axis and SNS

*Starts with anything that can activate the SNS

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10
Q

Common signalments with FIC

A
  • Occurs most commonly between 2-7 years old
  • Both males and females
  • Persians are overrepresented
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11
Q

Clinical signs of feline idiopathic cystitis

A
\+ Pollakuria
\+ Inappropriate elimination
\+ Stranguria
\+ Hematuria
\+ Vocalization
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12
Q

Diagnosis of FIC

A

> Diagnosis of exclusion

1) GOOD HISTORY - looking for risk factors
2) PE = small and painful abdomen
3) CBC, chem, imaging, U/A, culture = rule out uroliths, UTI, neoplasia

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13
Q

What do we commonly see in cats with FIC, on urinalysis?

A

> Hematuria and proteinuria

- USG, pH and crystalluria are only mildly helpful

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14
Q

What do we need to remember with refrigeration of urine?

A

Can precipitate out and increase the finding of crystals in samples

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15
Q

When do we culture urine in cats we suspect with FIC? (2)

A

1) < 10 years old, USG < 1.045, and there’s > 5 WBC’s in sediment
2) > 10 years old, USG < 1.045, history of FLUTD

  • Also = if azotemic, has had a perineal urethrostomy or recent catheterization
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16
Q

Who do we perform CBC and chem screenings on? (4)

A
  • Obstructed cats (electrolyte abnormalities)
  • Recurrent FLUTD animals
  • Systemic signs = vomiting, fever, anorexia
  • > 10 years old
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17
Q

What can radiographs see when it comes to uroliths?

A

Radio-opague stones > 3 mm

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18
Q

What advantage does U/S have over radiography with detecting uroliths?

A

Can see both radio-opague and radiolucent stones, masses, anatomic abnormalities, and thickening of the urinary bladder

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19
Q

Is antibiotic therapy indicated in FIC cases?

A

NO

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20
Q

Main treatment for FIC (3)

A

1) Analgesia - treat pain and reduce SNS tone
2) Sedation = help break the SNS cycle
3) Environmental cleaning = so they don’t keep urinating in the same spots
* For 5-7 days

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21
Q

What things do you do to prevent FIC recurrence?

A

1) Litterbox management - have enough spread apart, uncovered, frequently cleaned, different substrates
2) Increase water intake = fountains, canned food, salt the food
3) Decrease conflict - establish safe havens
4) Promote natural behaviors = toys, catnip, environmental enrichment
5) Increase available space - horizontally or vertically
6) Synthetic pheromones
7) Amitryiptyline if MEMO doesn’t work

22
Q

Correlation of FIC recurrence and age

A

FIC decreases in frequency and severity with age

23
Q

How long until urinary obstruction can be damaging to an animal’s health?

24
Q

Where is the most common site of obstruction in cats?

A

Urethra, esp the penile urethra

25
Top three causes for feline uroliths
1) Idiopathic urethral obstruction (general inflammation) 2) Urolithiasis 3) Urethral plugs - Others = increased urethral tone w/ neuro dysfunction, neoplasia, strictures, iatrogenic, etc.
26
Cause of urethral plugs
Thought to be a consequence of FIC = result of inflammation, edema, urethral spasm --> formation from mucoproteins, cellular debris, and embedded minerals *Inflammation and edema, even after urethral plug has been removed = can contribute to obstruction
27
Common signalment of blocked cats
Commonly male cats, present at any age (median = 4.7 yrs)
28
Common clinical signs of blocked cats
``` + Stranguria + Dysuria + Vocalizing + Lethargy and anorexia + Vomiting + Excessive licking of the perineal area ```
29
What does the bladder feel like on palpation in blocked cats?
Full, turgid, painful
30
PE/clinical signs of a ER blocked cat case
``` + Collapse + Shock + Depression + Tachypnea + Bradycardia (due to hyperkalemia) + Weak pulses + Hypothermia due to poor cardiac output ```
31
Chem panel and lyte abnormalities with blocked cats
- Azotemia = high BUN and creatinine (1/3 of cats) - Hyperphosphotemia - Hyperkalemia = muscle weakness, bradycardia - Low serum bicarb = inability to excrete H+ and uremic acids - Hypocalcemia = complexing with P
32
True or false = magnitude of the increases of BUN, creatinine, and phosphorus are prognostic indicators for blocked cats
FALSE - high values can be reduced to normal, even with timely therapy
33
ECG findings of blocked cats (3)
1) Tall, peaked T waves 2) Prolonged PR interval and QRS complexes 3) Decreased amplitude, increased width, to disappearance of P waves (atrial standstill)
34
Diagnostics for blocked cats (5)
- PE = general demeanor, heart rate, bladder size - Chemistry and lyte values - ECG - U/A and urine culture (UTI's unlikely, unless recently catheterized) - AFTER PATIENT HAS STABILIZED = Imaging = radiographs +/- CBC = in older cats, if showing systemic signs
35
What must always occur first with blocked cats?
STABILIZE THE PATIENT - address hypovolemia, acidemia, lyte imbalances, and blockage (anuria or oliguria)
36
Treatment of hyperkalemia
1) IV fluids for diuresis 2) Ca++ gluconate = cardio-protectant (TRANSIENT, only lasts for 1 hour) 3) Decrease K+ levels = insulin+dextrose, bicarbonate
37
When don't we use bicarb in blocked cats?
In hypocalcemic patients = exacerbates the problem
38
Treatment of hypocalcemia
Ca++ gluconate - but rarely necessary
39
Treatment of acidosis
- IV fluids and unobstructing the patient should suffice | - Bicarb in very severely affected patients
40
What may help relieve the obstruction in cats?
Sedation = relax urethra and allow plugs to pass before catheterization, Ex: midazolam and butorphanol
41
What should you do if you palpate a very large bladder in a blocked cat?
Decompressive cystocentesis = pressure release to decrease risk of bladder rupture, decrease back pressure on kidney so they can produce urine
42
What must occur with anesthesia to successfully unblock the cat?
Achieve COMPLETE urethral relaxation = ketamine, midazolam + propofol or inhalant anesthesia
43
How do we physically unblock the cat?
- Have full relaxation - Extrude the penis fully = straighten the sigmoid flexure - Pass a rigid catheter with fluid to try and push the obstruction to the urinary bladder - Pass a soft catheter for long-term bladder drainage and measure volume - Place an E-collar *DO NOT FORCE THE CATHETER AGAINST RESISTANCE
44
Causes for catheter resistance placement (7)
1) Haven't fully extended the penis 2) Urethral plug or urolith obstructing 3) Urethral tear 4) Inadequate relaxation and urethral spasm Less common: 5) Urethral stricture 6) Severe urethritis 7) Extraluminal compression
45
When do we remove urinary catheters? (3)
> For as little time as possible 1) Azotemia resolves 2) Urine is a normal color and consistency 3) After the post-obstructive diuresis has occurred
46
What causes the post-obstructive diuresis?
Occurs secondary to the retention of osmotically active solutes and the relieving of the back pressure on the kidney *Lasts for about as long as the azotemia does
47
Why is monitoring the post-obstructive diuresis important?
If you don't keep up with fluids during that time, it can lead to a life threatening hypovolemia and hypokalemia
48
Things to be monitoring post-obstruction (3)
1) Azotemia 2) Lyte values - esp K+ 3) Urine output
49
Drugs we can use to relax the urethra
Alpha blockers = acepromazone, PRAZOSIN, phenoxybenzamine *AVOID the use of antibiotics, steroids, and NSAID's
50
Complications of blocked cats (7)
1) Persistent urethral obstruction 2) UTI secondary to catheterization 3) Catheter induced trauma (urethral tears) 4) Urethral stricture 5) Bladder rupture 6) Urinary bladder atony and incontinence 7) Kidney injury
51
What do we recommend with cats who chronically re-obstruct?
Perineal urethrostomy surgery