Lower Urinary Tract ER

Question 1

Discuss common emergencies of the lower urinary tract in dogs and cats

Answer 1

Dogs: UTI’s, stones, mass/cancer

Cats: Idiopathic cystitis -> mucus plug, Stones, mass/cancer

Question 2

Review how to recognize lower urinary tract disease from a history

Answer 2

Both obstructed and unobstructed will show signs of irritation/inflammation of the bladder such as pollakiuria, stranguria, dysuria, accidents, hematuria/pyuria

Question 3

discuss diagnostics commonly needed for LUT

Answer 3

Imaging (rads/AUS) is typically the most helpful but a urine culture and/or BW are also helpful

Question 4

treatments for most common LUT disorders

Question 5

do cats commonly get UTI’s?

Answer 5

No, if they do its usually secondary to something else like CKD or diabetes

Question 6

what history would make you suspect obstructed LUT over non obstructed?

Answer 6

Systemic disease -> polyuria, systemic malaise, incontinence/dribbling of urine

Question 7

PE of LUT animal

Answer 7

• small firm bladder for UTI, stones, idiopathic cystitis, tumor
• large firm bladder for obstruction or tumor
• pain on bladder palpation
• irritation of penis/prepuce
• anatomical abnormalities
• rectal with enlarged prostate/thickened urethra

Question 8

__ and __ are common findings/factors when stabilizing a LUT patient

Answer 8

hypovolemia and hyperkalemia

Question 9

main steps of stabilization for LUT ER animal

Answer 9

1. IV catheter (collect blood)
2. Fluids (don’t stress give isotonic crystalloids)
3. Hyperkalemia therapy (calcium gluconate for electrical activity and then drive potassium into cells with insulin, dextrose, or bicarb)
4. Pain management/sedation (CV sparing: opioids, benzos, ketamine)
5. Unblocking

Question 10

Once you get a cat unblocked, what are the next steps?

Answer 10

1. attach a collection system and quantify the urine output (normal is 1-2ml/kg/hr)
2. recheck potassium
3. post obstructive polyuria -> keep up with patient losses
4. remove u-cath on case by case basis

Question 11

UTI treatment

Answer 11

amoxicillin for 3-5 days

Question 12

FIC treatment

Answer 12

its caused by stress so most just need time and maybe some pain and/or anxiety meds

Question 13

stones treatment

Answer 13

fastest tx is cystotomy or lithotripsy

slowest tx is dissolution diet

Question 14

uroabdomen tx

Answer 14

often needs surgical tx and is more common in male dogs from trauma.

1. drain the urine with peritoneal catheter
2. place urinary catheter
3. small tears may heal w/out sx (3 days)
4. surgery needed for major tears or rupture of a ureter

Question 15

uroabdomen dx

Answer 15

compare the peripheral creatinine and/or potassium to the effusion -> if abd K+ in effusion is 40% higher its uroabdomen or if abd creatinine in effusion is twice the concentration as peripheral blood -> uroabdomen

Question 16

T/F: you can use BUN to diagnose uroabdomen

Answer 16

F