Urinary3- Lower UT Dz

  1. Causes of LUT inflammation. (5)
    bacterial, fungal, chemical, obstructive idiopathic, non-obstructive idiopathic
  2. Idiopathic cystitis occurs in __________; granulomatous urethritis occurs in __________.
    cats; dogs
  3. What is the purpose of GAGs in the bladder, and why are decreased GAGs thought to be a cause of FIC?
    GAG layer is the protective substance that prevents urine from burning/scalding the bladder mucosa; decreased GAG layer will cause inflammation/irritation
  4. What short phrase can sum up susceptibility to FIC?
    sensitive cat in a provocative environment
  5. Alterations in the sympathetic NS normally lead to _________ effects; in FIC cats, there is stress-induced release of __________, restraining __________ synthesis, release, and re-uptake.
    analgesic; cortisol; catecholamine
  6. With chronic stress/stimulation, alpha and beta receptors __________.
    down-regulate/ decrease their numbers
  7. Chronic stress leads to __(3)__ in FIC cats.
    smaller adrenal glands, decreased response to ACTH, down-regulation of HPA axis
  8. Chronic stress leads to increased _______ production in the brain, leading to increased _________ and decreased _________.
    norepinephrine; sympathetic flow; alpha2 sensitivity
  9. What will you see on cystoscopy of an FIC cat? (3)
    friable GAG layer, glomerulations (bleeding spots), increased vascularity
  10. How did the stress response become altered in FIC cats? (2)
    genetics (breed, familial), epigenetics (environment/stress during pre/post-natal environment, maternal stress)
  11. Pandora syndrome is an abnormal development of the ___________; _____ is just one of the chronic systemic manifestations.
    stress response system; FIC
  12. 3 components of FIC.
    neurogenic inflammation and pain syndrome, dysregulation of the SRS, organ-specific manifestation of a systemic disorder
  13. ____________ WAS NOT found to be associated with increased risk for FIC.
  14. UTI may play more of a role in FIC in _______ cats.
  15. Why might it seen like atb help to alleviate FIC, when it really does not?
    FIC flare-ups resolve in 7-10 days on its own
  16. What 3 concurrent diseases increase the incidence of bacteruria in older cats?
    CKD, DM, hyperthyroidism
  17. Clinical signs of FIC. (6)
    periuria (peeing outside the box), hematuria, pollakiuria, stranguria, dysuria, painful urination
  18. What is the classic presentation for a cat with FIC? (6)
    indoor cat, obese, dry diet, multiple-cat household, sedentary, 2-7 years old
  19. What are common UA findings with FIC? (4)
    • USG> 1.035
    • +/- hematuria
    • +/- crystals
    • pH usually <7
  20. Therapeutic strategy for FIC. (10)
    client education, litter box management, stress reduction (activity, feliway, "safe zones", increased resource opportunities), diet changes (wet food, gradual changes), increase water intake (fountains, faucets), MAYBE medical therapy
  21. Why is wet food beneficial for cats with FIC? (3)
    dilutes urine, increases urination and flushing bladder, decreased crystals
  22. What is the target USG in cats with FIC?
  23. Why should you avoid medical therapy in FIC cats, if at all possible?
    medicating a cat will stress it out, and probably precipitate a flare up
  24. Do steroids/NSAIDs help cats with FIC?
    no evidence of efficacy
  25. What are some antidepressants you can give to cats with FIC?
    FLuoxetine, Amitriptyline, Clomipramine (must have a loading period; if you have to stop it, TAPER IT SLOWLY)
  26. Do we need to further acidify diets for cats with FIC?
    no- excessive acidification is more irritating, calciuresis, stones/crystals
  27. What is the prognosis for FIC?
    without changes, 65% of cats with FIC will recur in 1-2yrs; 36-43% re-obstruction rate in blocked males
  28. Granulomatous urethritis in dogs is ______________ inflammation; it may be associated with ________ and can be _________.
    lymphoplasmacytic; chronic UTI; obstructive
  29. With granulomatous urethritis in dogs, there will be a(n) __(2)__ appearance to the urethra.
    erosive and nodular
  30. Granulomatous urethritis in dogs is diagnosed by ________.
  31. Granulomatous urethritis in dogs is treated with... (2)
    immunosuppressive dose of steroids, cyclophosphamide
  32. Underlying causes of urethral obstruction in dogs. (5-in order)
    urethral calculi, neoplasia, prostatic disease, lower urinary tract trauma, stricture
  33. Underlying causes of urethral obstruction in cats. (4-in order)
    idiopathic cystitis, urethral calculi, stricture, neoplasia
  34. Obstruction starting in the bladder/urethra pathophysiology.
    pressure necrosis--> mucosal injury--> muscle/neurologic injury, neurogenic inflammation
  35. Obstruction starting in the renal tubule pathophysiology.
    pressure transmitted through tubule to Bowman's space--> diminished GFR as pressure exceeds RPP--> pressure necrosis to tubular epithelium--> loss of conc ability
  36. 3 main consequences of obstruction.
    uremia, hyperkalemia, metabolic acidosis
  37. Adverse affects of uremia on the body. (6)
    direct CNS consequences- mental depression, malaise; activation of CRTZ- nausea, vomiting, anorexia; direct injury to intestinal mucosa- ulceration
  38. Effects of hyperkalemia on the heart. (7)
    slow, diminished depolarization; rapid, robust repolarization;BRADYCARDIA; spiked T waves, prolonged P-R interval, diminished P waves, widened QR
  39. Factors other than K+ that contribute to ECG changes. (5)
    patient, acute vs chronic, acid-base status, Ca2+ levels, Mg2+ levels
  40. Effects of acidemia on the body. (8)
    protein denature, enzymes deactivate, diminished catecholamine function, cardiac arrhythmias, loss of CNS osmotic gradients, impaired depolarization, mental alteration, muscle weakness
  41. Bradycardia leads to... (2)
    decreased cardiac output and mean arterial pressure.
  42. Hyperkalemia causes __________ [vessels]; acidosis decreases sensitivity to ____________, which are __________[in vessels]; GI signs of obstruction lead to __(2)__; the end result is __(2)__.
    vasodilation; catecholamines; vasoconstrictive; dehydration and hypovolemia; hypotension and cardiovascular collapse
  43. Common components of the history associated with obstruction. (9)
    stranguria, pollakiuria, hematuria, lethargy, anorexia, vomiting, painful/distended abdomen, recumbency, mentation change
  44. Obstruction is much more common in ________[sex].
  45. What may you find on physical exam of a patient with urinary obstruction? (6)
    tachy/bradycardia (depending on how far along in the process they are- tachy early, brady-late), hypothermia, dehydration, firm/distended bladder, prostatomegaly, urethral calculus on rectal or at base of os penis [dogs]
  46. What CBC changes are associated with obstruction? (1)
    PCV increased due to hemoconcentration
  47. What biochem and blood gas changes are associated with obstruction? (6)
    hyperkalemia, azotemia, metabolic acidosis, hyperphosphatemia, hypocalcemia, hyperglycemia
  48. Initial/immediate treatment of obstruction. (4)
    IV fluids- doesn't matter which kind if adequate amount is given and obstruction is relieved, calcium gluconate (cardioprotective- monitor ECG during), insulin/dextrose (push K+ into cells), bicarb (push K+ into cells)
  49. How does calcium gluconate serve cardioprotective purposes?
    raises threshold potential to re-establish rate of depolarization (DOES NOT EFFECT K+ LEVELS)
  50. Insulin drives K+ into intracellular space by activation of _________.
    NaKATPase pump
  51. How long does it take exogenous insulin to lower the K+ serum conc?
    15-30 min
  52. What are the benefits of giving bicarb to treat obstruction? (2)
    drive K+ into cells, treat metabolic acidosis
  53. What are the adverse effects of giving bicarb to treat obstruction? (3)
    sodium retention, volume overload, decreases iCa2+ from increased binding to albumin
  54. Under what conditions should you give calcium gluconate to treat obstruction?
    significant bradycardia, ECG changes
  55. Under what conditions should you give insulin/dextrose to treat obstruction?
    K+> 8mmol/L
  56. Under what conditions should you give sodium bicarb to treat obstruction?
    K+> 10mmol/L, pH< 7.1
  57. How can you decompress an obstructed patient?
    cystocentesis (immediate decompression), urethral catheterization (long-term until unblocked)
  58. What is the safest technique for performing cystocentesis on an obstructed patient?
    22g needle inserted tangential toward bladder neck, remove as much fluid as possible
  59. __________ is used to establish drainage until more definitive procedure is performed, such as cyststomy or urethrotomy.
    Tube cystostomy
  60. Should you do a urine culture on a blocked patient?
    cats- probably not; UTI unlikely in cats; dogs- absolutely
  61. What diagnostic is imperative for an obstructed patient?
    abdominal radiographs
  62. Post-obstructive care. (4)
    IV fluids, monitor ins and outs, monitor electrolytes/azotemia/acid-base status, pain management
  63. Pain management in blocked cats? (3)
    buprenorphine, methadone, fentanyl
  64. Pain management in obstructed dog? (3)
    methadone, fentanyl, +/- buprenorphine
  65. Why is acepromazine useful in post-obstructive care?
    sedation and antispasmodic effects (NOT AN ANALGESIC)
  66. Causes of uroabdomen.
    trauma/rupture of kidneys, ureters, urinary bladder, or urethra
  67. How can you iatrogenically cause bladder rupture? (4)
    urinary catheterization, manual expression of bladder, devitalized bladder wall + cysto, surgical accidents
  68. Uroabdomen leads to the development of... (4)
    post-renal azotemia, hyperkalemia, metabolic acidosis, +/- peritonitis.
  69. Common components of a history associated with uroabdomen. (6)
    recent trauma, abdominal distension, reluctance to walk, dysuria/stranguria/pollakiuria, hematuria, signs of uremia (vomiting, depression)
  70. Common findings on PE of patients with uroabdomen. (4)
    fluid wave on abdominal palpation, shock, signs of trauma, frank blood on rectal, +/- pelvic fracture on rectal (if HBC, other trauma)
  71. Biochem changes associated with uroabdomen. (3)
    BUN elevates first (6-12hr), Cre elevates within 24hr, K+ increases in 48+hrs
  72. What will you see on abdominal radiographs of a uroabdomen patient? (3)
    loss of abdominal detail, +/- pelvic fractures; just b/c you see the bladder, doesn't mean it isn't ruptured!
  73. What will you see on abdominal US of a uroabdomen patient? (1)
    free abdominal effusion
  74. How do you confirm uroabdomen?
    abdominocentesis- compare to peripheral blood- Cre >2X peripheral Cre, K+ >1.4X peripheral K+ [BUN NOT HELPFUL]
  75. Treatment of uroabdomen.
    initial 24-48hr- stabilization and resolution of metabolic derangement, IV fluids, establish drainage (urinary catheter) to keep bladder empty, +/- peritoneal catheter (if unable to place urinary catheter or u cath not draining)
  76. Bladder rupture definitive correction.
    small tears may heal by themselves with continuance of u cath; large tears require surgery
  77. Urethral tear definitive correction.
    surgery with risk of stricture; may be able to manage small tears with u cath
  78. What is Pandora Syndrome?
    term coined by Dr. Buffington to describe a variable constellation of clinical signs associated with an abnormal systemic stress response in cats
  79. What is obstructive uropathy?
    a progression of FIC in male cats that may experience inflammation of the urethra as well as the bladder
  80. Will you see cystoscopic signs of FIC when a cat is not having a "flare up" of the disease?
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Urinary3- Lower UT Dz
vetmed urinary3