FIC

Question 1

What type of patient does FIC describe?

Answer 1

a cat with clinical signs indicative of Dz associated with lower UT

Question 2

CS of FIC

Answer 2

hematuria
dysuria
stranguira

Hx of getting in/out of litterbox frequently, straining to urinate, production of very little to no urine

Question 3

What are the different types of categories for FIC?

Answer 3

idiopathic vs secondary to bacterial cystitis/neoplasia, uroliths
obstructive vs non-obstructive

Question 4

Why do we see the clinical signs we see with FIC?

Answer 4

Inflamed bladder –> edema and pain within bladder wall –> irritation and contraction of detrusor muscle –> stranguria and dysuria

Inflammation and damage to local blood vessels within wall of bladder –> hematuria

Question 5

Typical course of FIC

Answer 5

self-limiting and resolves in 10-14 days regardless of meds given

if obstructive, requires immediate intervention for survival but doesn’t change time course of Dz

Question 6

How does urethral obstruction affect the body and how might this result in clinical signs?

Answer 6

Inability to eliminate urine –> hampers kidney’s efforts to filter blood of toxins, electrolytes, and other substances –> quick increase of urea, creatinine, phosphorus, and potassium concentrations in blood

      Increased potassium can lead to serious cardiac dysfunction & circulatory instability & hypovolemia
  Rising toxins can lead to circulatory instability and hypovolemia 

If complete obstruction, anorexia, vomiting, lethargy, weakness, collapse

Question 7

List and describe two main therapeutic strategies for obstructive FIC.

Answer 7

IVF

• P usually unstable and will require meds
• P usually needs to be sedated for catheter placement
• supports management of circulatory disturbances

Placement of Urinary Catheter
-re-establishes urine flow

Question 8

What does the body begin to eliminate from the blood after urine flow is re-established?

Answer 8

BUN
CRE
phosphorus
potassium
other toxins

Question 9

What condition may develop due to hyperkalemia

Answer 9

heart conditions

Question 10

What are risk factors that are present even after reliving the obstruction?

Answer 10

acute renal failure
hypokalemia
dehydration secondary to post-obstructive diuresis

Question 11

What does placement of an indwelling catheter allow for?

Answer 11

• allows for time for the inflammation and urethral spasms secondary to the obstruction to subsite
• ensure urethral patency

Question 12

What does the use of a collection system allow?

Answer 12

• continue evaluation of kidney function (if sudden drop in amount, may be suffering from kidney failure)
• ability to quantify urine output (eval for kidney failure and detection of diuresis)
• monitor for presence of blood cells, blood clots, crystals, and proteinaceous material within urine

Question 13

How often should a CBC and biochem panel be done?

Answer 13

q24-36hr post urethral obstruction

Question 14

What things are checked for on the CBC/Chem?

Answer 14

resolution of…

• secondary hemoconcentration
• azotemia
• hyperphophatemia
• hyperkalemia

start of…
-hypokalemia

Question 15

When should hemoconcentration resolve?

Answer 15

as the P is rehydrated

Question 16

when should azotemia and hyperphosphatemia resolve?

Answer 16

over 1-2 days

Question 17

When should hyperkalemia resolve?

Answer 17

within 24hrs of reliving blockage

Question 18

Why can hypokalemia develop? What can you do about it?

Answer 18

due to post-obstructive diuresis & not eating well b/c potassium is being lost from the kidneys and not being replaced thru food

supplement IVF with potassium chloride

Question 19

What are 2 things that are done after removing the urinary cathter?

Answer 19

• monitor for signs of re-obstruction (could be urethral spasms or actual reobstruction)
• follow up UA to make sure no bacteria was introduced to bladder

Question 20

When is a patient usually discharged?

Answer 20

able to pass urine

able to eat/drink normally

Question 21

List risk factors for FIC development

Answer 21

sedentary lifestyle
neuter status
obesity
increased crystals/protein in highly concentrated urine with acidic/basic pH

Question 22

Ways to manage increased crystals/protein in highly concentrated urine with acidic/basic pH

Answer 22

• increase water intake (canned food, adding water/juice from tuna/salmon)
• litterbox maintenance to prevent P from holding urine (clean it frequently, add or remove a lid, alter type of litter)
• dietary manipulation to correct pH (won’t work if P presents with ideal pH of 6.5)

Question 23

Ways to manage sedentary lifestyle

Answer 23

interactive play/feeding

Question 24

Ways to manage obesity

Answer 24

caloric restriction

exercise

Question 25

What is the surgical option for FIC management?

Answer 25

``` Perineal Urethrostomy (PU) -reroutes the urethra, bypassing the penile urethra, in a way that it becomes wider ```

Question 26

Pros of Perineal Urethrostomy Sx

Answer 26

decreased chance for obstruction