MAX FIC

Question 1

if we have a dysuric cat with unproductive straining, what test should we run?

Answer 1

> Emergency bloodwork
* Packed cell volume
* Total solids
* Glucose
* Lactate
* Electrolytes
* Blood smear evaluation
* +/-iCa, Urea and Creat

> Blood pressure

Question 2

Patient Triage of Dysuric Cats
- important questions to ask, tests to answer these?

Answer 2

1. How stable is the cat?
2. Is it potentially obstructed?
   <><>
   * Physical examination (if patient stable)
   > Hydration status, etc.
   * If unproductive straining (potential obstruction)
   > Emergency bloodwork
   > blood pressure
   * Point of Care Ultrasound (POCUS)
   > Free fluid in the abdomen?
   > Bladder size?

Question 3

with dysuric cat ultrasound, we see a bladder. does this rule out a tear?

Answer 3

presence of bladder DOES NOT rule out a tear

Question 4

Feline Urologic Syndrome “Feline idiopathic cystitis”
- clinical signs

Answer 4

Lower urinary tract clinical signs
* Pollakiuria
* Stranguria
* Hematuria
* +/- stranguria

Question 5

Feline Urologic Syndrome “Feline idiopathic cystitis”
- how common?

Answer 5

4-10% of all feline admissions

Question 6

Feline Urologic Syndrome “Feline idiopathic cystitis”
- what kind of obstructions can we see?

Answer 6

Partial or complete urethral obstruction
* 65-90%: Urethral plug & urethral spasm
* 10-35%: Stones
* Rare: Strictures, urethral trauma, blood clots, neoplasia

Question 7

« Stress » or « Idiopathic » Cystitis Pathogenesis?

Answer 7

• Neurohumoral theory
• Imbalance between sympathetic nervous system
  and hypothalamic-pituitary-adrenal axis
• Impaired blood flow and release of inflammatory mediators
• Causing edema, smooth muscle spasm, and pain within the lower urinary tract
• Urethral smooth muscle dysfunction and urethral inflammation

Question 8

Predispostion for Feline Urologic Syndrome

Answer 8

• Young male cats (obstruction)
• Overweight cats
• Inactivity
• 2-6 year old
• Dry food; less digestible; high Mg content * Pedigreed ?
• Longhair cat ?
• Multicat households ?

Question 9

Feline Urologic Syndrome “Feline idiopathic cystitis”
- Major Complaints and Clinical Signs for partial or no obstruction vs complete obstruction

Answer 9

Partial or no obstruction:
* Urinary signs
* Still U+
* No systemic signs
<><>
Complete Obstruction:
* Urinary signs and systemic signs (anorexia, lethargy, vomiting)
* Unproductive straining
* Big bladder
* +/- Fractious cat
* No urination for >12 hours

Question 10

Feline Urologic Syndrome “Feline idiopathic cystitis”
- Diagnostic tests for partial or no obstruction vs complete obstruction

Answer 10

Partial or no obstruction:
* Urinalysis
* Point of care ultrasound
<><><>
Complete Obstruction:
* Blood work
* Urinalysis +/- culture
* Point of care ultrasound
* Radiographs

Question 11

Feline Urologic Syndrome “Feline idiopathic cystitis”
- how often do we find the cause?

Answer 11

No cause found in 54-79% cats

Question 12

CASE:
Max, 5 y old DLH
Pollakiuria, hematuria, straining
*Normal energy
*Good appetite, no vomiting
*Normal vitals
*BCS 7/9
*Bladder not palpable
*Soft abdomen
*Purring in arms
*POCUS: small bladder, no free fluid
<><>
* Stable
*Normal energy
*No systemic signs
*Productive straining
*Bladder not palpable
*No obstruction
<><>
What can we do?

Answer 12

• Pollakiuric++++
  > Collection of urine impossible
• Oral buprenorphine
• No antibiotics
• Monitoring at home

Question 13

“Feline idiopathic cystitis”
Management of Unobstructed Cat
- how many cases resolve? how fast?
- what is the usual therapy?

Answer 13

Resolution of clinical signs within 2 to 3 days in 85% cats spontaneously
<><>
Analgesic therapy
* Oral buprenorphine or
* Butorphanol or
* Fentanyl patch
* NSAIDS (questionable)
> NSAID can be bad for kidneys

Question 14

“Feline idiopathic cystitis”
Environment Alterations

Answer 14

• “MEMO “ : Multimodal Environmental MOdification
• Obtaining a thorough environmental history
• Several litter boxes
• Increase water consumption
  > several sources of fresh water, automatic dispensers, broth

Question 15

“Feline idiopathic cystitis”
- diet

Answer 15

• Canned diet - wet food better than dry
• Hill’s® Diet® c/d® Multicare Urinary
• Royal Canin Urinary S/O calm
• Weight loss program

Question 16

“Feline idiopathic cystitis”
- pheromone options

Answer 16

• Feliway reduces anxiety of cats * Spray and room diffusers

Question 17

Medical Management Idiopathic Cystitis? how fast do they work?

Answer 17

Numerous agents tried (see Textbook for doses)
* Antibiotics, tranquilizers, anticholinergics, antispasmodics, anti-
inflammatory drugs tried for idiopathic cystitis in cats
* No controlled studies
* More recently glycosamminoglycans, amitriptyline, NSAIDs
* Antispasmodics: propantheline and oxybutynin
<><>
* Can take longer than 1 week to see improvement
* If fails, drug should be tapered over 1 to 2 weeks
<><>
> 70% cats with idiopathic cystitis responded to placebo treatments

Question 18

idiopathic cystitis response to placebo

Answer 18

> 70% cats with idiopathic cystitis responded to placebo treatments

Question 19

Prognosis
Non-obstructed idiopathic cystitis

Answer 19

• Fair to good
• Rarely life threatening

Question 20

Management of Obstructed Cat idiopathic cystitis

Answer 20

• Hospitalisation
• Analgesia
  > Full opioid (methadone), maropitant
  > NSAIDs should be avoided at presentation (acute)
• Fluid therapy
  > Restoration of renal perfusion
  > Dilute plasma potassium
• Monitor electrolytes and renal profile
• Priority: stabilise and anesthetize patient
  > Urinary catheterization
  > Soft 3.5 to 5F catheter, strict aseptic technique

Question 21

should we take radiographs for obstructed idiopathic cystitis?

Answer 21

TAKE RADIOGRAPHS
Could be obstructed with a stone!!

Question 22

ultrasound use for idiopathic cystitis

Answer 22

• Evaluation of thickness of bladder wall and contours
• Detection of uroliths or mass?
• Major limitations
  > Inability to evaluate distal urethra

Question 23

does successful catheterization rule out urethroliths?

Answer 23

• Successful catheterization DOES NOT rule out urethroliths!!!
• → possible reobstruction after catheter removal if not checked

Question 24

Contrast Urethrography
- how do we do it? what is its use?

Answer 24

• Contrast instilled with enough pressure in the catheter
• +/- double contrast cystogram
  > Stones?
  > Soft tissue lesions?
• Only contrast urography and rectal exam can evaluate the distal 2/3 of the urethra

Question 25

idiopathic cystitis Urinalysis and Urine Culture? when do we do them? why?

Answer 25

Urinalysis: * Recommended in all cats if possible * Crystals? * Signs of infection? <><> Urine culture: * Infection = rare, except in all cats or when multiple recent catheterization

Question 26

Decompressive cystocentesis prior to catheter placement? Decompressive cystocentesis advantages

Answer 26

* Allows immediate relief of pressure within the urinary tract * More rapid resolution of glomerular filtration rate * Increased comfort * Minimal sedation * Uncontaminated urine for tests * ↓back pressure against the obstruction→ facilitates catheterization <><> Best: cystocentesis on sedated or anesthetized patient

Question 27

Decompressive cystocentesis prior to catheter placement? disadvantages

Answer 27

* Risk of tearing or rupturing the bladder * Distended bladder > More friable > Greater risk of uroabdomen or hemoabdomen > Vagovagal collapse (can be fatal) →Sedation or anesthesia required + 2 people to do cysto

Question 28

Decompressive cystocentesis or no? when to do it?

Answer 28

* If catheterization not possible * If money constraint and alternative to euthanasia * Warn owners about the risks <><> * Uroabdomen less than ideal BUT preferable to ongoing obstruction and hyperkaliemia in a cat that is unable to be catheterized