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36 Cards in this Set
- Front
- Back
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What is the most common cause of urethral obstruction according to Minnesota?
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MOST COMMON--> Urethral plug
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Conventional wisdom about the effects of urethral plugs...
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Cause urethral obstruction (partial & complete)
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Unconventional wisdom about the effects of urethral plugs...
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Cause Urethritis (edema and inflammation)
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T/ F Urethral plugs are NOT the same as uroliths.
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TRUE*****TQ
Plugs do not equal stones |
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What are some laboratory abnormalities found with urethral plugs?
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-hyperproteinemia
-azotemia -hyperphosphatemia -*****metabolic acidosis -Hyperkalemia -hypocalcemia -hyperglycemia |
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T/ F Once you obstruct a cat you should see resolution of azotemia in 1-2 days (48 hours)!!!
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TRUE
if not there is something else going on or you are not keeping up with the diuresis |
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What is the metabolic abnormality that occurs with urethral plugs?
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metabolic acidosis
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What are some of the contributing factors that cause death in urethral obstructions?
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-Hyperkalemia
-metabolic acidosis -Post-renal azotemia often is severe -Hypocalcemia often mild to moderate |
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What causes azotemia in cats with urethral obstruction?
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Incr intratubular pressure
Decr GFR Decr renal perfusion |
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What kind of kidney problem is this?
a) pre-renal b) renal c) post-renal |
Renal and post-renal
Post- renal problem initially...eventually both post renal and renal because it backs up into the kidney |
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When you relieve an obstruction what happens to BUN/ Creatinine and what happens to urine output?
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BUN & CREATINE DECR 48hours after you relieve the obstruction
Increase urine output (ml/ hr)--> after you relieve the obstruction |
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When should you place a urinary catheter?
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anytime you want to measure urinary output....AIRF, urethral obstruction, etc
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what are the effects of post-obstructive diuresis?
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-self-limiting
-lasts 2 to 7 days -often proportional to severity of initial azotemia |
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What is the prognosis for urethral obstruction?
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GOOD!!
Most (>90%) survive if treated appropriately --> 15% will re-obstruct while in the hospital after removal of their urinary catheter |
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What can cause the animal to reobstruct?
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-intraluminal debris in urethra
-Urethral spasms -urethral edema and inflammation - stricture (trauma) - large blood clots in the bladder |
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T/ F Complete urethral obstruction is a medical emergency!!
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TRUE****
get diagnostics at the same time you are treating |
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Moribund cat....What do we do?
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1. IV line- volume expand & correct dehydration
2. Radiography 3. Stat Bloodwork 4. ECG 5. Manage hyperkalemia, metabolic acidosis, hypocalcemia, hyponatemia 6. Therapuetic cystocentesis- pass urinary catheter--> collect urine |
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What type of fluid is going to help give volume expansion and correct dehydration?
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Alkalinizing crystalloids- LRS, Normosol-R.... low potassium fluids if severely hyperkalemic
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Severe hyperkalemia causes...
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Severe Bradycardia with dramatic EKG changes- sinoventricular rhythms (atrial standstill)
1. Tented T waves, P waves 2. Sinoventricular rhythms (p waves absent) 3. RARE- ventricular fibrillation |
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What is the treatment for acute symptomatic hyperkalemia?
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- Calcium gluconate (protect the heart, does not lower potassium)
- Promote intracellular translocation of potassium: sodium bicarb/ dextrose with or without insulin |
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Can you give dextrose alone to a hyperkalemia patient for tx?
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Yes ...most healthy dogs can produce their own source of insulin, so it may not be important to add
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Can you give insulin alone to a hyperkalemic patient for tx?
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NO... causes diabetes
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When evaulating a radiograph of a LUT obstruction...what is the most important thing to get in the radiograph?
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Make sure to get the urethra in the abdominal radiograph
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What is the best for relieving an obstruction?
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Urethral catheterization
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what is decompressive cystocentesis? Is it a good approach for relieving a urethral obstruction?
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NOT the best approash...urethral catheterization is better
- it can however, buy you time before a procedure |
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T/ F Urethral catheterization is a painful procedure...MUST USE chemical restraint.
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True
Analgesic: Butophanol, Buprenophine, Dexmedetomideine Anesthesia: Ketamine (use if cardio concerns), midazolam, Propofol (side effect hypotension), isoflurance |
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When do you remove an indwelling urethral catheter?
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- relatively easy catheterization
-urine is clear after flushing -minimally sick cat |
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When do you place an indwelling urethral catherter?
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- difficult catheterization
-urine still very bloody or cloudy after flushing -very sick cats |
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Do we use antibiotics in cats with urethral obstructions with an indwelling catheter?
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NO!!!!
UTI still will develop but organisms will be resistant!!! Better to start antimicrobials when catheter is removed (based on culture results) |
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T/ F Urethral obstructed cats can become HYPOkalemic.
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True
supplement fluids with KCl IV DO NOT exceed 0.5 mEq/kg/hr****TQ |
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How do you tx urethral spasms from urethral obstruction?
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acepromazine IV or PO
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How do we treat bladder over-distension and atony from urethral obstruction?
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- keep pressure very low in damaged bladder (indwelling catheter, repeated cystocenesis, avoid manual expression of the bladder)
- Parasympathomimetic drugs (bethanechol to stimulate the detrusor contractions) |
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Should you use parasympathetomimetic drugs such as bethanechol in animals with no outflow obstruction?
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NO!!! NO !!!!--> Rupture the bladder
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When should you do a perineal urethrostomy in a urethral obstructed cat?
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- Multiple episodes of urethral obstructions --> "3 strikes your out"
- surgery does not prevent recurrence of feline idopathic cystitis or of obstruction |
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What is the most common complications of PU surgery?
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bacterial UTI
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What are all complications of PU surgery?
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Bacterial UTI, infection-related calculi, urinary incontinence, urethral strictures
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