Term
| What are some CS of lower UTI? |
|
Definition
-pollakiuria
-dysuria
-stranguria
-inappropriate elimination
-malodorous urine
-MAY HAVE NO CS
-hematuria
-pyuria |
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Term
| Describe the epidemiology of bacterial infection. |
|
Definition
-females > males
-dogs > cats |
|
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Term
| What is the most common cause of bacterial UTIs? |
|
Definition
| -ascending intestinal or cutaneous bacteria |
|
|
Term
| Which bacterial is most commonly the culprit of bacterial UTIs? |
|
Definition
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Term
| Describe the pathogenesis & virulence of E. coli as an etiology behind UTI. |
|
Definition
-virulence is a major contributing factor to infection
-fibriae: adherence
-K Ag: interfere w/ opsonization & phagocytosis
-O Ag: dec smooth muscle contraction
-Hemolysins: inc invasiveness through tissue damage |
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Term
| What are the host mechanisms in the urinary tract? |
|
Definition
-normal micturition
-anatomic structures
-mucosal defense barriers
-antimicrobial properties of urine
-systemic immunocompetence |
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Term
| Why is mucturition important as a host defense against bacterial UTI? |
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Definition
-voiding washes out approx 95% of non-adhernt bacteria
-inc urine pdn results in inc washout |
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|
Term
| True or False: Outflow obstruction & incomplete voiding of the bladder predispose to UTI by dec washout of bacteria |
|
Definition
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Term
| Why are females predisposed to bacterial UTIs as opposed to males? |
|
Definition
|
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Term
| What parts of the lower urinary tract anatomy affect the frequency of bacterial UTI? |
|
Definition
-high-P zone in mid-urethra
-urethral contractions
-long urethra in males
-prostatic secretions contain immunoglobulins |
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Term
| What parts of the upper urinary tract anatomy affect the frequency of bacterial UTI? |
|
Definition
-large renal blood supply (approx 25% of CO)
-ureterovesicular valve
-ureteral peristalsis |
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Term
| Describe the mucosal defenses against bacterial UTI. |
|
Definition
-normal flora in the vulva & prepuce
-mucosal secretions (Ig & GAG) prevent adhesion by uropathogens |
|
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Term
| Describe the antimicrobial props of urine. |
|
Definition
-urine is bacteriostatic/bacteriocidal depending on composition
-low pH + inc urea + inc weak organic acids in conc urine
-super conc urine in cats is the primary reason for a low incidence of UTI |
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|
Term
| True or False: Any dz that results in pdn of more dilute urine predisposes patients to bacterial colonization (even though washout is increased). |
|
Definition
|
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Term
| What are some examples of systemic immunocompetence that predispose to bacterial UTIs? |
|
Definition
-immunosuppressive therapy
-hyperadrenocorticism
-DM
-renal failure
-nidus: calculus, neoplasia, forign material |
|
|
Term
| What diagnostics do we run on UTI cases? |
|
Definition
-complete UA: microscopic exam most important part
+/-CBC
+/- serum chem
-anatomical exam
+/-urine culture
+/-abdominal rads
+/-abdominal U/S
***urine culture |
|
|
Term
| What is the gold standard for diagnosing UTI? |
|
Definition
|
|
Term
| When is it ideal to culture urine for UTI dx? |
|
Definition
-prior to Ab therapy if possible
-if patient is on Ab, discontinue 3-5d prior to culture |
|
|
Term
| What kind of urine culture do we do for UTI dx? |
|
Definition
| -quantitative: give you CFUs |
|
|
Term
|
Definition
-uncomplicated infection: tx for 3-5d
-CS should resolve in 24-48h
-Complicated infections REQUIRE culture & sensitivity & a prolonged course of abx |
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|
Term
| What is relapse? What are some common causes in the case of UTIs? |
|
Definition
-same organism(s) w/in a few weeks of treatment
-ex: failure to correctly treat: owner compliance, wrong abx, inappropriate dose or duration, bacteria sequestered away from AB penetration |
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|
Term
| What is re-infection? What are some common causes in the case of UTIs? |
|
Definition
-same or different organism > 2w after treatment
-ex: correct tx but failure to address underlying predisposing factors |
|
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Term
| What diagnostics do we run on reccurent UTIs? |
|
Definition
-hx: owner compliance
-CBC
-serum chem panel
-UA
-URINE CULTURE & SENSITIVITY
-abominal rads +/- contrast
-anatomical exam
+/-prostatic wash |
|
|
Term
| How do we treat UTI relapses/reinfections? |
|
Definition
-BASED ON CULTURE & SENSITIVITY
-tx for min of 4w
-reculture 1w into tx to ensure adequate response to therapy
-reculture 8-10d after tx to ensure resolution of dz
-Cranberry extract |
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|
Term
| What is the rate of recurrence of Feline Interstitial Cystitis (FIC)? |
|
Definition
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|
Term
| What are some predisposing factors to FIC? |
|
Definition
-obesity
-indoor housing
-multiple cats in household
-dec activity
-eating a dry food
-stressful event |
|
|
Term
| What are the two types of FIC? Describe the incidence. |
|
Definition
-obstructive or non-obstructive
-non-obstructive: male & female equally
-obstructive: males > females |
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|
Term
| What are some common causes of obstructive FLUTD? |
|
Definition
-urethral plugs
-stones
-tumors: rare |
|
|
Term
| What is the most common cause of obstructive FLUTD? |
|
Definition
|
|
Term
| What is the most common composition of urethral plugs in male cats? |
|
Definition
| -struvite stones & proteinacious matrix |
|
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Term
| What are the common CS of FLUTD/FIC? |
|
Definition
-stranguria
-dysuria
-hematuria
-pollakiuria
-frequent trips to box w/ little or no urine pdn
-crying in litterbox
-excessive licking of perineal tissues
-no bladder on palpation or very firm
+/- dehydration
+/- bradycardia (if hyperkalemic)
+/-weakness/collapse |
|
|
Term
| What diagnostics do we run for FLUTD/FIC? |
|
Definition
-if patient not obstructed, no diagnostics may be needed
-approx 85% of patients will have resolution of signs in 2-3d
-if sings are recurrent or not resolving testing is necessary
-CBC/Chem: may show azotemia or hyperkalemia if obstruction is present
-UA: +/-crystalluria, hematuria, pyuria
-rads: most stones in cats are radiopaque
-U/S: see stones or masses in urinary bladder
-cytoscopy |
|
|
Term
| How do we treat FLUTD/FIC? |
|
Definition
-usually symptomatic
-analgesics: opioids (NSAIDs if not azotemia, dehydration, obstruction)
-abx only indicated unless there is evidence of bacteriuria on UA or culture is positive |
|
|
Term
| Before unblocking a male cat, what do we do? How do we do it? |
|
Definition
-stabilize!
-poor perfusion
-hypotension
-electrolyte distrubances (hyperkalemia or hypocalcemia)
-acidosis
-analgesics
-decompressive cystocentesis |
|
|
Term
| How do we unblock a male cat? |
|
Definition
-flush the urethra w/ saline
-indwelling urinary catheter |
|
|
Term
| Why do we avoid abx if a urinary catheter is in place? |
|
Definition
| -use of abx w/ urinary catheter inc the risk of resistant ifnections |
|
|
Term
| Why do we not leave poypropylene catheters in male cats? |
|
Definition
|
|
Term
| How do we prevent recurrence of FLUTD/FIC? |
|
Definition
-environmental enrichment
-provide opportunities for play
-addition of scratching posts & climbing platforms
-minimizing conflict b/n cats
-litterbox care
-nutritional mangament: inc water intake, feed multiple times a day
-meds: Amitriptyline, facial pheromone, GAGs, propantheline |
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