PATIENT OF THE MONTH OCT 09
History
Albus was presented to Wilston Vet Surgery because his family had found him underneath the BBQ reluctant to walk and not wanting to move. He had been off his food and when his abdomen was touched he criedout in pain.
Albus and his family had moved house in thelast three weeks and they noted he had been very stressedby the change in environment. Albus had not shown signs of this problem before.
Examination
After an initial health check, Dr Phillipa Cox examined Albus's lower abdomen to find the cause of the pain and a large, hard bladder was palpated. It was suspected Albus had a condition called FLUTD caused by a urethral obstruction such as crystals. Therefore he could not pass urine causing his bladder to keep filling becoming very painful. The urethra is longer and narrower in males than females, which seems to increase the risk of it becoming blocked by inflammation or stones in the urine.
A blocked bladder is a serious medical condition that can be fatal in as little as 48-72 hours as urine backflow from the bladder reaches up to the kidneys causing renal toxicity and failure. There is also risk of the bladder rupturing releasing toxin filled urine into the abdomen. We suspect the stress of moving house may have contributed to the condition.
Plan
Albus needed treatment straight away to release the pressure on his bladder and alleviate his discomfort. He was admitted into the hospital and given initial pain relief. Albus was administered IV fluid therapy and placed under a general anesthetic. A plastic catheter was passed into his urethra to unblock the urethra and drain the urine from his bladder. The urine was blood tinged due to the imflammation of the bladder. Once the urethra was clear, a softer type of catheter was then inserted and sutured in place to his prepuce. This was keep the flow of urine going and prevent the blockage re-occurring until the cause was treated. Albus's urine was tested and was found to contain a type of crystal called 'struvite' which was causing the blockage.
Bloods were then taken to assess the severity of Albus's illness. Urea and Creatinine are waste products of the kidneys and increased levels in the blood can indicate kidney damage as they are not being excreted from the body. Potassium is an important electrolyte for the body, but if the kidneys are damaged a build up occurs in the blood leading to a heart failure. All of these were raised so the plan was to recheck the next day after bladder drainage and 24hrs of intravenous fluid therapy. A collection bag was attatched to the urinary catheter to monitor urine output.
The next day Albus had recovered from his anaesthesia and was bright and smoochy. He was offered a special food call Hills s/d which helps to dissolve the crystals. Later he would be given Hills c/d food to prevent more crystals forming. Bloods were rechecked and urea and creatinine were within normal ranges, potassium was only slightly high. Albus was started on antibiotics to prevent any secondary infection as well as given an anti-inflammatory injection. Albus was continued on intra-venous fluid therapy and supportive care over the next few days in hospital.
When Albus was eating ok, both his IV and urinary catheters were removed but he was still kept in the hospital to make sure he could urinate without trouble and wasn't re-blocking. After a few more days in the hospital Albus was sent home with his new diet and his family were advised to monitor for urination and to make sure had adequate water intake.
A follow-up call to Albus's family revealed he was passing urine well, had taken well to his new food and is more relaxed at home.
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