Feline Idiopathic Cystitis

Question 1

True/False: Feline Lower Urinary Tract Disease (FLUTD) is the same thing as Feline Idiopathic Cystitis (FIC)

Answer 1

False. FIC is the most common cause of lower urinary tract signs in cats <10 years. FLUTD is a broader term.

Question 2

What are some proposed etiologies of FIC?

Answer 2

1. Dysfunction of urothelium
2. Neurogenic inflammation
3. Systemic psychoneuroendocrine dysfunction

Question 3

What are predisposing risk factors of FIC?

Answer 3

A. Young-middle aged patients
B. Neutered
C. Higher BCS
D. Limited outdoor access (Indoor only or winter months)
E. Males may present more because they get blocked easier, but it occurs just as commonly as females
F. Dry cat food fed ad libitum
G. Litter tray/box trained

Question 4

What are the two forms of FIC?

Answer 4

1. Obstructive: A urethral plug made of serum proteins, crystals, RBCs, and WBCs.
2. Non-obstructive: Common

Question 5

How does an abnormal bladder contribute to FIC?

Answer 5

An abnormal bladder has increased permeability and the afferent neurons have increased excitability.

Question 6

What are the clinical signs of FIC?

Answer 6

They are non-specific! You must rule out other causes like uroliths, bacterial UTI, neoplasia, or other neurogenic probs.

1. Pollakiuria
2. Stranguria/dysuria
3. Hematuria
4. Vocalizing in the litter box

Just unblock the cat and see if it gets better

Question 7

Diagnosis of FIC:
Imaging

Answer 7

Radiographs and ultrasound can be used for potential urolithiasis

Question 8

Diagnosis of FIC:
Urinalysis

Answer 8

Likely to see:
1. Hematuria
2. Crystalluria
3. Pyuria but rarely a UTI
4. USG >1.035

Question 9

Diagnosis of FIC:
Urine culture

Answer 9

5-10% of FLUTD/FIC positive cases have a positive culture. They are likely iatrogenic cases where the vet did something to cause.

Question 10

Diagnosis of FIC:
Chemistry

Answer 10

May be normal if not blocked

If blocked:
A. Azotemia
B. Hyperkalemia - life threatening
C. Hyperphosphatemia - not usually a problem

Question 11

Diagnosis of FIC:
CBC

Answer 11

Elevated PCV and Hematocrit from dehydration

Stress leukogram that may show a lympho-penia or -cystosis

Question 12

What are the diagnostic tools for FIC?

Answer 12

Imaging to rule out urolithiasis, Urinalysis, Urine Culture, and CBC/Chem

Question 13

What is the main feature treatment for FIC

Answer 13

It has no cure but might be managed best by eliminating stress. Communicate this to owners!

50% will recur within a year

Question 14

Treatment for FIC:
Analgesia

Answer 14

This is the most important management strategy to break the pain cycle. There are many options available like buprenorphine, meloxicam, tramadol/gabapentin, etc.

Question 15

Treatment for FIC:
Multimodal environmental modifications

Answer 15

All centered around decreasing stress

-Freedom, toys, perches, scratching posts
-Food/water bowls and littler box (+1) for each pet
-Increase water intake
-Minimizing other stresses

Question 16

Treatment for FIC:
Diet

Answer 16

Canned food to increase water intake

Question 17

Treatment for FIC:
Miscellaneous

Answer 17

Abx are rarely needed

Pheromones may help

Fatty acid supplements to decrease inflammation

Glucosamine: GAG replacer for urothelium

Anti-anxiety meds

Question 18

Treatment for FIC:
Urethral sphincter relaxant

Answer 18

Prazosin (alpha adrenergic antagonist)

May be used if spasms lead to obstruction but may not make a difference

Question 19

Feline urethral obstructions

Answer 19

Are an emergency but commonly are sterile mucus/crystalline plugs

Question 20

How do you unblock a cat?

Answer 20

The goal is the retro-pulse the plug into the bladder. Then leave in the cat so they can pee out for 3-5 days

Question 21

What are some other considerations for FIC?

Answer 21

-Manage the pain
-Watch out for hyperkalemia
-Need IV fluids
-Re-obstruction is common
-Once the urine is yellow and not red they can leave the hospital