Feline Idiopathic Cystitis & Blocked Cats Flashcards
What is FLUTD and FUS?
- FLUTD = feline lower urinary tract disease
- FUS = feline urologic syndrome
+ Clinical signs associated with irritative voiding in cats
*Describes clinical signs, not necessarily the cause
Most common disease, in cats < 10 yr old, presenting with signs of FLUTD
1) Idiopathic cystitis
2) Urolithiasis or urethral plug
3) Other = anatomic abnormality, behavioral, UTI (< 1%), neoplasia
Most common disease, in cats > 10 yr old, presenting with signs of FLUTD
1) UTI (> 50%)
2) Idiopathic cystitis (5%)
What is feline idiopathic cystitis?
Diagnosis of exclusion when FLUTD signs are present and other diagnoses are ruled out
What causes feline idiopathic cystitis?
Neurogenic inflammation with vascular leaking = bladder wall edema and RBC diapedesis, brought on by environmental stressors
What is the most common sign associated with feline idiopathic cystitis?
Inappropriate elimination
What is the timeline of resolution with FIC?
90% will resolve within 5-7 days, with or without therapy
Risk factors for FIC
- Indoor cat
- Obese
- Eats dry food
- Easily stressed or nervous
- Living in a multi-cat household
- Decreased water intake
- Changes in environment
- Possibly genetics
Pathology behind FIC
> Disorder that links the urinary bladder, CNS, adrenal glands, and environmental stressors
- Damage to either the urothelium or glycoaminocoside layer = allows urine to permeate and irritate the underlying tissue
- Irritation results in SNS activation = release of inflammatory mediators = neurogenic inflammation
- Results in further urothelial damage and activates sensory fibers = perpetuates
- Deficient adrenocortical response = continual activation of hypothal-adrenocortical axis and SNS
*Starts with anything that can activate the SNS
Common signalments with FIC
- Occurs most commonly between 2-7 years old
- Both males and females
- Persians are overrepresented
Clinical signs of feline idiopathic cystitis
\+ Pollakuria \+ Inappropriate elimination \+ Stranguria \+ Hematuria \+ Vocalization
Diagnosis of FIC
> Diagnosis of exclusion
1) GOOD HISTORY - looking for risk factors
2) PE = small and painful abdomen
3) CBC, chem, imaging, U/A, culture = rule out uroliths, UTI, neoplasia
What do we commonly see in cats with FIC, on urinalysis?
> Hematuria and proteinuria
- USG, pH and crystalluria are only mildly helpful
What do we need to remember with refrigeration of urine?
Can precipitate out and increase the finding of crystals in samples
When do we culture urine in cats we suspect with FIC? (2)
1) < 10 years old, USG < 1.045, and there’s > 5 WBC’s in sediment
2) > 10 years old, USG < 1.045, history of FLUTD
- Also = if azotemic, has had a perineal urethrostomy or recent catheterization
Who do we perform CBC and chem screenings on? (4)
- Obstructed cats (electrolyte abnormalities)
- Recurrent FLUTD animals
- Systemic signs = vomiting, fever, anorexia
- > 10 years old
What can radiographs see when it comes to uroliths?
Radio-opague stones > 3 mm
What advantage does U/S have over radiography with detecting uroliths?
Can see both radio-opague and radiolucent stones, masses, anatomic abnormalities, and thickening of the urinary bladder
Is antibiotic therapy indicated in FIC cases?
NO
Main treatment for FIC (3)
1) Analgesia - treat pain and reduce SNS tone
2) Sedation = help break the SNS cycle
3) Environmental cleaning = so they don’t keep urinating in the same spots
* For 5-7 days
What things do you do to prevent FIC recurrence?
1) Litterbox management - have enough spread apart, uncovered, frequently cleaned, different substrates
2) Increase water intake = fountains, canned food, salt the food
3) Decrease conflict - establish safe havens
4) Promote natural behaviors = toys, catnip, environmental enrichment
5) Increase available space - horizontally or vertically
6) Synthetic pheromones
7) Amitryiptyline if MEMO doesn’t work
Correlation of FIC recurrence and age
FIC decreases in frequency and severity with age
How long until urinary obstruction can be damaging to an animal’s health?
3-5 days
Where is the most common site of obstruction in cats?
Urethra, esp the penile urethra
Top three causes for feline uroliths
1) Idiopathic urethral obstruction (general inflammation)
2) Urolithiasis
3) Urethral plugs
- Others = increased urethral tone w/ neuro dysfunction, neoplasia, strictures, iatrogenic, etc.
Cause of urethral plugs
Thought to be a consequence of FIC = result of inflammation, edema, urethral spasm –> formation from mucoproteins, cellular debris, and embedded minerals
*Inflammation and edema, even after urethral plug has been removed = can contribute to obstruction
Common signalment of blocked cats
Commonly male cats, present at any age (median = 4.7 yrs)
Common clinical signs of blocked cats
\+ Stranguria \+ Dysuria \+ Vocalizing \+ Lethargy and anorexia \+ Vomiting \+ Excessive licking of the perineal area
What does the bladder feel like on palpation in blocked cats?
Full, turgid, painful
PE/clinical signs of a ER blocked cat case
\+ Collapse \+ Shock \+ Depression \+ Tachypnea \+ Bradycardia (due to hyperkalemia) \+ Weak pulses \+ Hypothermia due to poor cardiac output
Chem panel and lyte abnormalities with blocked cats
- Azotemia = high BUN and creatinine (1/3 of cats)
- Hyperphosphotemia
- Hyperkalemia = muscle weakness, bradycardia
- Low serum bicarb = inability to excrete H+ and uremic acids
- Hypocalcemia = complexing with P
True or false = magnitude of the increases of BUN, creatinine, and phosphorus are prognostic indicators for blocked cats
FALSE - high values can be reduced to normal, even with timely therapy
ECG findings of blocked cats (3)
1) Tall, peaked T waves
2) Prolonged PR interval and QRS complexes
3) Decreased amplitude, increased width, to disappearance of P waves (atrial standstill)
Diagnostics for blocked cats (5)
- PE = general demeanor, heart rate, bladder size
- Chemistry and lyte values
- ECG
- U/A and urine culture (UTI’s unlikely, unless recently catheterized)
- AFTER PATIENT HAS STABILIZED = Imaging = radiographs
+/- CBC = in older cats, if showing systemic signs
What must always occur first with blocked cats?
STABILIZE THE PATIENT - address hypovolemia, acidemia, lyte imbalances, and blockage (anuria or oliguria)
Treatment of hyperkalemia
1) IV fluids for diuresis
2) Ca++ gluconate = cardio-protectant (TRANSIENT, only lasts for 1 hour)
3) Decrease K+ levels = insulin+dextrose, bicarbonate
When don’t we use bicarb in blocked cats?
In hypocalcemic patients = exacerbates the problem
Treatment of hypocalcemia
Ca++ gluconate - but rarely necessary
Treatment of acidosis
- IV fluids and unobstructing the patient should suffice
- Bicarb in very severely affected patients
What may help relieve the obstruction in cats?
Sedation = relax urethra and allow plugs to pass before catheterization, Ex: midazolam and butorphanol
What should you do if you palpate a very large bladder in a blocked cat?
Decompressive cystocentesis = pressure release to decrease risk of bladder rupture, decrease back pressure on kidney so they can produce urine
What must occur with anesthesia to successfully unblock the cat?
Achieve COMPLETE urethral relaxation = ketamine, midazolam + propofol or inhalant anesthesia
How do we physically unblock the cat?
- Have full relaxation
- Extrude the penis fully = straighten the sigmoid flexure
- Pass a rigid catheter with fluid to try and push the obstruction to the urinary bladder
- Pass a soft catheter for long-term bladder drainage and measure volume
- Place an E-collar
*DO NOT FORCE THE CATHETER AGAINST RESISTANCE
Causes for catheter resistance placement (7)
1) Haven’t fully extended the penis
2) Urethral plug or urolith obstructing
3) Urethral tear
4) Inadequate relaxation and urethral spasm
Less common:
5) Urethral stricture
6) Severe urethritis
7) Extraluminal compression
When do we remove urinary catheters? (3)
> For as little time as possible
1) Azotemia resolves
2) Urine is a normal color and consistency
3) After the post-obstructive diuresis has occurred
What causes the post-obstructive diuresis?
Occurs secondary to the retention of osmotically active solutes and the relieving of the back pressure on the kidney
*Lasts for about as long as the azotemia does
Why is monitoring the post-obstructive diuresis important?
If you don’t keep up with fluids during that time, it can lead to a life threatening hypovolemia and hypokalemia
Things to be monitoring post-obstruction (3)
1) Azotemia
2) Lyte values - esp K+
3) Urine output
Drugs we can use to relax the urethra
Alpha blockers = acepromazone, PRAZOSIN, phenoxybenzamine
*AVOID the use of antibiotics, steroids, and NSAID’s
Complications of blocked cats (7)
1) Persistent urethral obstruction
2) UTI secondary to catheterization
3) Catheter induced trauma (urethral tears)
4) Urethral stricture
5) Bladder rupture
6) Urinary bladder atony and incontinence
7) Kidney injury
What do we recommend with cats who chronically re-obstruct?
Perineal urethrostomy surgery
