Feline Lower Urinary Tract Disease Flashcards
Define feline lower urinary tract disease/feline urological syndrome
Collective terms for signs of lower urinary tract disease and abnormal voiding behaviour
FLUTD is a collective term for a variety of conditions affecting the bladder and/or urethra of cats that result in similar clinical signs
Name some non-obstructive feline lower urinary tract diseases
- Idiopathic cystitis
- Uroliths
- Anatomical defects, cancer, etc
- Behavioural problems
- Bacterial infection
Name some obstructive feline lower urinary tract diseases
Idiopathic cystitis
Uroliths
Urethral plug
Bacterial infection
What is feline idiopathic cystitis?
- Abnormal voiding behaviour after exclusion of other disorders
- No obvious cause
- Chronic, persistent or recurrent
Which animals are predisposed to lower urinary tract infections?
Any age or sex - young to middle-aged neutered cats, 2-6 years old
Males more prone to obstruction
Persians appear predisposed
List the 4 predisposing factors for lower urinary tract disease in cats
Obesity
Indoor / sedentary cats
Dry diet
Multi-cat household
How will a cat with lower urinary tract disease present?
Dysuria (difficulty urinating)
Pollakiuria (increased frequency)
Haematuria
Inability to urinate (urethral obstruction)
Behavioural changes
Appear to lose litterbox training
What is the term used to describe urinating in inappropriate places?
Periuria
How do cats with non-obstructed lower urinary tract disease most commonly present?
- Generally well
- Usually self limiting and resolves in 5-10 days
- Bladder small, firm and may be painful
How do cats with obstructed lower urinary tract disease most commonly present?
Emergency situation!
Large, painful bladder
Check penis for signs of trauma/crystals
Dehydration, uraemic breath, bradycardia
Bladder may rupture = non-palpable, abdominal pain
Describe the pathophysiology of feline idiopathic cystitis
- Alterations in neurotransmission to and from the bladder lead to inflammation
- Reduced glycosaminoglycan layer, which protects the bladder lining
- Get petechial haemorrhages on the bladder wall
How is ‘pandoras syndrome’ linked to FIC?
Cats with chronic LUT signs in the presence of comorbid disorders (e.g. behavioural, cardiovascular, dermatological, GI problems)
Describe the main features of urethral plugs
- More common in males (longer, narrower urethra)
- Most common cause of obstruction
- Plug consists of mucus / glycoprotein matrix, often with other substances trapped in the matrix
Name the 3 urolith types seen in cats
Struvite
Calcium oxalate
Urates
How are struvite uroliths different in dogs and cats?
Struvite uroliths in cats are most commonly sterile (different to dogs where they are usually associated with UTIs)
Describe UTIs in cats
Rare!
Name 4 inherited anatomical defects of the urinary tract in cats
Vesico-urachal diverticulae
Bladder hypoplasia
Urethral strictures
Phimosis
Name 2 acquired anatomical defects of the urinary tract in cats
Strictures due to trauma
Iatrogenic damage
Describe blood sampling as a diagnostic tool in FLUTD
Very important in blocked cats
- Hyperkalaemia
- Hyperphosphataemia
- Metabolic acidosis
- Azotaemia
Describe urinalysis as a diagnostic tool in FLUTD
Dipstick
Sediment analysis
USG
Culture
What are the considerations of the sediment analysis in cats?
RBC are a common finding, +/- WBC, epithelial cells.
Note that crystals are a normal finding – but if large numbers, may play a role - Don’t overinterpret
Why is USG important in FLUTD
Highly concentrated urine predisposes to urolith formation
How is radiography used as a diagnostic tool for FLUTD
Include ALL of the urinary tract, including penile urethra
Plain: may see radio-opaque calculi / plugs
Contrast studies
How is ultrasound used as a diagnostic tool for FLUTD
May see hyperechoic sediment / uroliths and acoustic shadowing, bladder masses, thickened bladder walls
A 6 year old MN cat has been urinating more often, vocalising when urinating, and urinating outside his litter box. What is the best term for this?
FLUTD
If you investigated further and found nothing you would probably diagnose as FIC
Which urolith of cats is associated with UTI?
None
Which urolith of cats does not dissolve and must be managed surgically?
Oxalate
Describe treatment of urethral plugs
- Blocked urethra is emergency situation
- Develop post-renal azotaemia within 24h
- Bladder may rupture
- Relieve pressure in bladder by emergency cystocentesis – this will relieve back pressure and allow glomerular filtration to recommence
- Start fluid therapy: very important (0.9% NaCl initially to rehydrate – correct dehydration over 1-4h)
- Treat electrolyte and acid-base disturbances
How are uroliths treated?
- Struvite may be dissolved with medical dissolution diet
- Calcium oxalate will need surgical removal
- Encourage water intake
- Use diet to prevent recurrence
How is feline idiopathic cystitis treated?
- Most cases resolve spontaneously in 5-10 days
- Most treatments have not been well investigated by double-blinded placebo controlled studies
- Corticosteroids and antibiotics have been critically assessed and have no positive effect
What questions may you ask to find out about stress in a cats life?
Changes in environment
- Household
- Pets
- Neighbours
Is the cat more anxious?
List the factors that can cause stress for cats
Other cats
Overcrowding
Changes in diet
Weather
Environment
Owner stress
Introduction of new pets or people
How can you reduce stress in cats?
- Reduce overcrowding and bullying; provide safe places
- Provide multiple and separated key environmental resources
- Reassure cat with physical contact
- Pheromone sprays (Feliway, Ceva) to reduce anxiety
- Optimal litter box management
How can you create dilute urine in cats with FLUTD?
Change to a wet diet
Free access to water at all times
Water fountain
Fish or chicken stock
What is the role of GAG supplements in management of FLUTD?
Exogenous GAG attaches to bladder lining and decreases bladder permeability
Some success in people with interstitial cystitis
Studies in cats no significant differences
What is the role of analgesic and Antinflammatories in management of FLUTD?
- Buprenorphine
- NSAIDs may help in some cases (check kidney function) e.g. Meloxicam - Stop if vomiting develops or introduce at a low dose and slowly increase to effect
- Don’t use steroids
What is the role of Tricyclic anti-depressants in management of FLUTD?
Amitriptyline
Usually require long term treatment
Reserve for chronic cases
What are the side effects of TCAs?
May cause somnolence
May cause urinary retention
Raised liver enzymes, neutropenia and thrombocytopenia
A cat presents with LUT signs. What is the MOST IMPORTANT thing to check on physical examination?
Bladder size – is it blocked or not
You prescribe amoxycillin to a cat with signs of FIC. Will it improve?
Yes – because it is self limiting, not because of the antibiotic
If 2 cats live in a house, how many litter trays should there be?
3
