Feline Lower Urinary Tract Disease, Calculi and Blocked Cats Flashcards
What is FLUTD?
A collection of conditions that can affect the bladder and/or urethra in cats
What are some of the causes of FLUTD?
What is a urethral plug?
- Protein-colloid matrix that’s made up of gunk basically…
- mucoproteins
- albumin
- globulin
- cells
- red blood cells
- white blood cells
- epithelial cells
- blood clots
- +/- crystalline material
- Crystals might just get trapped in the plug
- Male cats can obstruct easily in this condition which is why its an emergency in practice
Part of FLUTD clinical signs are some LUT signs - name some of these LUT signs
- Dysuria
- difficulty urinating
- vocalisation &/or pain
- Pollakiuria
- increased frequency
- Haematuria
- Stranguria
- straining to urinate
- similar/same as dysuria?
- Periuria
- urination in inappropriate places
- Signs of urethral obstruction?
Part of FLUTD clinical signs are some behavioural changes - what do you see?
- Loss of house training
- Aggression
- Excessive grooming
- “Constipation”
- May be misinterpreted as this
- Stilted gait
- Abdominal pain
- Pain – likely part of the reason why these cats are so bad tempered usually
What is the typical cat to get FLUTD?
- young or middle aged, but not older than 10 generally…
- Often overweight
- Relatively inactive
- mainly indoor
- eats dry food often
- multi cat house
- Not every cat with FLUTD ticks all of these boxes but these are most common
What are some older theories that were used to propose the cause of iFLUTD?
Old theories included…
- Infectious agents
- bacteria
- virus
- mycoplasma
- Crystalluria
- Urachal diverticula
- Anatomical defect
Why did people used to think that infectious agents were the cause of iFLUTD?
Why did people think this?
- Treatment with antibiotics seemed to work…
- Flare ups with stress could be viral…
- Crystalluria was often present…
What is the significance of crystalluria with mucus plugs?
- Struvite crystals are common in healthy cats and in urethral plugs from obstructed cats and in non obstructed iFLUTD cats…
- No evidence that crystals damage uroepithelium
- Crystals may just get trapped in plugs of mucus
What are the newer theories of the proposed causes of iFLUTD?
- Interstitial cystitis
- neurogenic inflammation
- mucosal defects
- Neuroendocrine imbalance
- This gets a bit quite challenging to discuss with owners as involved interaction between the way a cat perceives and responds to stress in their environment and what’s going on in the bladder lining – quite a difficult step to come to terms with
What is neurogenic inflammation - is this a real syndrome?
Characterised by submucosal histopathological changes in the urothelium
- vasodilation
- vascular leakage
- absence of mononuclear or neutrophilic infiltrate
- increased mast cells (20% of patients)
So far there is a poor correlation between resolution of clinical signs and histopathology changes….there is much we don’t know!
How can stress be a neuroendocrine trigger?
In normal cats stress causes activation of the hypothalamic pituitary adrenal axis with increased activity in the area of the brain dealing with vigilance and autonomic activity, increased catecholamine release, enhanced adrenal sensitivity to ACTH and increased secretion of glucocorticoids. In the normal situation one of the many glucocorticoid functions is to provide negative feedback and control the stress response. Cats with iFLUTD/ FIC and people suffering from some chronic pain syndromes essentially have an uncoupling of the hypothalamic-pituitary-adrenal axis –they are less able to cope with stress and have abnormal responses to stress.
How can we compare cats and people with iFLUTD?
- People with IC (idiopathic cystitis) are at increased risk of IBS, depression, anxiety and hostility
- Owners of cats with FIC (feline idiopathic cystitis) observe fear, nervousness and aggression in their pets
What is the brief pathophysiology of FLUTD?
In a cat that has suspected FLUTD, what do we want to know about the clinical history?
- Is this the first episode or is it recurrent?
- feline idiopathic cystitis
- relapsing signs are common
- spontaneous recovery occurs in 4-7 days in most cases
- not all cases need treatment or investigations
- Are there any features that increase the likelihood of – we need to spot these
- UTI
- neoplasia
- Urolith
- If we are getting recurrent episodes, we may need to rule these things out
On bladder palpation, what do we feel in a non-obstructed cat?
Systemic signs
- Bladder palpation
- small
- thickened?
- painful?
- Systemic signs are uncommon but could indicate concurrent disease
On bladder palpation, what do we feel in an obstructed cat?
Systemic and other signs?
- Bladder palpation
- distended?
- Might still feel small but might be tense and painful. The sooner we catch obstructed cats, the better!
- Firm
- If not sure if it is or isn’t obstructed – safer to think you might need to pass a urethral catheter to check as a non-obstructed cat will have a very empty bladder and is tiny
- painful
- Penis discoloured +/or swollen
- Dehydrated
- Bradycardic – look for systemic signs!
How quickly do clinical signs subside in cats with acute non-obstructive idiopathic cystitis WITHOUT treatment?
- Clinical signs subside within 5-7 days in up to 92% cats with acute non-obstructive idiopathic cystitis without treatment
- ie they get better irrespective of what we do!
- Recurrent episodes of acute iFLUTD tend to reduce in frequency and severity as a cat becomes older
With a repeat offender of non-obstructed FLUTD, what should we rule out and what should we be doing as a means of investigation?
Rule out
- infection
- uroliths
- Neoplasia
- Maybe higher up the list in an older cat
What should we be doing?
- haematology & biochemistry
- urinalysis
- radiography
- ultrasound
Idiopathic disease becomes less likely if recurrent and severe episodes persist…. so at some point we have to think about ruling out other possible causes of LUT signs
A cat only has iFLUTD when we have ruled out all other causes. It’s often fine to assume a cat has iFLUTD to see if the signs resolve rather than putting the cat through all the investigations and the owner through all the expense of those investigations. BUT if things aren’t going smoothly ie the signs don’t resolve or get worse, the recurrent episodes are severe and frequent, the cat seems systemically ill- then we need to do more.