FLUTD

Question 1

Diagnostic approach to FLUTD in an older cat?

Answer 1

• urinalysis and culture
• other dx test (renal function, hyperthyroid)
• imaging for stones

Question 2

How is idiopathic FLUTD dx?

Answer 2

• diagnosis of exclusion
• clinical signs spontaneously resolve within 3-7d
• recurrence common
• subset of animals have chronic dz

Question 3

Increased risk factors for idiopathic FLUTD?

Answer 3

• Persian
• 2-6years
• spayed/castrated
• obesity
• V activity
• dry cat food
• stress

Question 4

What is the old proposed aetiology of IFLUTD?

Answer 4

> infectious agents 
- bacterial 
- virus 
- mycoplasma 
> crystalluria
> urachal diverticula

Question 5

What is the new proposed aetiology for IFLTUD?

Answer 5

> interstitial cystitis
- neurogenic inflam
- mucosal defects
neuroendocrine imbalance

Question 6

Do young cats get bacterial infections?

Answer 6

NO!!

Question 7

Which viruses have been implicated in IFLUTD?

Answer 7

• bovine herpes virus type 4, calicivirus and feline syncytia forming virus most commonly implicated
• virus like particles found in crystalline-matrix urethral plugs
• could explain episodic signs and recurrence with stress

Question 8

Are crystals implicated in IFLUTD?

Answer 8

• struvite found in normal cats
• not directly injurious and Tx PDF oxalate stone formation
• adverse effects from acidification
  > not the cause but may predispose to obstruction with gelatinous crystally plug

Question 9

Are vesiculourachal diverticula causes of lower urianry tract signs?

Answer 9

No - seen with obstruction as pressure increases and opening of the outpouching
- if obstruction cleared will heal spontaneously, no need to Tx

Question 10

What is Interstitial cystitis ?

Answer 10

• dz of unknown aetiology in humans

- analogies between iFLUTD and IC

Question 11

Outline similarities and differences between Interstitial cystitis and iFLUTD?

Answer 11

• young cats and women
• dysuria, pollakiurua
• sterile urine
• haematuria in cats but few RBCs in people
• glomerulations
• ^ bladder permeabilities

Question 12

What are glomerulations ?

Answer 12

• petichial haemorrhage

- not very specific ! Just shows bladder damage

Question 13

What is the current proposed aetiology for interstitial cystitis?

Answer 13

• lack of GAG layer in the bladder
• solutes can pass into bladder wall
• retrograde transport in axons -> histamine release, pain and local smooth muscle contraction
• pain

Question 14

How is neuroendocrine imbalance implicated wrt interstitial cystitis?

Answer 14

> current popular explanation

• decreased ability to produce cortisol -> overstimulation of the SNS
• evidence still sketchy (small adrenals and less cortisol response with ACTH stim, but study questionable)

Question 15

Risk factors for idiopathic FLUTD?

Answer 15

• in conflict with other cats (less dominant, hiding cats)
• overweight
• pedigree
• long haired

Question 16

Tx options for FLUTD?

Answer 16

• ABx/antiseptics
• Analgesia
• SQ fluids
• Steroids
• Diuretics
• DMSO
• bladder stropping
• acidifiers
• amitriptalyine
• urphydrodistension
• megestrol acetate
• sodium chloride
• copper coil
• moist food
• antispasmodics
• GAGs
• Lidocaine

Question 17

Eg of antispasmodics? Mechanism? Is there evidence for efficacy?

Answer 17

> propantheline 
- anticholinergic 
- v detrusor contraction 
- oral
- care to avoid urine retention
* no evidence for efficacy * 
> smooth and skeletal mm. antispasmodics
- dantrolene
- diazepam
- prazosin
- phenoxybenzamine

Question 18

Which anti inflammatory agents are used for FLUTD? Any contraindications?

Answer 18

> GCs
- contraindicated in azoteamia and with urinary catheters in place 
- no evidence of efficacy
> NSAIDs
- now more common 
- still no evidence for efficacy

Question 19

Which antidepressant is give to treat FLUTD?

Answer 19

Amitryptaline

• also sedative effect
• anticholinergic, antihistaminic, anti-inflam, analgesic

Question 20

Potential side effects of amytriptaline?

Answer 20

• urine retention
• sedation
• liver enzyme elevation
• ^ risk of recurrence
• ^ risk UTIs
• no improvement over placebo

Question 21

What is the most common current Tx?

Answer 21

> GAGs
- pentosan polysulphate
- N-acetyl glucosamin (cystease)
no evidence for either in placebo controlled trials

Question 22

Is Feliway indicated?

Answer 22

Very underpowered study

- likely to help (more positive response from Feliway than placebo but not statistically sig)

Question 23

How is diet indicated in FLUTD?

Answer 23

• ^ water intake (wet food, fountain, tuna water etc.)

- Hills C/D multicare (appeared promising but study never published so questionable)

Question 24

Current best advice for managed FLUTD?

Answer 24

> MEMO (multimodal environmental modification)

• avoid punishment
• canned food ^ water intake
• unscented litter
• improved litter box management (no cats +1)
• environmental enrichment
• ^ interaction with owner
• minimise conflict

Question 25

What is the strongest evidence for?

Answer 25

Diet and environment change

Question 26

Best approach to young cat with LUT signs?

Answer 26

• UA and imaging first time, definitely for repeat offenders
• wet food and drinking fountains
• behavioural and environmental modification
  +- synthetic GAGs (No evidence but not harmful)
  +- amitryptaline for refractory cases only last resort
• pain killers (butorphanol/buprenorphine)

Question 27

What is FLUTD?

Answer 27

• straining, pollakiuria, periuria
• clinical signs referable to the lower urinary tract
  = feline urologic syndrome (FUS)
  = feline interstitial FLUTD (FIC)
  > may be caused by UTI, neoplasia etc. But most commonly in younger cats no underlying cause