FLUTD Flashcards
Diagnostic approach to FLUTD in an older cat?
- urinalysis and culture
- other dx test (renal function, hyperthyroid)
- imaging for stones
How is idiopathic FLUTD dx?
- diagnosis of exclusion
- clinical signs spontaneously resolve within 3-7d
- recurrence common
- subset of animals have chronic dz
Increased risk factors for idiopathic FLUTD?
- Persian
- 2-6years
- spayed/castrated
- obesity
- V activity
- dry cat food
- stress
What is the old proposed aetiology of IFLUTD?
> infectious agents - bacterial - virus - mycoplasma > crystalluria > urachal diverticula
What is the new proposed aetiology for IFLTUD?
> interstitial cystitis
- neurogenic inflam
- mucosal defects
neuroendocrine imbalance
Do young cats get bacterial infections?
NO!!
Which viruses have been implicated in IFLUTD?
- 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
Are crystals implicated in IFLUTD?
- 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
Are vesiculourachal diverticula causes of lower urianry tract signs?
No - seen with obstruction as pressure increases and opening of the outpouching
- if obstruction cleared will heal spontaneously, no need to Tx
What is Interstitial cystitis ?
- dz of unknown aetiology in humans
- analogies between iFLUTD and IC
Outline similarities and differences between Interstitial cystitis and iFLUTD?
- young cats and women
- dysuria, pollakiurua
- sterile urine
- haematuria in cats but few RBCs in people
- glomerulations
- ^ bladder permeabilities
What are glomerulations ?
- petichial haemorrhage
- not very specific ! Just shows bladder damage
What is the current proposed aetiology for interstitial cystitis?
- 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
How is neuroendocrine imbalance implicated wrt interstitial cystitis?
> 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)
Risk factors for idiopathic FLUTD?
- in conflict with other cats (less dominant, hiding cats)
- overweight
- pedigree
- long haired
Tx options for FLUTD?
- ABx/antiseptics
- Analgesia
- SQ fluids
- Steroids
- Diuretics
- DMSO
- bladder stropping
- acidifiers
- amitriptalyine
- urphydrodistension
- megestrol acetate
- sodium chloride
- copper coil
- moist food
- antispasmodics
- GAGs
- Lidocaine
Eg of antispasmodics? Mechanism? Is there evidence for efficacy?
> propantheline - anticholinergic - v detrusor contraction - oral - care to avoid urine retention * no evidence for efficacy * > smooth and skeletal mm. antispasmodics - dantrolene - diazepam - prazosin - phenoxybenzamine
Which anti inflammatory agents are used for FLUTD? Any contraindications?
> GCs - contraindicated in azoteamia and with urinary catheters in place - no evidence of efficacy > NSAIDs - now more common - still no evidence for efficacy
Which antidepressant is give to treat FLUTD?
Amitryptaline
- also sedative effect
- anticholinergic, antihistaminic, anti-inflam, analgesic
Potential side effects of amytriptaline?
- urine retention
- sedation
- liver enzyme elevation
- ^ risk of recurrence
- ^ risk UTIs
- no improvement over placebo
What is the most common current Tx?
> GAGs
- pentosan polysulphate
- N-acetyl glucosamin (cystease)
no evidence for either in placebo controlled trials
Is Feliway indicated?
Very underpowered study
- likely to help (more positive response from Feliway than placebo but not statistically sig)
How is diet indicated in FLUTD?
- ^ water intake (wet food, fountain, tuna water etc.)
- Hills C/D multicare (appeared promising but study never published so questionable)
Current best advice for managed FLUTD?
> 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
What is the strongest evidence for?
Diet and environment change
Best approach to young cat with LUT signs?
- 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)
What is FLUTD?
- 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
