FLUTD & Incontinence (Marin) Flashcards
what is FLUTD?
feline lower urinary tract disease: any disorder affecting the bladder or urethra of cats, males and females
it is a syndrome, not a diagnosis
regardless of cause, common clinical signs: hematuria, stranguira, dysuria, pollakiuria, inapp urinations, vocalizing, hiding
how difficult is it to find an actual diagnosis for FLUTD cats?
very! 2/3 will not have a specific diagnosis. it is a multifactorial syndrome and difficult to manage sometimes!
what are the big causes of FLUTD?
feline idiopathic cystitis (FIC) is MOST COMMON
urolithiasis
urethral plugs
true or false: FLUTD affects male cats only
false! it affects both males and females but it affects males more commonly
true or false: any cause of FLUTD can also cause urinary obstruction in male cats
true! usually urolithiasis or FIC
what causes FIC?
we dont know, thought to be an anxiopathy, activation of the central threat response system. the bladder is NOT the origin of the problem. it’s more like the cat is just generally out of whack
what are some risk factors for FIC?
obesity, anxiety, frquent diet change, indoor cat, multi cat household, humans
essentially the big thing is STRESS and OVERDRIVE of the STRESS response
if a cat comes in with classic signs of FLUTD, how should you diagnose?
minimum database, UA +/- culture, medical imaging
OR treat as FIC and see if they dont want to do this
what kind of medical imaging should you do for FLUTD diagnosis?
radiographs because you can see stones. POCUS is only good for looking at the bladder and you can’t rule out stones completely because they could be anywhere in the urinary tract
when diagnosing FLUTD, what do you expect to see on CBC/chem?
CBC will be normal likely
chem: azotemia if obstructed, can be hypercalcemic too
a cat named Professor Purr-fessor Fuzzybottoms comes to you for straining in the litter box and some bloody drip drops out of his pee pee. you collect a urine sample via cytocentesis. What sorts of things are you looking for?
I suspect FLUTD
if FIC: sediment will be active (WBCs, blood, sometimes mucus or debris, sometimes crystals)
active sediment does NOT mean infection, and crystals do NOT mean stones!!
can sometimes see bacteria in the urine too!
Professor Purr-fessor Fuzzybottoms has FLUTD. What is your treatment plan for him?
he needs fluids, either in hospital or at home: for hydration and to dilute debris
pain control: opioids, buprenorphine or methadone, NSAIDs dont work
appetite stimulant and nausea control: let them eat WHATEVER THE @#&@^%#!* THEY WANT
prazosin is controversial
reduce stress and give them a safe place to rest and recover
if a male cat is blocked, how long should a U cath stay in for?
at least 24 hrs but no more than 36 hrs. after you take it out you should monitor the cat for another 6-12 hrs to make sure they can pee!!!!!!!
when should you consider a decompressive cysto?
only if life threatening bradycardia and you cannot catheterize them for some reason
Captain Meowmerica is blocked but his owner has very limited funds. what options are there?
euthanasia :(
in-out catheterization but this has a very high reoccurance rate
could consider: acepromazine, buprenorphine, medetomidine, and decompressive cysto, give SQ fluids, and some cats can unblock themselves?
the acute phase of FIC lasts
5-7 days
Duchess Whiskerella comes in with FIC based on your initial workup. what acute treatments can you offer her?
MEMO*****: multiple environmental modification incluiding space, no strong scents, give them plenty of play opportunities, enrichment, at least 2 litter boxes, decrease stress, feed in a quiet place, decrease the number of cats
make your cat #@^#*@ing happy
DO NOT GIVE ANTIBIOTICS YOU DUMMY
meloxicam, lidocaine, and GAGs all DO NOT WORK
Duchess Whiskerella’s owner wants to know how they can prevent FIC and you say…
water water water water water water water!!!!
fresh, refilled, running, fountains, multiple, cleanliness, hydrate the diet
why does it work? it dilutes problematic substances
how can you best manage a cat’s diet with FIC?
consistency is key, diet changes can cause recurrance!
if possible, use wet food
promote weight loss
decrease anxiety: avoid feeding them in high traffic areas, let them do puzzles, offer positive reinforcement
urinary diets can have some good benefit but not essential
when would you consider a perineal urethrostomy for recurring UO?
only consider if the cat has blocked more than 2-3 times. It can cause strictures and sometimes UTIs and it does NOT solve the FIC problem, it just changes their anatomy so they are less likely to obstruct
what is Amitriptyline?
used only for chronic/recurrent cases of FIC, it is an antidepressant. it takes 2-3 months to work and has some side effects like weight gain, somnolence (eepy)
what is urinary incontinence?
loss of voluntary control of urination, resulting in urine leakage. you must differentiate from inappropriate urination which is behavioral
a 4 mo golden named Wiggles McSnugglebutt comes to you because the owner is upset!!!!!! ANGY!!! she keeps peeing herself in her crate at night time, in her dog bed, and when walking around the house. the owner says it’s like she doesnt even know she’s doing it! She has no troubles urinating. what do you suspect and what do you want to do next?
palpate the bladder and try to express it, a full neurologic exam, and test the cranial nerves
ectopic ureters
what are the 3 muscle ayers of the bladder?
detrusor muscle: smooth muscle that contracts during micturition (peeing)
internal sphincter: smooth muscle
external spinchter: striated
2 main causes of incontinence are…
you can differentiate them by…
failure of the storage phase, or the voiding stage
storage disorders usually have small residual bladder volume so the bladder will be small on palpation–>this is more common
voiding disorders usually have incomplete emptying of the bladder so the bladder will be large
the most common cause of incontinence in dogs is…
primary urethral sphincter mechanism incontinence–>in spayed female dogs due to decreased estrogen and lack of sphincter closure. It can take years to see clinical signs!! Thought to be maybe a spay done too early? (wait until 6 months to spay)
what treatment options are there for UMSI?
phenylpropanolamine/PPA=proin: it is an alpha adrenergic receptor stimulator that increases urethral sphincter tone
- side effects: hyperactivity, restlnessness, hypertension
- expensive but VERY effective!!
can also do diethylstilbestrol: an estrogen compound, this is not as good as proin because it can cause aplastic anemia
other: estriol, hard to get in canada, but doesnt cause aplastic anemia, works the same as DES
best way to prevent USMI?
in dogs more than 25kg, wait until after first heat cycle to spay (doesn’t matter for young dogs)
what is ectopic ureters?
where one or both of the ureters enters the bladder at an abnormal location (neck of bladder, vaginal vault, urethra, etc). Most are intramural
golden retrievers predisposed
you think Wiggles McSnugglebutt has ectopic ureters. How do you want to diagnose?
radiographs + contrast, contrast CT, ultrasound
cytoscopy especially helpful
how will you treat Wiggles McSnugglebutt with ectopic ureters?
surgery, laser ablation(only if intramural)
do not respond well to medical management
what is large bladder incontinence?
detrustor atony: a distended flaccid bladder and that easil expressed caused by bladder overdistention which damages the tight junctions of the muscle
can be seen in cats that have had severe urethral obstruction and bladder distention
true or false: dogs with urinary incontinence are less likely to get UTIs
false they are MORE likely to get UTIs!!!
