FLUTDs Flashcards
What etiologic diagnosis can be made in LUTD?
None! Often idiopathic
Are LUTDs common or rare
Common
If not idiopathic, what are some possible etiologies behind LUTDs?
- bacterial if cat >10 YO
- Uroliths
- Neoplasia, trama, anatomical, behavioral
- Feline interstitial cystitis
How do we dx feline interstitial cystitis?
Dx based upon cystoscopy (glomerulations)- GOLD STANDARD!
What are some risk factors for developing FLUTDs?
- age: 2-6 YO most common
- litter box use only (how many boxes)
- mainly indoor
- dry cat food
- inactive
- stress
- seasonality: seen predominantly in winter and spring
What five things could be behind Feline Idiopathic Cystitis?
- Mucosa fucked
- Submucosa fucked
- Sympathetic NS abnormalities & C-pain fibers
- Stress Response System Dz (I prob have this)
- Comorbid Disorder
What about the mucosa is fucked up with regards to Feline Idiotpathic Cystitis?
- altered urinary glycosaminoglycan excretion
- increased ion leakage across urothelium
What about the submucosa could contribute to Feline Idiopathic Cystitis?
-mast cell presence
What aspects of the sympathetic NS are screwed up with Feline Idiopathic Cystitis?
- afferent sensory info: substance P (sensory NT)
- capsaicin: activates C-fiber vanilloid receptors
- substance P and capsaicin end up being much higher than they should be
How does stress contribute to Feline Idiopathic Cystitis?
- Neural: stresses activate the stress response system (stimulate peripheral nn, hormones, and immune complexes)
- Hypothalamic pituitary adrenal axis abnormalities
- Immune response: immune activation and pro inflam cytokine release
What clinical signs will we see with FLUTDs?
- hematuria
- stranguria
- pollakiuria
- inappropriate urination
- palpate large, firm bladder
- inability to urinate (block) vs periuria
Initially, cat will come in and pee in your room and then it pees blood and then eventually it’s blocked
How do we diagnose FLUTDs?
- OUR MAIN DX IS HISTORY!! Find out about that environment !
- Exclusion: negative culture, imaging (rule out urolithiasis w US and Rads)
- Cystoscopy
What percentage of cats younger than 10 YO have a true bacterial cystitis?
What’s the main way to tx FLUTDs?
CHANGE ENVIRONMENT! Environmental enrichment is the ONLY evidence based medicine shown to be beneficial.
Enviro enrichment associated w reduction in LUT signs and also w normalization of circulating catecholamine concentrations, bladder permeability and cardiac fxn
In what ways can we improve the environment and thus, improve FLUTDs?
- reduce stress
- litter boxes: always have +1 so if one cat have 2 litter boxes, if four cats then have 5 litter boxes
- water sources
- activity/playing
How can we medically tx FLUTDs?
Often dislodge obstruction
Catheterization is preferred method of dislodgment !
What dietary changes should we make for FLUTDs?
- avoid frequent changes
- wet food not dry
Do we give drugs to FLUTDs patients?
Sure. Analgesics-opioids for pain management
What techniques do we use to investigate female genital dz?
-vaginal: speculum exam and cytology
Vaginal hyperplasia/ prolapse (Estrogen effect) are more commonly seen in intact or spayed females?
Intact!
How can we ID TVT on cytology?
-lots of vacuoles in cytoplasm and that’s typical for a TVT round cell tumor
Are intraprostatic or paraprostatic cysts likely to get huge?
Paraprostatic cysts can get huge
What signalment is associated with prostatic dz?
- male dog obv (INTACT except for neoplasia!)
What are the 3 main things we should associated with Benign Prostatic Hyperplasia?
- Normal aging change
- NOT painful
- asymptomatic
All intact dogs with UTI have . . .
All intact dogs with UTI have prostatitis! (urinalysis will show evidence of UTI)
How do acute prostatitis cases present?
Sick and painful
Which is more common: acute or chronic prostatitis?
Chronic Prostatitis more common
Is chronic prostatitis asymptomatic?
- It can be but it can also have clinical signs such as recurrent UTIs or preputial discharge.
- Prostate is NOT painful but it is enlarged
How do we tx Benign Prostatic Hyperplasia (BPH)?
Surgical (orchidectomy) or medical chemical castrations (GnRH)
How do we tx Prostatitis?
Antimicrobials or sx
What antibiotics would we use to tx Prostatitis?
Antibiotics that penetrate well: fluoroquinolones, doxycycline, trimethoprim, rifampin and erythromycin
The second generation quinolines widely used to tx prostatic infection include ciprofloxacin, ofloxacin, norfloxacin and levofloxacin.
What signalment is associated with prostatic neoplasia?
Can be intact OR fixed dog! Neutering does not protect them :(
What is the presenting complaint associated with prostatic neoplasia?
-lameness and mass effect signs
What do we find on the PE of prostatic neoplasia?
- painful gait with pain in sacrum
- prostate palpable in a neutered dog
- possible asymmetry
- sublumbar LN may be palpable
Where does prostatic neoplasia metastasize?
LN, vertebrae, lungs
Why are surgery and radiation not good tx options for prostatic neolasia?
sx= incontinence post op radiation= poor success and radiation induced fibrosis
What tx methods do we utilize for prostatic neoplasia?
- Chemo-Mitoxantrone: topoisomerase inhibitor: disrupts DNA synthesis and repair
- COX inhibitors
- urethral stents
What kind of neoplasia is commonly found in the bladder or urethra and what breed is predisposed to it?
TCC very common in Scottish terrier
What is the #1 sign we see in TCC?
Hematuria
How do we tx TCC?
- Piroxicam: MST 6 mos
- Sx
- Chemo (Mitoxantrone) . . . together w Piroxicam = median survival of 12 mos
