Internal Medicine: Feline Lower Urinary Tract Disease Flashcards
What is FLUTD and Feline Urological Syndrome?
Collective terms for signs of lower urinary tract disease and abnormal voiding behaviour
What is the definition of feline idiopathic cystitis?
- Abnormal voiding behaviour after exclusion of other disorders
- No obvious cause
- Chronic, persistent or recurrent
What are the potential different causes of non-obstructive FLUTD?
- Idiopathic cystitis
- Uroliths
- Anatomical defects/cancer/other
- Behaviour problems
- Bacterial infection
Bacterial infection uncommon
What may cause obstructive FLUTD?
- Idiopathic cystitis
- Uroliths
- Urethral plug
- Bacterial infection
Bacterial infection uncommon
What is a more common presentation of FLUTD?
- Any age or sex
Young to middle-aged neutered cats, 2-6 years old - Males more prone
- Persians appear predisposed
What are pre-disposing factors for FLUTD?
- Obesity
- Indoor/sedentary cats
- Dry diet
- Multi-cat household
What are history and clinical signs of FLUTD?
- Dysuria- difficulty urinating
- Pollakiuria (increased frequency)
- Haematuria
- Inability to urinte- urethral obstruction
- Behaviour changes
- Appear to lose litterbox training
- Periuria- urinating in inappropriate places
How can obstructive and non-obstructive cats be distinguished?
Non-obstructed
* Generally well
* Usually self-limiting and resolves in 5-10 days
* Bladder small, firm, may be painful
Obstucted cats- emergency
* Large, painful bladder
* Check penis for signs of self-limiting/ crystals
Describe the pathophysiology of FIC
- Alterations in neurotransmission to and from the bladder causes neurogenic inflammation
- Reduced glycosaminoglycan layer
What hormones are affected by FIC?
- Cats with FIC have increased norepinephrine to moderate stress
- FIC cats have reduced cortisol
Struggle to deal with stress which plays role in FIC
What does a urethral plug consist of?
- Plug consists of mucus
- Glycoprotein matrix
- Often with other substances trapped in the matrix
What anatomical defects may cause FLUTD?
Inherited
* Vesico-urachal diverticulae
* Bladder hypoplasia
* Urethral strictures
* Phimosis
Acquired
* Strictures due to trauma
* Inflammation
* Iatrogenic damage
What is important about blood samples in blocked cats?
- Hyperkalaemia
- Hyperphosphataemia
- Metabolic acidosis
- Azotamia
How are feline uroliths treated?
- Struvite may be dissolved with medical dissolution diet
- Calcium oxalate will need surgical removal
- Encourage water intake
- Use diet to prevent recurrence
How is FIC treated?
- Most cases spontaneously resolve in 5-10 days
- Most treatments have not been well investigated
Corticosteroids and ABS have no positive effect
Reduce stress
NSAIDs may help
Buprenorphine
TCAs- amitritptyline
How could stress be reduced for FIC?
- Reduce overcrowding and bullying
- Provide multiple and separated key environmental resources- food/water, toileting
- Reassure cat with physical contact
- Pheromone sprays
- Liter box managment
What is the function of GAG supplement?
- Exogenous GAG attaches to the bladder lining and increases bladder permeability
- Some success in people with interstitial cystitis
- Studies in cats not significant
What are the side effects of TCAs?
When should they be used for treatment of FIC?
- May cause somnolence
- May cause urine retention
- Raised liver enzymes, neutropenia, thrombocytopenia
What uroliths can cats get?
- Struvite
- Calcium oxalate
- Urates
What may be looked at for urinalysis with FLUTD show?
- Dipstick
- Sediment- don’t over interpret
- Specific gravity- high conc predisposes to uroliths
- Culture- unlikely to be useful
When imaging a cats urinary tract what needs to be done?
Include all of the urinary tract, including urethra
* Plain and contrast strudies
Ultrasound
What is MEMO?
Multimodal environement modification
