FLUTD & Incontinence

Question 1

what is FLUTD?

Answer 1

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

Question 2

how difficult is it to find an actual diagnosis for FLUTD cats?

Answer 2

very! 2/3 will not have a specific diagnosis. it is a multifactorial syndrome and difficult to manage sometimes!

Question 3

what are the big causes of FLUTD?

Answer 3

feline idiopathic cystitis (FIC) is MOST COMMON
urolithiasis
urethral plugs

Question 4

true or false: FLUTD affects male cats only

Answer 4

false! it affects both males and females but it affects males more commonly

Question 5

true or false: any cause of FLUTD can also cause urinary obstruction in male cats

Answer 5

true! usually urolithiasis or FIC

Question 6

what causes FIC?

Answer 6

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

Question 7

what are some risk factors for FIC?

Answer 7

obesity, anxiety, frquent diet change, indoor cat, multi cat household, humans

essentially the big thing is STRESS and OVERDRIVE of the STRESS response

Question 8

if a cat comes in with classic signs of FLUTD, how should you diagnose?

Answer 8

minimum database, UA +/- culture, medical imaging

OR treat as FIC and see if they dont want to do this

Question 9

what kind of medical imaging should you do for FLUTD diagnosis?

Answer 9

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

Question 10

when diagnosing FLUTD, what do you expect to see on CBC/chem?

Answer 10

CBC will be normal likely

chem: azotemia if obstructed, can be hypercalcemic too

Question 11

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?

Answer 11

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!

Question 12

Professor Purr-fessor Fuzzybottoms has FLUTD. What is your treatment plan for him?

Answer 12

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

Question 13

if a male cat is blocked, how long should a U cath stay in for?

Answer 13

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!!!!!!!

Question 14

when should you consider a decompressive cysto?

Answer 14

only if life threatening bradycardia and you cannot catheterize them for some reason

Question 15

Captain Meowmerica is blocked but his owner has very limited funds. what options are there?

Answer 15

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?

Question 16

the acute phase of FIC lasts

Answer 16

5-7 days

Question 17

Duchess Whiskerella comes in with FIC based on your initial workup. what treatments can you offer and what are you gonna tell the owner for home modification to prevent this from happening again?

Answer 17

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

Question 18

Duchess Whiskerella’s owner wants to know how they can prevent FIC and you say…

Answer 18

water water water water water water water!!!!

fresh, refilled, running, fountains, multiple, cleanliness, hydrate the diet

why does it work? it dilutes problematic substances

Question 19

how can you best manage a cat’s diet with FIC?

Answer 19

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

Question 20

when would you consider a perineal urethrostomy for recurring UO?

Answer 20

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

Question 21

what is Amitriptyline?

Answer 21

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)

Question 22

what is urinary incontinence?

Answer 22

loss of voluntary control of urination, resulting in urine leakage. you must differentiate from inappropriate urination which is behavioral

Question 23

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?

Answer 23

palpate the bladder and try to express it, a full neurologic exam, and test the cranial nerves

ectopic ureters

Question 24

what are the 3 muscle ayers of the bladder?

Answer 24

detrusor muscle: smooth muscle that contracts during micturition (peeing)

internal sphincter: smooth muscle

external spinchter: striated

Question 25

2 main causes of incontinence are…

you can differentiate them by…

Answer 25

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

Question 26

the most common cause of incontinence in dogs is…

Answer 26

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)

Question 27

what treatment options are there for UMSI?

Answer 27

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

Question 28

best way to prevent USMI?

Answer 28

in dogs more than 25kg, wait until after first heat cycle to spay (doesn’t matter for young dogs)

Question 29

what is ectopic ureters?

Answer 29

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

Question 30

you think Wiggles McSnugglebutt has ectopic ureters. How do you want to diagnose?

Answer 30

radiographs + contrast, contrast CT, ultrasound

cytoscopy especially helpful

Question 31

how will you treat Wiggles McSnugglebutt with ectopic ureters?

Answer 31

surgery, laser ablation(only if intramural)

do not respond well to medical management

Question 32

what is large bladder incontinence?

Answer 32

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

Question 33

true or false: dogs with urinary incontinence are less likely to get UTIs

Answer 33

false they are MORE likely to get UTIs!!!