FLUTD CR

Question 1

What is this cases history and signlament?

Answer 1

• MB is a 2 year old male neutered DSH
• He has been in the owner’s possession since he was 8 weeks old.
• He is a 100% indoor cat.
• For the last 48 hours MB has been urinating in odd places. Mr Mills says it smells very strong and there are only small amounts. He says MB has never done anything like this before and has always used a litter tray.

Question 2

What are MBs presenting signs?

Answer 2

• MB weighs 6.38kg and is overweight.
• He has a small patch of thinned hair on the caudal ventral abdomen
• Clinical examination is otherwise unremarkable, his bladder is small and not painful when you palpate it
• MB is sitting on your consulting room table licking his perineal area

Question 3

Create your first SOAP notes for this case

Include a differential diagnosis list using the DAMNITV scheme in the assessment section

Answer 3

S

• Smelly urine
• Small quantity of urine
• small patch of thinned hair on the caudal ventral abdomen
• Small unpainful bladder

O

• 2yo DSH
• Indoor cat – 100%
• Always used litter tray
• 6.38kg
• licking his perineal area

A
D
A – behavioural
M – uroliths,
N – Neoplasia
I – Feline idiopathic cystitis, fleas, UTI, FLUTD,
T -
V

P
Urinalysis; including sediment exam, Abdominal ultrasounded. Skin scrape, Hair pluck, Radiograph

WARN THE OWNER ABOUT THE RISKS OF A BLOCKED CAT

Question 4

• You talk at length to Mr Mills about feline lower urinary tract disease and he wants no investigations at this stage
• You decide to give MB an injection of meloxicam, and advise:

Answer 4

• MB has wet food rather than dry food
• Place a second litter tray in the house
• Encourage MB to play and exercise more

Question 5

You warn Mr Mills of the signs of urinary tract obstruction and that this is an emergency situation.

Mr Mills makes an appointment for you to see MB in 4 days time

Answer 5

• Mr Mills doesn’t keep his appointment.
• MB is back in your consulting room 7 weeks later with the same problem. Mr Mills says MB got better within 2-3 days last time so didn’t see the point of coming back and he didn’t change his diet.
• Mr Mills wants you to give him a ‘jab to make him better’ like last time
• Clinical examination is as before, and you express MB’s bladder for a free catch urine sample

Question 6

Interpret these results:

Answer 6

USG – able to concentrate urine

Small amount of protein in the urine

Large amount of blood

Question 7

• Think about what you are going to say to Mr Mills
• Explain if you think it was your treatment that ‘cured’ MB?

Answer 7

Meloxicam probably helped to relieve some discomfort but this cant be proven as FLUTD is a waxing and waning disease.

Question 8

Draft an explanation about possible dietary and management options for this case?

Answer 8

Wet diet

•frequent smaller meals?

Free access to water

• water fountains
• dripping taps

Broths/flavoured ice cubes

• tuna water?
• bolied meat?

Glycosaminoglycans – no proven evidence

Anxiolytics?

• amitriptyline
• tricyclic antidepressant, anticholinergic, antihistaminic, anti inflammatory, analgesic…
• helpful for IC in women
• controversial in cats and has side effects

Muscle relaxants

• dantrolene
• prazosin

Question 9

You give MB a 5 day course of metacam Mr Mills goes home with Feliway, a new litter tray and urinary SO diet.

He returns 5 days later as requested and wants no further investigations as MB is fine again.

But…..

Answer 9

Mr Mills re-presents MB 5 weeks later with signs of dysuria once more. MB has been on wet food (not urinary SO) since you last saw him.