What is cystitis?

Cystitis is a general term referring to inflammation in the urinary bladder. The term cystitis does not imply a specific underlying cause.

In cats, diseases of the lower urinary tract (the bladder and urethra) are grouped under the term ‘feline lower urinary tract disease’ (FLUTD) as it can be difficult sometimes to distinguish between diseases of the bladder and urethra, and many diseases will affect both structures.

What are the signs of FLUTD?

Typical signs in cats with FLUTD are those of inflammation and irritation of the lower urinary tract. The common signs are therefore:-

•           Increased frequency and urgency of urination.

•           Difficulty in urinating (spending a long time straining on the litter tray while passing only small quantities of urine).

•           The presence of blood in the urine or blood spots in the litter tray.

•           Occasionally complete obstruction to the passage of urine (straining persistently without producing any urine).

With the latter sign particularly (straining without the passage of any urine), it is important to seek urgent veterinary attention as complete blockage to the flow of urine is life-threatening if left untreated.

What causes FLUTD?

There are a vast number of potential causes of FLUTD, but in many cats there may be severe inflammation of the bladder and/or urethra without an identifiable underlying cause (so called ‘idiopathic' FLUTD). These idiopathic cases have to be differentiated from other potential causes of the clinical signs, however, so that appropriate treatment can be given.  Some of the potential causes of FLUTD are listed below:

•           Idiopathic (inflammation with no known cause) but possibly caused by stress

•           Bacterial infections

•           Urinary calculi (‘bladder stones’)

•           Neoplasia (cancer)

•           Anatomical abnormalities

•           Urethral plugs (blockage of urethra with a mixture of crystals or small calculi/stones, mucus and inflammatory material)

How is FLUTD diagnosed?

The initial diagnosis of FLUTD is based on the identification of signs of lower urinary tract inflammation. The clinical signs displayed by the cat are often characteristic of FLUTD, but where there is doubt, analysis of a urine sample will confirm the presence of inflammation or blood.

Initially, a cat with uncomplicated FLUTD may be treated symptomatically. However, if the signs do not respond to this treatment, or if there is recurrence of the clinical signs, further investigation may be required to identify the underlying cause of the FLUTD.

What further investigations are required to diagnose the cause of FLUTD?

Where clinical signs are persistent or recurrent, a number of investigations may be required to differentiate idiopathic FLUTD from the other known causes of urinary tract inflammation.

These investigations may include:

•           Laboratory analysis of a urine sample

•           Bacterial culture of a urine sample

•           Blood samples to look for other evidence of urinary tract disease or systemic disease

•           Radiographs (x-rays) and/or ultrasound examination of the bladder and urethra

The information from these investigations should help to identify a specific treatable underlying cause if one is present.

What is the treatment for FLUTD?

This depends on the underlying cause. For example:

•           Cases of idiopathic disease may respond to treatment with anti-inflammatory or analgesic (‘pain-relieving’) drugs, but it is crucial that you only use drugs specifically prescribed by your veterinary surgeon, as many human products are extremely dangerous to use in cats. Dietary therapy and anti-depressant medications may also be very effective.

•           Bacterial infections of the lower urinary tract, although uncommon in cats, will usually respond well to antibiotic therapy.

•           If a cat develops a blocked urethra (this almost exclusively occurs in males), emergency treatment is required to remove the blockage, which may require flushing of the urethra while the cat is given a short anaesthetic. Most cats will need to stay in hospital for several days.

•           If bladder stones (calculi) are present they may have to be removed surgically or, depending on their type, they may be able to be dissolved by using a special diet, or dietary additive

There is no universal treatment for FLUTD. Each case has to be investigated to determine the underlying cause, and then the treatment has to be tailored to the individual cat. Sometimes despite appropriate investigation and treatment, clinical signs may still recur, requiring further therapy.

How can FLUTD be prevented?

It is impossible to completely prevent diseases of the lower urinary tract occurring. However, several therapies may be beneficial in reducing the number of attacks of idiopathic FLUTD. These include special acidifying diets (only available at vet clinics), adding water to food or feeding canned food, anti-depressant medications and anti-inflammatory medications. Minimising stressful events is very important in some cases.

A perineal urethrostomy is recommended for cats that have recurrent blockages of their urethra. This involves surgically removing the penis and approximately 3cm of urethra leaving a large opening for urine to be excreted from.

Chyle is a mixture of lymph and chylomicrons from the intestinal lymphatics that contains 60-70% of all ingested fat. It is connected to the venous circulation by way of the mesenteric lymphatics that empty into a dilated lymphatic collecting channel at the base of the diaphragm known as cisterna chili. The cisterna chyli continues forward as the thoracic duct and is located between the aorta and the azygous vein on the left side of the dorsal thorax. The thoracic duct empties into the left external jugular vein of the neck or the jugulosubclavian angle.

A lesion or obstruction along this pathway will result in the collection of chyle in the chest and sometimes abdomen as well. Trauma, neoplasia, malformation, lymphatic obstruction, congestive heart failure are known to cause chylous effusion. Many times though, no cause can be identified and is termed idiopathic chylothorax. This effusion can compromise respiration and cause breathing difficulties. Fibrosing pleuritis or constrictive pleuritis is a frequent sequela to chylothorax. The pleura becomes fibrosed and thickened causing atelectasis and preventing normal lung expansion.

Causes:
Heart disease, heartworm disease, congenital, diaphragmatic hernia, idiopathic, lung lobe torsion, lymphangiectasia, neoplasia, pancreatitis, obstruction to thoracic duct flow and traumatic rupture of thoracic duct.

Clinical findings:
ANOREXIA, ARRHYTHMIA, ASCITES, COUGHING, CYANOSIS, CARDIAC MURMUR, DYSPNEA, FEVER, TACHYCARDIA, WEAKNESS
Slow heart rate, heart sounds muffled, abdominal breathing, open mouth breathing, rapid shallow breaths, restrictive breathing pattern, cachexia, depression, dehydration, hypothermia, malaise
chest percussion dull, pulmonary sounds decreased, chest trauma, exercise intolerant or reluctant to move, onset gradual, chronic pale mucous membranes

Diagnosis:
Evidence of pleural effusion from thoracic radiographs or ultransonography. Thoracocentesis demonstrates chyle from the lymphatic system in the thorax. The distinguishing features are an opaque milky fluid, of moderate protein content, and moderate cellularity. Chylous and pseudochylous fluids are difficult to separate. Chylous fluids are high in triglycerides (cholesterol:triglyceride ratio less than 1), are positive for orange staining chylomicrons when stained with Sudan III, and clear when alkalinized and mixed with ether.

Treatment:

What causes chronic upper respiratory tract disease?

Chronic upper respiratory tract (URT) disease is a relatively common problem in cats, and can have many causes. The most common form is termed chronic post viral or idiopathic rhinitis. In this condition viral infection (e.g. cat ‘flu - caused by feline herpes virus or feline calici virus) causes the initial mucosal damage; but the chronic signs relate to secondary bacterial infection of the damaged nasal passages. This may then lead on to chronic osteomyelitis of the turbinate bones and cartilage (bacterial infection of the fine bones within the nose).

More unusual causes include:-

1.       Fungal infections including cryptococcosis.

2.       Inflammation which can result in polyps of inflammatory tissue.

3.       Neoplasia (cancer) which can be localised within the nose, or be part of more widespread disease.

4.       Physical damage which can result from foreign objects getting stuck up the nose, facial trauma (e.g. from cat bites or car accidents), or be associated with severe dental disease.

What are the clinical signs of chronic URT disease?

The main signs are nasal discharge and difficulty in breathing i.e. chronic ‘snuffles’. The exact nature of the discharge, whether both sides of the nose are affected, and the presence of other clinical signs are dependent on the exact nature of the disease process occurring within the nose, and on the presence of any other illness the cat may have.

In order to determine the extent and nature of the disease it is important that the cat be given a thorough physical examination by a veterinary surgeon. Particular points that the vet will look for include:-

1.       The presence of nasal discharge, and whether it is bilateral (affecting both sides of the nose) or unilateral (affecting only one side of the nose). Some diseases tend to show unilateral signs (e.g. foreign bodies, or cancer), while others more often cause bilateral signs (e.g. chronic post viral rhinitis, cryptococcosis).  The type of discharge can also be important; whether it is clear, purulent (pus), or blood stained. Although the presence of a discharge can be helpful in making a diagnosis, it can on occasion be misleading.

2.       Facial swelling may indicate a more serious underlying problem such as cancer or fungal infections arising within the nasal chambers. Although facial pain is seen rarely, resentment of facial examination is common among cats with URT obstruction, especially those with intranasal foreign bodies, or polyps.

3.       Sneezing, difficulty in breathing, noisy breathing and mouth breathing may all be seen, but their presence is usually of little diagnostic value.

4.       Examination of the eyes may reveal ocular discharge ‘runny eyes’, usually resulting from tear duct damage associated with previous URT viral disease or post viral conjunctivitis, but occasionally associated with cancer within the nose. Another legacy of URT viral infection can be the development of chronic inflammation of the cornea (the clear front part of the eye).

5.       Evidence of painful or infected ears may be associated with inflammatory polyps. Cats with polyps may have problems eating if the polyps are large enough to cause obstruction at the back of the throat, and these cats often have a snoring type of breathing.

6.       Cats with URT obstruction often have a poor appetite and so experience a degree of weight loss. Marked weight loss is more suggestive of cancer, fungal disease or severe systemic disease.

7.       The size and shape of the kidneys may be altered if certain cancers are present.

8.       Mild to moderate enlargement of the lymph nodes (glands) at the angle of the jaw is common, resulting from a local inflammatory response. If the lymph nodes become very large, or if lymph nodes elsewhere in the body are also affected, cancer or fungal infections are most likely to be the cause.

Over-interpretation of clinical signs can be very misleading since different diseases can give rise to similar signs. However, a few general rules do apply, e.g. facial deformity (changes in face shape) with associated pain, especially if accompanied by a unilateral nose bleeds or marked lymph node swelling is suggestive of more serious underlying problems such as nasal cancer or fungal disease. Lack of these clinical signs does not rule out these diagnoses as some cases of nasal lymphosarcoma (a common type of cancer) can cause bilateral nasal obstruction and little nasal discharge of any kind. Although post viral rhinitis usually presents as chronic bilateral purulent discharge, it can also result in unilateral discharge, sometimes blood tinged and occasionally with severe nose bleeds after ‘sneezing fits’.

Does the history of the cat make a difference to the likely diagnosis?

Yes. It is very important to know the answers to a number questions relating to the cat’s previous experiences. e.g.

1.       Did the cat have an acute URT infection (cat ‘flu) as a kitten? This is the most common initiating cause of chronic rhinitis.

2.       Is there any history of facial trauma, dental disease or ear infections?

3.       At what age did the cat first develop the clinical signs? The age of onset and speed of onset of clinical signs can often be misleading, but can occasionally be of help in the diagnosis.

4.       Has the nasal discharge always been of the same type, consistency and colour, and has it always been unilateral or bilateral? Are the signs progressing, is the cat systemically ill, and has the cat responded to any previous treatments? The answers to these questions may help determine the underlying cause of the problems.

My cat had ‘flu as a kitten and has had ‘snuffles’ ever since, although he is well in himself. Should I ask the vet to find out what is wrong with him?

Arrange for your vet to examine your cat but if chronic post viral rhinitis is believed to be the most likely cause of the patients clinical signs, and the cat is not too distressed by the nasal discharge, it is probably best not to put it through further examinations. Further investigations are generally best left for cats with severe or progressive clinical signs, or those with evidence of generalised disease.

When considering treating cats with severe chronic URT disease it is helpful, (where possible), to differentiate between the possible underlying causes. This allows for the correct treatment to be given and the probable outcome to be discussed. However, since most cases of URT disease will result from chronic post viral damage, it is important to remember that tests may give negative results and the likelihood for full recovery, even with treatment, may be guarded to poor.

What tests can be done to find the cause of the disease?

1.       Non-invasive tests, such as haematology, biochemistry and tests for FeLV and FIV may help to determine the extent of systemic disease.

2.       Nose and throat swabs may be taken to look for the presence of fungi.

3.       For the best hope of finding a diagnosis it is necessary to give the cat a general anaesthetic in order to perform more extensive investigations. These include taking radiographs (X-rays) and examining the nose, throat and mouth using endoscopy. Detailed examination includes looking up the cat’s nose, and examining behind it’s soft palette (the flap of skin at the back of the throat). While examining the nose it is possible to take samples to look for bacteria, fungi, evidence of inflammation or cancer cells. Endoscopy allows access to the nasal chambers, but it is is possible that underlying disease may sometimes be missed. Deep biopsies of the nasal cavity with special forceps are very helpful in obtaining an accurate diagnosis.

Can chronic URT disease be treated?

Yes, but in only some cases is treatment likely to give a long term cure. In most cases the clinical signs can merely be controlled, since the chronically damaged bones cannot be repaired.

Antibiotics can be given to reduce secondary bacterial infection. However to control the clinical signs it is usually necessary to give them for long periods of time or as repeated courses in order to control the clinical signs. Some cases can be permanently cured with long courses of expensive antibiotics. In the remaining cases it is generally hoped that with time the cat, and its owners, will learn to live with the cat’s disease, without the need for repeated courses of antibiotics.

Other treatments that can be considered include drugs to reduce the thickness of the nasal secretions (mucolytics), or treatments to help the cat breath more easily (anti-congestants or steam inhalation). If the cat is severely affected by ‘snuffles’ and is undergoing further investigation, it is possible to therapeutically flush the pus from the nasal passages while the cat is under general anaesthetic. Although this procedure can occasionally give some degree of short term relief, the clinical signs usually return. The most essential aspect of treatment is good nursing care; keeping the cat’s face clean and clear of discharge, and encouraging it to eat by feeding warmed up food that is strong smelling.

Specific treatments can be given where a specific causes have been found, e.g. polyps can be surgically removed, some cancers can be controlled with chemotherapy, and fungal disease can be cured with anti-fungal drugs.

An abscess is a collection of pus.  In cats, abscesses are common after a cat fight. Cats are territorial animals, and will fight with other cats to defend their territory. If your cat gets bitten during a fight, bacteria from the other cat’s teeth infect the wound and cause an abscess.

Bites are most common around the face and shoulders or around the rump and tail.

If you know your cat has been in a fight, have him or her checked out by a veterinarian. If your cat starts taking antibiotics within 24 hours after the fight, you may be able to keep an abscess from forming.

Symptoms

Abscesses usually appear two to seven days after your cat gets bitten. Usually, your cat will act like he is not feeling well. He may be listless and not eating well.  She may be cranky, especially if she is touched where her injuries are.  She could feel warm and have a fever.

If you gently probe where the cat is tender (put rubber gloves on for this—you could get a nasty surprise), you may feel a soft, warm lump. If the abscess has burst, you will find an open wound that is draining pus. Some of the skin around the abscess may have died from the pressure created by the pocket of pus.

Treatment

Abscesses are treated with surgery to flush out the pus and cut away any dead skin. Small latex drains may be inserted to drain the pus out so that the wound can heal.

Your cat will also need to take antibiotics to fight the infection that is causing the abscess.

Post-operative Care

You will need to continue to care for your cat after you take her home. You will need to:

• Gently tug at the drains twice a day.
• Remove any scab that forms twice a day. This is extremely important so that the wound stays open and the pus can drain out.  If necessary, you can soak the area in warm salty water (1 teaspoon of salt to 1 litre of warm water) to make it easier to remove the scab.  Neither you nor your cat will enjoy this procedure.
• Keep your cat indoors. He may need to wear an Elizabethan collar to keep him from chewing the drains out.  Keep him indoors so that you can make sure he doesn’t get the collar off or get in another fight.
• Make sure your cat takes all the antibiotics. Follow the directions on the packet.
• Call your veterinary if you think the wound is not healing correctly, or if you have any other concerns.

Preventing Future Abscesses

Most abscesses are caused by cat fights, so the best way to prevent them is to keep your cat from fighting. You can do this by:

• Keeping your cat indoors as much as possible, especially at night. More cat fights happen at night.
• Get your cat neutered. Male cats fight more than females, and they fight over territory and females. Neutered males don’t get in as many fights.

If you think your cat has been in a fight, take him to the vet as soon as possible. You can prevent abscesses from forming by getting early treatment for any injuries.

FIV (Feline AIDS) Infection

Cats spread FIV through bites and scratches. Any time he has a cat fight wound, your cat may be exposed to Cat Aids.  We recommend a blood test 2 months after the injury to see your cat has contracted FIV.

We strongly recommend vaccination against cat aids (FIV) for all cats that go outside. Please contact us for more information or to arrange a vaccination.

Measurement of blood glucose concentration (BG) is usually the best method of determining the correct insulin dose for diabetic cats. Stress hyperglycaemia occurs commonly when cats visit a veterinary surgery and can result in the wrong dose of insulin being selected. Thus, the stress-free environment at home is the best place to measure a cats BG.

Most human glucometers are very accurate at measuring cat blood. We prefer the Accu-Chek brand which can be purchased from any chemist for approximately $60.

The easiest and safest place for owners to sample blood from is the ear veins. Cats have small veins that run around the outside of their ears and these veins can be easily accessed from the dorsal surface. Blood can be sampled on both the cranial and caudal border of each ear giving a total of 4 sites to sample. Shaving the hair directly over the vein with a scalpel blade allows much better visualisation and with very slow hair regrow, will last for many weeks.

Procedure
1. Turn the glucometer on or insert test strip so the digital display is requesting blood.
2. Hold the edge of the ear between index-middle finger and thumb-fourth finger and firmly pull taut.
3. Quickly prick the vein with an insulin needle so a small drop of blood is produced on the skin surface. Pre-used insulin syringes are fine to use for this.
4. Bring glucometer down to the skin and place the end of the test strip into the blood until it beeps.
5. Read the number on the display and record it.
6. Wipe any excess blood away with a moist tissue.

Cats rarely react to their ears being pricked but topical anaesthetic creams such as EMLA can be applied prior to sampling if required. The most common complaint from owners is spraying of blood around the house if they shake their heads while blood is pooled on the skin. This can be minimised by not releasing the initial grip on the ear until blood has been transferred (with one hand) to the glucometer and a tissue applied to the ear.  Blood glucose samples are best collected just before an insulin dose is due so dose adjustments can be made immediately if required rather than waiting until the next injection.

Selecting insulin dose
For newly diagnosed diabetic cats (less than 2 months):
If BG is above 12mmol/L then increase insulin dose 0.5 units (half a unit)
If BG is between 6 and 11mmol/L then keep insulin dose the same
If BG is between 3 and 6mmol/L then reduce dose by 0.5 units
If BG is less than 3mmol/L then don’t give insulin and call the clinic to discuss

For longer-term diabetic cats (more than 2 months of insulin therapy):
If BG is above 25mmol/L then increase insulin dose 1 units
If BG is between 14 and 25mmol/L then increase insulin dose 0.5 units
If BG is between 6 and 13mmol/L then keep insulin dose the same
If BG is between 4 and 6mmol/L then reduce dose by 0.5 units
If BG is less than 4mmol/L then don’t give insulin and either check for remission or call the clinic to discuss.

How often to sample
Ideally, diabetic cats should have BG sampled several times daily (just like humans do) but for many reasons this is not practical. We recommend that newly diagnosed cats should have their BG checked every 2-3 days for the first few weeks and longer-term diabetic cats be sampled every 1-2 weeks. If insulin dose is changed, then a repeat BG should be done 2-3 days afterwards to check the right decision was made, whereas if the insulin dose is kept the same then a repeat BG is probably not required for 1-2 weeks.

Record keeping
A table should be kept which contains the date, current insulin dose, the BG reading and the new insulin dose selected. Initially, this table should be reviewed by a veterinarian in consultation every few weeks. Your veterinarian will assess the BG readings and the decisions you have made and comment as necessary. Most owners rapidly become competent at sampling blood and selecting the correct insulin dose making it unnecessary to consult us for long periods.