Emphysematous pyelonephritis in a domestic shorthair cat

Medical management of feline emphysematous hepatitis-A case report

Case report summary: A 9-year-old male castrated domestic shorthair feline was presented to the emergency department with a chief complaint of constipation of 3-day duration, decreased urination of 1-day duration, vomiting, and hind limb weakness. Physical examination abnormalities included hypothermia, dehydration, and generalized paresis with inability to stand for a prolonged period of time. Abdominal ultrasonography showed pinpoint hyperechoic foci throughout the hepatic parenchyma, small gas foci circulating within the portal vasculature consistent with emphysematous hepatitis, and mild volume of ascites. Cytology of the ascites was consistent with inflammatory effusion. Hepatic cytology was consistent with mixed inflammation/hepatitis with no apparent cause for inflammation noted. Urine culture yielded a negative result. Surgical liver biopsy and culture were declined by the patient's family. Ultrasound changes were presumed to be most likely secondary to an ascending infection.

Feline abdominal ultrasonography: What's normal? What's abnormal? Renal pelvis, ureters and urinary bladder

PRACTICAL RELEVANCE

Abdominal ultrasound plays a vital role in the diagnostic work-up of many cats presenting to general and specialist practitioners. Ultrasound examination of the urinary tract provides important information useful in the investigation of several conditions including ureteral obstruction and cystitis.

CLINICAL CHALLENGES

Despite ultrasonography being a commonly used modality, many practitioners are not comfortable performing an ultrasound examination or interpreting the resulting images. Even for the experienced ultrasonographer, differentiating between incidental findings, such as lipid droplets in the bladder, and pathological changes can be challenging.

AIM

This review, part of an occasional series on feline abdominal ultrasonography, discusses the ultrasonographic examination of the normal and diseased renal pelvis, ureters and urinary bladder. Aimed at general practitioners who wish to improve their knowledge of and confidence in feline abdominal ultrasound, this review is accompanied by high-resolution images and videos available online as supplementary material. Ultrasound examination of the kidneys and perinephric space was discussed in an article published in May 2020.

EQUIPMENT

Ultrasound facilities are readily available to most practitioners, although the use of ultrasonography as a diagnostic tool is highly dependent on operator experience.

EVIDENCE BASE

Information provided in this article is drawn from the published literature and the author's own clinical experience.

Urinary tract infection and subclinical bacteriuria in cats: A clinical update

PRACTICAL RELEVANCE

Urinary tract infection (UTI) is an important cause of feline lower urinary tract disease (FLUTD), particularly in female cats older than 10 years of age. In addition to cats with typical clinical signs of FLUTD or upper UTI, many cats have subclinical bacteriuria, but the clinical relevance of this is currently uncertain. UTIs are one of the most important indications for antimicrobial use in veterinary medicine and contribute to the development of antimicrobial resistance. Adherence to treatment guidelines and confinement to a few first-line antimicrobial agents is imperative to avoid further deterioration of the antimicrobial resistance situation. The decision to treat with antimicrobials should be based on the presence of clinical signs, and/or concurrent diseases, and the results of urine culture and susceptibility testing.

CLINICAL CHALLENGES

Distinguishing between cats with bacterial cystitis, and those with idiopathic cystitis and concurrent clinical or subclinical bacteriuria, is challenging, as clinical signs and urinalysis results may be identical. Optimal treatment of subclinical bacteriuria requires clarification as there is currently no evidence that demonstrates a beneficial effect of routine treatment. Management of recurrent UTIs remains a challenge as evidence for most alternatives used for prevention in cats is mainly anecdotal, and no preventive treatment modality is currently recommended.

EVIDENCE BASE

This review draws on an extensive literature base in veterinary and human medicine, including the recently updated guidelines of the International Society for Companion Animal Infectious Diseases for the diagnosis and management of bacterial urinary tract infections in dogs and cats. Where published evidence is lacking, the authors describe their own approach; notably, for the bacteriuric cat with chronic kidney disease.

Emphysematous cystitis: review of current literature, diagnosis and management challenges

Emphysematous cystitis (EC) is a rare disease in human as well as in veterinary medicine; in both it is defined as an uncommon form of complicated urinary tract infection (UTI), characterized by the presence of gas within the bladder wall and lumen. While female dogs are at increased risk of developing an UTI, patients with EC are not subject to gender or age predisposition and may present with variable clinical manifestations. Diabetes mellitus (DM) appears as the most common risk factor for the development of EC, but many other underlying conditions have been mentioned in literature and should be taken into consideration. In case of EC, Escherichia coli appears to be the most common pathogen isolated from urine cultures. A conclusive diagnosis of EC requires necessarily the recourse to imaging methods, such as abdominal radiography and ultrasonography. An early diagnosis and appropriate medical therapy, consisting in protracted antibiotic treatment associated with control over underlying diseases, could lead to avoid surgical intervention.

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