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ACVECC Board Prep > Repro > Flashcards

Repro Flashcards

Drobatz

1
Q

Peak progesterone concentrations during pregnancy

A

Day 20-30 ranging between 15-80ng/mL

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2
Q

Explain parturition on a hormonal level

A
  1. Fetal release of cortisol from adrenal gland causes increase in estrogen production from ovaries
  2. Estrogen causes upregulation of genes needed for uterine contractions and prostaglandin release from trophoblastic cells
  3. PGE2 causes luteolysis causing progesterone to drop over a 12-24hr period
  4. Prolactin concentrations increase
  5. Parturition occurs 24-48hrs after decline in progesterone
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3
Q

Other hormones that play a role in parturition?

A
  1. PGF2-alpha: increases myometrium sensitivity to oxytocin
  2. Oxytocin: released from posterior pituitary which increases myometrial contractility
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4
Q

True/False: You can use the mating date as an estimate for parturition date

A

False.

Use vaginal cytology: cytological diestrus (50% non cornified parabasalar cells and intermediate cells) and parturition occurs 57+/- 3 days after

LH peak: parturition 65 days later

Progesterone: measures 4-10ng/mL during ovulation, parturition occurs 63 days after ovulation

Transabdominal US: fetal crown rump length and body diameter measured days 30 and 39

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5
Q

Stages of parturition

A
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6
Q

Define dystocia. What are some risk factors?

A

Dystocia is defined as the inability to expel the fetuses from the uterus or birth canal

Risk factors: brachycephalic/chondrodysplastic canine breeds, brachycephalic/dolichcephalic feline breeds, small litter size, excessive litter size, increase age of the bitch, underlying metabolic diseases contributing to uterine inertia

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7
Q

Maternal and fetal etiologies of dystocia

A
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8
Q

Diagnostics to consider

A

CBC/Chem, blood gas (ionized Ca), electrolytes, radiographs to confirm pregnancy assess for abnormalities in presentation, gas in uterus, serum progesterone if whelping date has passed with no labor, US to evaluate fetal HR (should be 200-220bpm, if drops below 180bpm intervention may be needed)

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9
Q

Indications to intervene in dystocia

A
  1. Obstruction diagnosed with vaginal exam, rads or US
  2. Bitch/queen has not entered labor and progesterone is <2ng/mL
  3. The bitch/queen is systemically ill
  4. Fetal HR is bradycardic ( <160-180bpm)
  5. There is suspicion of uterine rupture or torsion
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10
Q

Pre-requisites for medical management of dystocia

A
  1. Labor has not been prolonged
  2. Cervix is dilated
  3. Fetal size is within limits for vaginal delivery
  4. Obstructive causes of dystocia have been ruled out

Hypocalcemia needs to be corrected prior to starting medical management as well as hypoglycemia

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11
Q

What should be attempted for medical management of dystocia?

A

Once hypocalcemia and hypoglycemia have been corrected and met pre-requisite, oxytocin at a dose of 0.5-2IU SC or IM. Best used with in conjunction with Ca gluconate

Repeat dosing is controversial.

Medical management of bitch results in parturition success rate of 30%

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12
Q

Eclampsia

A

Acute depletion of ionized Ca in extracellular compartment

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13
Q

Time frame for eclampsia to develop

A

2-4 weeks post partum (peak time of lactation)

Can also occur late pregnancy (fetal skeletal ossification), parturition or 45 days post partum (time of weaning; if cats develop this is the time frame usually)

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14
Q

Predispositions of eclampsia and risk factors

A

Predisposition: small, toy breed dogs, or those that are young, primiparous

Other risk factors: inappropriate prepartum Ca supplementation (excessive Ca or decreased Mg inhibits parathyroid hormone release > parathyroid gland atrophy, also increased Ca causes calcitonin secretion), improper or inadequate perinatal nutrition

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15
Q

Clinical signs of eclampsia stages

A

Stage 1: anxiety, restlessness, pacing, hypersalivation, anorexia, polyuria, polydipsia, vomiting, diarrhea, potential facial pruritis of variable intensity and biting at feet

Stage 2: ataxia, staggering, muscle tremors, mydriasis with diminished pupillary light reflexes, behavioral changes associated with lack of interest in offspring

Stage 3: muscle stiffness and hyperesthestia, hyperthermia secondary to muscle contractions, tachycardia, behavior changes associated with agression

Stage 4: tonic-clonic muscle spasms in all 4 limbs (tetany), collapse with opisthotonos, labored respiration, behavior changes associated with disorientation

Stage 5: arrhythmia (VPCs), seizures (musculoskeletal signs exacerbated with tactile stimulus), death

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16
Q

Explain how a low ionized Ca causes signs of neuromuscular excitation?

A

Neuromuscular transmission is directly proportional to the calcium to magnesium ion ratio in the ECF. Decreased ECF ionized Ca results in increased nerve cell permeability to Na, especially in peripheral nerves, which has excitatory effect. Allows for spontaneous discharge of nerve fibers to induce contraction of the skeletal muscles and alterations in CNS function

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17
Q

In addition to checking ionized Ca, what else needs to be checked and may require supplementation?

A

Hypoglycemia often accompanies eclampsia due to the energy demands of tetany

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18
Q

Treatment of eclampsia

A

10% Ca gluconate or 20% Ca borogluconate

Dogs: 1-1.5mL/kg
Cats: 2.5mL/kg

Administer over 10-30min and monitor with ECG

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19
Q

Signs to watch for if Ca is administered too quickly?

A

ECG changes: bradycardia, QT shortening, or arrhythmias, asystole has been reported

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20
Q

How should neonates and dam be handled if dam had eclampsia?

A

Neonates removed from dam and hand fed milk for 24-36hr, if over 4 weeks old then they should be weaned

Dam should be orally supplemented with Ca carbonate or lactate at 100mg/kg/day divided up with meals

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21
Q

Describe the Apgar scores in neonates?

A
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22
Q

Neonatal reflexes that should be present 1hr after birth

A
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23
Q

True/False: Neonates should be swung in a downward arc as part of the resuscitation process to help clear fluid from the airways

A

False! Can cause intracranial bleeding and trauma.

Bulb syringe should be used to clear fetal membranes from nose/mouth, anything generating more negative pressure than this should be avoided, as it can cause airway injury and laryngospasm

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24
Q

What can be done to stimulate respiration in a neonate?

A

Cleaning/drying the neonate stimulates respiration, crying and movement.

Stimulating genital and umbilical areas induces reflex respiration

Jen Chung acupuncture point (GV26): needle inserted into nasal philtrum at the base of the nares and rotated when cartilage/bone contacted

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25
Q

If you encounter respiratory distress in the neonate, what should be done?

A
  1. Provide oxygen via face mask
  2. If no improvement after 1min, then apply positive pressure ventilation with a tight fitting face mask. Initially 40-60br/min then 12-20br/min with 40-60%FiO2 and pressure of 10cmH2O pressure
26
Q

Most common causes of bradycardia or asystole in a neonate?

A

Hypoxia or hypothermia

27
Q

Can you use atropine in a neonate? Why or why not?

A

Bradycardia is not vagally mediated in neonates and anticholinergic induced tachycardia will only exacerbate myocardial oxygen deficits

28
Q

At what age can neonates regulate their body temperature?

A

At approximately 4 weeks old

29
Q

Why is hypothermia a concern for neonates?

A

Hypothermia has been shown to have negative impact on immunity, nursing, digestion. It also decreases food intake, and exacerbates dehydration, hypoglycemia, bradycardia and ileus, decreases willingness to nurse, and predisposes tube fed puppies to aspiration pneumonia

30
Q

Why do neonates require such large volumes of fluid?

A

Neonatal kidneys have minimal capacity to conserve water before 40 days of age, they also have greater water requirements and greater insensible losses than adults

31
Q

What isolates are common in neonatal sepsis?

A

E. coli, streptococci, staphylococci, and Klebsiella spp.

32
Q

When to consider stopping resuscitative efforts in a neonate?

A

Discontinue after 30min of effort with either no response, persistent bradycardia or agonal breaths despite resuscitative efforts

In the face of serious congenital defects: cleft palate, loud heart murmur, large umbilical hernia, large omphalocele, large open fontanelle, anasarca, anogenital defects, severe vertebral or limb abnormalities

33
Q

What are some disorders of metabolism in neonates? How do they present?

A

Inborn errors of metabolism, lysosomal storage disorder, mucopolysaccharidoses occur in dogs and cats, congenital hypoglycemia and intracellular accumulation of deleterious substances will occur

Will appear normal at birth, then display progressive lethargy, poor nursing, persistent vomiting and CNS changes

Prognosis is hopeless

34
Q

What is anasarca and how does it present?

A

Anasarca: lethal congenital edema with or without cardiac abnormalities. Inherited as an autosomal dominant trait.

Usually have generalized subcutaneous edema with intrathoracic and intraperitoneal fluid accumulation. Usually are the cause of dystocia due to oversize, and often are born stillborn. If born alive can attempt to treat with diuretics

35
Q

What is ciliary dyskinesia and how do they present?

A

Ciliary dyskinesia: extremely rare causes immotile cilia. Abnormal mucociliary transport and neutrophil function results in chronic rhinitis, tracheobronchitis, and bronchopneumonia.

Neonates will have persistent mucopurulent nasal discharge, coughing, and abnormal breath sounds without another demonstrable cause (like cleft palate)

36
Q

How can hydrocephalus occur and how does it present in neonates?

A

Can be inherited or acquired. Acquired from intrauterine teratogens, trauma from parturition, aqueduct atresia, meningoencephalitis, etc.

Usually have a domed calvarium, open fontanelle, or prominent suture lines. Can have varying clinical signs to inapparent to seizures for which no metabolic, or toxic etiology can be identified

Treatment: omeprazole to decrease CSF movement into ventricles via PPI inhibition, corticosteroids/diuretics, ventriculoperitoneal shunting

37
Q

What is umbilical herniation in the neonate and what is the prognosis?

A

Umbilical herniation: developmental anomaly (not traumatic) resulting in extrusion of a portion of the GI tract into the umbilical canal (omphalocele) or lateral to the umbilical canal (gastroschisis)

Prognosis: hopeless, 30-70% survival rate in humans with immediate surgical intervention. Omphalocele worse than gastroschisis

38
Q

What are the different types of bowel malformations in the neonate?

A

Angenesis: most common at terminal colon but can occur anywhere
Duplication: rare but can occur anywhere along GI tract

Failure to defecate, abdominal distention and vomiting are often seen

Surgical repair of rectal angenesis possible, but results in fecal incontinence

39
Q

What is a patent urachus and how is it treated?

A

The urachus permits urine to flow from the urinary bladder to the allantoic sac of the fetus. Will see dribbling of urine from the umbilicus at birth. Diverticulum may develop if incompletely closed urachus is present, which can predispose to urinary tract infections

Must be ligated if does not close spontaneously on its own, diverticulum, if it developed, will need to be removed

40
Q

What are the common causes of cleft palate? What can be done about them?

A

Cleft palate results from an incomplete fission of the palatine shelves. Can be congenital (recessive or incompletely dominant polygenic variance), teratogenic (drugs, supplements), nutritional (folic acid deficiency) or infectious (viral factors)

Feeding puppies via orogastric tube until surgery can be performed (at 8-12 weeks of age, palatoplasty) but may need multiple surgeries as they grow/age, can occasionally close as they age

41
Q

What is neonatal isoerythrolysis?

A

Occurs in kittens after initial colostrum ingestion. Most common in Type B queens with type A kittens, since type B carries strong anti-A antibodies.

Kittens show signs of anemia and are often icteric, may have necrosis of the tail tips or other extremities due to ischemia. Diagnosis is made if there is findings of anemia and icterus with no evidence of blood loss or hemoparasites

Kittens must be removed from queen and given blood (either cross-matched donor blood or washed type B blood from dam can be used) but prognosis is poor

42
Q

How long can neonates absorb antibodies intestinally?

A

24 hrs, mostly IgG.

If deprived of colostrum, considered immunodeficient can have hypoglycemia, excessive vocalization due to hunger, lethargy, or subsequent signs of infectious disease

43
Q

What is neonatal ophthalmia and how is it treated?

A

Neonatal ophthalmia: acute, mucopurulent infection of the conjunctiva before the eyelids separate. Often have noticeable swelling over the eyes.

Use gentle manipulation to open the eye. Cytology and culture of the fluid present. Then irrigation with sterile saline. Topical antibiotics for 10-14 days and ocular lubrication (decreased tear production until 10-14 days of life)

44
Q

What is considered normal weight gain for a neonate?

A

After 1st day of life, they should steadily be gaining 5-10% of the body weight daily

1-3g/kg of anticipated adult weight in puppies

50-100g weekly in kittens

45
Q

What are some causes of neonatal aspiration pneumonia? What therapies should be started?

A

Often found with those that have a cleft palate, but can also occur during spontaneous nursing, bottle feeding or tube feeding. Overfeeding causing overdistension or placement of feeding tube in trachea are common causes also

Oxygen, beta lactam antibiotics

46
Q

What are some common causes of swimmer puppies? What therapies should be initiated?

A

Swimmer puppies fail to develop ambulation by 10-14 days and move around on ventrum by paddling limbs, often causes compression and deformation of the sternum

Obese puppies from small litters, raised on slippery surfaces seem predisposed

Caloric restriction, physical therapy, improved traction in nesting box should all be attempted but those that ares till affected may need body harnessing to keep limbs under trunk

47
Q

What is juvenile cellulitis?

A

Puppy strangles is a progressive, granulomatous, pustular disorder in puppies younger than 4 months. Diagnosis is primarily on clinical appearance, but can be confirmed via biopsy.

Usually eyelids, pinnae, lips, chin, muzzle but can also be on the paws, abdomen, thorax, vulva, prepuce and anus have lesions that fistulate, drain and crust. Lymphadenopathy most commonly under the mandible and cervical LN are large and painful. Can have a fever, inappetence and arthritis

Requires aggressive immunosuppressive therapy (prednisone 2.2mg/kg/day). Griseofulvin can also be used. Vaccines cannot be pursued during therapy, and they should be isolated from infectious disease

48
Q

Other than predisposing to aspiration pneumonia, what other concern does overfeeding have?

A

Bacterial overgrowth syndrome associated diarrhea.

Decreased motility in the neonate predisposes to bacterial overgrowth. Can see diarrhea, weight loss (due to malabsorption) producing osmotic diarrhea

Can give antibiotics (ampicillin, amoxicillin or metronidazole) vs probiotic

49
Q

What are some common causes of hypoglycemia in neonates?

A

Glycogen reserves are depleted at birth, so neonates have a limited capacity for gluconeogenesis and depend on frequent feedings.

Can also result from endotoxemia, septicemia, portosystemic shunts, or glycogen storage abnormalities

50
Q

Why is metritis different than a pyometra? What are the predisposing causes? What is the treatment?

A

Metritis often occurs post partum, and occurs when progesterone concentrations are low. Metritis occurs primarily from ascending bacterial infection associated with parturition

Predisposing factors: abortion, dystocia, obstetric manipulation, retained fetal or placental tissue, and uterine prolapse

Treatment involves rehydration, antimicrobial therapy (need to know if dam will still be feeding neonates for choice of antibiotic) and an ecbolic agent (oxytocin not used if over 24hr). PGF2 alpha used at 250ug/kg q24hr until uterine involution has occurred

51
Q

What are common signs of mastitis? When does it typically occur? What is the treatment?

A

Mastitis typically occurs in the postpartum period (within first 2 weeks) and can range from non-septic galactostasis vs gangrenous mastitis and sepsis.

Usually discomfort, pain and swelling in one or more of the glands. May have a fever. Severe cases can present in septic shock

Warm compressing, pain medications and antibiotics if indicated. Nursing of the affected glands should continue. For cases where mammary abscessation or gangrenous mastitis occurs, the neonates should be removed and affected glands removed or surgically debrided.

52
Q

When does pyometra typically occur? What are the clinical signs associated? What are the common isolates?

A

Pyometra occurs typically 1-4 months after estrus in the bitch and within 4 weeks of estrus in the queen.

Most common signs: vaginal discharge (80%), pyrexia (47%), PU/PD (<50%) and emesis. Also non specific signs such as lethargy or anorexia also occur

Most common pathogens: E. coli (most have uropathogenic virulence factors, so stick to uterus better, and produce LPS that leads to SIRS/MODS), Staphylococcus aureus, Enterobacter, Pseudomonas, Klebsiella, Proteus, and Streptococcus sp

53
Q

Diagnosis of pyometra?

A

Cranial vaginal cytology (degenerate neutrophils, intra or extracellular bacteria), culture, vaginal spectrum visualization (if cervix open), US (double bladder). Use US to also look for free fluid to indicate peritonitis of uterine torsion/rupture

CBC changes: monocytosis and severe neutrophilia with left shift, moderate normocytic, normochromic non-regenerative anemia

Chemistry changes: azotemia (secondary to prerenal dehydration or endotoxin induced renal tubular damage), increased liver values (due to cytotoxic necrotizing factors produced by some E.coli can cause liver damage or hypoxia), hyperbilirubinemia, hypercholesterolemia, hyperglobulinemia, hypoalbuminemia

54
Q

What are the goals of medical management of a pyometra? When is it contraindicated and when should surgery be considered?

A

Goals: remove effects of progesterone to cause cervix to relax, cause myometrial contractions, and improve local uterine immunity. Also want to attempt to prevent bacterial proliferation through antibiotic therapy

Medical management contraindicated if there is evidence of uterine torsion or rupture and should be aborted if patient clinically deteriorates at any time or if no improvement seen within 2 days

55
Q

What drugs are used alone or in combination for medical management of a pyometra?

A

Prostaglandin F2 alpha and prostaglandin agonists: causes luteolysis > opening of cervix and uterine contractions; has a narrow therapeutic range (shock and death at high doses), future fertility is 75-87% in bitches

Dopamine agonists: antiprolactin activity and causes luteolysis by decreasing prolactin levels

Progesterone receptor antagonists: can be used safely regardless of cervical patency. Can convert closed to open pyometra but has minimal uterine contractions. Used in conjunction with prostaglandin and has some reported success

56
Q

What causes benign prostatic hyperplasia (BPH) or cystic benign prostatic hyperplasia (CBPH)? What is the treatment?

A

Dihydrotestosterone causes symmetrical, progressive, eccentric prostatic parachymal enlargement, if cystic could be asymmetrical.

Castration is curative (noticeable shrinkage in 2 weeks, max in 4 months) or if valuable stud can consider antiandrogen therapy

57
Q

What happens to prostate if exposed to estrogen?

A

Squamous metaplasia

Estrogen from functional Sertoli cell tumor vs exogenous (therapies for BPH, transdermal hormone replacement therapies).

Usually firm on palpation and may form cysts. Treat with discontinuation of exogenous therapies vs neuter if functional Sertoli cell tumor present in testes

58
Q

What are paraprostatic cysts?

A

Fluid filled structures adjacent to or attached to the prostate. Chronicity and size dictate clinical signs. US identifies fluid filled structure adjacent to urinary bladder, can drain the cyst until surgery is performed to remove it. Neutering is also recommended. Antibiotics based off of culture and sensitivity of the fluid

59
Q

What are some predisposing factors to infectious prostatitis? What isolates are typically found? What are the treatment options?

A

Cystic benign prostatic hyperplasia can predispose, as well as recurrent urinary tract infections.

Isolates: E. coli, Staphylococcus, Streptococcus, Mycoplasma, Proteus and Pseudomonas

Treatment: if abscess is present surgical drainage and omentalization, or drainage via US guidance. Pending culture results fluoroquinolone with potentiated amoxicillin can be considered (blood prostate barrier likely not intact given inflammation). Antibiotics continued for 4 weeks. Castration should be considered.

60
Q

What are the most common prostatic neoplasias?

A

Transitional cell carcinoma: spreads to regional LN, but also lungs and skeleton

Prostatic adenocarcinoma: locally invasive and spreads to regional LN, lungs, skeleton

Most dogs euthanized within 2 months of diagnosis due to poor quality of life. Use of NSAIDs can be considered in carcinomas

61
Q

When does a uterine prolapse typically occur? What can be done?

A

Usually occurs during parturition or in the immediate post partum phase since cervix needs to be open in order for it to prolapse. Can present in hypovolemic shock from ruptured uterine artery.

Can used gloved finger with lubrication or lubed object to replace uterus (with endotracheal tube can insert 5-10mL of sterile saline to slightly distend horns to keep in abdomen), place purse string and hysteropexy should be performed if using again for breeding. If not successful, tissue not viable or retired from breeding perform OVH

62
Q
A

ACVECC Board Prep (3 decks)

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