Clinical Relevance Cases

Question 1

What are some differential diagnoses for vaginal discharge in the Bitch?

Answer 1

Vaginitis, cystitis, metritis, ulceration, neoplasia. If pregnant – can be normal, placental separation, abortion, parturition.

Question 2

What are the normal discharges that occur in the different stages of the cycle in the bitch?

Answer 2

Oestrus - Clear/straw coloured discharge or haemorrhagic discharge

Metoestrus - Mucoid discharge

Dioestrus - No discharge commonly seen

Proestrus - Haemorrhagic discharge

Question 3

What are the differentials for a purulent vaginal discharge in the bitch?

Answer 3

Vaginitis
Pyometra
Metritis

Question 4

What are the differentials for haemorrhagic discharge in the bitch during pregnancy?

Answer 4

Placental separation

Abortion

Question 5

What are the differentials for a haemorrhagic discharge in the bitch? (not during pregnancy)

Answer 5

Cystitis
Vaginal ulceration
Urinary tract neoplasia

Question 6

What would you expect to see on an ultrasound image that may cause you to suspect a pyometra?

Answer 6

Fluid (anaechoic areas) present in the uterus. Thickening of endometrium.

Question 7

What is the treatment of choice for pyometra with systemic signs?

Answer 7

Surgical removal of ovaries and uterus

Question 8

What is the medical management of pyometra?

Answer 8

Prostaglandins - products where the aim is to end the luteal phase (since the condition is essentially ‘driven’ by progesterone) and to cause dilation of the cervix and to promote uterine contractions in an attempt to encourage drainage of pus from the uterus

Question 9

Which bacteria are commonly cultured in pyometra?

Answer 9

E.coli

Staph and strep

Question 10

What are some of the haematological and biochemical changes that can occur in a pyometra?

Answer 10

• High lactate –often indicating poor peripheral perfusion and metabolic acidosis
• Hypokalaemia (low potassium)
• Azotemia (raised urea, creatinine)
• Neutrophilia/band neutrophils and changes on blood smear.

Question 11

How can you manage metabolic lactic acidosis in a pyometra case?

Answer 11

Resolves with restoration of tissue perfusion using fluids

Use of bicaronate rarely required

Question 12

How can you manage hypokalaemia in a pyometra case?

Answer 12

Appropriate addition of potassium to IV fluids

Question 13

How can you manage raised amylase and lipase in a pyometra case?

Answer 13

Will resolve once dehydration resolved

Question 14

How can you manage changes in liver enzymes in a pyometra case?

Answer 14

return to normal rapidly following removal of the uterus and restoration of fluid and electrolyte balance.

Question 15

How can you manage non-regnerative normochromic anaemia in a pyometra case?

Answer 15

. Blood transfusion is rarely indicated, unless the packed cell volume (PCV) decreases below 20% and parameters such as HR, pulse.

Question 16

Why can you get a non regenerative normochromic anaemia in a pyometra case?

Answer 16

mild bone marrow suppression, blood loss at surgery and high volumes of fluid replacement therapy.

Question 17

Why should you do a urinalysis in a pyometra case with azotemia?

Answer 17

Differentiate between pre-renal azotemia and renal azotemia

Identify if dog is diabetic - could complicate surgery due to increased anaesthetic risk

Question 18

What effect does endotoxaemia associated with E.coli have on the kidneys in a pyometra case?

Answer 18

E.coli toxaemia results in reduced resorption of sodium and chloride within the loop of Henle and there is a subsequent polyuria and compensatory polydipsia.

Question 19

Why is blood pressure monitoring important in a pyometra case?

Answer 19

A GA and stages of the surgery (e.g pulling on the ovaries) can cause the BP to fluctuate, so should be monitored throughout
A decrease in BP will affect blood supply ito kidneys and result in damage

Question 20

What are the contributing factors to dehydration in a pyometra case?

Answer 20

• polyuria due to endotoxaemia
• fluid accumulation in the uterus
• vomiting due to endotoxaemia +/- abdominal pain
• poor appetite
• inadequate compensatory polydipsia due to debilitated state