Cystic endometrial hyperplasia-pyometria complex

Question 1

What is cystic endometrial hyperplasia-pyometria complex?

Answer 1

polysystemic metestrual dz of mature bitch >4yr

Question 2

Is cystic endometrial hyperplasia-poymetra common in breeding animals?

Answer 2

no–non-bred 10x more likely to develop CEH than multiparous

Question 3

Where is CEH common?

Answer 3

in areas where ovariohysterectomy not common–can be pretty common in unspayed animals

Question 4

What is the pathophysiology of CEH-pyometra?

Answer 4

1. repeated exposure/stimulation of endometrium by estrogen followed by prolonged P4 (metestrus)
2. interaction of hormonal stimulation, bacteria
3. P4 exposure–>immunosuppression, decreased leukocyte function
4. increased susceptibility to bacterial colonization
5. progressive, may develop rapidly (months) but usually over a number of years
6. cumulative–proliferation of endometrial glands, excessive secretions, decreased myometrial activity
7. cysts arise from endometrial glandular epithelium, luminal epithelium
8. hyperplastic endometrial tissues prone to inflammation and/or infection–decreased clearance
9. CEH may prevent distribution of embryos or nourishment of embryos or inhibit placental attachment or development

Question 5

What are predisposing factors for CEH-pyometra?

Answer 5

progestin (estrus suppresion)
estrogen treatment
subclinical UTI

Question 6

What bacteria are usually found in CEH-pyometra?

Answer 6

1. e. coli (K antigens allow colonization)

2. staph, strep

Question 7

What are the clinical signs if an animal has CEH?

Answer 7

usually none

Question 8

W/out bacterial insult, CEH may progress to what?

Answer 8

mucometra: sterile mucoid fluid
hematometra: sterile blood fluid
hydrometra: sterile watery fluid

Question 9

When infection of uterus with CEH occurs, what usually happens?

Answer 9

pyometra

Question 10

What are the clinical signs when CEH progresses to pyometra

Answer 10

vaginal discharge in cervix open
usually sicker if cervix closed: depression, lethargy, inappetence, anorexia, vomiting, diarrhea
clinical signs worsen with time (e.g. closed cervix pyometra may start with mild depression and get workse)
1. slow onset systemic signs
2. abdominal enlargement
3. PU/PD +/- nocuria
4. temperature may or not be elevated
5. dehydration

Question 11

Which is a worse dz closed cervix or open cervix pyometra?

Answer 11

closed cervix

Question 12

How is CEH diagnosed?

Answer 12

1. signalment
2. history
3. clin path
4. vaginal cytology/culture
5. ultrasonography and/or radiography

Question 13

What is the signalment for CEH?

Answer 13

intact bitch >4mo old not bred/pregnant

Question 14

What are the clinical pathology signs of CEH?

Answer 14

no changes or regenerative anemia

Question 15

What are the clinical pathology signs of CEH-pyometra

Answer 15

leuoctosis (left shift), normocytic, normochromic anemia
prerenal azotemia
hypergammaglobulinemia, hypoalbuminemia
metabolic acidosis
UA: SG variable, +/- proteinuria (endotoxin related renal dz?)

Question 16

What is seen with vaginal cytology/culture in CEH, pyometra

Answer 16

if just CEH: predominantly lymphoplasmacytic inflamation but may be normal for metestrus/diestrus and culture negative
in pyometra: predominantly neutrophilic inflammation (degenerate neutrophils, bacteria), culture postitive

Question 17

What is seen with U/S with CEH, pyometra?

Answer 17

with CEH se fluid filled uterus, may be able to watch swirl esp if pyometra

Question 18

What is seen on radiography with CEH?

Answer 18

homogenous tubular fluid density mass in posterior abdomen (uterus)

Question 19

What are differential diagnoses for CEH, pyometra

Answer 19

1. pregnancy (abdominal distention)
2. anorexia, vomiting, diarrhea, PU/PD: renal dz, DM, hepatic ailure, hyperadrenocorticim, UTI (may be concurrent)
3. vaginal discharge: estrus, vaginitis, vaginal neoplasia, subinvolution of placental sites, retained placenta, metritis

Question 20

What is the treatment of choice of CEH-pyometra?

Answer 20

ovariohysterectomy

Question 21

How might CEH-pyometra be treated in expensive breeding animals?

Answer 21

marsupialization, evacuate uterus of purulent material

Question 22

What is the danger of treating CEH-pyometra w/ surgery?

Answer 22

the dog is sick,
high risk of contamination of abdomen due to uterine rupture because it is fragile and friable and operating on a sick dog

Question 23

What is the post-op care after spaying a CEH-pyometra dog?

Answer 23

1. watch incision for dehiscence
2. monitor uterine stump infection
3. provide post op analgesia as needed
4. antibiotics 7-20d minimum
5. monitor for resolution of signs
6. monitor U/A if PU/PD, siosthenuria, proteinuria–PU/PD should clear up, if doesn’t then animal in renal failure

Question 24

Why might one choose medical treatment for CEH-pyometra?

Answer 24

1. young bitches with breeding value

2. severely ill endotoxic bitches that not candidates for surgery

Question 25

How is medical CEH-pyometra performed?

Answer 25

1. drain/evacuate uterine contents
2. eliminate bacterial infection
   luteolysis (remove source of P4 3. responsible for initiation of dz)–prostaglandin
3. antibiotics
4. supportive

Question 26

Why should you be cautious using prostaglandin to treat a pyometra?

Answer 26

because even though causes relaxing of the cervix in most dogs, must still be careful to minimize the dose as much as possible and do to effect. Try to establish a vaginal discharge–get the cervix to relax and open otherwise the prostaglandin stimulation of the uterus may result in uterine rupture!!!

Question 27

What is an issue with trying to maintain fertility in a breeding bitch with CEH-pyometra?

Answer 27

high rate or reoccurance

Question 28

Why would you breed a bitch in the next cycle after CEH-pyometra?

Answer 28

because most dogs will have again in next cycle unless they are preg
cannot reverse pathologic changes in the uterus