Diseases of diestrus and anestrus

Question 1

Cystic Endometrial Hyperplasia results from chronic/repeated __ exposure where uterine glands __ in number, size, secretion and cystic dilatation and is ___

Answer 1

progesterone, increase, irreversible

Question 2

__ of all female dogs >9 years with normal estrus cycles will have CEH

Answer 2

2/3

Question 3

CEH is usually an incidental finding but can affect __bitches, __,and ___

Answer 3

breeding, infertility, decreased pregnancy rate

Question 4

therapy of choice for CEH

Answer 4

ovariohysterectomy (OHE)

Question 5

pyometra

Answer 5

suppurative bacterial infection of the uterus with accumulation of inflammatory exudate in the uterine lumen

Question 6

young dogs usually have pyometra __ CEH while older dogs usually have pyometra __ CEH

Answer 6

without, with

Question 7

what species and age are most likely to have a pyometra?

Answer 7

middle to older age bitches, 20% diagnosed before 10yrs

Question 8

progesterone is dominant during diestrus causing the cervix to be __ and uterine defense mechanisms to be __ allowing opportunistic bacteria to ascend the vagina/GI tract

Answer 8

closed, decreased

Question 9

what is the most common opportunistic bacteria in cases of pyometra?

Answer 9

E. coli (65-90%)

Question 10

predisposing factors to pyometra

Answer 10

• endogenous and exogenous progesterone
• CEH, hydrometra, mucometra
• bacterial virulence: adhesin factors, biofilm production
• breed predisposition

Question 11

T/F: pyometra is a differential diagnosis in all intact female dogs

Answer 11

T

Question 12

what diagnostics are appropriate if you suspect pyometra?

Answer 12

abdominal ultrasound
CBC, Chem
+/- Vaginal Cytology
+/- X-ray

Question 13

in pyometra cases, purulent hemorrhagic malodorous vulvar discharge is an __ cervix while no vulvar discharge indicates a __ cervix

Answer 13

open, closed

Question 14

clinical presentation of pyometra is very __

Answer 14

variable

Question 15

if you decide to ultrasound a patient with pyometra what would you see?

Answer 15

• fluid filled uterine horns
• uterine wall often thickened
• u/s cannot accurately differentiate between hydro/muco- or pyometra

Question 16

pyometra lab findings

Answer 16

WBC: usually has a leukocytosis with neutrophilia and left shift, monocytosis

RBC: often mild normocytic normochromic anemia

Chemistry: azotemia, increased ALP, bilirubinemia, hypoalbuminemia, electrolyte imbalances; coagulation impairment (hypercoagulable state)

urinalysis: iso or hyposthenuria, concomittant cystitis

Question 17

vaginal cytology is only informative in cases of __ pyometra and would show __, __, and __. what else does the patient need to demonstrate?

Answer 17

open, PMN, bacteria, vaginal epithelial cells

needs to demonstrate fluid accumulation in the uterus

Question 18

__ pyometra causes more severe signs of illness but the outcome is not poorer

Answer 18

closed

Question 19

treatment of pyometra

Answer 19

1. OHE!!!!
2. antibiotics (broad spec, bactericidal), amoxi-clav, enroflox or combo
3. supportive care

Question 20

medical treatment only for pyometra cases is only attempted in __ breeding bitches with no other abnormalities and it must be an __ pyometra

Answer 20

young, open

Question 21

the goal of medical management of pyometra is to empty the uterus and decrease progesterone levels and/or prevent its actions. What drugs would you use for this?

Answer 21

1. PGF2
2. aglepristone: progesterone receptor blocker
3. prolactin inhibitors: cabergoline (luteolysis)

Question 22

medical tx of pyometra needs __ until clinical improvement and has a __ recurrence rate. If it fails __

Answer 22

24-48 hours, high, OHE

Question 23

t/f: the recommendation for medical management is to breed on the next heat cycle

Answer 23

T, the pregnancy is generally considered protective for the development of pyometra but are high risk

Question 24

consequences of a non-treated pyometra

Answer 24

sepsis
uterine rupture
death

Question 25

juvenile vaginitis is in __ dogs

Answer 25

prepubertal (6wks - 8mths)

Question 26

puppy vaginitis

Answer 26

- mucopurulent discharge - inflammatory vaginal cytology - spontaneous resolution after 1-2 heat cycles - treat with benign neglect

Question 27

t/f: you should spay a puppy with vaginitis before it resolves

Answer 27

F!!!!!! do not spay before vaginitis resolves because chronic vaginitis may develop

Question 28

primary vaginitis of the intact bitch is caused by __, __ or __ while secondary is __, __, etc.

Answer 28

canine herpesvirus, brucella canis, opportunistic bacteria, anatomic, neoplasia

Question 29

__ is the most common bacterial culprit for vaginitis in intact bitches and __ is the most common clinical sign at any stage of the repro cycle

Answer 29

e. coli, vulvar discharge

Question 30

intact vaginitis dx

Answer 30

- digital palpation for bands/strictures/tumors - vaginal cytology and bacteriology with c/s via guarded vaginal swab - vaginoscopy - +/- urinalysis with c/s

Question 31

vaginal cytology of intact vaginitis

Answer 31

inflammatory: degen neutrophil granulocytes, epithelial cells according to cycle stage, bacteria, mucus, debris

Question 32

tx of intact vaginitis

Answer 32

correct underlying cause - antibiotics -> start with amoxicillin- clavulanic acid - probiotics

Question 33

vaginitis in spayed dogs is secondary to __ following spay due to lack of estrogen influence and is usually __

Answer 33

vaginal atrophy, chronic

Question 34

treatment of spayed vaginitis

Answer 34

1. correct underlying cause 2. estriol(incurin) tablets PO -short acting estrogen -> proliferation and cornification of vaginal mucosa, increases local defense mechanism 3. antibiotics 4. probiotics

Question 35

perivulvar dermatitis is more common in __ dogs in the __ with vaginitis, UTI and urinary inconinence common

Answer 35

spayed, skin folds (recessed vulva and obesity)

Question 36

tx for perivulvar dermatitis

Answer 36

1. underlying cause of incontinence or UTI 2. weight loss 3. clean with chlorohex 4. e-collar 5. antibiotics

Question 37

type 1 vaginal hyperplasia

Answer 37

slight-moderate eversion of the vaginal floor just cranial to the urethral orifice. No tissue protrudes through the vulva

Question 38

Type II hyperplasia

Answer 38

prolapse of the cranial vaginal floor and lateral walls of the vagina through the vulvar lips forming a pear-shaped mass

Question 39

type III hyperplasia

Answer 39

prolapse of the entire vaginal circumference as a doughnut-shaped edematous tissue with a lumen

Question 40

vaginal hyperplasia recurs at __ and is __. For tx, remove __ influences for regression in 1-3 weeks, place an __ and use 50%__ , cleaning and lubrication to reduce.

Answer 40

peak estrus, hereditary, estrogen , e-collar, dextrose

Question 41

vaginal tumors are usually __ and in __ dogs

Answer 41

benign, older

Question 42

dx and tx for vaginal tumors

Answer 42

palpation, vaginoscopy, FNA, biopsy, impression smear tx with sx resection, OHE if hormone dependent and chemo