Diseases of the female Flashcards
What are the most common bacteria isolated in pyometra?
E.coli most
few staph/ strep/ pseudomonas/ proteus
What medical management of pyometra is there?
Contraindicated for medical management
Antibiotics with aglepristone (progesterone receptor blocker)
high recurrence rate
cervical relaxation within 48 hours
Can also use prostaglandins but they have higher severe s/e rate
What are some predictive markers for the outcome of pyometra cases?
leukopenia has been associated with both presence of peritonitis and increased postoperative hospitalization in surgically treated bitches with pyometra
Band neutrophil concentrations, lymphopenia and monocytosis, blood urea nitrogen greater than 30 mg/dL, and creatinine concentrations greater than 1.5 mg/dL have been associated with death
In queens, white blood cell counts, neutrophils, band neutrophils, monocytes, and the
percentage band neutrophils were positively, and albumin concentrations negatively,
associated with postoperative hospitalization
What is agalactia?
Primary - anatomic or physiological abnormality
Secondary agalactia results from low milk production or decreased let down of milk into the teat canal. Often the lack of milk supply is identified within 2 to 3 days postpartum when the neonates fail to gain 5% to 10% of body weight daily
How is milk production controlled hormonally?
During late gestation when progesterone is decreasing, prolactin increases and subsequently increases again when the neonates start to suckle.
Prolactin production receives both inhibitory
and stimulatory signals. Dopamine is a main inhibitory factor of prolactin and the relationship is important for modulating milk production with drug therapy
What can cause secondary agalactia?
Concurrent medical conditions: malnutrition, systemic illness, premature parturition, progesterone therapy, mastitis, metritis, endotoxemia, stress, and pain from
a cesarean delivery.
The dam is highly nervous and anxious and the production of adrenalin blocks the release of oxytocin from the pituitary.
The dam has a large litter with high lactational demands.
The dam has poor appetite and is unwilling to consume adequate nutrition
How can agalactia be treated?
Tx underyling disease - may need fluids etc
Oxytocin - can help mild let down
Metoclop - dopamine antagonist
ACP - can reduce anxiety
Add water to meals and provide an energy-dense diet approved for reproduction and lactation, consisting of 30% protein, 20% fat, and 20% to 30% carbohydrate
on dry matter basis.
House the dam in a quiet and traffic-free room.
Use a dog-appeasing pheromone plug-in diffuser, spray, or collar (ADAPTIL, Ceva
Sante Animale, Libourne, France), which provides a synthetic equivalent of the
calming pheromone produced by dams when they are reassuring their pups
When does galactostasis occur (can appear similar to septic mastitis but the pet shouldn’t be ‘ill’
s shortly after parturition or after a dam has weaned from pups or lost a litter. It can also be associated with a dam nursing a small litter that has produced a large amount of milk or when neonates are weak or not rotating to nurse all glands
How do you treat galactostasis?
Treatment for Dams Nursing Neonates:
Confirm neonates’ ability to effectively suckle and dam’s acceptance to nursing
the litter.
Cool compress hard and engorged glands and alternate with warm compresses to gently soften. Massage the glands frequently, relieving pressure and eliciting milk ejection. Neonates nursing immediately after the application of warm compresses will maximize the emptying of glands.
When glands soften and milk ejection occurs, assist nurse neonates to further stimulate milk let down.
Treatment for Dams Weaned from Neonates
Reduce food intake and physically separate the dam from the pups.
Apply cool compresses 10 minutes 3 times per day to engorged glands.
Give nonsteroidal analgesics for pain relief.
If necessary, the dopamine agonist cabergoline reduces prolactin secretion and milk production: give 2.5 to 5 mg/kg/d for 4 to 6 days
How can you diagnose mastitis?
Bloods may show inflammatory changes
Can submit milk for culture, cytology of milk will show degenerate neutrophils/ ontracellular bacteria
US can be used to look for abscesses
What would be appropriate ABs for mastitis?
Co-amox or cephalexin
7-14d course
What other tx apart from ABs should be given for mastitis?
Pain releif
Moist hot packing of gland(s) softens mammary tissue and allows the expression of infected milk. Frequency depends on inflammation, but initially every 4 to
6 hours is ideal.
Apply rinsed, cool cabbage leaves to engorged glands after hot packing. Cabbage contains antibiotic and anti-irritant properties.
if painful, apply a bandage or loose fitting shirt on the dam to protect gland from trauma and prevent nursing of the affected gland.
When necessary for the dam’s comfort, separate the dam from litter during initial healing and only allow nursing with supervision.
The dam may continue to nurse neonates, even on the infected glands, unless the infected glands become too painful, abscessed, or gangrenous, or the
dam is receiving medication that neonates should not consume in milk.
Debridement of tissue may be needed
What is metritis?
Metritis is an acute infection involving the endometrium and the myometrium of the uterus and typically occurs 1 to 7 days after whelping
How do you tx metritis?
ABs
frequent walks and baths
consider prostaglandin treatment
INI will require surgery to remove anything stuck within the uterus or OVH
Which patients are likely to get eclampsia?
Eclampsia typically occurs during the first 4 weeks of lactation ; however, symptoms may arise prenatally on rare occasions.
small breed dams with large litters are typical, but any size and breed of dog may develop the condition.
Calcium supplementation or ingesting calcium containing foods during gestation inhibits parathyroid hormone secretion, predisposing the dam to eclampsia during lactation.
A dam with heavy lactational demands or one that is reluctant to maintain adequate nutrition is also at risk.
What are the signs of ecampsia?
Restlessness Poor mothering Facial pruritis Hyperthermia Hypersalivation Panting Anxiousness/whining Muscle fasciculation Stiffness Staggering Dilated pupils Tachycardia Opisthotonos Collapse/lateral recumbency Involuntary tremors/twitching Seizures
How do you treat eclampsia?
IV infusion over 10-30 minutes (monitor carefully)
Can then move to oral calcium
Remove the dam from neonates for 12 to 24 hours, or permanently, depending on the dam’s response to initial treatment and oral supplementation.
If the dam is receiving adequate nutrition and is recovered, then gradually allow neonates to nurse while providing commercial milk supplementation.
Optimize the nutrition of dam and feed a balanced diet while providing her with frequent opportunities to be away from the litter to eat and drink
Which breeds are predisposed to pyos?
Golden Retrievers (pregnancy possibly not protective)
CKCS
Bernease mountain dogs
Rotties
What is the recent thinking with pyos and CEH?
CEH and pyometra should be considered seperate
Low grade uterine infection leads to endometrial proliferation
Progesterone decreases cellular immunity and myometrial contractility
Increases chance of infection
What may you see on bloods/ urine of a pyo?
Bloods - azotaemia. low glucose, high ALP, hyperglobulinaemia, hypoalbuminaemia
Proteinuria, iso or hyposthenuria
avoid cystos
Intial Tx = fluids and ABs
What are the aims of medical pyometra treatment?
Open cervix
Myometrial contraction
Remove effects of P - luteolysis or blocking PG binding
Regeneration of endometrium by prolonged anoestrus
Outline the use of PG F in the treatment of pyometra
Luteolytic
Opens cervis
Promotes myometrial contractions
Natural form = dinoprost. Start with a low dose and increase. S/E of v/d/p+
Synthetic form = cloprostenol. Has a longer duration of action, fewer s/e but less effective
Outline the use of dopamine agonists for the treatment of pyometra
Anti prolactin
Used in combination with PG
Cabergoline/ bromciptidine
When with PG, synergystic luteolytic effects and more rapid luteolysis
Outline the use of progesterone receptor antagonist
Aglepristone (alizin)
Opens cervix, not expected to induce contractions
Combine with PGF to increase effectiveness
Outline the use of ABs with medical management of pyometra
Continue 10-14 days post resolution (clinical and by US)
Can also consider uterine irrigation
How can you try to prolong anoestrus with medical pyotreatment?
Try deslorelin (GnRH analogue) If given during anoestrus it can bring dog back into oestrus Therefore place somewhere that the chip can be easily removed (e.g. umbilicus)
How successful is medical management of pyometras?
Should see improvement within 48 hours
Recurrence rate 10-77% within 27 months
Highest rate of recurrence if have CEH or cystic ovaries
Breed at next oestrus
Conception rates 50-70%, best in the young
How useful are FNAs for the diagnosis of malignancy in canine mammary tumours?
Used to be considered poor sensitivity and specificity, recent reports suggest a more favourable picture
If doing FNA, be aware that there may eb a discrepacny, and taken at least four samples.
Canine mammary tummours are quite heterogenous so take samples from lots of different areas
How is CEH defined?
proliferation of endometrial glands, endometrial hyperplasia and formation of cysts
What are the clinical signs of ovarian remnant tissue and why?
Can just get oestrus signs
However, remnant ovarian tissue can develop follicles and corpora lutea, and folliclesmay become cystic. Signs of this would be:
vaginal bleeding for several weeks, swelling of the vulva, licking of the vulvar lips, and attraction to males
Occasionally, multifocal areas of erythema are noted on the ventral aspect of the abdomen.
Less frequent clinical signs include mammary gland enlargement due to progesterone activity, pollakiuria and stranguria, dermal hyperpigmentation and alopecia
How can you dx ORS?
The presence of cornified anucleate or pyknotic vaginal epithelial cells on cytology confirms ovarian activity to be present.
Best blood test is anti mullerian hormone test - should be low if no remnant
Can do stimulation tests - either GnRH or hCG
hCG stimulation tests are performed if the patient does show signs of oestrus, while GnRH stimulation tests should be performed if the patient does not show any signs of oestrus
How do you Tx ORS?
Ideally surgical exploration and removal
If not an option or can’t be found, can do medical tx with Megestrol acetate or mibolerone
Why do follicular ovarian cysts occur?
failure to ovulate
What are the clinical signs of follicular cysts
persistent or irregular proestrus/estrus manifestations due to hyperestrogenism, anestrus, and infertility.
In chronic cases, symmetrical bilateral alopecia and bone marrow suppression may occur; it also predisposes both species to cystic endometrial hyperplasia (CEH)-pyometra complex
What is metritis?
inflammation of the uterus involving the mucosa and myometrium layers.
Unlike pyometra, this is an acute problem generally occurring during the first week postpartum as consequence of bacterial invasion through a dilated cervix to a susceptible uterus.
What are the clinical signs of metritis?
foul-smelling vaginal discharge from purulent to sanguine-purulent. Clinical signs develop very
quickly especially when associated with retained fetal membranes; signs include lethargy, anorexia, pyrexia, dehydration, decreased milk production, and abandonment of newborn. Abdominal palpation may reveal a flaccid uterus, and if the presence of a retained fetus or placenta is suspected, an ultrasound and radiology should confirm the diagnosis
Outline endometritis
Often chronic/ subclinical
Can be a cause of infertility
If a queen has three matings and no litter, consider this
10-14d Broad spec ABs, can consider addition of aglepristone
Outline uterine neoplasia
Leiomyomas account for 85% to 90% of all canine uterine tumors, commonly associated with ovarian follicular cysts, CEH, mammary neoplasia, and hyperplasia
Clinical signs are typically not evident until a uterine tumor reaches a large size. In queens, it may present alterations in the estrus cycle, vaginal discharge, and secondary pyometra.
Other less frequent uterine but malignant neoplasms are leiomyosarcoma and carcinoma. Treatment entails OVH.
Outline endometrial polyps
seen in old bitches and queens but normally only one
develops and they are frequently small and of little consequence unless their growth compromise the uterine lumen.
Serosal inclusion cysts may develop in the uterus of
the bitch during post partum uterine involution and are incidentally found during OVH or laparotomy
What vaginal neoplasias are there?
Vaginal leiomyomas are among the most
common benign tumors in bitches together with fibromas and fibroleiomyomas.
Other tumors reported include lipomas, polyps, melanomas, myxomas, and myxofibromas, but these are much less frequent. Canine transmissible venereal tumor is the most common tumor in the vagina in tropical developing countries
Most = surgical excision. TVT needs chemotherapy
What kidney issues can be found with pyometra?
Proteinuria common, often resolves.
In addition, glomerulosclerosis, tubular atrophy, and interstitial nephritis
