Diseases of the Female Repro tract Flashcards
Definition of pyometra
Pus-filled uterus
Final stage of the cystic endometrial hyperplasia-pyometra complex
What is required for a pyometra to exist ?
Ovarian or exogenous progesterone
What is pyometra a disease of?
Diestrus phase of the ovarian cycle
- while the corpus luteum is actively secreting progesterone
Why is pyometra less common in cats ?
Cats are induced ovulators
- therefore should only occur with sterile matings
What does progesterone do that contributes to pyometra?
Increases secretions of the uterine glands
Inhibits myometrial contraction
Closes the cervix
What can progesterone secretion result in ?
Cystic endometrial hyperplasia
Inhibition of leukocyte response facilitating bacterial colonisation
Pyometra signalment
Older, entire bitches (>6 years)
Usually within 8-12 weeks of previous season (4 weeks in cats)
Increased risk of exogenous oestrogen or progestagens
What is the influence of oestrogen on the uterus ?
Increases the sensitivity of the uterus to progesterone
What is present with chronic endometritis?
Cystic endometrial hyperplasia
Role of infection in pyometra
not a primary cause but is usually present secondarily
Commonly isolated bacteria in pyometra
E.coli (most common)
Streptococcus
Staphylococcus
Enterococci
Klebsiella
Proteus and pseudomonas (less common)
Bacteria reported in pyometra with secondary toxaemia
Anaerobic bacteriodes and clostridium
Is pyometra systemic or localised?
Systemic
Pyometra clinical signs
Temperature is often normal
Anorexia / depression
Vomiting/ diarrhoea
PU (urine production)/ PD (increased thirst/ water consumption)
+/- vaginal discharge (depending on patency (opening) of cervix)
Poorly concentrated urine (<1.030 USG)
Pyometra clinical pathology
Leukocystosis(15 –100 x 10(9)/L)
Left shift and toxic change common
Anaemia (often masked by dehydration)
Azotemia (kidney damage)
Low USG (<1.030)
Pyometra imaging
Gentle abdominal palpation
Radiographs –soft tissue density, displacement of GI structures
ultrasound
What is the best imaging for pyometra?
Ultrasound most sensitive –gives an indication of uterine size, the thickness of the uterine wall and the presence of fluid within the peritoneal cavity.
Medical pyometra treatment
PGF2a luteolysis - lowering progesterone should open the cervix to allow drainage
+
Broad spectrum antibiotics
Surgical pyometra treatment
Ovariohysterectomy
- careful not to rupture
- stabilise pre op
- broad spectrum antibiotics
- remove all infected tissue
Previously recommended to oversew stump but now omentalise
LAVAGE LAVAGE LAVAGE
What did vaginal odema used to be known as?
Vaginal hyperplasia
When does vaginal oedema occur?
During oestrogenic phase (oestrous and proestrous)
What occurs during vaginal oedema?
Vaginal mucosa becomes swollen allowing transverse fold to prolapse through vulva
How does vaginal oedema present ?
As a large mass protruding through the vulva
Where do the folds arise from in vaginal oedema?
From the floor of the vagina, cranial to the urethral orifice
What is the exposed tissue in vaginal oedema predisposed to?
Dessication (removal of moisture)
Ulceration
Trauma
How is vaginal oedema reversed?
Regresses spontaneously during luteal phase
Consequences of vaginal oedema
Interferes with breeding
May reoccur during parturition resulting in dystocia
How to provide permanent relief from vaginal oedema?
Ovariohysterectomy
Treatments of vaginal oedema
excision of the prolapse
conservative (lubrication and protection)
pharmacologic induction of ovulation (GnRH or hCG)
Is vaginal prolapse common or rare in small animals?
Rare
How to differentiate vaginal prolapse from hyperplasia and tumour
By circumferential prolapse
careful examination +/- biopsy
How does vaginal prolapse occur?
After forced separation during mating
or in advanced stages of parturition during excessive straining
Treatment of vaginal prolapse
Early - attempt to reduce
Late - amputation
What % of vaginal neoplasia’s are benign ?
70 - 80%
Common vaginal/ vulva neoplasms
Leiomyoma
Fibroma
Lipoma
What is the name of a malignant neoplasm of the vulva/vagina?
Leiomyosarcoma
Treatment for vulva/ vaginal neoplasia
Surgical excision
How to better expose a vulva/ vaginal neoplasm during surgical excision?
Episiotomy - also known as perineotomy, is a surgical incision of the perineum and the posterior vaginal wall
What is episioplasty used for?
Used in the treatment of perivulvar dermatitis
(which may also be associated with juvenile vaginitis)
CHANGES THE ANATOMY of the perivulvar region
What is this procedure known as?
Episioplasty
