Exam 3 - Postpartum Disease

Question 1

what are some increased risks associated with causing maternal hypocalcemia?

Answer 1

increased risk with large litters & if calcium is supplemented during pregnancy

Question 2

T/F: maternal hypocalcemia is rare in cats

Answer 2

true

Question 3

what are the causes of maternal hypocalcemia?

Answer 3

increased calcium demands from fetal skeleton mineralization & milk production postpartum

Question 4

what are the clinical signs of eclampsia?

Answer 4

stiff gait, tremors, anxiety, panting, fever

Question 5

when does eclampsia usually occur?

Answer 5

usually 3 weeks postpartum but can occur in late gestation

Question 6

T/F: fever/agitation day 1 after parturition is more often hypocalcemia than metritis

Answer 6

true

Question 7

what is the treatment for eclampsia?

Answer 7

1-20 ml of calcium gluconate IV to effect over 30 minutes SLOWLY (0.5-1.5 ml/kg)

monitor EKG for bradycardiac or PVC - d/c calcium if noted

oral calcium 25-50 mg/day - continue until puppies are weaned

Question 8

when should puppies be weaned?

Answer 8

after 3 weeks of age

Question 9

what drug can be used to stop lactation?

Answer 9

cabergoline - anti-prolactinic

Question 10

how is eclampsia diagnosed?

Answer 10

serum chemistry - low serum calcium

EKG - tachycardia & prolonged q-t interval

Question 11

what is metritis?

Answer 11

acute, serious postpartum infection of the uterus

Question 12

what are some causes of metritis?

Answer 12

bacterial invasion of the uterus via open cervix

retained fetuses or abortion

prolonged delivery or dystocia

Question 13

what are the clinical signs associated with metritis?

Answer 13

foul smelling vulvar discharge generally 1 week postpartum

fever

+/- anorexia

Question 14

how is metritis diagnosed?

Answer 14

vaginal cytology - neutrophils & bacterial

vaginal culture

Question 15

what is the treatment for metritis?

Answer 15

antibiotics - penicillins, cephalosporins, fluoroquinolones if puppies are < 4 weeks old (pick based on culture)

nursing pups stimulate oxytocin which will help in uterine clearance

acupuncture to stimulate uterine clearance - CV1, SP6, BL67

Question 16

what is subinvolution of placental sites?

Answer 16

delayed uterine involution post-whelping where fetal trophoblastic cells persist that is non-infectious & usually resolves on its own

Question 17

what are the clinical signs of subinvolution of placental sites?

Answer 17

sanguineous/serosanguinous vulvar discharge for > 6-12 weeks - monitor for anemia/hypoproteinemia in severe cases

Question 18

why not use ergonovine in a bitch with subinvolution of placental sites?

Answer 18

stimulates uterine contraction but puts mom at risk for uterine rupture

Question 19

why does progesterone carry risk for a bitch with subinvolution of placental sites?

Answer 19

it sloughs the trophoblastic cells but puts mom at risk for pyometra

Question 20

what therapy can be done if subinvolution of placental sites persists or is severe?

Answer 20

OHE

Question 21

what is mastitis?

Answer 21

inflammation of glands with or without bacterial infection that ranges from mild/sub-clinical to life-threatening gangrenous

Question 22

what are some causes of mastitis?

Answer 22

environmental - unsanitary, trauma from untrimmed puppy nails, & rubbing whelping box as they enter/exit

galactostasis

hematogenous spread from neonatal death

Question 23

if you see gas near the mammary glands on rads for a mastitis patient, what do you suspect?

Answer 23

gangrenous mastitis - worry about septic shock

Question 24

what are the subclinical signs of mastitis?

Answer 24

neonatal failure because mom won’t let puppies nurse

Question 25

what are the clinical signs associated with mastitis?

Answer 25

one or more glands affected heat, redness, abnormal milk color/texture, can see bruising/ulceration gas = gangrenous can progress to septic shock

Question 26

how is mastitis diagnosed?

Answer 26

cbc- neutrophilia & thrombocytopenia if severe milk cytology - neutrophils & bacteria milk culture xray - check for gas!!! ultrasound - check for pockets on fluid

Question 27

T/F: gangrenous mastitis has a grave prognosis

Answer 27

true

Question 28

why does gangrenous mastitis have a grave prognosis?

Answer 28

quick progression of mastitis over hours - need ICU care for sepsis may have better prognosis with quick surgical intervention

Question 29

what is the treatment used for mastitis?

Answer 29

broad spectrum antibiotics - based on culture, penicillins, cephalosporins, fluoroquinolones if < 4 week old puppies warm compress & gentle drainage - don't drain/milk if pseudocyesis because it encourages more milk production cabbage - decrease swelling neonates can continue to nurse surgical drainage of abscesses may be necessary but ulcerations can heal with wound care

Question 30

what is uterine torsion?

Answer 30

rare - rotation of one or both horns that can occur anytime but most commonly postpartum

Question 31

what are the clinical signs of uterine torsion?

Answer 31

vaginal discharge, abdominal pain, lethargy, anorexia, vomiting

Question 32

what is seen on xray & ultrasound that supports a diagnosis of uterine torsion?

Answer 32

rads - caudal abdominal soft tissue mass ultrasound - fluid filled segment of uterus

Question 33

what is the prognosis of uterine torsion?

Answer 33

good prognosis with OHE

Question 34

what is uterine prolapse?

Answer 34

prolapse of the uterus through the cervix & into the vagina

Question 35

what causes uterine prolapse?

Answer 35

etiology unknown but excessive straining or forced fetal extraction can play a role

Question 36

how is uterine prolapse diagnosed?

Answer 36

physical/digital exam exposed uterus can be necrotic

Question 37

what do you need to differentiate uterine prolapse from?

Answer 37

vaginal hyperplasia

Question 38

how is uterine prolapse treated?

Answer 38

manual replacement if tissue isn't necrotic OHE if tissue is necrotic

Question 39

T/F: mortality of puppies/kittens is the highest during the first week of life

Answer 39

true

Question 40

what is fading puppy/kitten syndrome?

Answer 40

disease or death of neonates from parturition to weaning

Question 41

what are some risks for neonates regarding fading puppy/kitten syndrome?

Answer 41

higher risk for neonates: - born late in delivery or dystocia due to hypoxemia/trauma - low birth weight, >25% below average for puppies & < 75g for kittens, they are more prone to dehydration, hypothermia, hypoglycemia, & sepsis

Question 42

before all else, how should you treat fading puppy/kitten syndrome?

Answer 42

treat hypoglycemia & hypothermia

Question 43

what are some maternal causes of fading puppy/kitten syndrome?

Answer 43

dystocia, neglect, malnutrition of dam, agalactia, trauma, cannibalism, & systemic disease

Question 44

what are some examples of systemic disease in the bitch that can cause fading puppy/kitten syndrome?

Answer 44

mastitis, parasitism, & maternal diabetes mellitus causing puppies to have low BG

Question 45

what are some congenital anomalies that attribute to mortality in fading puppy/kitten syndrome?

Answer 45

atresi ani, cleft palate, hydrocephalus, heart defects, & hernias

Question 46

fading puppy/kitten syndrome is responsible for up to ____% of neonatal deaths in puppies & ____% in neonatal kittens?

Answer 46

40% - puppies 20% - kittens

Question 47

what is the anomaly shown in this puppy?

Answer 47

cleft palate

Question 48

what are some treatment options for fading puppy/kitten syndrome?

Answer 48

warmth, fluids, correct hypoglycemia, nutritional support, O2 support, antimicrobials (amoxi clav, cephalosporins - reduce dose by 30-50% in neonates) & blood transfusions

Question 49

how does malnutrition play a role in fading puppy/kitten syndrome?

Answer 49

overeating causing discomfort inadequate milk production of mom or inadequate nursing

Question 50

how do you improve malnutrition in fading puppy/kitten syndrome?

Answer 50

allow smaller pups to nurse first encourage suckle with warm, clean pinky finger dextrose on nipple to stimulate suckling

Question 51

when are puppies able to shiver?

Answer 51

7-9 days old

Question 52

what is a big common cause of fading puppy/kitten syndrome?

Answer 52

environmental causes - too cold & malnutrition

Question 53

how do environmental causes play a role in fading puppy/kitten syndrome?

Answer 53

whelping box is too hot or too cold & puppies can't shiver until they are 7-9 days old

Question 54

what causes neonatal isoerythrolysis in kittens?

Answer 54

queen & kittens don't share the same blood type - kitten RBC undergo immune-mediated destruction by maternal antibodies in colostrum

Question 55

if you know the queen's blood type doesn't match her kittens, what do you do?

Answer 55

must separate kittens & queen for a period after birth

Question 56

what blood type cats are often affected by neonatal isoerythrolysis?

Answer 56

type a or type ab kittens born to a type b queen type b cats have high levels of antibodies against type a cats type a cats have low levels of antibodies against type b cats

Question 57

when can parasites be considered as a cause of fading puppy/kitten syndrome?

Answer 57

after 2 weeks of age

Question 58

what viral causes attribute in causing fading kitten syndrome?

Answer 58

calicivirus, herpesvirus, panleukopenia, felv, & coronavirus

Question 59

what viral causes attribute in causing fading puppy syndrome?

Answer 59

herpesvirus - high mortality in first 3 weeks of life parvo, coronavirus, distemper

Question 60

how does bacteria cause fading puppy/kitten syndrome?

Answer 60

acquired from birth canal, placenta, or uterus - common cause of disease in the first week

Question 61

what puts puppies/kittens at risk for developing a bacterial cause of fading puppy/kitten syndrome?

Answer 61

lack of colostrum!!! symptoms progress quickly over hours & die within a day TREAT QUICKLY

Question 62

what are some general categories of infectious causes of fading puppy/kitten syndrome?

Answer 62

bacterial viral protozoal parasitic

Question 63

what virus is responsible for high mortality in puppies in the first 3 weeks of age?

Answer 63

herpesvirus

Question 64

what is this?

Answer 64

uterine prolapse

Question 65

what is this?

Answer 65

uterine torsion

Question 66

what is this?

Answer 66

subinvolution of placental sites

Question 67

what is this?

Answer 67

metritis

Question 68

what is this?

Answer 68

mastitis