Module 1: Pyometra

Question 1

Life-threatening uterine infection that affects older dogs. It is extremely common.

Answer 1

Pyometra

Question 2

Pyometra will affect 1/4 of intact female dogs by the age of _______

Answer 2

10

Question 3

What are the breeds predisposed to pyometra?

Answer 3

• Bernese Mountain Dog
• Great Dane
• Leonberger
• Rottweiler
• Irish Wolfhound

Question 4

They are must higher to develop Pyometra if they have NEVER been ___________

Answer 4

Pregnant

Question 5

This disease happens during _________, a period of HIGH Progesterone following their estrous cycle

Answer 5

Diestrus

Question 6

1/3 of these cases can happen during ___________, meaning that they have not had a recent heat cycle within the past four weeks

Answer 6

Anestrus

Question 7

What predisposes them to Pyometra?

Answer 7

CEH (Cystic Endometrial Hyperplasia)

Question 8

• A cystic degenerative change of the endometrium (lining of the uterus)
• Intact females develop over time
• Prolonged/repeat exposure to estrogen and progestogens

Answer 8

CEH (Cystic Endometrial Hyperplasia)

Question 9

(T/F) Not all dogs with pyometra have CEH

Answer 9

True

Question 10

What is the most common type of bacteria that creates pyometra?

Answer 10

E. coli

Question 11

Has the ability to produce endotoxin, that then gets into the blood stream to cause many problems

Answer 11

E. coli

Question 12

What are the Clinical Presentations for Pyometra?

Answer 12

• Recent Estrus ( 4-6 weeks)
• +/- Vulvar Discharge
• PU/PD (50%)
• Lethargy
• Anorexia
• Vomiting/Diarrhea
• Fever is NOT common

Question 13

(T/F) You will always see discharge no matter if the cervix is closed or opened

Answer 13

False, if it is closed you may not see any sort of discharge

Question 14

When do you consider pyometra?

Answer 14

in ANY intact bitch that is sick

Question 15

What is the most common hallmark in a laboratory result for Pyometra?

Answer 15

Elevated White Count with Left Shift (elevation in segmented neutrophils)

Question 16

• Does not differentiate early pregnancy
• Enlarged uterus

Answer 16

Radiographs

Question 17

• Rule out pregnancy
• Thick uterine wall
• Hypo-hyperechoic uterine contents

Answer 17

Ultrasound

Question 18

What is our treatment for Pyometra?

Answer 18

• Spay (Ovariohysterectomy)
  - CEH is a progressive disease with no cure

Question 19

When do we only pursue medical management?

Answer 19

• VALUABLE breeding animal
• YOUNG
• Good body condition
• Normal renal function
• NO evidence of endotoxemia
• +/- Open Cervix

Question 20

What is the goal of Medical Management?

Answer 20

Reduce the effects of Progesterone

Question 21

• Is a progesterone antagonist, that blocks progesterone from binding to the receptor
• it does not lower progesterone but stops the effects of progesterone in the reproductive tract. This will allow the uterus to contract, it will open the cervix, and will help clear the discharge

Answer 21

Aglepristone (Alizin)
- is unavailable commercially in the US

Question 22

Is natural prostaglandin that causes lysis of the CL. By getting rid of the CL, it gets rid of the source of Progesterone

Answer 22

Prostaglandin F2 alpha
- makes them sick

Question 23

What is multimodal therapy? (helps evacuate the uterus faster)

Answer 23

• Dopamine Agonist (Cabergoline/Bromocriptine)
• Misoprostol (PGE2)

Question 24

Antibiotics for __________ weeks

Answer 24

3 - 4