Pyometra

Question 1

When is pyometra likely to occur in the bitch?

Answer 1

Post-ovulation or during diestrus

Question 2

What is the most common signalment associated with pyometra?

Answer 2

Older nulliparous bitch

Other includes a young bitch with very virulent strain of bacteria to cause significant ascending infection

Question 3

What are the clinical signs associated with pyometra?

Answer 3

• Purulent vaginal discharge (if open)
• Lethargy, depressed, hyporexia/anorexia, PU/PD, febrile, GI upset
• Pain on abdominal palpation or abdominal distention

Question 4

What else is on your differentials list if you suspect a pyometra?

Answer 4

• Endometritis
• Metritis
  -Vaginitis (should not be systemically ill)
• Pancreatitis
• Foreign body

Question 5

T/F: Progesterone has an immunosuppressive effect on the uterus.

Answer 5

T

Question 6

Is the cervix open or closed during the luteal phase (aka when progesterone is high)?

Answer 6

Closed

Question 7

It is the repeated exposure of high/low estrogen and high/low progesterone for long periods of time that can cause pathologic changes to the endometrium of the bitch.

Answer 7

High estrogen, high progesterone

Question 8

You perform an ultrasound on an older bitch and see a cobblestone like appearance within the endometrium. What is your top differential?

Answer 8

Cystic endometrial hyperplasia

Question 9

T/F: Cystic endometrial hyperplasia creates changes to the endometrium that are reversible.

Answer 9

F, irreversable

Question 10

What are the 3 risk factors for pyometra?

Answer 10

1. Irregular cycles
2. Exogenous hormone (either non-surgical control methods or owner’s cream/hormonal therapies)
3. Older nulliparous bitch

Question 11

Does an open or closed pyometra tend to cause more systemic signs?

Answer 11

Closed; more likely to lead to endotoxemia

Question 12

An 8-year-old spayed female dog presents to your clinic for being lethargic, decreased appetite for a few days, and feels warm to the touch. No vaginal discharge present. Should a pyometra still be on your differential list?

Answer 12

Yes, could be a stump pyometra where there is ovarian tissue remaining that could have formed a CL to have high P4. Can become fluid-filled to create signs similar to a pyometra.

Question 13

What is the most common pathogen causing pyometra in dogs?

Answer 13

E. coli (biofilm production is what can lead to endotoxemia)

Question 14

What antibiotics can be used to treat pyometra?

Answer 14

Amoxicillin/Clavulanic acid, Enrofloxacin, or Unasyn

Question 15

What type of patients are candidates for medical management of pyometra?

Answer 15

• Young bitch with no severe comorbidities & no obvious uterine pathology

Question 16

What type of fluids would you use to provide supportive care to a patient with pyometra?

Answer 16

Isotonic - LRS or Normosol

Question 17

Why should you not use Prostaglandins in patients with cardiovascular comorbidities?

Answer 17

Because it causes smooth muscle contraction not just in the uterus, but also in the heart, leading to tachypnea & tachycardia.

Question 18

If an owner refuses to spay their dog with a pyometra because they want to breed her, what are your recommendations?

Let’s say she is a candidate for medical management.

Answer 18

Breed on next estrus & then OHE after breeding

Question 19

What are negative prognostic indicators for patients with pyometra?

Answer 19

• Sepsis
• Endotoxemia
• Severe renal dysfunction/changes on chemistry