Pyometra

Question 1

What are the two common signalments associated with pyometras?

Answer 1

(Older nulliparous bitch and young bitch with virulent ascending bacteria)

Question 2

Why are pyometras a diestrual disease?

Answer 2

(Bc a CL needs to be present to have the effects on the uterus to cause a pyometra → holding it closed and keeping the immune system quiet)

Question 3

What does repeated estrous cycles lead to in older, nulliparous bitches that predisposes to infection later in life?

Answer 3

(Cystic endometrial hyperplasia)

Question 4

Pyometras usually crop up in what time period after a heat cycle?

Answer 4

(1-3 months, can be closer to 1 month for younger bitches with aggressive bacteria)

Question 5

What induces the cervix to open in pyometra cases?

Answer 5

(Enough pressure on the cervix and enough PGF excreted from the uterus d/t pus/inflammation → open pyometra)

Question 6

What is the primary causative agent of pyometras?

Answer 6

(E. coli)

Question 7

What type of anemia can be associated with pyometras?

Answer 7

(Normocytic, normochromic regenerative anemia)

Question 8

What is the purpose of giving Alizin/Aglepristone to dogs with pyometras when pursuing medical therapy?

Answer 8

(Allows cervix to open and fluid to drain, also kills the CL providing the progesterone)

Question 9

What is the purpose of giving cabergoline to pyometra cases when pursuing medical therapy?

Answer 9

(Dopamine agonist → stops prolactin feedback to allow for better luteolysis)

Question 10

What hormone is integral to the formation of a pyometra?

Answer 10

(Progesterone → immunosuppressive)

Question 11

What are some of the clinical signs associated with pyometras?

Answer 11

(Lethargy, depression, hypo to anorexia, PU/PD, fever, dehydration, GI upset (v/d, nausea), abdominal pain, hindlimb pain, and tachypnea/tachycardia indicate endotoxemia)

Question 12

What antibiotics are typically used in pyometra cases?

Answer 12

(Clavamox, enrofloxacin, or unasyn)

Question 13

What are some negative prognostic indicators in pyometra cases?

Answer 13

(Signs of sepsis or endotoxemia and severe renal dysfunction/changes on blood work)

Question 14

How can you confirm luteolysis occurred in a medically managed pyometra case?

Answer 14

(Check progesterone, < 2 ng/ml at least, < 1 ideal)

Question 15

When confirming that a medically managed pyometra case was successful via ultrasound, what do you look for?

Answer 15

(A uterine diameter of 0.5-1 cm and reduced edema)

Question 16

What are the pharmacokinetics of the drugs listed below:

Aglepristone/alizin
Estrumate/cloprostenol
Lutalyse/dinoprost
Cabergoline

Answer 16

Aglepristone/alizin (progesterone antagonist)
Estrumate/cloprostenol (synthetic prostaglandin)
Lutalyse/dinoprost (natural prostaglandin)
Cabergoline (dopamine agonist, prolactin antagonist)

Question 17

What are the anesthetic concerns pertaining to pyometra cases?

Answer 17

(Hypotension and electrolyte/renal derangements)

Question 18

What can you expect to see on cytology of pyometra pus?

Answer 18

(Degenerate neutrophils, proteinaceous debris, and intracellular/overwhelming #s bacteria)

Question 19

What treatments and drugs are used for supportive care in pyometra cases?

Answer 19

(Fluids (isotonic → LRS or normosol), NSAIDs/analgesia, gastroprotectants (ondansetron, famotidine, omeprazole), and antiemetics (maropitant))

Question 20

What is the ideal candidate for medical management of pyometra?

Answer 20

(Young dog with no comorbidities and no uterine pathology (i.e. CEH))

Question 21

When treating a pyometra medically, the most critical refractory period is what time period after completion of treatment?

Answer 21

(14-21 days)