Pyometra, metritis, mastitis and eclampsia Flashcards
Fill in the following sentences:
a. Eclampsia occurs more frequently …………………….. post-partum
b. Eclampsia is rare in large-breed bitches except in ………………………………..
c. Ionised Calcium is normally about ……% of total serum calcium concentration
d. Clinical manifestations of eclampsia occur with ionized calcium serum concentrations of less than ……………. mmol/l in bitches and less than …. mmol/l in queens.
a. Eclampsia occurs more frequently 2-4 weeks post-partum
b. Eclampsia is rare in large-breed bitches except in German short-haired pointers
c. Ionised Calcium is normally about 55% of total serum calcium concentration
d. Clinical manifestations of eclampsia occur with ionized calcium serum concentrations of less than 0.6-0.8 mmol/l in bitches and less than 1 mmol/l in queens.
Excessive prenatal calcium supplementation can lead to eclampsia by which two mechanisms?
- Inhibits parathyroid hormone release + can promote parathyroid gland atrophy
- Stimulated thyroid calcitonin secretion, which then acts to decrease the rate of bone resorption of calcium
Describe the 5 stages of progression of eclampsia
I Anxiety, restlessness, pacing, whining, hypersalivation, anorexia, polyuria, polydipsia, vomiting, diarrhoea +/- facial pruritus of variable intensity and biting at the feet II Ataxia, staggering, muscle tremors, mydriasis with diminished pupillary light reflexes, behavioural changes associated with lack of interest in offspring III Muscle stiffness and hyperesthesia, hyperthermia secondary to tetanic muscle contractions, panting, tachycardia, behaviour changes associated with aggression IV Tonic-clonic muscle spasms in all four limbs (tetany), collapse with opisthotonos, laboured respiration, behaviour changes associated with disorientation V Arrhythmia (premature ventricular complexes) and seizures (musculoskeletal signs are often exaggerated with tactile stimulus); death may ensue
What laboratory abnormalities can be associated with eclampsia?
- Alkalosis (usually respiratory – hyperventilation)
- Hypomagnesemia
- Secondary hypoglycaemia
What are the predisposing factors for the development of metritis?
- Abortion
- Dystocia
- Obstetric manipulation
- Retained foetal or placental tissue
- Uterine prolapse
True or false:
a. Metritis and mastitis are most commonly caused by E. coli, Staphylococcus and Streptococcus infections
b. In dogs, mastitis is most commonly caused by systemic blastomycosis and Mycobacterium infections
c. TMPS may be the preferred empirical oral treatment as it is safe for neonates
d. Amoxicillin is recommended for E. coli infections
e. Cytology with identification of bacteria and white blood cells is normally diagnostic for mastitis
a. Metritis and mastitis are most commonly caused by E. coli, Staphylococcus and Streptococcus infections T
b. In dogs, mastitis is most commonly caused by systemic blastomycosis and Mycobacterium infections F
c. TMPS may be the preferred empirical oral treatment as it is safe for neonates F
d. Amoxicillin is recommended for E. coli infections F
e. Cytology with identification of bacteria and white blood cells is normally diagnostic for mastitis F
Potential side effects of antibiotics that should be used cautiously in mastitis owing to neonatal toxicity include:
a. Tetracyclines
b. Fluoroquinolones
c. Sulfas
d. Chloramphenicol
a. Tetracyclines: discoloration of teeth
b. Fluoroquinolones (impaired cartilage development). Controversy surrounds its use in neonatal/pediatric populations; however, the benefits may outweigh the risk of cartilage abnormalities. The risk may be low in non–weight-bearing neonates less than 3 weeks of age, but informed consent with the client is recommended.
c. Sulfas: autoimmune disorders and bone marrow suppression
d. Chloramphenicol: safety to neonates has been questioned owing to its association with toxicity in infants, although it has good penetration into milk
List the roles of the following hormones in the pathogenesis of pyometra:
a. Progesterone
b. Oestrogens
c. TGF alpha
a. Progesterone
- Stimulates endometrial growth and glandular secretory activity after the uterus has been primed by oestrogen
- Reduces myometrial contractility and maintains cervical closure
- Diminishes immune function by decreasing neutrophil chemotaxis and phagocytosis + increases endometrial bacterial adherence
b. Oestrogens
- Up-regulation of endometrial progesterone and oestrogen receptors
c. TGF alpha
- Plays an important role in cell proliferation and differentiation
- Produced by inflammatory cells –> aberrant growth of endometrial glands, contributing to the development of CEH
- The average interval from the onset of proestrus to the diagnosis of CEH-pyometra is ………………………. in dogs. In cats, pyometra occurred within ……………… from oestrus.
The average interval from the onset of proestrus to the diagnosis of CEH-pyometra is 35 days (20 – 70) in dogs. In cats, pyometra occurred within 8 weeks from oestrus.
Complete the following sentences:
a. Up to …….% of pyometra cases can have a normal CBC
b. BUN over ………………… has been associated with AKI and a poor prognosis
c. In bitches, the mean age of pyometra diagnosis is …………………………………… and the risk is increased in the following breeds: ………………………………………………………..
d. ………………………………….. predispose younger bitches and queens to developing pyometra
e. Vaginal and uterine cultures have been reported negative in …………….% of the cases (Reproductive emergencies. Vet Clin North Am Small Anim Pract 2005)
a. Up to 25% of pyometra cases can have a normal CBC
b. BUN over 60mg/dl (21 mmol/l) has been associated with AKI and a poor prognosis
c. In bitches, the mean age of pyometra diagnosis is 7.25 years/8-9 years (range 4m to 16 years) and the risk is increased in the following breeds: rough-coated Collies, Rottweilers, CKCS and Golden Retrievers
d. Vaginal strictures predispose younger bitches and queens to developing pyometra
e. Vaginal and uterine cultures have been reported negative in 10-30% of the cases (Reproductive emergencies. Vet Clin North Am Small Anim Pract 2005)
Anaemia of chronic disease (nonregenerative, normochromic, normocytic) can be due to RBC diapedesis into the uterus or toxic suppression of erythropoiesis and is observed in % of cases with pyometra?
a. 25%
b. 10-20%
c. 70%
d. 55%
c. 70%
Explain the mechanisms of action of the following substances used for medical management of pyometra:
a. PGF2α or PGF2α analogs
b. Progesterone receptor antagonists
c. Dopamine antagonists
a. PGF2α or PGF2α analogs:
- Cause myometrial contractility expels the luminal content
- Cause luteolysis decreases progesterone concentrations
b. Progesterone receptor antagonists:
- Competes for uterine receptors at a fixating rate three-fold of that of progesterone
- Cause cervical opening
c. Dopamine antagonists:
- Cause luteolysis by reducing prolactin concentrations
List the potential side-effects of PGF2-alpha treatment
- Panting
- Emesis
- Hypersalivation
- Hypothermia
- Diarrhoea
- Urination (?)
- Anxiety
- Shivering
- Ataxia
- Abdominal contractions
+ Queens: - Vocalisation
- Grooming
- Kneading
- Mydriasis
- Lordosis
The recurrence rate of pyometra within 1-2 years in medically manages cases is between ………………% and approx. ……………% of bitches whelp a normal litter after medical management.
The recurrence rate of pyometra within 1-2 years in medically manages cases is between 20-77% and approx. 40-90% of bitches whelp a normal litter after medical management.
Concurrent UTIs have been discovered in …………….% of bitches with pyometra.
Concurrent UTIs have been discovered in 22-72% of bitches with pyometra.
