Pyometra + Miscellaneous Surgeries of the Bitch Flashcards
Define Pyometra
Accumulation of purulent exudate within the uterus lumen
Define Cystic Endometrial Hyperplasia (CEH)
This is a hormonally dependent, predictable condition in the bitch that results from repeated cycles of progesterone stimulation, which induces endometrial glandular proliferation and secretion
What is the Cystic Endometrial Hyperplasia-Pyometra complex?
This is where normal endometrial hyperplasia resulting from progesterone secretion results in a growth medium that is ideal for bacterial proliferation
What is the pathogenesis of CEH-Pyometra complex?
During the luteal phase of the estrous cycle, progesterone suppresses the leukocyte response to infectious stimuli in the uterus, decreases myometrial contractility, and stimulates endometrial gland development and activity. During diestrus, the nongravid uterus is flaccid and contains endometrial gland secretions that are a growth medium for bacteria. Bacteria reach the uterus via ascension from the distal portion of the genitourinary tract, or less commonly by hematogenous spread. Failure to clear transient bacterial inhabitants from the uterus after estrus can result in pyometra
What is the most commonly isolated etiological agent of pyometra?
E.coli
This includes both bitches and queens
Can also isolate Staph, Strep and Klebsiella
What is the difference between a closed and open pyometra?
Closed = Vulvar discharge is not present = more serious condition, as there is potential for leakage of purulent fluid through the fallopian tube(s) or uterine rupture, resulting in septic peritonitis
Open = Vulvar discharge is present, as the cervix remains patent and discharge is able to leak out
What are the clinical signs associated with Pyometra?
- Purulent vulvar discharge
- Lethargy
- Anorexia
- Abdominal distension + pain
- PUPD
- V/D
- Dehydration
- Fever
- UTI
How can Pyometra be diagnosed?
- Radiographs
- Ultrasound
- Hematology: anemia is present in 70% of cases (anemia will be non-regenerative, normocytic, normochromic)
- Hematology: Elevated WBC’s
- Biochemistry: Hyperglobulemia +/- azotemia
caution: during pregnancy, you will also see. neutrophilia, hyperglobulemia, and anemia therefore don’t mistake the two
What are the treatment options for Pyometra and when are they indicated?
1) Medical:
- Prostaglandins F2 alpha: 0.1-0.25 mg/kg
- PGF2alpha stimulates uterine motility, which increases intrauterine pressure
- High chance of uterine rupture due to the fragile uterus lining, abortion will occur if there is a fetus, and there is a high recurrence rate (77% chance)
- Indicated for young, stable, valuable breeding bitches who have an OPEN pyometra
- MOST WILL ARGUE THIS IS NOT EVEN AN OPTION AT ALL
2) Stabalization with IV fluids + antibiotics + Ovariohysterectomy
What are the indications of performing a C-section in dogs or cats?
Mother-related issues:
- Complete primary uterine inertia
- Gross abnormalities of the maternal pelvis
- Maternal evidence of systemic illness
- Suspicion of uterine torsion, rupture, prolapse or herniation
Fetal-related issues:
- Large number of fetuses
- Fetal malformation
- Malpresentation that is not amenable to manipulation (e.g. transverse)
- Fetal Putrefaction
- Evidence of fetal distress with poor response to medical intervention
What anesthetic considerations are necessary when preparing for a C-section?
1) Prep the mother in advance of GA
2) Minimize the exposure of the fetus to anesthetics by using: epidural, lidocaine line blocks and lower concentrations of inhalant agent
3) Try to use short duration of action drugs (like propofol) or reversible agents (narcotics)
4) AVOID: thiopental, ketamine, xylazine and methoxyflurane
What drugs should be avoided when anesthetizing a dog or cat for a C-section?
AVOID Thiopental, ketamine, xylazine and methoxyflurane
What is an episiotomy, and when is it indicated in cats and dogs?
An episiotomy is a surgical incision of the vulvar orifice to allow access to the vagina
Indications:
- Exploration of the vagina
- Vaginal masses
- Lacerations
- Congenital defects
- Exposure of the urethral papilla
- Facilitate fetal extraction
What is an episioplasty and when is it indicated in dogs?
This is a reconstructive procedure in which the skin folds around the vulva are excised
Indications:
- Chronic dermatitis
- UTI
- Urine incontinence
