Reproductive Disorders: Non-Pregnant Dog Flashcards
describe cystic endometrial hyperplasia (CEH)
- abnormal endometrial gland proliferation and hypersecretion
-development of endometrial cysts
-endometrial hyperplasia
-accumulation of intraluminal fluid - a progressive degenerative condition
- consequences:
-sub or infertility
-predisposition to pyometra (and mucometra, hydrometra, or hematometra)
describe pathogenesis of CEH/pyometra
- when a uterus has CEH, bacteria can colonize the endometrium
- cysts = harder to uterus to expel bacteria = bacteria get stuck in there during diestrus
- microbiome studies suggest uterus isn’t actually sterile, cystic changes play a role in development of infection
- progesterone also important for development of uterine infections
-inhibits uterine contractions, increases glandular secretions, closes and changes the cervix (making it harder to clear bacteria), also dampens the immune response slightly!
describe pyometra
- often occurs in conjunction with CEH
-CEH-pyometra complex - affects up to 25-50% of intact females by 10 years of age
- disease of bacterial infection in uterus under the influence of progesterone
-uterine secretions that support both bacteria and embryos - estrogen exposure also considered significant
-allows endometrial growth and vascularization, may contribute to CEH - pregnancy may be mildl protective but CAN develop pyometra during pregnancy
describe incidence of pyometra
- adult intact females
-can see if never had a litter or on first heat cycle tho too - more common in long-haired large breeds and bully breeds
- occurs during DIESTRUS or early anestrus
- estrus suppression or mis-mating and increase risk
- increased risk if animal treated with exogenous progestagens or estrogens (disease or exogenous)
-4x more likely to develop pyometra within 4 months of estradiol benzoate admin
describe clinical signs of pyometra
1, anorexia
2. depression/lethargy
3. V/D
4. PU/PD maybe first sign!!
5. vulvar discharge
6. enlarged uterus
7. hind limb lameness: especially closed pyometras
8. septic shock
depends on owner observation, open/closed
common: history of being in heat in the past 2 months
describe clinical pathology of pyometra
- leukocytosis/leukopenia
- neutrophilia
- azotemia
- hyperproteinemia
- hyperglobulinemia
progresses to endotoxemia/septicemia
describe differential diagnoses of pyometra
- vaginitis
- brucellosis
- proestrus
- ovarian cysts
- neoplasia
- coagulopathy (more bloody)
- mucometra: treat similar to pyometra anyways
- hematometra
- pregnancy: if the dog has a history of being bred, there can be normal discharge with pregnancy (usually not many WBCs on preg discharge cytology tho)
describe diagnosis of pyometra
- imaging!!
-ultrasound preferred to radiographs
-ureteromegaly, thickened uterine walls, cystic endometrial changes, anechoic to hyperechoic luminal fluid - can palpate severely distended uterus
- open pyometra: cervix is patent so fluid can drain out
- closed pyometra: cervix does not allow fluid drainage so no vaginal discharge
open versus closed affects prognosis and treatment
-considered a life threatening emergency!
-open pyometras early in disease process are less urgent, but can always progress to critical/sepsis in a short period of time
describe treatment of pyometra
- ovariohysterectomy
-ANY case with a systemic inflammatory response/sepsis/SIRS
-esp if C reactive protein, SAA, PGFm elevated - medical management:
-young, genetically valuable
-open cervix and no systemic illness
-maybe if too compromised for surgery
-goal: remove progesterone source, evacuate uterus, and eliminate infection via: - maintain or establish cervical patency
- evacuate uterine contents
- control bacteria
- promote endometrial regeneration
describe PGF2a to medically manage a pyometria
- to remove progesterone and maintain cervical patency, aid with fluid evacuation
- must give LOW frequent doses
-higher doses cold rupture uterus
-3-5 times daily, 3 times less likely to make dog sick - continue treatment until progesterone <2ng/ml for more than 24 hours AND uterus is normal size with NO fluid
- if need to treat/no progress longer than 6 days, it’s time to spay
-poor prognosis and likely to recur - better resolution when combined with dopamine agonists
how to control bacterial growth with pyometra?
- start broad spectrum therapy immediately
-often flurorquinolone +/- extended spectrum penicillin
-less commonly cephalosporin and aminoglycosides (renal concerns) - based on culture results, treat for a minimum of 4 weeks
- 70% of infections are E/ coli!
-often the uropathogenic strains with virulence factors favoring adherence (biofilm strains maybe)
-can also be staph aureua, pseudomonas, klebsiella, proteus, streptococcus
how to allow endometrial rengeration with medical management of pyometra?
- animal should improve within 48 hours
-discharge should cease within 5-7 days
-bloodwork should be normal within 10 days - +/- moblerone:
-prolongs anestrus and allows endometrial repair
-start 1 month after end of treatment for pyometra and continue AT LEAST 60 days
-will cycle within 60-70 days of stopping treatment
describe prognosis of pyometra
- 80-90% survival rate
- 75% will recur within 2 years
-CANT reverse underlying CEH
-likely chronic subclinical endometritis - recommend vaginal culture and breeding on next estrus if still want to breed
- conception rates range from 35-70%
- recommend spaying as soon as breeding career is finished
describe vaginitis
- vaginal inflammation due to
-bacterial or viral infection
-chemical irritation
-tumors or foreign bodies
-anatomical abnormalities (os clitoris, os penis) - juvenile versus adult vaginitis:
-self limiting (puppy) versus chronic battle (adult)
describe vaginal defense mechanisms and how these are in dogs with vaginitis
- squamous epithelium: pretty thick
- flow of fluids
- normal bacterial flora: should have a normal healthy flora!
dogs with vaginitis often have atrophy of vaginal epithelium, frequent recurrent UTIs, diabetes, or anatomical abnormalities
describe vaginitis diagnosis
- vaginal cytology +/- culture
-normal vaginal flora include E. coli, beta hemolytic streptococci, staph aureus and intermedius
-makes culture hard bc bacterial growth doesn’t always mean antibiotics, more looking for heavy overgrowth - vaginoscopy: esp if recurrent
-usually need sedation esp if not in heat - serology
-brucella (always rule out for vaginal discharge: brucella!!!!!)
-herpes virus - RULE OUT PYOMETRA and diabetes
describe treatment of vaginitis
- eliminate underlying problem if present/possible
- antibiotics for 4 weeks (chronic adult cases)
- vaginal douching? acetic acid or probiotics
-probiotic fine, douching not great - oral estrogens: if spayed
describe vaginal hyperplasia
- common in adult intact females
- estrogen mediated: vaginal edema during proestrus and estrus
- treatment:
-keep moist, clean, and prevent trauma
-will resolve in diestrus: hCG or GnRH
-will recur in future cycles
-permanent treatment: OHE! circumferential excision rarely helps - ddx:
-vaginal tumors or polyps: rare, but if so are likely leiomyomas
give 3 examples of abnormal estrus cycles
- lack of cyclicity
- persistent estrus
- short inter-estrus intervals
describe primary versus secondary anestrus and list causes
anestrus is lack of external signs of proestrus/estrus
primary anestrus: no estrus by 24 months
secondary: 18 months from last estrus
causes:
1. silent heat: vaginal cytology to check
2. ovarian aplasia
3. endocrine or systemic disease: hypothyroidism, addison’s, cushing’s
4. exogenous steroids
5. luteal cysts
6. ovarian senescence (aging)
7. diet/malnutrition
8. previous OHE
how to determine if an animal is spayed?
- bloodwork:
-AMH and steroids (progesterone): may have functional ovaries - persistent elevated LH: probs no ovaries (could also be gonadotroph adenoma)
-witness LH test: positive if LH >1ng/ml
if negative, is 98% sensitive for intact animal - could in theory look for a jump in estradiol following GnRH stimulation test
-intact: detectable estradiol before and after injection or if significant rise after injection
-not preferred method - AMH: expensive, test for ovarian remnant
-can be negative with ovaries if prepubescent or after repro senescence
describe silent estrus
- ovarian activity without external signs
- diagnosis:
-monthly serum progesterone
-weekly vaginal cytologies - treatment: timed AI
- no estrus detected?
-GnRH implants
-cabergoline most effective
-fertility lower than normal heat
describe aging and canine fertility
- fertility begins to decline around 5 years of age
- may stop cycling by 8 years (breed dependent)
- lower fertility, decreased litter size
- longer inter-estrus interval
- increased risk of dystocia
- higher neonatal death
describe persistent estrus
- external signs of estrus for longer than 28 days
- estrogen secretion without progesterone
- ddx: follicular cysts, GCT, coagulopathy, pyometra, brucellosis, neoplasia
- diagnosis:
-high serum estradiol
-vaginal cytology: >90% cornified cells - risks:
-chronic estrogen exposure can cause hyperestrogenism syndrome: bone marrow aplasia, CEH-pyometra, mammary, ovarian, or uterine neoplasia
describe follicular cysts
- anovulatory follicles: >8mm size (proestrus/early estrus)
-present in diestrus, anestrus - risk factors: large breeds, never bred intact females
- treatment: OV or OVH, bc often concurrent uterine disease
-can try luteinizination with GnRH or hCG
