Reproductive disorders of the Dog Flashcards
1
Q
What is Cystic Endometrial Hyperplasia?
A
- Degenerative, progressive, irreversible
- Progesterone-mediated
- repeated exposure of the estrogen-primed uterus to progesterone
- proliferation and secretory activity of endometrial glands
- Closure of cervix
- Inhibits myometrial contractility
- Dilation of the endometrial glands resulting in cysts and endometrial hyperplasia
- Asymptomatic ⇢ subfertility
- embryo distribution
- placentation
- Predispose to pyometra
- repeated exposure of the estrogen-primed uterus to progesterone
2
Q
What is the CEH-Pyometra Complex?
A
- During Proestrus and Estrus the cervix opens and bacteria ascend
- During diestrus progesterone
- suppresses the immune system
- stimulates endometrial gland secretion
- uterine contractility decreases
- stimulates closure of the cervix
- RESULTS in:
- bacterial growth
- accumulation of inflammatory exudate
- Bacteria colonize the pathologic endometrium
3
Q
What are the different types of pyometra
A
- Open-cervix pyometra
- uterine drainage is established
- mild systemic disease
- Closed-cervix pyometra
- uterus distends with purulent fluid
- severe systemic disease due to endotoxemia and septicemia
4
Q
What is the common signalment and history of patients with pyometra
A
- 8+ years old
- Nulliparous > multiparous
- Commonly seen
- receiving estrogen for pregnancy termination
- Progesterone for estrus suppresion/prevention
- hyperestrogenism: ovarian cysts, granulosa cell tumor
- No breed predispositions
- Occurs during diestrus or anestrus
- 8 wks after estrus (1 wk to 4 months)
5
Q
What are the clinical signs of Pyometra?
A
- Anorexia
- Depression
- Vomiting
- Diarrhea
- PU/PD
- Enlarged uterus
- Abdominal enlargement
- Vulvar discharge
- malodorous
- mucoid to watery, red-brown
6
Q
What is the clinical pathology of pyometra?
A
- Leukocytosis
- Neutrophilia
- Hyperproteinemia
- Hypergloculinema
- If endotoxemia/septicemia
- leukopenia
- neutropenia
7
Q
How is pyometra diagnosed?
A
- Recent history of estrus
- Clinical signs
- Vaginal cytology and aerobic culture
- E. coli
- Streptococcus spp. Staphylococcus spp, pasteruella multocida, pseudomonas aeurginosa
- Diagnostic imaging
- abdominal palpation, radiographs/US
- Pyometra should be considered in any ill post-estrual intact female
8
Q
What is the treatment for CEH-Pyometra complex?
A
- OHE
- CEH is irreversible
- predisposed to recurrence
- Medical therapy
- young, genetically valuable
- Open-cervix, no systemic illness
- too compromised for surgery
9
Q
What are the goals of medical management of pyometra?
A
- Remove the effects of progesterone
- Maintain and promote an open cervix
- Promote uterine evacuation
- Control bacterial growth
- Antibiotics up to 4 weeks
- Culture and sensitivity
- Ampicillin 20 mg/kg PO TID
- Promote endometrial regeneration
- prolong anestrus
- mibolerone for 2-3months following treatment of pyometra
10
Q
What is the medical treatment for pyometra?
A
- PGF2a
- Luteolysis
- uterine contractions and evacuation
- Measure progesterone
- >2ng/ml indicates functional luteal tissue
- Progesterone inhibits uterine contractility
- Dinoprost
- 0.1-0.5 mg/kg SC BID-TID
- 2-7 days or until uterine size returns to normal
- Combo dinoprost and bromocriptine
- faster luteolysis and resolution
11
Q
What is the prognosis for pyometra
A
- Good if improvement clinically w/in 48 hrs
- vulvar discharge stops in 4-7days
- leukogram w/in normal values 10-15 days
- Survival rate with medical therapy 80%
- Recurrence 10-77%
- 40-68% conception rate on next estrus
- failure to conceive
- early embryonic death
- abortion
12
Q
How can pyometra be prevented from recurrence?
A
- Vaginal culture at next proestrus
- Breed at the next estrus
- OHE
13
Q
What is vaginitis
A
- Inflammation of the mucosal lining of the vagina
- Forms:
- Juvenile (pre-pubertal) - self-limiting
- immaturity of the vaginal canal and epithelium
- immaturity of natural immune system defense mechanism
- transient inflammation from bacterial colonization until natural defenses develop
- Resolves with first estrus
- Adult (post-pubertal)
- Bacterial or viral infection
- Urine pooling
- UTI
- anatomical abnormalities
- Foreign body or neoplasia
- Juvenile (pre-pubertal) - self-limiting
14
Q
What are the clinical signs of vaginitis
A
- purulent or mucopurulent vulvar discharge
- Excessive vulvar licking
- vulvar hyperemia
- clitoral hypertrophy
15
Q
How is vaginitis diagnosed?
A
- Vaginal cytology
- large number of neutrophils
- non-cornified epithelial cells
- Vaginoscopy
- hyperemia
- +/- follicular hyperplasia
- Vaginal culture
- overgrowth of single isolate of normal flora
- E. coli, B-hemolytic streps, S. aureus and intermedius
- overgrowth of single isolate of normal flora
- brucella canis and canine herpes virus
16
Q
What is the treatment for vaginitis
A
- juvenile form is self-limiting
- ID and terating the predisposing cause
- Systemic antibiotics for 4 weeks
- SPayed females with no underlying cause:
- oral estrogen to reinstate local defense mechanisms
- Diethylstilbestrol: 1mg PO SID for 5 days followed by 1 mg PO twice weekly for 2-3wks. then decrease to once weekly unless sings recur
17
Q
What is vaginal hyperplasia
A
- Extrusion of the vaginal mucosal lining through the vulva
- Estrogen-mediated
- exacerbation of normal thickening of the vaginal squamous epithelium and edema
- proestrus and estrus
- Adult, intact females
- occur during any estrous cycle
17
Q
What are the clinical signs of vaginal hyperplasia
A
- Solid tumor-like mass protruding from the vulva
- Mucosal excoriation
18
Q
What is the treatment for vaginal hyperplasia?
A
- Self-limiting
- Induce ovulation: GnRH or hCG
- Keep tissue clean and prevent trauma
- tissue regresses with the onset of diestrus
- Does not affect fertility
- Recurrence 66-100%
- Purse-string suture
- OHE or ovariectomy
19
Q
What are the causes of failure to cycle in the bitch
A
- Previous OHE or ovariectomy
- Husbandry
- Silent Heat
- Endocrine or systemic disease
- Hypothyroidism
- Hyperadrenocorticism
- Diabetes mellitus
- Exogenous steroids
- Luteal cyst
- Aging
20
Q
How can the presence of ovaries in a bitch be determined/?
A
- Serum concentrations of gonadotropins LH and FSH are elevated because of lack of negative estrogen feedback from the ovary to the pituitary
- Estrogen - negative feedback
- occurs during follicular phases when estrogen levels are still low
- Following Ovariectomy ⇢ loss of negative feedback resulting from an increase in FSH and LH
- LH secretions increase w/in 10 days of Ovariectomy
- Estrogen - negative feedback
- Serum LH Test Kit:
- Positive if LH >1ng/ml
- Negative = intact
- Sensitivity 98%
21
Q
What happens to progesterone and Anti-muellerian hormone (AMH) due to failure to cycle? How can these be used to judge whether or not ovaries are preset
A
- Progesterone:
- <0.2 ng.ml in dogs w/out ovaries
- Rise following ovulatoin
- Anti-Muellerian Hormone (AMH)
- Produced solely by granulosa cells
- Used at any point of estrous cycle in post-pubertal femal
- Utilized to detect ORS
22
Q
What is Canine Brucellosis
A
- Reportable disease in most states
- Most common presentation is abortion in late gestation
- 45-60 days
- W/out signs of maternal illness
- If pregnancy reaches term both live and dead puppies may be born
- die w/in a few days
- generalized lymphadenomagaly, hyperglobulinemia, recurrent fever, leukocytosis and seizures
- Causes:
- Brucella canis **
- Brucella melitensis
- Brucella suis
- Brucella abortus
- Phagocytosis by macrophages occurs at the site of bacterial exposure
- Replicates in lymphatic and genital tissue
- Prolonged bacteremia may be intermittent
23
Q
How is Canine Brucellosis transmitted?
A
- Routes:
- Oral
- vaginal
- Conjunctival
- Transplacental
- Infectious:
- Vulvar discharge
- Milk
- Urine
- Semen
- Aborted tissue
- fetal membranes
- 1-4 week incubation
- 6-64 months of shedding
24
What are the clinical signs of Canine Brucellosis?
* Systemically Asymptomatic
* Reproductive:
* Embryonic death
* Abortion
* 7-9 wks gestation
* prolonged vaginal discharge following
* Still birth
* Vulvar discharge
* Testicular atrophy
* Epididymitis
* Scrotal dermatitis
25
How is Canine Brucellosis diagnosed
* SUspect if a healhty female aborts approximately 2 wks before term or if she fails to whelp following an apparently successful mating
* Definitive:
* Culture
* blood
* lymphnode aspirates
* aborted material
* vulvar discharge urine
* PCR
* AGID
26
What is the treatment for Canine Bruceloosis
* Intracellular location of organisms makes achieving effictive antibiotic levels difficult
* Antibiotic therapy is unreleable and often unsuccessful at eliminating the organism from tissues
* dog may relapse afer stopping treatment
* Combo tetracycline (4wk) w/ gentamicin for first 2wk
* combo tetracyclein (4wk) w/ streptomycin for first 2wk
* Sterilization
* Proestrus, estrus, pregnancy and abortion
* shed in urine
* tissue persistence
* Euthanasia
27
How is canine brucellosis controlled
* Quarantine and test new dogs 2x at 30 day intervals
* Remove proven positive dogs form breeding program
* Use only *Brucella* negative males
* Test all animals at 3-6 month intervals
* Positive dogs on property ⇢ quarantine and test all dogs monthly
* require 3 consecutive negative tests
* Prognosis for cure without recrudescence is guardd
28
What is Canine herpes virus 1
* Mild respiratory disease in adults
* Severe viral infection of puppies worldwide
* often 100% mortality rate
* Focal necrosis and hemorrhage
* Seroprevalence 20-98%
* Lifelong llatent infection
* persists in tonsils and parotid salivary gland
29
What are the clinical signs of canine herpes virus 1
* classic presentation of the infected female
* loss of previously confirmed pregnancy
* Birth of abnormal, nonviable pups
* stillborn
* low birth weight
* weak
* Abortion
* Maceration
* Mummification
* Stillbirth
* neonatal death \< 1wk
30
How is Canine herpes virus 1 transmitted?
* Transplacentally
* Passage through the birth canal (Vulvar discharge)
* Oronasal secretions
* Venereal
* Aborted tissues
31
How is canine herpes virus 1 diagnosed?
* Poorly immunogenic
* short lived antibody response
* paired serum samples
* Virus isolation or immuno fluorescence
* nasal or vaginal swabs
* aborted tissues
* **Histopathology**
* necrosis and viral inclusion bodies in placenta and fetal tissues
32
What is the treatment for Cnine herpes virus 1
* Unnecessary in adults
* self-limiting in immune competent
* Neonates
* supportive care and antiviral therapy
* persistent neurological and myocardial damage
* shed large amounts of virus for 2-3wks
33
How ic canine herpes virus 1 controlled
* No vaccine
* Expose naive female prior to breeding
* high titer have protective immunity
* less likely to develop reproductive or neonatl problems
* Isolate during the last 3 wks of testation & first 3 wks after parturition
* Good biosecurity
* Neonatal prophylaxis
* ensure adequate colostrum
* immunized serum from preciously infected animal
* maintain adequate ambient temperature
34
How should a post-partum bitch be monitored? what for?
* Rectal temperatures daily for 2 weeks
* metritis
* mastitis
* eclampsia
* Vulvar discharge
* greenish black to tan for 3wks
* non-odorous
* Mammary glands
* secretions white to yellowish
* no heat, non-painful
35
What is subinvolution o placental sites?
* Failure of fetal trophoblastic cells to degenerate
* abnormal involution/repair endometrial placental sites
* continued invasion of the uterus by trophoblastic cells
* endometrium
* myometrium
* Systemic signs normally not present
* May result in
* damage to blood cessels
* endometrial ulceration
* uterine perforation
36
What are the signs of subinvolution of placental sights? differentials?
* Uncomplicated gestation and parturition
* Present with vulvar hemorrhage
* \>3wks post-partum
* intermittent or persistent
* DDx:
* metritis
* vaginitis
* cystitis
* trauma
* vaginal neoplasia
* brucellosis
* coagulopathy
37
How is subinvolution of placental sites diagnosed
* Presumptive dx
* persistent hemorrhagic discharge
* otherwise healthy
* Radiographs or US
* placental sites are 2x size of normal
* Vaginal cytology
* trophoblast-like cells
* **Pathognomonic \>4 days post-partum**
38
What is the treatment for subinvolution of placental sites? Prognosis
* Spontaneous resolution
* Severe cases:
* blood transfusion
* OHE
* Prognosis:
* reproductive potential is not compromised
* Not predisposed to SIPS in subsequent pregnancies
39
What is Post-partum metritis
* Inflammation of the endometrium and myometrium
* Develops within the 1st wk post-partum
* prolonged delivery
* Dystocia
* retained fetus or fetal membranes
* Dilated post-partum cervix leave the uterus vulnerable to ascending infection
* retained tisue or lochia serve as ideal grouth medium
40
Clinical signs of Post-partum metritis
* Depression
* anorexia
* fever
* vomiting
* neglect of puppies
* Malodorous, red-brown, purulent vulvar discharge
* endotoxemia
* septicemia
41
how is post-partum metritis diagnosed
* Clinical signs
* vaginal cytology - degenerate neutrophils
* Bactreial Culture - aerobic and anaerobic
* US and Radiographs
42
What is the treatment for post-partum metritis
* Stabilize patient
* Broad-spectrum antibiotics
* Ecbolics - cautiously
* devitalized uterus could be prone to rupture
* Surgical evacuation of uterine contents
* fetal membranes
* pups
* OHE
* Prognosis for future fertility - normal
43
What is Eclampsia?
* Depletion of ionized calcium increases membrane permeability and results in spontaneous muscle depoolarization when demand for milk is high
* Most cases present 1-4eks post-partum
44
What are the signs of eclampsia
* Restlessness
* nervousness
* whining
* panting
* muscle tremors
* dilated pupils
* hypertherma (\>105
* Can progress to recumbency, extensor rigidity, convulsions and death
45
HOw is eclampsia diagnosed
* Hx
* Clinical signs
* Ionized hypocalcemia
* some may have normal total calcium conentraiotn
* \<7mg/dl indicates hypocalcemia
* +/- hypoglycemia
46
Treatment for exlampsia
* immediate calcium supplementation
* Correct hypoglycemia
* lower body temperature
* remove puppies for at least 24 hrs ow wean
* Hypocalcemia may recur during corrent lactation and subsequent litters
* Prevent w/ balanced diet with Ca:P ratio of 1:1 or 1.2:1
