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
25
Q
How is Canine Brucellosis diagnosed
A
- 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
- Culture
