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Y3 MOD Reproductive > SA Reproductive problems and pharmacology > Flashcards

SA Reproductive problems and pharmacology Flashcards

1
Q

Define pyometra and state when it occurs

A

Acute or chronic suppurative bacterial infection of the uterus, occurs during the dioestrus phase of the oestrous cycle

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2
Q

Which hormone mediates the dioestrus phase?

A

Progesterone

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3
Q

Most common bacterial isolate from canine pyometra is ?

A

E.coli

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4
Q

Which animals are most likely to get a pyometra?

A

Common in adult intact middle-aged to older female dogs/cats (4 months – 18 years)

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5
Q

What are the 5 effects of progesterone on uterine tissues?

A
  • Endometrial hypoplasia
  • Cervical closure
  • Myometrial contractility
  • Hormone sensitivity
  • White blood cell function
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6
Q

Describe the pathogenesis of pyometra linked to the effects of progesterone on uterine tissues

A
  • Increase in endometrial tissue growth leading to cystic changes (cystic endometrial hyperplasia – CEH)
  • Closure of cervix provides closed environment for bacterial growth
  • Reduction in myometrial contractions interferes with normal defence mechanisms
  • Positive feedback loop: increased receptor numbers and sensitivity
  • Progesterone decreases local leucocyte function
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7
Q

What are the clinical signs of mild pyometra?

A
  • Pyrexia
  • Lethargy
  • Reduced appetite
  • Vaginal discharge if open
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8
Q

What are the clinical signs of a moderate pyometra?

A 
All of the mild signs +
Inappetence
Vomiting  
PUPD
Abdominal distension/pain
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9
Q

What are the clinical signs of a severe pyometra?

A

All mild & moderate signs plus:
- Collapse
- Hypovolaemic shock: Tachycardia, Pale MMs with long CRT, poor pulses
OR
- Distributive shock: Tachycardia, Pink to red MMs with rapid CRT, good pulses

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10
Q

Describe abdominal radiography for pyometra

A

This is not the preferred imaging modality for pyometra, but will show a soft tissue opacity in the caudal abdomen.

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11
Q

Describe abdominal ultrasound for pyometra

A

This is the preferred imaging modality for suspect pyometra.
Look for the hypoechoic bladder, and you will see hypoechoic uterine loops below

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12
Q

Describe the changes on a complete blood count in pyometra cases

A
  • Leucocytosis due to increased production in response to the infection OR
  • Leucopaenia due to increased consumption.
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13
Q

Which change in complete blood count is associated with a worse prognosis?

A

Leucopaenia is associated with a worse prognosis and a warning that your patient is struggling to respond appropriately to the infectious burden

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14
Q

As pyometra patients present with PUPD, it is important to rule out other differentials including …?

A
  • Diabetes
  • Renal disease
  • Liver dysfunction
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15
Q

Describe pre-renal azotaemia in pyometra patients

A

This is a common cause for azotaemia in pyometra patients.

They are often dehydrated due to fluid losses (vomiting, discharge), and may also have poor renal perfusion due to shock

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16
Q

Describe renal azotaemia in pyometra patients

A

This can be seen in pyometra patients, especially those with PUPD. The most common bacteria in pyometra is
E. coli. This bacteria can have direct impacts on glomerular and tubular function.

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17
Q

Describe post-renal azotaemia in pyometra patients

A

This is unlikely to be a cause of azotaemia in a pyometra patient.
Post renal azotaemia occurs due to urinary tract obstruction, and it is unusual to see this due to pyometra

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18
Q

What is the use of vaginal cytology in pyometra cases, what will be seen on cytology?

A

Vaginal cytology will differentiate the cause of the discharge.
In a pyometra we would expect to see degenerate neutrophils with intracellular bacteria

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19
Q

What is the most appropriate treatment for pyometra?

A

Surgery (ovariohysterectomy)

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20
Q

When would medical management be considered for a pyometra?

A
  • Young otherwise healthy animals to avoid surgery on this cycle
  • Animals who are systemically compromised to delay surgery in the short term while they are stabilized
  • Medical management alone is NOT suitable for patients who are systemically unwell
21
Q

Describe pre-op treatment for a pyometra patient

A

Stabilisation prior to surgery is important – this is a systemically ill patient at risk of SIRS and sepsis

  • Assess volume status (shock) and correct with appropriate fluid therapy
  • Broad spectrum IV antibiotics if patient is systemically unwell
  • Consider anaesthetic choices appropriate for a patient at risk of hypotension
22
Q

Describe pyometra surgery

A
  • Tissues may be friable so handle carefully
  • Pack abdominal cavity with lap swabs to prevent contamination in case of spillage of uterine contents
  • At level of cervix clamp across uterine body just above cervix as for normal spay, then remove any remaining uterine content using swabs. Do not oversew the stump – this increases the risk of localized peritonitis
  • Flush the abdomen thoroughly prior to closure – 1-2L of warmed saline – prevent a peritonitis
23
Q

What are the 3 aims of pyometra treatment?

A
  • Minimise effects of progesterone
  • Eliminate uterine infection
  • Remove uterine contents (cervical relaxation and myometrial contraction)
24
Q

What are the potential drug options for medical management of a pyometra?

A
  • Prostaglandins
  • Dopamine agonists (e.g. cabergoline, Galastop)
  • Receptor blockers (e.g. aglepristone, Alizin at Day 1, 2 + 7)
25
Q

What is important to discuss with owners when choosing medical management for a pyometra?

A
  • This is not a cheap option, the drugs used are expensive and at high frequencies
  • The prognosis for longer term fertility is variable – careful communication is needed when attempting medical management in a breeding animal
    Concern if owners have chosen this method to maintain fertility as it is not guaranteed
26
Q

How does a stump pyometra occur?

A

This condition occurs in animals who have not been completely spayed. There must be some ovarian tissue remaining to cause a stump pyometra

27
Q

How is a stump pyometra managed and treated?

A

Diagnosis of the pyometra is similar, but focus on the caudal abdomen during imaging.
Treatment involves surgical resection of the cervical stump AND identification and removal of the ovarian remnant

28
Q

Describe ovarian remnant syndrome

A
  • Animals will continue to show behavioural signs of oestrous despite being spayed. Can happen in both dogs and cats.
  • Usually iatrogenic – incomplete removal of ovarian tissue at the time of the spay
29
Q

How can iatrogenic ovarian remnant syndrome be avoided?

A

This can be avoided by placing your first clamp as deep as possible. This gives you plenty of room for the rest of your clamps. Also don’t want to reuse a clamp that has just camped any ovarian tissue as there may be cells on this clamp which can translocate

30
Q

Describe when to test for ovarian remnant syndrome

A

Easiest to test for this during oestrus signs. If in anoestrus period is very hard to differentiate – good communication with clients is important.

31
Q

How is ovarian remnant syndrome treated?

A

Surgical removal of ovarian tissue

32
Q

What are the clinical signs of ovarian remnant syndrome

A

Continued physical signs of oestrus despite being spayed

33
Q

Describe laboratory testing methods for ovarian remnant syndrome

A
  • Vaginal cytology: as for oestrus detection
  • When showing signs of oestrus: GNRH stimulation test, measuring Oestradiol pre + post
  • When not showing signs of oestrus: HCG stimulation, measuring progesterone 2 wks later
  • Anti-Mullerian hormone (AMH) + progesterone – can be taken anytime! Must take both together
34
Q

When are pseudo pregnancies most likely to occur?

A

Typically, 6-8 weeks post season

35
Q

What are the clinical signs of a pseudo pregnancy

A
  • Lactation (most common)
  • Behavioural signs: nesting, aggression, guarding of/babying a toy
  • Inappetence
36
Q

How is a pseudo pregnancy diagnosed?

A

No specific test, this is a diagnosis of clinical assessment. True pregnancy MUST be ruled out, as treatment for pseudopregnancy may terminate an actual pregnancy

37
Q

How can pseudo pregnancy be treated?

A
  • Cabergoline (dopamine D2 agonist) once daily for 4-14 days (44% success rate)
  • Reduce caloric intake/increase exercise
  • Removal of toys, especially if nesting/mothering behaviours
  • Can see spontaneous regression – 52% (20-80%) resolve with no treatment
38
Q

What must not be done during a pseudopregnancy?

A

Spay

  • Progesterone drop will sustain the pseudopregnancy.
  • Spay in anoestrus as likely to have a repeat pseudopregnancy with next oestrus cycle
39
Q

What questions are important to ask in a misalliance case?

A

Was the mating witnessed?
When did mating take place?
Is anyone in the household pregnant or trying to be?

40
Q

Why is it important to ask if anyone in the household pregnant or trying to be?

A

The medications we may want to use in these cases can also cause pregnancy termination in humans. They should be carefully risk assess and discussed with the owners before use

41
Q

What is the only licensed product for treating misalliance in the dog

A

Aglepristone (Alizin)

42
Q

Describe the protocol for Aglepristone (Alizin) use

A
  • 2 injections 24h apart
  • Can be given from day of mating up to day 45 post mating
  • If used post d20 of pregnancy will be accompanied by signs of parturition – owner communication important in these cases
  • Risk of pyometra after usage, warn owners of this
  • Ultrasound check at least 10 days after treatment (should be 30 days gestation or greater)
43
Q

Which technique is 100% effective for pregnancy termination?

A

Ovariohysterectomy

44
Q

Describe the surgical technique for a misalliance Ovariohysterectomy

A

Do not open uterus – temperature change and movement stimulates pups to start breathing. Leave in uterus and check heart rates slowing with ultrasound. Far nicer for pups and for team
Can administer intraperitoneal barbiturates (through uterus, ultrasound guided or exteriorize and inject)

45
Q

What can be used off licence for misalliance?

A

Cabergoline (galastop)

46
Q

Describe the action of Cabergoline (galastop)

A
  • Dopamine agonist, prolactin antagonist: reduction of CL and pregnancy termination
  • Dose not very well established (SID dosing x 5-10 days)
  • Can be used from day 25-45 post mating (foetal resorption vs expulsion).
  • Minimal side-effects
  • 100% effective when used after 40 days of gestation.
47
Q

What is juvenile vaginits

A

Mucoid to mucopurulent vulvar discharge seen in pre- pubertal bitches
Typically resolves after the first season – unclear if this is due to hormonal influences or a more mature immune system
Current recommendation is no antibiotic treatments needed, should be self limiting

48
Q

Which type of shock is characterised by dark pink – red membranes with a rapid capillary refill time?

A

Hypovolaemic

Y3 MOD Reproductive (11 decks)

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