Diseases of the Female Repro tract

Question 1

Definition of pyometra

Answer 1

Pus-filled uterus
Final stage of the cystic endometrial hyperplasia-pyometra complex

Question 2

What is required for a pyometra to exist ?

Answer 2

Ovarian or exogenous progesterone

Question 3

What is pyometra a disease of?

Answer 3

Diestrus phase of the ovarian cycle
- while the corpus luteum is actively secreting progesterone

Question 4

Why is pyometra less common in cats ?

Answer 4

Cats are induced ovulators
- therefore should only occur with sterile matings

Question 5

What does progesterone do that contributes to pyometra?

Answer 5

Increases secretions of the uterine glands
Inhibits myometrial contraction
Closes the cervix

Question 6

What can progesterone secretion result in ?

Answer 6

Cystic endometrial hyperplasia
Inhibition of leukocyte response facilitating bacterial colonisation

Question 7

Pyometra signalment

Answer 7

Older, entire bitches (>6 years)

Usually within 8-12 weeks of previous season (4 weeks in cats)

Increased risk of exogenous oestrogen or progestagens

Question 8

What is the influence of oestrogen on the uterus ?

Answer 8

Increases the sensitivity of the uterus to progesterone

Question 9

What is present with chronic endometritis?

Answer 9

Cystic endometrial hyperplasia

Question 10

Role of infection in pyometra

Answer 10

not a primary cause but is usually present secondarily

Question 11

Commonly isolated bacteria in pyometra

Answer 11

E.coli (most common)

Streptococcus

Staphylococcus

Enterococci

Klebsiella

Proteus and pseudomonas (less common)

Question 12

Bacteria reported in pyometra with secondary toxaemia

Answer 12

Anaerobic bacteriodes and clostridium

Question 13

Is pyometra systemic or localised?

Answer 13

Systemic

Question 14

Pyometra clinical signs

Answer 14

Temperature is often normal
Anorexia / depression
Vomiting/ diarrhoea
PU (urine production)/ PD (increased thirst/ water consumption)
+/- vaginal discharge (depending on patency (opening) of cervix)
Poorly concentrated urine (<1.030 USG)

Question 15

Pyometra clinical pathology

Answer 15

Leukocystosis(15 –100 x 10(9)/L)

Left shift and toxic change common

Anaemia (often masked by dehydration)

Azotemia (kidney damage)

Low USG (<1.030)

Question 16

Pyometra imaging

Answer 16

Gentle abdominal palpation

Radiographs –soft tissue density, displacement of GI structures

ultrasound

Question 17

What is the best imaging for pyometra?

Answer 17

Ultrasound most sensitive –gives an indication of uterine size, the thickness of the uterine wall and the presence of fluid within the peritoneal cavity.

Question 18

Medical pyometra treatment

Answer 18

PGF2a luteolysis - lowering progesterone should open the cervix to allow drainage
+
Broad spectrum antibiotics

Question 19

Surgical pyometra treatment

Answer 19

Ovariohysterectomy
- careful not to rupture
- stabilise pre op
- broad spectrum antibiotics
- remove all infected tissue

Previously recommended to oversew stump but now omentalise

LAVAGE LAVAGE LAVAGE

Question 20

What did vaginal odema used to be known as?

Answer 20

Vaginal hyperplasia

Question 21

When does vaginal oedema occur?

Answer 21

During oestrogenic phase (oestrous and proestrous)

Question 22

What occurs during vaginal oedema?

Answer 22

Vaginal mucosa becomes swollen allowing transverse fold to prolapse through vulva

Question 23

How does vaginal oedema present ?

Answer 23

As a large mass protruding through the vulva

Question 24

Where do the folds arise from in vaginal oedema?

Answer 24

From the floor of the vagina, cranial to the urethral orifice

Question 25

What is the exposed tissue in vaginal oedema predisposed to?

Answer 25

Dessication (removal of moisture) Ulceration Trauma

Question 26

How is vaginal oedema reversed?

Answer 26

Regresses spontaneously during luteal phase

Question 27

Consequences of vaginal oedema

Answer 27

Interferes with breeding May reoccur during parturition resulting in dystocia

Question 28

How to provide permanent relief from vaginal oedema?

Answer 28

Ovariohysterectomy

Question 29

Treatments of vaginal oedema

Answer 29

excision of the prolapse conservative (lubrication and protection) pharmacologic induction of ovulation (GnRH or hCG)

Question 30

Is vaginal prolapse common or rare in small animals?

Answer 30

Rare

Question 31

How to differentiate vaginal prolapse from hyperplasia and tumour

Answer 31

By circumferential prolapse careful examination +/- biopsy

Question 32

How does vaginal prolapse occur?

Answer 32

After forced separation during mating or in advanced stages of parturition during excessive straining

Question 33

Treatment of vaginal prolapse

Answer 33

Early - attempt to reduce Late - amputation

Question 34

What % of vaginal neoplasia's are benign ?

Answer 34

70 - 80%

Question 35

Common vaginal/ vulva neoplasms

Answer 35

Leiomyoma Fibroma Lipoma

Question 36

What is the name of a malignant neoplasm of the vulva/vagina?

Answer 36

Leiomyosarcoma

Question 37

Treatment for vulva/ vaginal neoplasia

Answer 37

Surgical excision

Question 38

How to better expose a vulva/ vaginal neoplasm during surgical excision?

Answer 38

Episiotomy - also known as perineotomy, is a surgical incision of the perineum and the posterior vaginal wall

Question 39

What is episioplasty used for?

Answer 39

Used in the treatment of perivulvar dermatitis (which may also be associated with juvenile vaginitis) CHANGES THE ANATOMY of the perivulvar region

Question 40

What is this procedure known as?

Answer 40

Episioplasty