Pyometra Flashcards
Risk factors
- > 6y/o
- may occur in young bitches following 1st or 2nd reproductive cycles
- 5-80d after oestrus
- after exogenous administration of oestrogens or progestogens
- labs, poodles and pinscher more predisposed
Presentation
- PUPD
- v+
- vulvar discharge if open pyometra
- abdominal enlargement
- depression
- anorexia
- palpation of distended uterus may be possible
- acute presentation: endotoxaemia, shock, collapse
Pathophysiology
- secondary bacterial infection of material in the endometrial glands: E.coli, Proteus spp, Klebsiella
- 5-6 oestrus cycles -> progesterone primed uterus -> cystic endometrial hyperplasia = pyometra
- bacterial toxins or immune complexes interfere with resorption -> tubular dz -> impaired ability to concentrate urine -> PU -> dehydration + electrolyte loss
Differentials
Uterine enlargement
- pregnancy
- hydrometra
- mucometra
- uterine tumour
Vulval discharge
- vaginal/uterine tumours
- vaginitis
- haemorrhage
Investigations
US
- enlarged uterine horns filled with fluid of marked echogenicity
Cytology
- toxic neutrophils on smear of discharge
Tx and management
Initial symptomatic
- fluid replacement, electrolyte replacement
Antibiotic use
- if surgically managed and well = no need
- if unwell, or medically managing = amoxiclav
Surgical
- ovariohysterectomy
Medical management
- not recommended, pyometra likely to reoccur, can rupture -> death
- only attempted where no signs of systemic illness, O understands risks
- Dinoprost (PGF2a): luteolysis and rapid uterine contractions
- Cabergoline (dopamine agonist): induce luteolysis, once confirmed cervix open need addition of ecbolic (PGF2a)
- Algepristone (progesterone-receptor antagonist): blocks all biological effects of endogenous progesterone, mimics luteolysis and causes cervical relaxation, can be used in combination with Cloprostenol (PGF2a)
Euthanasia
- older
- financial constraint
- poor surgical candidate
- comorbidities
