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Therio Exam 2 > Small Animal Reproduction 2: Disorders > Flashcards

Small Animal Reproduction 2: Disorders Flashcards

(46 cards)

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1
Q

CEHMEP complex

A

cystic endometrial hyperplasia, mucometra, endometritis and pyometra: complex of diseases of the uterus linked by pathogenesis

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2
Q

what is the classical/prevalence theory of pathogenesis of pyometras?

A
  • estrus: predominant hormone estrogen/estradiol: stimulates development of endometrial glands and progesterone receptors in uterus = “priming”
  • then progesterone: further development and secretion of glands, suppresses motility of endometrium, closes cervix, decreased immune function
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3
Q

development of CEH

A
  • older maiden bitch
  • continuous “non pregnant” cycels
  • development of CEH
  • during estrous opportunistic pathogens like Ecoli
  • BUT uterine cysts make it difficult to clear bacteria before cervix closes
  • bacteria then establish infection among cyst and with uterine secretions
  • all under influence of PROGESTERONE DIESTRUS
    = PYOMETRA
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4
Q

what is the special pathogen theory pathogenesis of pyometra?

A

more pathogenic strains of bacteria (ecoli) ascend in the uterus during estrous, and these have special virulence factors that allow them to establish infection
= endometritis
= stimulates CEH
= progesterone influence = pyometra

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5
Q

regardless of the pathogenesis, a bitch cannot develop a pyometra (or CEH) without the presence of

A

PROGESTERONE

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6
Q

T/F: every intact bitch is susceptible to developing a pyometra whether bred or not

A

true
serum progesterone levels in pregnant and non pregnant bitches are very similar as there is no luteolytic mechanism in the bitch

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7
Q

T/F: there are no luteolytic mechanisms in the bitch

A

true

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8
Q

role of progesterone

A
  • stimulates proliferation and secretion of endometrial glands
  • keeps cervix functionally closed
  • inhibits myometrial contractions
  • suppresses immune response to pathogens
    BUT WHEN THERE IS NO PREGNANCY = PERFECT ENVIRONMENT FOR BACTERIAL GROWTH!
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9
Q

classic pyometra signalment

A
  • middle aged to older intact bitches (7.5 yrs)
  • increasing incidence in younger bitches
  • haven’t been pregnant previously: nulliparous
  • ovary-intact including stump pyo
  • history of treatment with estrogen or progestins
  • usually 1-4 weeks since previous estrus/heat (key history!)
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10
Q

clinical signs for pyometra

A

“open pyometra”: pus coming out, usually not too sick
“closed pyometra”: very sick, bad

refers to the patency of the cervix which affects degree of vaginal discharge and degree of systemic illness

clinical signs are not specific! but always think pyo in any intact bitch showing non specific signs of illness!

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11
Q

how can you diagnose pyometra

A
  • hemotology
  • serum chem
  • vaginal cytology
  • radiography: difficult to differentiate from pregnancy if <4 weeks
  • ultrasound: gold standard for early detection and differentiation from pregnancy
    DO NOT PERFORM ABDOMINAL PALPATION
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12
Q

Is culture and sensitivity necessary with a pyometra?

A

yes- even tho >90% are ecoli
there are more cases of abx resistant ecoli, also pseudomonas!

endometrial guarded swab passed up as far as you can in the vaginal cavity

get on broad spectrum abx: amoxicillin, cavulanate, cefazolin, but submit sample

continue abx txt 10-14 days after resolution of pyo

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13
Q

surgery vs medical therapy for pyo txt?

A
  • OVHE: curative and preventative
  • indications for sx: bitches not intended for breeding, uterine rupture, older bitches, ill/emerg cases, non responsive to medical txt
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14
Q

when to attempt medical txt with pyometra?

A
  • genetically valuable working dog breeding bitch
  • systemically healthy
  • YOUNG BITCHES < 4 years old
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15
Q

what are the aims of medical txt of pyometra

A

GET RID OF PROGESTERONE!
1. evacuate uterus of purulent material!
2. treat bacterial infx

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16
Q

what medical txt for pyometra?

A

prostaglandin F2a
1. induces luteolysis: removal of progesterone
2. induces uterine contractions

problem: they are resistant to luteolysis so you need a lot!! but high doses = severe side effects

natural PGF, or synthetic derivatives

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17
Q

aglepristone/alizin

A

progesterone receptor antagonist = anti-progestin = binds to progesterone receptors to displace progesterone to open cervix and some contactions to assist with evacuation for pyometra
not in US but can get from canada

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18
Q

what meds can you use for pyometra txt

A
  1. aglepristone/alizin
  2. dopamine agonists: prolactin inhibitors have anti luteotrophic activity, minimal side effects
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19
Q

most valuable tool to evaluating response to therapy for pyometra

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A

ultrasound
3 days: 50% reduction in size
5 days: want to see no fluid in uterine lumen

20
Q

vaginitis

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A
  • inflammation of vagina
  • 2 forms: juvenile and adult
  • present with vulvar discharge, licking of vulva, attract male dogs even when not in heat
  • history of many abx
  • less common signs: dysuria, pain on urination
21
Q

juvenile/puppy vaginitis

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A
  • prepubertal: 8 weeks to <1 year
  • etiology not understood; likely immune mediated reaction of vaginal vault during initial colonization of normal flora bacteria
  • clinical signs: mucoid vulva discharge
    often no other clinical signs than licking at vulva
22
Q

adult onset vaginitis

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A
  • post pubertal: onset > 1 year, more common in spayed than intact bitches
  • primary vaginitis: brucella canis, canine herpesvirus, TVT
  • secondary vaginitis: anatomic abnormalities, perivulval dermatitis, excessive hooding/tucked vulva, foreign body (grass awn/seed), neoplasia, UTI
  • idiopathic
23
Q

neoplasia causing secondary vaginitis

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A

leiomyoma, leiomyosarcoma, carcinoma

24
Q

diagnosis of adult onset vaginitis

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A

VAGINOSCOPY! where does it start, is it from cervix, etc
- examination of area: hooded? dermatitis?
- digital exam
- vaginal cytology
- culture
- urinalysis
-CBC/brucellosis/herpes PCR

25
vaginal culture and normal flora
- mixed population with commensal bacteria normal - only significant if there is PURE HEAVY GROWTH OF A SINGLE BACTERIA together with history and signs - often see where bitch has been on many abx
26
most common causes of bacterial vaginitis
1. e coli 2. strep 3. pasteurella 4. staph BUT these are also the most common ones isolated from clinically normal!
27
treatment of adult onset vaginitis
- treat underlying disorder - supporting: break licking cycle and prevent further inflammation and secondary ascending infections - restore the normal flora! implement modulators to create healthy vaginal flora - anti inflamms, pain management, surgical correction, foreign body removal, UTI, etc
28
vaginal hyperplasia
- protrusion of edematous vaginal mucosa into vaginal lumen - associated with ESTROGEN! most commonly occurs during proestrus and estrus - occurs subsequent cycles - most common in young boxers, mastiffs, bulldogs - heritable!
29
vaginal hyperplasia is associated with what hormone?
ESTROGEN most commonly in proestrus and estrus!
30
grading system of vaginal hyperplasia
grade 1: swelling of caudal vaginal floor, cranial to urethral orifice, looks like swollen vestibulum grade 2: similar to 1 but vaginal floor mucosa protrudes from the vulva grade 3: whole vaginal circumference protrudes from vulva (donut shape) - not technically prolapse
31
diagnosis of vaginal hyperplasia
vaginal cytology to confirm presence of ESTROGEN - pro-estrus/estrus - other sources of estrogen? cream, medication, diet - if spayed consider ovarian remnants!
32
treatment of vaginal hyperplasia
- medical therapy: wait it out: e collar, lube, abx - will resolve once estrogen concentration baseline - resolution about a week after ovulation - DO NOT USE PROGESTINS CAN CAUSE PYOMETRA - DO NOT TRY MANUAL REPLACEMENT AND PURSE TRING IN VULVA- TRAUMA - but can use a Buhner suture! with vaginal suture tape and effective - surgery: spaying: immediate removal, or you can amputate tissue resolution occurs once pt reaches diestrus and progesterone dominance
33
ORS
ovarian remnant syndrome
34
what is ORS?
heat/estrus occurs after spaying of a queen or bitch has been performed - due to presence of residual functional ovarian tissue not completely removed at surgery - surgical complication of OV/OVH, but not related to the ability of the surgeon or the breed/age/etc - happens more in cats compared to dogs bc of ovarian anatomy
35
clinical signs of ORS
- associated with proestrus or estrus at cyclic or irregular intervals, can be delayed after surgery but usually right after - bitch: vulvar swelling, bloody vulvar discharge, behavior changes - queen: vocalizing/calling, behavioral changes, receptivity - can present with concurent repro disease - can be very challenging to recognize
36
differential diagnoses of a spayed bitch with bloody vulval discharge or appearance of being in heat
1. exogenous estrogen therapy/cream used by pet owners 2. trauma 3. coagulopathy
37
what if a bitch was spayed last year and is in heat again?
need to confirm if bitch/queen is truly in estrus - vaginal cytology - resting hormone levels - hormone stimulation tests - US - surgery and resection
38
how can you diagnose the presence of estrogen
1. vaginal cytology 2. measure serum estradiol: not beneficial bc pulsatile
39
how can you diagnose ORS?
1. determine presence of estrogen: vaginal cytology 2. progesterone: CL will produce after ovulation: hormone challenge test: >2ng/mL is diagnostic of luteal tissue present 3. detection of LH 4. AMH: single blood test
40
what is the hormone challenge test
ovulation/lutealization induction: test for ORS - ovulation induction using hCG or GnRH analogue - increase in progesterone level >2ng/mL about 1 week after ovulation - helpful in queens! - perform before exploratory bc CLs easier to ID than follicles
41
detection of LH in ORS
- in intact animal, should be low - spay: will be very high - RIA gold standard but can use snapish test - high LH concentration >1ug/L = no tissue present - low LH concentration = presence of ovarian tissue
42
AMH detection for ORS
- inhibits development of female repro tract - single blood sample at any stage - positive = have ovarian tissue - human AMH assay not great, but is a canine one recently developed and is really good
43
T/F: you can measure AMH at any stage of an animal for detecting ORS
true!
44
US for detecting ORS?
limited: ovarian fragment really tiny - tissue reaction around ovarian pedicle can prevent detection
45
definitive diagnosis of ORS
exploratory laparotomy: txt of choice - perform surgery after ovulation is induced: diestrus under progesterone: detection of CL nodules easier, less oozing and surgical risk, only disadvantage is may cause pseudopregnancy after removal of ovarian tissue - tissue resection: remove BOTH OVARIAN PEDICLES even if not ovarian tissue is visualized - cats: check abdominal cavity: for dropped/seeded ectopic ovarian tissue
46
histopath for detection of ORS
- submit ALL RESECTED TISSUE regardless of if you see ovarian tissue or not - confirms diagnosis - ensures it has been completely removed by checking tissue margins

Therio Exam 2 (10 decks)

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