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Introduction Introduction Garret Pachtinger, VMD, DACVECC COO, VETgirl UNIVERSITY OF MINNESOTA Veterinary Medical Center Introduction Introduction Jus$ne A. Lee, DVM, Dr. Margaret V. Root DACVECC, DABT Kustritz, DVM, PhD, CEO, VETgirl DACT Professor, Small Animal ReproDuc$on UNIVERSITY OF MINNESOTA Veterinary Medical Center • The tech-savvy way to get online veterinary CE! • A subscription-based podcast and webinar service offering veterinary RACE-approved CE 50-60 podcasts/year plus 24+ hours of webinars! • $199/year • 30+ hours of RACE-CE 1 • Up to 5 members: $599/year • Up to 10 members: $999/year • > 10 members: $1399/year Easier playback, less buffering – better! ! No neeD to raise your hanD! ! Type in ques$ons ! EmaileD to you 48 hours aer the webinar ! Ac$ve par$cipaon = no quiz ! Watching viDeo later, must complete quiz ! ELITE members only ! Email / contact with ANY ques$ons ! [email protected] ! [email protected] 2 Introduction Dr. Margaret V. Root Kustritz, DVM, PhD, DACT Professor, Small Animal ReproDuc$on UNIVERSITY OF MINNESOTA Veterinary Medical Center PYOMETRA Pyometra - Pathogenesis * Primary pathologic change = cystic Margaret V. Root Kustritz, DVM, PhD, DACT endometrial hyperplasia (CEH) University of Minnesota UNIVERSITY OF MINNESOTA UNIVERSITY OF MINNESOTA Veterinary Medical Center Veterinary Medical Center Pyometra - CEH develops due to prolonged exposure of the estrogen-primed uterus to progesterone. - CEH develops due to unique cycle of the bitch, can also occur after administration of exogenous estrogen and/or progesterone. UNIVERSITY OF MINNESOTA UNIVERSITY OF MINNESOTA Veterinary Medical Center Veterinary Medical Center 3 Cystic endometrial hyperplasia Cystic endometrial hyperplasia UNIVERSITY OF MINNESOTA UNIVERSITY OF MINNESOTA Veterinary Medical Center Veterinary Medical Center Pyometra Pyometra - Pathogenesis - Common question – Did she get this from the * Secondary pathologic change = infection stud dog? – No, because… E. coli beta hemolytic Streptococcus sp. - The bacteria causing the secondary infection alpha hemolytic Streptococcus sp. are invariably those of the bitch’s normal flora Pasteurella sp. Staphylococcus sp. and CEH / are more common in nulliparous Proteus mirabilis bitches than in pluriparous bitches. Bacillus sp. Corynebacterium sp. Pseudomonas aeruginosa Klebsiella sp. Mycoplasma sp. UNIVERSITY OF MINNESOTA UNIVERSITY OF MINNESOTA Veterinary Medical Center Veterinary Medical Center Pyometra Pyometra Pathogenesis timeline -> CEH present – bacteria ascend during Incidence? proestrus / estrus and colonize the abnormal uterus – cervix closes at onset of diestrus – progesterone inhibits uterine contractility, Reported incidences are 15.2% in dogs greater promotes secretion of endometrial glands, than 4 years of age and 23-24% in dogs 10 makes endometrium “hyper-reactive” – years of age or older. subsequent disease dependent on cervical patency UNIVERSITY OF MINNESOTA UNIVERSITY OF MINNESOTA Veterinary Medical Center Veterinary Medical Center 4 Pyometra Pyometra - Presentation - Presentation Bitch greater than 5-6 yrs of age Breed predisposition? In heat 1-12 wks ago - Rottweiler, rough collie, Cavalier King Charles spaniel, golden retriever, chow chow, St. Bernard, Bernese mountain dog, English cocker spaniel at increased risk - German shepherd dog, dachshund at decreased risk UNIVERSITY OF MINNESOTA UNIVERSITY OF MINNESOTA Veterinary Medical Center Veterinary Medical Center Pyometra - Clinical signs Pyometra Anorexia, vomiting - Diagnosis Fever, depression CBC - Leukocytosis with left shift Polyuria / polydipsia Reported in 70-87% of cases. More +/- abdominal distension severe in cases with closed cervix. +/- purulent vulvar discharge UNIVERSITY OF MINNESOTA UNIVERSITY OF MINNESOTA Veterinary Medical Center Veterinary Medical Center Pyometra Pyometra - Diagnosis CBC - Leukocytosis with left shift Palpation / Radiography / Ultrasound - Uterine enlargement UNIVERSITY OF MINNESOTA UNIVERSITY OF MINNESOTA Veterinary Medical Center Veterinary Medical Center 5 Pyometra Pyometra - Diagnosis CBC - Leukocytosis with left shift Palpation / Radiography / Ultrasound - Uterine enlargement Chemistry profile - Azotemia Renal disease develops secondary to endotoxemia, with decreased renal tubular function and formation of antigen/antibody complexes causing glomerulonephritis UNIVERSITY OF MINNESOTA UNIVERSITY OF MINNESOTA Veterinary Medical Center Veterinary Medical Center Pyometra - Diagnosis Pyometra CBC - Leukocytosis with left shift - Treatment Palpation / Radiography / Ultrasound - - Closed cervix = Ovariohysterectomy is best Uterine enlargement in all cases Chemistry profile - Azotemia Cytology - Purulent vulvar discharge Successful medical therapy of closed cervix pyometra has been reported. Possible complications include uterine rupture or movement of purulent fluid through the uterine tubes into the abdomen – both of the above will be cause peritonitis. UNIVERSITY OF MINNESOTA UNIVERSITY OF MINNESOTA Veterinary Medical Center Veterinary Medical Center Pyometra Pyometra - Treatment - Treatment - Closed cervix = Ovariohysterectomy is best Ovariohysterectomy always is the best in all cases therapy for pyometra. Medical therapy will not cause resolution of CEH.The bitch will be - Open cervix = Ovariohysterectomy is best; predisposed to pyometra after each subsequent prostaglandin therapy is possible estrus. UNIVERSITY OF MINNESOTA UNIVERSITY OF MINNESOTA Veterinary Medical Center Veterinary Medical Center 6 Pyometra Pyometra - Assess uterine size. - Treatment Palpation, imaging Medical therapy with prostaglandins may be considered if: * The cervix is open, evidenced by vulvar discharge. * The bitch is of breeding age. * The bitch is valuable in a breeding program. * The bitch is not azotemic. UNIVERSITY OF MINNESOTA UNIVERSITY OF MINNESOTA Veterinary Medical Center Veterinary Medical Center Pyometra Pyometra - Assess uterine size. - Assess uterine size. - Culture vulvar discharge, if present. - Culture vulvar discharge. - Institute antibiotic therapy and correct fluid deficits. Amoxicillin or ampicillin are common empirical choices; may need to alter therapy once culture/sensitivity results are back. UNIVERSITY OF MINNESOTA UNIVERSITY OF MINNESOTA Veterinary Medical Center Veterinary Medical Center Pyometra Pyometra - Assess uterine size. - Assess uterine size. - Culture vulvar discharge. - Culture vulvar discharge. - Institute antibiotic therapy and correct fluid - Institute antibiotic therapy and correct fluid deficits. deficits. - Administer PGF2-alpha at a dose of 250 - Administer PGF2-alpha at a dose of 250 mcg/kg SQ once to twice daily x 2-7 mcg/kg SQ once to twice daily x 2-7 days. days, until uterine size nears normal. Give twice daily if serum - Leave on an appropriate antibiotic for one progesterone concentration > 2 ng/ml. Treat month. until uterine size nears normal or until no fluid is visible in uterine horns by ultrasound. UNIVERSITY OF MINNESOTA UNIVERSITY OF MINNESOTA Veterinary Medical Center Veterinary Medical Center 7 Pyometra Pyometra Other medical therapies? - At the bitch’s next season: - Aglepristone - Perform anterior vaginal culture early in proestrus, institute appropriate antibiotic Progesterone receptor blocker therapy Available in Europe and South - Breed her – pregnancy is protective America against development of pyometra Reported successful in 81.8 – - If she does not become pregnant, 92.8% of cases (with antibiotic consider treatment with prostaglandin to lyse therapy) CL and decrease progesterone exposure. UNIVERSITY OF MINNESOTA UNIVERSITY OF MINNESOTA Veterinary Medical Center Veterinary Medical Center Pyometra Pyometra - What kind of fertility can we expect after - Perform ovariohysterectomy as soon as medical treatment for pyometra? the bitch’s breeding life is over. Recurrence averages 31.5% within one year of treatment – usually due to same organism Reported conception rate after medical treatment for pyometra is 40-68%. UNIVERSITY OF MINNESOTA UNIVERSITY OF MINNESOTA Veterinary Medical Center Veterinary Medical Center VAGINITIS: AN UPDATE VAGINITIS * Prepuberal (puppy) vaginitis Margaret V. Root Kustritz, DVM, PhD, DACT * Adult-onset vaginitis University of Minnesota UNIVERSITY OF MINNESOTA UNIVERSITY OF MINNESOTA Veterinary Medical Center Veterinary Medical Center 8 PREPUBERAL (PUPPY) VAGINITIS PREPUBERAL (PUPPY) VAGINITIS There is no evidence that dogs that exhibit puppy vaginitis are more likely to suffer from adult-onset vaginitis. There is no evidence that the tucked-up (juvenile) vulva seen in dogs spayed young and sometimes associated with perivulvar disease is permanently changed by allowing a dog to go through one heat cycle. UNIVERSITY OF MINNESOTA UNIVERSITY OF MINNESOTA Veterinary Medical Center Veterinary Medical Center PREPUBERAL (PUPPY) VAGINITIS PREPUBERAL (PUPPY) VAGINITIS If clinical signs are mild to moderate, If clinical signs are severe, more aggressive conservative therapy is best: therapy may be warranted: - Collect vaginal culture sample and treat only if - As for conservative therapy there is significant growth - Consider use of estrogens (close growth - Clean the perivulvar area as needed with baby plates in young dogs) or glucocorticoids (altered wipes or non-alcohol otic cleanser pharmacokinetics and perhaps increased side- effects in young dogs) - +/- of going through one heat cycle? UNIVERSITY OF MINNESOTA UNIVERSITY OF MINNESOTA Veterinary Medical Center Veterinary Medical Center ADULT-ONSET VAGINITIS VAGINITIS
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