Pyometra and spay in dogs / fetch dvm360 / August 2023 / Kansas City, MO / Dr. Shadi Ireifej скачать в хорошем качестве

Pyometra and spay in dogs / fetch dvm360 / August 2023 / Kansas City, MO / Dr. Shadi Ireifej

Pyometra is defined as a pus-filled uterus and ovaries due to cystic endometrial hyperplasia and inflammation that occur in response to estrogen-induced endogenous luteal ovarian progesterone or exogenous progesterone, and a secondary Gram-negative bacterial infection (purulent endometritis), that ultimately results in systemic changes. Cystic endometrial hyperplasia-pyometra complex is the most common uterine disorder of intact bitches. The incidence of pyometra is 19 to 25% in intact female dogs by the time they reach 10 years of age. It is seen in 19% of all intact female bitches. Without treatment the disease is fatal. Pyometra occurs in middle to older age bitches, at an average of 8 to 9.36 years of age. Affected animals can be any age with dogs ranging from 6 months to 18 years of age. Most are over 4 to 6 years of age and within 8 weeks of their last estrus. Nulliparous bitches are more often afflicted than multiparous and primiparous bitches. Despite the common nature of this condition, the suspected causes of pyometra are multiple. Such causes include hormonal influences, the presence of an open cervix, and structural uterine changes. The most common and influential is hormonal influences. Estrus promotes uterine cell growth, endometrial vascularization, uterine sensitivity, and uterine response to progesterone. These hormonal changes are less prominent in the face of estrogen. Hormonal imbalances or an abnormal response to the normal concentration of estrogen and progesterone alters uterine epithelial cells, facilitating bacterial adherence, colonization, and growth. Formation of the cystic hyperplasia-pyometra complex usually occurs in the early or first half of the diestrus phase. However, pregnancy and the luteal phase itself may be involved. Postpartum bacterial presence or bacterial infiltration after breeding may occur due to the presence of an open cervix. Retained fetal and placental tissues, obstetrical manipulations, and infectious abortions can also contribute to pyometra development. Clinical signs in the bitch affected by pyometra include none (70%), vaginal discharge (50 to 85%), vomiting or anorexia (75%), vomiting alone (21.1 to 27%), depression (36 to 63%), anorexia alone (10 to 69%), polyuria-polydipsia (20 to 70%), lethargy (20 to 70%), lameness (16.4%), and diarrhea (14 to 15.4%). Dogs will exhibit two to three clinical signs (60%). The duration of clinical signs before diagnosis ranges (0 to 45 days) with most being 15 days. Affected dogs may present with a closed cervix (lack of purulent vaginal discharge, 23% incidence) or open cervix (40 to 73.3%, presence of purulent, mucoid, sanguinopurulent, or hemorrhagic vaginal discharge). Cervical opening is also depicted by significant inflammation and purulent fluid-filled uterine horns. Closed pyometra relates to purulent fluid that distends the uterus lumen and is associated with late ovulation with the endometrium being atrophied. Vaginal discharge may not be evident as the cervix will alternate in opening and closing. Prevention as well as surgical treatment is ovariohysterectomy via open ventral midline celiotomy. Surgery is considered curative. Ovariohysterectomy complications (15 to 20%) include those related to anesthesia, any combination of gastrointesintal, cardiovascular, respiratory complications (16.3%), hemorrhage (3%), peritonitis, incomplete ovarian tissue removal, wound swelling, ureteral damage form ligation, wound infection (5%), pancreatitis (0.5%), incisional inflammation (9%), granuloma formation (less then 30% of dogs of uterine or ovarian pedicles when braided nonabsorbable suture material is used), fistula tract formation (due to ligature reaction and primarily seen with braided nonabsorbable suture material or surgical gut suture material), urinary sphincter mechanism incontinence (11 to 20%), intestinal or urethral obstruction due to adhesions and ligature usage, intestinal or colonic partial obstruction, neoplastic formation (transitional cell carcinoma, osteosarcoma, and hemangiosarcoma), hypothyroidism, increased food intake and appetite (dogs), acute renal failure (seen with E. coli in 8% of cases), persistent polyuria-polydipsia and proteinuria (12% incidence), suture reaction (leading to inflammation, abscess formation, seroma formation, scar tissue formation, and dehiscence which decreases with the use of polyglactin 910 when compared to surgical gut orifice polydioxanone for subcutaneous tissue closure), and death (5% within 3 years). Death occurs with 1 to 17% incidence overall and 0 to 27% in the dog and 8% in the cat. Death is due to sepsis, peritonitis, hepatic disease, anemia, and anorexia. Mortality from euthanasia is 10 to 12.5%. Uterine rupture mortality is 50% and the peritonitis mortality is 3 to 12%. Survival seen with open peritoneal drainage is 70% and survival with closed peritoneal drainage (with use of a closed suction drain) is 70%.