ISSN 2398-2969      

Pyometra

icanis
Contributor(s):

Lori Ludwig

Carlos Pinto

Synonym(s): Cystic endometrial hyperplasia with pyometra


Introduction

  • Disease of the luteal phase (metestrus - diestrus).
  • Cause: hormonally-mediated cystic endometrial hyperplasia associated with bacterial hemo-purulent metritis.
  • Signs: polydipsia/polyuria, vomiting, hemorrhagic-purulent vulvar discharge.
  • Diagnosis: signs, history, imaging (especially ultrasonography), exploratory laparotomy.
  • Treatment: ovariohysterectomy or conservative therapy with antibiotics and ecbolics if breeding potential is to be preserved.
  • Prognosis: good - if prompt treatment before animal systemically ill.
    Print off the owner factsheet Pyometra ('pyo' or womb infection) Pyometra ('pyo' or womb infection) to give to your client.

Pathogenesis

Etiology

  • 5-6 estrous cycles → cyclic progesterone concentrations → marked proliferation and increased secretory function of the endometrium → cystic endometrial hyperplasia → pyometra.
  • Secondary bacterial infection of the material in the endometrial glands (embryotroph). 60-90% are due to E. coli Escherichia coliProteusspp Proteus spp and Klebsiellaspp Klebsiella pneumoniae. B-hemolytic streptococci are also important Streptococcus spp.

Predisposing factors

General
  • Older bitch (more than 6 years old); it may occur in young bitches following their first or second reproductive cycles.
  • 5-80 days after the end of estrus. >80% of bitches affected with closed pyometra still have a functional corpus luteum.

Specific

  • Use of estrogen for prevention of pregnancy (mismating).
  • Prolonged use of progestagens for the prevention or suppression of estrus.

Pathophysiology

  • 5-6 estrous cycles → progesterone-primed uterus → cystic endometrial hyperplasia → pyometra.
  • Renal disease: several aspects of the renal changes associated with pyometra are incompletely understood. In most dogs with E.coli pyometra, renal dysfunction is transient and it involves the nephron both at the glomerular and proximal tubular level. The renal dysfunction may be characterized by:

Prerenal uremia

  • Dehydration, shock and toxemia → poor renal perfusion → Ab-Ag complexes deposited on the basement membrane → glomerular disease → persistent proteinuria Proteinuria.
  • Bacterial toxins or immune complexes interfere with resorption → tubular disease → impaired ability to concentrate urine → polyuria → dehydration and electrolyte loss.
  • Concurrent renal disease is commonly found in older dogs.

Acid base balance

  • Metabolic acidosis Acid base imbalance is more common but metabolic alkalosis may develop through prolonged vomiting.

Electrolytes

  • Vomiting, uterine loss and renal dysfunction → Na/K loss.

Bone marrow

White cells

Timecourse

  • 9-10 estrous cycles.
  • Metestrus (5-80 days after estrus).

Diagnosis

This article is available in full to registered subscribers

Sign up now to obtain ten tokens to view any ten Vetlexicon articles, images, sounds or videos, or Login

Treatment

This article is available in full to registered subscribers

Sign up now to obtain ten tokens to view any ten Vetlexicon articles, images, sounds or videos, or Login

Outcomes

This article is available in full to registered subscribers

Sign up now to obtain ten tokens to view any ten Vetlexicon articles, images, sounds or videos, or Login

Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Verstegen J, Dhaliwal G, Verstegen-Onclin K (2008) Mucometra, cystic endometrial hyperplasia, and pyometra in the bitch: advances in treatment and assessment of future reproductive success. Theriogenology 70 (3), 364-374 PubMed.

Related Images

RELATED ARTICLES

Abdominal organomegaly

Acid base imbalance

Acute metritis

Arthritis: polyarthritis - idiopathic

Blood biochemistry: creatinine

Blood biochemistry: gamma globulin

Blood biochemistry: glucose

Blood biochemistry: total protein

Blood biochemistry: urea

Cabergoline

Chronic myeloid leukemia

Diabetes insipidus

Diabetes insipidus: nephrogenic

Diabetes mellitus

Diabetes mellitus: complications of treatment

Diabetic ketoacidosis

Dinoprost tromethamine

Escherichia coli

Fluid therapy: for electrolyte abnormality

Glomerulonephritis

Heart: ventricular premature contraction

Hematology: leukocyte (WBC)

Hematology: neutrophil

Hematology: platelet count

Hematology: red blood cell count

Hematuria

Hyperadrenocorticism

Hyperosmolar hyperglycemic state

Hypoproteinemia: investigation

Immunoglobulin

Immunology: granulocytopathy syndrome

Kidney: chronic kidney disease (CKD)

Klebsiella pneumoniae

Liver: chronic disease - overview

Mammary gland: neoplasia

Medroxyprogesterone

Megestrol acetate

Mesalliance

Misoprostol

Ovariohysterectomy

Ovary: neoplasia

Peritonitis

Pleuritis

Polyuria/polydispia (PU/PD)

Proligestone

Prolonged pro-estrus and estrus

Proteinuria

Proteus spp

Pyrexia: overview

Radiography: abdomen

Shock: septic

Staphylococcus pseudintermedius

Streptococcus spp

Therapeutics: antimicrobial drug

Ultrasonography: spleen

Ultrasonography: uterus

Uremia

Urinalysis: centrifuge sediment

Urinalysis: protein

Urinalysis: specific gravity

Urinary obstruction

Uterus: neoplasia

Uveitis

Vaginal neoplasia

Vaginitis

Ventricular tachycardia

Vomiting

Can’t find what you’re looking for?

We have an ever growing content library on Vetlexicon so if you ever find we haven't covered something that you need please fill in the form below and let us know!

 
 
 
 

To show you are not a Bot please can you enter the number showing adjacent to this field

 Security code