Loobani AcademyAbstract
Canine pyometra refers to a disease in which a large amount of pus accumulates in the uterine cavity of dogs, accompanied by abnormal endometrial hyperplasia and bacterial infection. According to whether the cervix is open or not, it can be divided into closed type and open type. The disease is more common in older animals older than 7 years, and often occurs 2 to 4 weeks after estrus. The clinical manifestations are depression, decreased appetite, polydipsia and polyuria, vomiting, vulvar discharge (open type), weight loss, and increased abdominal circumference.
In this paper, the canine atresia pyometra was mainly treated with surgery and achieved a good prognosis. The cases are organized as follows.
1: Patient Information
1.Name: Kimi
2.Breeds: Schnauzer
3.Age: 7 years old
4.Gender: female
5.Diagnosis time: March 2022
2: Medical History Investigation
1.Diagnose the problem: lethargy, lack of activity, enlarged stomach, vomiting, fever
2.Main statement: The dog has a loss of appetite for about a week, likes to lie down, does not like to move, the stomach seems to be a little bigger, the stool is less, frequent urination, vomiting 3 times, not neutered, the estrus time is extended this year, deworming and vaccination on time vaccine. The owner gave the dog amoxicillin-clavulanate potassium and it did not improve. Today, the owner found that its ears became hot, and then brought it to our hospital for treatment.
3: Physical Examination
1.Overall inspection
BCS4/9 Good body condition, poor skin tone
2.General inspection
BW: 7kg, T: 39, 8, HR90 times/min, RR: 25 times/min
3.System check
Auscultate heart rhythm, no obvious heart murmur, mild abdominal pain on palpation, tubular contents, clean anus, no obvious abnormality of vulva, dry hair, excessive licking of limbs, dehydration assessment 5
4.Laboratory tests
Inspection items: blood routine, acute reaction protein, biochemistry, image X-ray and abdominal B-ultrasound
Blood Routine
Project | Test Result | Reference Range |
WBC | 31.2×10^9/L | 6-16.9 |
LYM# | 7.5×10^9/L | 1.1-6.3 |
GRA# | 22×10^9/L | 3.30-12.00 |
RBC | 5.2×10^12/L | 5.50-8.50 |
HGB | 11.9g/dl | 12.0-18.0 |
HCT | 49.1% | 37.0-55.0 |
MCHC | 34.0g/dl | 30.0-36.9 |
PLT | 167K/μL | 175-550 |
Acute inflammatory
Project | Test Result | Reference Range |
CRP | 196mg/L | <20mg/L |
Biochemical
Project | Test Result | Reference Range |
TP | 24.1g/l | 23-40 |
ALB | 70.3g/l | 52-82 |
GLOB | 46.2g/l | 23-45 |
A/G | 0.52 |
|
ALT | 98u/l | 5-125 |
ALP | 614u/l | 17-212 |
GREA | 719.0umol/l | 44-159 |
BUN | 37.78umol/l | 2.5-9.6 |
BUN/Creatinine | 52.548 | 16-218 |
Blood Glucose | 5.29umol/l | 4.11-7.94 |
X-ray
B Ultrasound
Routine blood anemia, inflammation, blood smear a large number of neutrophils, acute reaction protein severe acute inflammation infection, imaging X-ray dogs can see homogeneous tubular images in the abdomen and posterior abdomen, multiple mixed echoes in front of the bladder displayed by B-ultrasound Liquid dark area. Combined with the clinical history, the direction of diagnosis is pathological uterine lesions in the reproductive system, and azotemia caused by acute loss of kidneys. An increase in alkaline phosphatase will prompt steroids, and further consideration needs to be given to endocrine diseases caused by estrogen.
4: Diagnosis and treatment
1.Diagnosis: canine atresia pyometra
2.Treatments:
Surgical treatment: Surgical removal of pathological ovaries and uterus
Medical Treatment: Kidney Loss
Before surgery:
1.In view of the fact that the dog is dehydrated and has low blood pressure, a routine rehydration was performed first to increase blood pressure and improve azotemia and acid-base balance in the body.
2.Give cephalosporin antibiotics 2 hours before the operation.
3.Preoperative blood coagulation test: normal
During surgery:
Open the dual forelimb veins, shave and disinfect the surgical department, prepare blood pressure and heart rate detection equipment, and emergency medicine and equipment for surgery
1: Intravenous access 1: iv: Slow intravenous infusion after dilution of lidocaine to maintain a stable heart rhythm and have a certain sedative and pain relief effect
2: Intravenous access 2: iv: Lingner lactate to maintain blood pressure
After surgery:
Pain relief, antibacterial, anti-inflammatory and wound care are required
1~5 days medication
1: iv: 0.9% NACL100ML + cephalosporin third generation 0.7ML
2: iv: G/S100ML+ energy group
3:iv:LRS150
4: iv: Lidocaine 5ML+0.9NACL% 50ML
5: sc: Enrofloxacin 0.7ML
6: sc : Butorphanol 0.7ML
7: sc: vitamin B complex 0.7ML
8: Bailing Jinfang Wound Spray
9: Headgear
10: Surgical gown
11: Hospital monitoring
12: PO kidney medicine × 14
5: Notes
1. Although the diseased uterus and ovaries are surgically removed, there is still a dangerous state after the operation. After the operation, you still need to be hospitalized for 24 to 72 hours to observe the breathing, heart rate, blood pressure, etc.
2. Due to the infection of the uterine Asahi endotoxin to the whole body, there may still be blood sepsis after the operation, and regular blood routine and blood gas analysis are required after the operation.
3. Lesions in other systems may be secondary to the operation, such as renal failure, liver, spleen heterotopic myeloid tissue formation, hemorrhage and atrophy of the adrenal cortex and medulla, and the postoperative risk period is one week. Death may occur.
4. Antibiotic treatment should be rechecked at least five days after the operation, and the medication can only be stopped after the blood indicators are qualified.
5. Inflammatory response syndrome may cause systemic hypovolemic shock
6. Any changes during hospitalization require adjustment of medication
7. There may still be a small amount of secretions from the vulva in the early stage after the operation. Tell the owner in advance that after the treatment, the infection will be controlled and it will improve.
8. Review metrics based on recovery
9. Wound care requires daily routine dressing changes, and stitches are usually removed within one week to ten days.
6: Prognosis
Ovariohysterectomy is the best way to cure this disease as soon as possible for closed pyometra. After the operation, the dog’s desire to defecate and defecate was normal, and the wound returned to normal. The sutures were removed and discharged after 10 days. The follow-up visit was normal one week after discharge, and the prognosis was good.
Diseased Uterus
The fifth day of surgery
7: Pathogenesis and Prevention of Diseases
Pyometrium is the accumulation of purulent substances in the uterine cavity. It is a cystic endometrial hyperplasia and inflammation. Among them, the incidence is more frequent in elderly dogs, dogs without production and dogs with production, and the incidence rate will also increase with a history of hormone therapy. The disease mainly occurs in the late stage of estrus, when progesterone promotes the growth of endometrium and secretion of glands, and reduces the activity of uterine smooth muscle. Excessive progesterone will cause the uterine glandular tissue to become cystic edema and thinner. At the same time, with the exudation of lymphocytes and cells, fluid will accumulate in the uterine glands and uterine cavity, and eventually develop into cystic uterus Membrane hyperplasia. Progesterone can inhibit the contraction of uterine smooth muscle and hinder the normal excretion of the uterus. Progesterone can also inhibit the bacterial proliferation of white blood cells against bacterial infection, resulting in pyometra. Estrogens increase the number of uterine progesterone receptors, so use of estrogens during estrus increases the risk of pyometra. Uterine tumors can also cause discharge of uterine secretions, causing pyometra. Infection increases morbidity and mortality in pyometra. According to whether the cervix is open or not, the disease can be divided into two types: atresia and open. Dogs with an open cervix will discharge viscous purulent secretions, often with blood. In sick dogs with cervical atresia, the symmetrical distension of both sides of the lower abdomen is especially obvious, and the atresia uterine asphyxia can easily lead to animal sepsis, shock and death. The prevention of the disease suggests that female dogs who do not plan to breed should be sterilized as soon as possible, which can not only prevent pyometra but also reduce mammary gland diseases.
