Pyometra
The purulent inflammation of the uterus is referred to as pyometra (from ancient Greek πύον pyon , German ' pus ' and metra ' uterus ') . Purulent uterine inflammation and purulent endometritis are also used as synonyms for this term . It occurs mainly in dogs .
Frequency and causes
Pyometra is the most common sexual organ disease in bitches. Around a quarter of the uncastrated bitches develop uterine suppuration by the age of 10.
The cause of the disease can be seen in the course of the dog's heat . At the end of the oestrus , the uterine lining ( endometrium ) is reduced in its ability to defend against pathogens due to the influence of estrogen . At the same time, however, are cervix and cervical ( cervix ) for germs still passable. A local infection develops . At the end of the estrus, the cervix closes again and the defenses of the uterine lining increase and a purulent fluid forms. The secretions formed cannot leave the closed uterus and collect in it. The symptoms of the disease typically develop three to eight weeks after the last heat has ended. This shape is known as the closed pyometra .
Another common cause of uterine infections is the treatment of dogs with progestogen- containing contraceptives (“ pills ”) to prevent them from going into heat. If the application of the drug is not carried out during the phase of hormonal inactivity of the bitch ( anestrus ), there is also the risk of ascending infections. The administration of oestrogens to prevent the egg cell from implanting ( nidation ) is particularly critical in bitches during inter estrogen . It leads to pyometra in 25% of the treated animals.
The development of a pyometra is also a likely complication if the bitch has not completely removed the ovaries during castration , but hormonally active residual tissue remains in the body ( Ovarian-Remnant Syndrome ). The associated hormonal disorder almost inevitably causes a so-called stump pyometra , i.e. a purulent inflammation of the remnant of the uterus that remains after an ovariohysterectomy (removal of the ovaries and a large part of the uterus).
In connection with the normal sexual cycle notwithstanding recurrent oestrous cycles and increased or excessively attenuated Scheinträchtigkeitssymptomen there is an increased risk of developing pyometra, as these symptoms may be a hormonal disorder indication.
Some dog breeds appear to be at higher risk of developing pyometra. These include Airedale Terriers , St. Bernard Dogs , Bernese Mountain Dogs , Cavalier King Charles Spaniels , Collies , Golden Retrievers , Irish Terriers , Miniature Schnauzers , and Rottweilers .
Symptoms
The disease usually develops two weeks to four months after heat or hormone treatment. A typical symptom is the occurrence of a strong feeling of thirst and increased urination ( polydipsia and polyuria ) in the corresponding period. In addition, affected animals often show apathy and reluctance to eat . In addition, there is sometimes pain in the abdomen , the animals often also suffer from diarrhea and have a noticeably enlarged vulva .
In the further course, bloody-purulent, sometimes foul-smelling vaginal discharge can be determined - an open pyometra has formed. Animals with this form of the disease often clean their genital area by licking, which is noticeable to the observer. The diagnosis can usually already be made on the basis of the clinical symptoms; the final clarification is carried out using an ultrasound or X-ray examination . The blood test often shows leukocytosis with a shift to the left and increased urea levels . In the majority of cases, bacteria , especially E. coli , Staphylococcus intermedius and streptococci, are detectable in the secretion that is drained off .
therapy
Acute pyometra is an absolute emergency. The absorption of the poisons ( toxins ) of the bacteria in the uterus leads to intoxication (poisoning). Immediate emergency surgery ( ovariohysterectomy ) is usually necessary to save the dog's life.
During this ovariohysterectomy or castration , the ovaries and the entire uterus are removed. The advantage of this treatment method is the safe removal of the cause of the disease. Disadvantages are the known side effects of castration in dogs: tendency to urinary incontinence , changes in coat and obesity ( obesity ). In addition, especially for breeders, the loss of fertility is of concern.
The use of antigestagens ( aglepriston ) has established itself as a new method in recent years . This conservative treatment can only be attempted in the case of a pyometra without menstrual disorders or ovarian disease; it is contraindicated for an emergency pyometra with evidence of sepsis and / or uterine rupture. The drug used causes the uterus to open and clean itself. The disadvantage of this method is the fact that a special form of uterine inflammation, glandular-cystic endometritis , can even be made worse by this treatment. In addition, Aglepriston only works safely in metestrus (progesterone value> 1.5 ng / ml, no superficial cells and clods in vaginal cytology ), but not in the presence of follicular cysts and in anoestrus. In anestrous (progesterone level <1.5 ng / ml), prostaglandin (twice a day for at least one week) can be used with an open pyometra . The recurrence rate with conservative therapy is 25%.
With both forms of treatment, parallel administration of antibiotics is necessary over a longer period of time. Usually antibiotics with a broad spectrum of activity such as amoxicillin - clavulanic acid combinations or gyrase inhibitors are used here. Depending on the general condition of the sick animal, therapy is preceded by stabilization of the circulatory system , possibly through infusions and intensive treatment .
The safe prophylaxis of a pyometra can only be achieved by castrating the animal. If the bitch remains uncastrated, the risk of hormonally effective contraceptives should be weighed against the benefits.
Complications
The main complication of the disease is seen in the rupture of the organ in the abdominal cavity. This almost inevitably occurs if the patient is not operated on. However, it can also be a result of the manipulation of the uterus during the operation, since the wall of the uterus is usually severely damaged. From the resulting tear in the uterine wall, parts of the contaminated pus spill into the abdomen . If the defect can be covered by the large mesh , only a locally limited peritonitis occurs , but if the pathogen material is distributed over the entire abdominal cavity, the infection affects the entire abdominal cavity . An acute abdomen develops . This requires surgical treatment as soon as possible in order to save the animal's life.
Another complication is the damage to the organism through toxic metabolic products of the bacteria contained in the pus ( endotoxins ), which can cause lasting damage to kidney and liver tissue in particular .
Other species
| Classification according to ICD-10 | |
|---|---|
| N71 | Inflammatory disease of the uterus, excluding the cervix - pyometra |
| ICD-10 online (WHO version 2019) | |
Although dogs are by far the most likely to develop pyometra, it also plays a role in cats , rabbits and guinea pigs . In humans it is also described in the form of a chronic disease.
It is of clinical relevance in cattle after the embryo dies as a result of an infection with Trichomonads or Arcanobacterium pyogenes , which is also the cause of the Holstein udder disease in cattle. In addition, the disease occurs in this species as a result of covering infections and as a disease of the puerperium (postpartum phase). In cattle, treatment is usually not performed surgically, but rather by rinsing with disinfecting and antibiotic drugs and the administration of prostaglandins to empty the uterus.
See also
literature
- Freudiger / Grünbaum / Schimke: Clinic of Dog Diseases . 2005, ISBN 3-8304-1021-2
- Nobody / Suter: Internship at the dog clinic . 2004, ISBN 3-8304-4159-2
- Theise / Münnich / Heuwieser: Gynecology in bitches . ISBN 3-931253-67-8
Individual evidence
- ↑ A. Egenvall et al .: Breed risk of pyometra in insured dogs in Sweden. In: J Vet Intern Med 15 (2001), pp. 530-538.
- ↑ a b c Konrad Blendinger: The bitch's pyometra - an overview . In: small animal concrete volume 19, 2016, issue 3, pp. 24–33, doi : 10.1055 / s-0041-110496 .
- ↑ a b Axel Wehrend: Key symptoms of gynecology and obstetrics in dogs. Enke Stuttgart 2010, ISBN 978-3-8304-1076-8 , pp. 104-106.
