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Uterus Infection

For the past week Candy has been lethargic, She shows very little interest in her food yet she's been thirstier than usual. Her stomach looks bloated, she is reluctant to move around and she is panting heavily. There has been no vomiting, diarrhea or abnormal discharges. There was no known exposure to toxins or inappropriate food and her owner could not recall the last time she had been in heat.

SIGNALMENT:

9-year-old female Terrier mix, "Candy"

HISTORY:

For the past week Candy has been lethargic, She shows very little interest in her food yet she's been thirstier than usual. Her stomach looks bloated, she is reluctant to move around and she is panting heavily. There has been no vomiting, diarrhea or abnormal discharges. There was no known exposure to toxins or inappropriate food and her owner could not recall the last time she had been in heat.

PHYSICAL EXAMINATION:

Temperature = 103.4 Fº (Normal = 100 Fº - 102.5 Fº)
Pulse = 110 beats/min (Normal = 80 - 100 beats/min)
Respiration = panting (Normal = 16 - 24 breaths/min)

Candy was weak, depressed, and appeared uncomfortable as she lay quietly on the exam table. Her heart rate was elevated and she was panting heavily. Her gum color was pink but her gums were very dry and her eyes had somewhat sunken appearance. Her abdomen was distended and tense and she did not appreciate attempts to feel her internal organs. Her skin and genitalia had a normal appearance.

PROBLEM LIST:

Lethargy, inappetence, fever, abdominal distention and dehydration

DIFFERENTIAL DIAGNOSIS:

Peritonitis (infection of the abdominal cavity)
Abscess/infection of an abdominal organ
Splenic torsion
Pancreatitis
Abdominal Cancer

DIAGNOSTIC PLAN:

Due to her obvious distress, we quickly drew blood for a chemistry profile and complete count. Urine was obtained for urinalysis and radiographs were taken of her abdomen.

DIAGNOSTIC RESULTS:

Candy's blood chemistry profile showed normal liver, kidney, and pancreatic enzymes. Her blood protein Albumin was elevated indicating dehydration, her complete blood count also showed dehydration and her white blood cells were markedly elevated out of the normal range supporting infection or possibly cancer. Her abdominal radiographs showed her stomach, spleen, liver, and kidneys were all normal in size and shape. There was one subtle abnormality in that her intestines appeared to be be ing pushed somewhat forward in her abdomen.

After reviewing our results we still did not have a clear-cut diagnosis, Her blood work supported infection yet her major organ systems appeared to be functioning normally. Because she had not been spayed we felt her reproductive system needed to be evaluated as a source of her injection. We used our ultrasound machine to image her uterus, and in fact it was distended and filled with infections fluid.

DIAGNOSIS:

Cystic endometrial hyperplasia / Pyometra (Infection in the uterus)

TREATMENT:

The treatment for Pyometra is surgical removal of the uterus. The decision to proceed to surgery was made quickly. We placed an intravenous catheter and ran balanced electrolyte fluids to correct her dehydration. Broad-spectrum antibiotics were administered and Candy was anesthetized for surgery.

We performed an overiohysterectomy (also known as a spay) to remove her ovaries and the infected uterus. Pyometra surgery is however riskier and more difficult to perform than a healthy dog spay. The patient is debilitated from infection and dehydration, and the uterus is diseased, friable, and prone to rupture during surgery if not handled very gently.

Fortunately Candy recovered uneventfully. The following day her temperature returned to normal, she was well hydrated and interested in food. Candy was released with antibiotics and pain relievers to complete her recovery at home.

DISCUSSION:

Pyometra is a potentially life threatening disorder of the uterus. It is primarily a disease of middle aged cycling females. Typically there is a history of having a heat cycle in the previous two months.

During that heat cycle, glands within the uterus enlarge and secrete fluid. Ascending bacteria from the genitalia used this fluid as a culture medium and proliferate. This results in a uterine infection. Pyometra is classified as either open cervix or closed cervix. When the cervic is open the infectious fluid is released and is easily recognized as a mucoid vaginal discharge. When the cervix is closed, as with Candy, there is no discharge, the infectious fluid is trapped causing enlargement of the utereus with abdominal distention and discomfort. Fluid is retained in the uterus resulting in dehydration and bacteria gets into the blood stream causing septicemia. (infection throughout the bloody stream) In extremely advanced cases when the uterus is greatly enlarged it can often be seen on radiographs displacing the intestines and abdominal organs.

In this case, her uterus was only moderately enlarged blending in with the surrounding abdominal organs and organ displacement was minimal. Imaging the uterine enlargement with ultrasonagraphy was used to make our diagnosis. The ultrasound sounds waves can differentiate the soft tissue structures creating a real time picture of soft tissues and fluid filled structures.

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