Cystic Endometrial Hyperplasia/Pyometra Complex

50 Cystic Endometrial Hyperplasia/Pyometra Complex



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1. Define cystic endometrial hyperplasia (CEH).

Cystic endometrial hyperplasia (CEH) is a progressive condition of the uterus that begins with a mucoid discharge during diestrus, through diffuse plasma cell infiltration and cystic hyperplasia, to squamous metaplasia of the endometrium. In the bitch, the 2-to-3-month diestral elevated progesterone plays a major role in producing hyperplasia of the endometrium.


Intact bitches that go through estrous cycles will have repeated exposure of the endometrium to progesterone. The estrogen elevation during proestrus and early estrus will enhance the formation of endometrial hyperplasia.


2. Define pyometra.

Pyometra is defined as an accumulation of purulent exudate in the uterus.


3. What is the role of estrogen and progesterone?

Estrogen priming of the endometrium, followed by progesterone, will increase the risk of developing CEH and pyometra.


4. What is the pathogenesis?

Repeated exposure to estrogen and progesterone will induce either a normal aging process or CEH and secretions of the uterine glands, which are conducive to bacterial growth.


5. Who is susceptible to pyometra?

Pyometra is most often seen in middle-aged, intact bitches 2 to 8 weeks after a heat cycle. Most of these animals have a certain degree of CEH. However, pyometra may also be seen in young bitches that have been treated with estrogen injections for mismating or with progestins for suppression or delay of an estrous cycle.


6. What is the difference between closed and open pyometra?

In open pyometra the cervix is open with a corresponding vaginal discharge. In closed pyometra the cervix is closed and little or no vaginal discharge is noted. In general, the systemic signs are more severe in closed pyometra than in open pyometra.


7. Describe the clinical signs of pyometra.

The clinical signs may differ between open pyometra and closed pyometra. In open pyometra one will observe a varying amount of vaginal discharge, often with a foul odor. The discharge may be mucoid, reddish, purulent, or a combination. The animal may not be very ill.


In closed pyometra, there is little if any discharge, but the bitch may be more systemically ill. Abdominal enlargement is more often noted with closed pyometra.


Signs observed in both open and closed pyometra may be depression, anorexia, vomiting, and diarrhea. Some animals may be polydipsic and polyuric with nocturia. The body temperature can be normal, elevated, or subnormal in the severely toxic animal.

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Jul 31, 2016 | Posted by in INTERNAL MEDICINE | Comments Off on Cystic Endometrial Hyperplasia/Pyometra Complex

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