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570 Lactation Disorders

Recommended Monitoring topical atropine, topical or general anesthe- the STT will not be reflective of the response
sia); lacrimomimetics may be sufficient.
• Varies, depending on underlying cause • May take weeks to months of therapy to therapy.
VetBooks.ir STT and corneal fluorescein staining per- before determining if favorable response to Client Education
• Complete ophthalmic examination with
Immune-mediated KCS is a chronic disorder
formed every 3-4 weeks initially until KCS
lacrimostimulants
controlled, then every 3-4 months; more
frequent rechecks if corneal ulceration is • If frequency of administration of cyclosporine that is manageable but usually requires lifelong
treatment.
or tacrolimus is decreased to q 24h, STT
present should be monitored a few days and then
a few weeks after reduction. SUGGESTED READING
PROGNOSIS & OUTCOME • Deep or infected ulcers should be stabilized Williams DL: Immunopathogenesis of keratocon-
with antibiotics and lacrimomimetics ± junctivitis sicca in the dog. Vet Clin North Am
Varies, depending on underlying cause and surgery before initiating treatment with Small Anim Pract 38(2):251-268, 2008.
severity at diagnosis cyclosporine or tacrolimus.
AUTHOR: Phillip A. Moore, DVM, DACVO
PEARLS & CONSIDERATIONS Prevention EDITOR: Diane V. H. Hendrix, DVM, DACVO
For breeds predisposed to KCS, avoid breeding
Comments affected or closely related dogs.
• Immune-mediated KCS usually requires
lifelong treatment. Technician Tips
• Some forms of KCS may require transient Owners should administer q 12h lacrimostimu-
treatment until tear production returns (e.g., lants the morning of recheck appointments or

Video
Lactation Disorders Available

BASIC INFORMATION ASSOCIATED DISORDERS pituitary–ovarian–mammary gland axis of
Lactation disorders can coexist with other unknown origin.
Definition puerperal diseases, such as mastitis, metritis, • Failure of milk letdown (secondary agalactia)
• Partial or complete failure to produce or and endotoxemia. can be due to stress, anxiety, premature deliv-
secrete milk to meet puppies’ demand ery, progesterone therapy, or systemic illness.
• Disorders include agalactia (complete failure Clinical Presentation
to produce milk), hypogalactia (partial DISEASE FORMS/SUBTYPES DIAGNOSIS
failure), and galactostasis (accumulation Depending on the cause, agalactia can be
of milk in the mammary gland due to classified as Diagnostic Overview
failure of ejection [letdown] from the • Primary, idiopathic, or true agalactia Crying puppies and a dam that is reluctant to
gland). • Secondary or poor milk letdown (galactostasis) nurse are suggestive of primary and secondary
• Primary agalactia is rare, and a delay in milk agalactia. Consideration of the environment
letdown is the most prevalent issue. HISTORY, CHIEF COMPLAINT where lactation is occurring and physical exam
History reveals the previous occurrence of of the mammary glands help differentiate the
Synonyms (premature) parturition or elective cesarean two causes.
Agalactia or agalactosis, hypogalactia, hypolacta- section. Inadequate neonate weight gain
tion and crying and restless puppies are frequent Differential Diagnosis
complaints due to insufficient lactation. Few • Mastitis
Epidemiology puppies to nurse or abrupt weaning may precede • Mammary tumors
SPECIES, AGE, SEX galactostasis. • Pseudocyesis
• Postpartum female dogs; young bitches seem • Care should be taken because mastitis and
more prone PHYSICAL EXAM FINDINGS mammary tumors can coexist with lactation
• There is only one report of agalactia in In cases of hypogalactia and agalactia, mammary disorders.
queens. development and milk appearance at nipple
squeezing are scarce or absent. Galactostasis is Initial Database
GENETICS, BREED PREDISPOSITION characterized by engorged, firm, and painful • History and physical findings (as previously
Any breed potentially can be affected. A genetic mammary glands, which may be associated with described)
component may exist with agalactia. nipple anatomic abnormalities. • CBC is normal if concurrent inflammatory
illness is present.
RISK FACTORS Etiology and Pathophysiology
Inadequate nutrition, stress, anxiety, pre- • Normal milk production is the consequence Advanced or Confirmatory Testing
mature delivery or elective cesarean section, of an endocrine cascade of estrogens, pro- • Diagnosis is confirmed by exclusion of other
progesterone therapy, and systemic illness may gesterone, and prolactin, as well as other diseases. Occult primary illness may require
trigger hypogalactia or poor milk letdown and ancillary hormones. Idiopathic, primary serum biochemistry profile, vaginal discharge
galactostasis. agalactia may represent a disruption of the exam, and ultrasound of the uterus.

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