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Large Animal Surgery > Mare Urogenital Surgery > Flashcards

Mare Urogenital Surgery Flashcards

1
Q

What are the 3 major protective barriers in the caudal reproductive tract of mares? What happens if any of these are damaged?

A
  1. constrictor vulvae muscles of the labia
  2. vestibular sphincter
  3. cervix

contamination of the repro tract –> infertility

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2
Q

What are 3 aspects of proper vulvar conformation in mares?

A
  1. vertical in craniocaudal plane
  2. approximately 2/3 should sit below ischial arch
  3. muscular labia should resist separation
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3
Q

In what mares is poor vulvar conformation common? What are 2 common findings? What can this lead to?

A

thin, multiparous mares

  1. sunken anus
  2. loss of vulvar constrictor muscle tone

pneumovagina (windsucker), fecal contamination, urine pooling

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4
Q

What are 2 indications of Caslick’s procedure?

A

(vulvoplasty)

  1. pneumovagina
  2. fecal contamination of the caudal repro tract
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5
Q

How is Caslick’s procedure performed? What is recommended in pregnant mares?

A

trim a small amount of tissue from the mucocutaneous junction and use 2-0 monofilament suture material to bring them together in a simple continuous or Ford interlocking pattern

remove 2-4 weeks before foaling –> replaced next year

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6
Q

What does excessive closure in Caslick’s procedure lead to? Excessive trimming of mucocutaneous junction?

A

urovagina - should be able to pass a tube speculum

less tissue available for following years

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7
Q

What are the 2 goals to perineal body reconstruction? What does this result in?

A
  1. restore integrity of DORSAL aspect of vestibule and vestibular sphincter function
  2. make vulva more vertical

perineal body remains intact, only mucosa and submucosa are transected

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8
Q

What are the 2 goals of perineal body transection? What does this result in?

A
  1. more vertical position of vulva
  2. correct pneumo and urovagina

horizontal incision between rectum and vulva extend cranially through muscles of the perineal body

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9
Q

What are 3 causes of urovagina? What sequelae are associated?

A
  1. cranial vaginal slopes ventrally, common in thin, multiparous mares
  2. excessive Caslick’s closure
  3. ectopic ureter

vaginitis, cervicitis, endometritis, infertility

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10
Q

What is the treatment of choice for urovagina? What sequelae is common?

A

urethral extension –> caudally

fistula formation

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11
Q

What are 3 indications for equine ovariectomies?

A
  1. behavior modification
  2. sterilization
  3. ovarian neoplasia (GCT), cysts, hematomas, or abscesses
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12
Q

What 3 signs are associated with granulosa cell tumors? What are 3 options for diagnosis?

A

anestrus, nymphomania, stallion-like behavior

  1. affected ovary is enlarged, contralateral is small and inactive
  2. honeycomb appearance on U/S
  3. increased testosterone and inhibin levels
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13
Q

What are 3 options for ovariectomy procedures?

A
  1. colpotomy
  2. laparotomy - stanking flank, ventral celiotomy (midline, paramedian, diagnoal paramedian)
  3. laparoscopy
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14
Q

In what ovaries are colpotomies recommended? What kind of procedure is this?

A

normal ovaries

standing, blind procedure

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15
Q

Where is the incision made in a colpotomy?

A

though vagina into the abdomen at 11 and 1 o’clock cranial to the cervix

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16
Q

How is a colpotomy performed?

A
  • place lidocaine-soaked gauze around the mesovarium
  • remove ovary with an ecraseur, which passes a chain over the ovary and tightens –> crushes and cuts
  • incisions heal by second intention
17
Q

What 3 complications are associated with colpotomies?

A
  1. adhesions
  2. evisceration - increased pressure when horse gets up from laying down, must keep horse standing 3-5 days post-op
  3. fatal hemorrhage from ovarian pedicle (branch of urogenital artery)
18
Q

What kind of procedure is a laparotomy? In what ovaries is this procedure recommended for?

A

standing flank, blind or laparoscopic-assisted

<20cm, unilateral

19
Q

What 3 approaches are used for ventral laparotomies? In what ovaries is this recommended?

A
  1. midline
  2. paramedian
  3. diagonal paramedian

normal to very large - >20cm (GCT)

20
Q

What are 5 advantages to performing a laparoscopy during ovariectomies?

A
  1. can be unilateral or bilateral
  2. direct visualization
  3. can remove large ovaries
  4. avoids general anesthesia
  5. minimal tension on pedicle
21
Q

What are 5 disadvantages to performing a laparoscopy during ovariectomies?

A
  1. flank incision is more likely to develop seroma and dehiscence
  2. bowel or splenic puncture possible
  3. causes retroperitoneal insufflation
  4. hemorrhage
  5. post-op pain, colic
22
Q

What is indicative of uterine torsion in mares?

A
  • colic in periparturient mares, most common in the last 60 days of gestation
  • acute presentation
23
Q

How is uterine torsion diagnosed? What affects prognosis?

A

rectal palpation - broad ligament toward the side of rotation, most commonly precervical so a vaginal exam will be normal

improved if earlier in gestation

24
Q

How are uterine torsions medically managed? When does it work most? What complication is possible?

A

rolling in the direction of the torsion, use board to hold gravid uterus in place (GA!)

pre-term pregnancies

uterine rupture

25
Q

What are 2 approaches used for surgically treating uterine torsion?

A

VENTRAL MIDLINE - recommended if foal is deceased or uterus is devitalized/ruptured (colic signs)

STANDING FLANK - standing sedation, incision on the side of the torsion, lift and rotate uterus upward OR incision on the opposite side and pulling toward surgeon

26
Q

What should be done on presentation in cases needing C-sections?

A
  • quick PE and rectal
  • place catheter
  • get owner consent
  • U/S for fetal viability

PROMPT REFERRAL

27
Q

What approach is performed for equine C-sections? What is necessary to perform on the uterus? What sequela is common?

A

ventral midline

hemostatic sutures –> diffuse placental attachment, left in place to pass later

retained placental membranes

28
Q

In what mares are perineal lacerations most common? What are the 3 degrees?

A

unassisted foalings, primiparous mares

  1. skin of dorsal commissure and mucosa of vestibule
  2. continue into muscles of the perineal body
  3. complete disruption of rectovestibular shelf
29
Q

How are each degree of perineal lacerations treated?

A
  1. typically no surgical intervention needed +/- Caslisk’s procedure
  2. Caslick’s procedure, reconstruction of perineal body - predisposed to pneumovagina and urine pooling without correction
  3. REQUIRES surgery
30
Q

When are 3rd degree perineal lacerations repaired? What is seen in acute tears?

A

MUST wait for stong scar tissue to develop - 6-8 weeks (3-4 minimum)

  • fecal contamination
  • edema
  • questionable tissue viability

(high % of repair failure)

31
Q

In what 3 ways are mares prepared for third degree perineal laceration repair? When is surgery delayed?

A
  1. reduce feed prior to surgery
  2. allow grass with laxatives after surgery
  3. tube with mineral oil/Epsom salts

delay surgery if feces are not soft

32
Q

What are rectovaginal fistulas? When do they most commonly happen? How are they repaired?

A

communication between rectum and vaginal vault

foal limbs replaced after puncturing through rectum

direct suturing, converting into a 3rd degree perineal lacreation repair

33
Q

How do uterine tears present? What causes them at different locations in the reproductive tract?

A

signs of septic peritonitis –> can result in evisceration during or after foaling due to prolapsed abdominal organs

  • tip of uterine horns - perceived normal foaling, foal kicking hind limbs
  • uterine body - dystocia
34
Q

When are cervical lacerations most commonly seen? How are they diagnosed?

A

dystocia, especially with fetotomy or induced parturition

examine cervix 21 days post partum - inflammation and edema makes it hard to see day of

35
Q

What does cervical laceration lead to? When is surgery required?

A

infertility

of >50% torn –> 3 weeks postpartum or immediately after rebreeding

36
Q

What is the most common cause of death in postpartum mares? In what mares is this most common? How do mares present?

A

broad ligament / uterine artery rupture

older mares

colic followed by signs of blood loss

37
Q

What are 3 other common foaling injuries?

A
  1. bladder rupture or eversion - manually reduce
  2. rectal prolapse
  3. mesocolon rupture - severe colic, requires R&A
38
Q

What are the 2 most common postpartum uterine conditions?

A
  1. uterine prolapse - rare in mares
  2. retained fetal membranes - >4 hours, requires prompt and aggressive treatment before laminitis develops

Large Animal Surgery (32 decks)

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