Clinical disease of the reproductive tract in the dog and cat 1

When investigating vulval discharge, what should you consider? 4

Age, neutered status v important
Stage of repro cycle (esp metoestrus and pregnancy)
COLOUR OF DISCHARGE
Where is it coming from - uterus, vagina, urethra?

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What are some causes of WHITE vaginal discharge? 4

vaginitis
early metoestrous
open pyometra
cystitis

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What is normal vaginal discharge like?

Clear, mucoid

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What might cause clear watery vaginal discharge?

amniotic/ allantoic fluid

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When might you see GREENY BLACK vaginal discharge? 2

Normal parturition

Dystocia

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When might you see BROWN/ RED–> BLACK vaginal discharge?

Metritis

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When might you see YELLOW vaginal discharge?

Incontinence

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When might you see red vaginal discharge?

Proestrus
Oestrus
Persistent ovarian follicle
Ovarian tumour (oestrogen secreting)
Vaginal trauma
Vaginal FB
Cystisi
Urethral neoplasia
Coagulopathy
Placental separation
Sub-involution post-partum
Vascular malformation

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What does vaginitis usually present as?

purulent discharge in the healthy bitch

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What are the 2 types of vaginitis?

JUVENILE (PREPUBERTAL) VAGINITIS - secondary to bacterial contamination and excess vaginal secretion, usually resolves spontaneously with first season and ABs should be avoided
ADULT VAGINITIS - less common, aim to identify and treat specific cause, may respond to exogenous oestrogens (topical/oral)

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What is pyometra?

V. important in SA practice - dogs and cats
Uterus fills with pus, life-threatening potential
Usually presents within 8 weeks of last oestrous
OPEN or CLOSED.

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Distinguish open and closed cervix pyometra.

OPEN = associated with mucopurulent vaginal discharge and mild-moderately enlarged uterus
CLOSED = not associated with vaginal discharge, uterus usually grossly enlarged and animal systemically ill

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What 4 factors all need to be in place to lead to a pyometra?

Bacterial infection
Cystic endometrial hyperplasia
Progesterone
Open cervix - commonly E.coli but also Klebsiella enter

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What signs may be seen with pyometra?

Depression, lethargy, mucopurulent vaginal discharge, pyrexia, PUPD, vomiting, collapse, shock

Neutropphilia with L shift, possible azotaemia, acidosis, endotoxaemia, hypoglycaemia, anaemia, coagulation abnormalities

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What is cystic change?

Something that leads to pyometra where cysts develop within mucosa of uterus and is a substrate for bacteria to interact with.

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How do you diagnose pyometra?

Ultrasound

Radiography

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How do you treat pyometra?

Medical

Surgical - most common, OVH

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What are the causes of vaginal trauma (uncommon)?

Iatrogenic
Forced separation of mating dogs
Malicious wounding

May bleed severely

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How do you investigate vaginal trauma?

Confirm origin

Conservative/ supportive treatment usually all that is required +/- BS ABs

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What history is important when investigating a vaginal mass?

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Age, neutered status
Stage of cycle (especially oestrus, pregnancy)
Size, shape and consistency of mass (does it contain a hole, is it within the wall or within the lumen, where is ti in relation to the external urethral orifice?)

What is the commonest tumour in the bitch’s vaginal/vestibular area?

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Smooth muscle tumours of the vagina/vestibule. Typically slow growing smooth muscle cell tumours - leiomyoma (commonest), leiomyosarcoma, other tumour types possible), 65% bitches entire, usually elderly, may present with visible mass, bulging perineum or dysuria/ dyschezia.

How do you diagnose vaginal/vestibular neoplasia?

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Hx and PE
Endoscopy
Radiography
Biopsy

Treatment of vaginal/vestibulo neoplasia

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Surgical excision combined with OCH (via episiotomy or via pubic symphysiotomy and vaginal excision).
Chemotherapy for TVT

Define episiostomy

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cut betweeen vagina and anus

What is a pubic symphisiotomy?

split pubic symphysis (i.e. a controlled fracture)

What causes vaginal hyperplasia and vaginal prolapse?

Excessive response of vaginal mucosa to oestrogens during follicular phase of oestrus cycle resulting in vaginal oedema and vaginal prolapse. Brachycephalic breeds predisposed May interfere with mating Exposed tissues traumatised

Diagnosis for vaginal oedema/hyperplasia?

Hx and PE

Treatment - vaginal oedema/hyperplasia?

Conservative measures such as keeping moist and vulvular sutures. Surgical excision, usually via episiotomy

Does vaginal oedema/hyperplasia tend to reoccur?

Yes - control oestrous or neuter

What is ambiguous genitalia the manifestation of?

intersexuality = disorders of sexual sifferentiation Many phneotypes possible Commonest - enlarged clitoris/underdeveliped penis in a 'female' puppy

How do you investigate ambiguous genitalia cases?

Evaluate pelvic anatomy Remove gonads - histopathology [Karyotyping] [SRY gene testing]

Treatment - ambiguous genitalia?

Gonadal removal Possible partial penile amputation/removal of the penis possibly via an episiotomy Treatment of other abnormalities if associated with clinical signs - e.g. incontinence secondary to reflux of urine into a uterine structure.

How is dystocia categorised?

MATERNAL MATERNOFOETAL FOETAL

What should be a cause of concern during parturition? 7

Foetal fluids passed >2-3 hours previously with no birth Dam straining vigorously and regularly for 20-30 mins with no birth Greenish/reddish brown vulval discharge apparent with no birth within 2-4 hours Weak/irregular straining for 2-4 hours and no birth >2-4 hours since last pup/kitten was delivered and more known/suspected to remain Second labour stage > 12 hours Sickness of dam

What are maternal causes of dystocia? 9

``` Narrow birth canal Disturbed labour Uterine abnormalities Prolonged pregnancy Psychogenic status Extra-uterine problems Premature birth Prolonged parturition Idiopathic ```

What do studies show about commonest cause of dystocia?

Maternal causes are most common (75% cases in bitches, 66% cases in queen) Others suggest maternofoetal causes were as common as maternal causes Commonest maternal cause is uterine inertia (i.e. disturbed labour)

What are foetal causes of dystocia?

Increased foetal sizze Foetal malpresentation Abnormal foetal development (e.g. hydrocephalus, other congenital abnormalities, foetal death)

What is the most common foetal cause of dystocia in dog and cat?

Malpresentation Foetal oversize is also common Foetomaternal - commonest is small litter size and large kittens

How is uterine intertia classified?

PRIMARY - most common, uterus fails to respond to foetal signals SECONDARY - due to exhaustion of the myometrium, secondary to an obstruction of the birth canal

What are the causes of primary uterine intertia?

``` small litter very large litter systemic disease of the dam inherited predisposition obesity age failure of neuroendocrine regulation ``` Thought to be related to low levels of oxytoxin COMPLETE (failure of uterus to contract at full term) or PARTIAL (uterus initiates parturition but fails to complete normal delivery of all foetuses)

When do you medically manage dystocia?

only when there is NO evidence of obstruction

How can dystocia be managed?

``` exercising the dam feathering the roof of the vaginal floor treatment with oxytocin treatment of hypocalcaemia/hypoglycaemia Tocospasolytic drugs used in combination with oxytocin in some countries. ``` C-section

How should oxytocin be given?

Repeat small dose (0.2-0.4 IU/kg) Single large dose associated with prolonged myometrial contraction --> placental compression and compromise Every 30-40 minutes OXYT alon associated with increased stillbirths and hypoxic pups

How are vulval vaginal abnormalities classified?

Congenital or acquired.

What are congenital vulval vaginal abnormalities? 4

Vulval stenosis Anovulvular cleft Rectovaginal fistula Vestibulovaginal stricture/band

What are some ACQUIRED vulval vaginal abnormalities? 4

Vulval hypertrophy (juvenile prolonged proestrous, excess oestrogens) Recessed vulva Traum Neoplasia

What are pathological causes of abdominal masses/distensions?

``` Pyometra Retained foetus Ovarian neoplasia Uterine neoplasia Segmental aplasia and mucometra ```

What is mucometra?

an abdominal mass where uterine secretions accumulate proximal to the stricture, often and incidental finding, not same as puometra

Which reproductive diseases may show systemic illness?

Closed pyometra Uterine torsion Uterine rupture

Clinical disease of the reproductive tract in the dog and cat 1 - FEMALE Flashcards

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