Equine Uterine and ovarian surgery Flashcards Preview

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Flashcards in Equine Uterine and ovarian surgery Deck (37)
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1

Ovariectomy indications

ovarian disease

behavior

genetic

uterine malformation

2

REBA

7 yo pony mare with stallion like behavior for 6 months, have not observed in heat

repro exam: left ovary >10 cm diameter, right ovary very small

U/s left ovary cystic appearance

DDx for large ovary? DDx for small ovary

Large ovary: hematoma, abscess, neoplasia, cyst

small ovary: anestrus, functional tumor on other ovary

3

REBA

7 yo pony mare with stallion like behavior for 6 months, have not observed in heat

repro exam: left ovary >10 cm diameter, right ovary very small

U/s left ovary cystic appearance

CBC/chem: WNL

Progesterone: low

Testosterone: high

inhibin: high

What does REBA have

Granulosa cell tumor

secretes inhibin>testosterone>estrogen

other ovary nonfunctional

rarely malignant

4

REBA

7 yo pony mare with stallion like behavior for 6 months, have not observed in heat

repro exam: left ovary >10 cm diameter, right ovary very small

U/s left ovary cystic appearance

CBC/chem: WNL

Progesterone: low

Testosterone: high

inhibin: high

She has granulosa cell tumor

What are the surgical options?

 

Colpotomy

laparoscopic removal

flank incision

ventral celiotomy

5

Surgical choice for : Best client's best horse for granulosa cell tumor

laparoscopic

less hemorrhage

6

surgical choice for: a backyard "rescued" mare (low dollar value) that gets an attitude with each heat cycle

colpotomy

cheap

7

Colpotomy

remove fecal ball or end of uterus-hold off feed

vaginal incision left open-keep cross tied

ovarian pedicle crushed-incomplete crush can lead to hemorrhage

risk of peritonitis, abscesses

colic postop-prevent with mineral oil prepop

8

Flank laparotomy

standing

may be able to reach ovaries from one side

best for smaller ovaries

crush pedicle or use stapler

9

Complications of flank laparotomy

hemorrhage-keep quiet for 2-3 days

incisional problems-edema, dehiscence

peritonitis

colic-prevent with mineral oil

10

Ventral laparotomy

oblique paramedian

direct visualization of pedicle

11

complications of ventral laparotomy

hemorrhage-esp with tumors

peritonitis, incisional infection

incisional hernia-stall rest 4-6 weeks

colic-prevent with mineral oil

12

laparoscopy

standing

hemorrhage is controlled-coagulation

may need bilateral approaches

small incisions

preferred technique

13

complications of laparoscopy

colic-gas insufflation

incisional problems-related to size of ovary

14

Ramona

8 yo QH mare

8 mo gestation

colic signs: intermittent, moderate

vaginal exam: normal, cervix closed

rectal exam: band running over top of uterus from left to right, band running on right ventrally, foal seems to be further forward than normal, impaction of small colon and twisted to the right

What's going on?

uterine torsion

typical presentation

8-9 mo gestation

normal vaginal exam

clockwise torsion

DDx colic

15

Tx options for uterine torsion

detorse using fetus

roll

sx: flank, ventral midline

16

uterine torsion: detorse using fetus

vaginal approach, grab foal, rock foal until torsion corrects

usually can't get to foal because cervix is not open

17

uterine torsion: roll

roll the mare to catch up with the uterus

in direction of torsion

repeat rectal to confirm detorsed

complications: uterine rupture, recurrence (camelids)

18

Uterine torsion: flank surgery

standing through PLF

complications: uterine tear, peritonitis, incisional problems

19

uterine torsion: ventral midline

if big foal, big horse, damaged uterus, emphysematous fetus

easier for C-section and repair of uterus

20

Uterine torsion Prognosis

mare survial: 73-84%, with no impairment on fertility

foal survival-54-70% if alive at time of surgery, may have maladjustment syndrome

better survival if <320 d gestation at time of torsion, able to correct via flank incision

21

Uterine torsion in Camelids

more like cows-later gestation with vaginal twist

tx: rolling, female does it on their own, C-section

22

Cesarean section: semielective

planned C-section: anticipated dystocia, poss trauma to mare

dying mare: quick delivery, sterility not crucial, low flank approach just after mare is anesthesized

23

Cesarean section: semiemergency

dead foal: need to remove witin 3-4 hours of membrane rupture

 

24

Cesarean section: emergency

foal alive or poss alive

need to remove within 45-60 min of membrane rupture

25

cesarean section details

ventral midline

good anes team

start caudal to umbilicus and extend forward

find limb

exteriorize so stable

pack off abdomen, stay sutures on uterus

chains ready, foal team ready, cut

tilt horse or table

hemostatis stitch to control hemorrhage-close uterus in 2 layers, don't suture in placenta

26

Cesarean section: post op

oxytocin until placenta is expelled

watch feet for laminitis

Abx +NSAIDS 3-5d

uterine lavage after 12-24 h

exercise

montiro manure

27

Cesarean section: complications

related to trauma of dystocia and manipulation: uterine, cervical or vaginal tear; interstinal bruising; postpartum straining; retained placenta

related to sx: incisional complications, anes complications, retained placenta, hemorrhage from uterine incision, myopathy, uterine adhesions

28

cesarean section: prognosis

foal-low

mare high decreased fertility

29

C-section Camelids

ventral midline or left flank

if no cria within 10 min of starting manipalution

always check for twin

placenta easier to remove

excellent future fertility

30

peripartum hemorrage

includes external iliac a, uterine a & its branches

often older mares

if external to broad ligament, will bleed out

if internal to broad ligament, may live

31

peripartum hemorrhage clin sxa

colic

anxious

pale

inc HR 

dec Temp

weakness

blood on abd tap

32

peripartum hemorrhage: tx

r/o colic

fluids: hypertonic, blood

aminocaproic acid, formalin

don't stress or rebreed

referral

33

causes of uterine rupture

dystocia (esp camelids)

uterine torsion

hydroamnois

normal delivery

34

uterine rupture

dorsal aspect

palpate per vagina

peritonitis

hemorrhage if large

death after lavage

supportive therapy

Refer'

35

hysterectomy

 rare

pyrometric

tumor

macerated fetus

structural anomaly

36

uterine cyst

 interfere with implantation

DDY preg

 TX: laser ablation

37