Ovaries and Uterus

Question 1

What are the clinical signs associated with functional ovarian cysts?

Answer 1

• prolonged estrus
• vaginal bleeding
• attractiveness to males
• standing heat

Question 2

What is meant by a “functional” ovarian cyst?

Answer 2

hormone secreting cyst

• follicular: estrogen
• luteal: progesterone

Question 3

How are ovarian cysts diagnosed?

Answer 3

• vaginal cytology
• hormone levels
• abdominal ultrasound

Question 4

How are ovarian cysts treated?

Answer 4

• OHE is curative

- for breeding animals: GnRH, HCG, cyst removal, unilateral OVE

Question 5

What is the likelihood of metastasis for ovarian neoplasia?

Answer 5

20-30%

Question 6

What are the possible tissues of origin and associated neoplasms of ovarian neoplasia?

Answer 6

• epithelial: adenoma/carcinoma
• stromal: granulosa cell tumor, functional hormone producing tumor
• germ cell: dysgerminoma, teratoma

Question 7

What are common clinical signs/results of granulosa cell tumors?

Answer 7

• persistent proestrus

- pyometra

Question 8

How is ovarian neoplasia diagnosed?

Answer 8

• radiographs

- ultrasound

Question 9

How is ovarian neoplasia treated?

Answer 9

OVE

Question 10

What is Ovarian Remnant Syndrome?

Answer 10

recurrence of estrus following OHE/OVE

Question 11

What is the cause of Ovarian Remnant Syndrome?

Answer 11

failure to remove all ovarian tissue

Question 12

Why is Ovarian Remnant Syndrome more common in cats?

Answer 12

ectopic tissue has been reported in the pedicle

Question 13

How is Ovarian Remnant Syndrome treated?

Answer 13

surgical removal of the remnants

Question 14

Where is the remnant usually located in Ovarian Remnant Syndrome?

Answer 14

caudal pole of the kidney

Question 15

Describe the pathogenesis of cystic endometrial hyperplasia

Answer 15

• excess/prolonged progesterone
• endometrial cells become hyperplastic
• glandular tissue becomes cystic
• uterus fills with fluid
• can lead to pyometra

Question 16

What are the clinical signs associated with cystic endometrial hyperplasia?

Answer 16

• failure to conceive
• vaginal discharge
• PU/PD

Question 17

How is CEH diagnosed and treated?

Answer 17

• ultrasound

- OHE

Question 18

What is the most common bacteria associated with pyometra?

Answer 18

E. coli

Question 19

What is the typical signalment associated with pyometra?

Answer 19

• middle aged intact females

- dogs more common than cats

Question 20

What is the difference between an open and closed pyometra?

Answer 20

• open: cervix is open and infected fluid can drain out

- closed: cervix is closed and infected fluid is trapped

Question 21

Describe the pathogenesis of pyometra

Answer 21

• prolonged/elevated progesterone levels with no pregnancy
• growth/secretions of endometrial glands
• uterine drainage is inhibited and fluid accumulates
• bacterial colonization
• estrogen will increase/sensitize progesterone receptors

Question 22

What are the clinical signs associated with pyometra?

Answer 22

• lethargy
• vomiting
• PU/PD
• vaginal discharge

Question 23

What is seen on physical exam of a dog with pyometra?

Answer 23

• painful distended abdomen
• fever
• tachycardia, tachypnea

Question 24

What are possible clinical pathology abnormalities that can be seen with pyometra?

Answer 24

• hypoglycemia
• azotemia, proteinuria
• anemia
• leukocytosis with left shift
• increased AST and ALP

Question 25

How is pyometra treated?

Answer 25

- stabilize patient first | - OHE

Question 26

When is medical management of pyometra indicated?

Answer 26

- if not systemically ill - open pyometra - high breeding value

Question 27

What is the medical treatment for pyometra?

Answer 27

PGF2 alpha | antibiotics 10-14 days

Question 28

What is metritis, and when does it usually occur?

Answer 28

- inflammation/infection of the uterus | - occurs post-partum

Question 29

What are possible causes of metritis?

Answer 29

- dystocia - devitalized uterus - fetal/placental retention

Question 30

What are the clinical signs associated with metirits?

Answer 30

- foul smelling red/brown discharge - fever - anorexia, lethargy - decreased milk production

Question 31

How is metritis treated?

Answer 31

- antibiotics | - OHE

Question 32

What is uterine torsion and what is it usually associated with?

Answer 32

- twisting of the uterus along the long axis | - associated with dystocia, pyometra, and CEH

Question 33

What are the clinical signs of uterine torsion?

Answer 33

- acute abdomen - abdominal distension - shock

Question 34

How is uterine torsion diagnosed?

Answer 34

- radiographs | - exploratory

Question 35

How is uterine torsion treated?

Answer 35

- fluids and analgesics | - OHE

Question 36

What is the usual cause of uterine prolapse?

Answer 36

complication of parturition/dystocia

Question 37

How is uterine prolapse treated?

Answer 37

- manual reduction - OHE - reduce edema with hypertonic agents

Question 38

What are possible causes of uterine rupture?

Answer 38

- dystocia - trauma - post c-section - pyometra - giving oxytocin when the cervix is not dilated

Question 39

What is the difference between dogs and cats in respect to uterine neoplasia?

Answer 39

- cats are more likely to metastasize

Question 40

What is dystocia?

Answer 40

inability to expel a fetus through the birth canal

Question 41

What are the possible causes of dystocia?

Answer 41

``` maternal: - primary or secondary uterine inertia - birth canal obstruction fetal: - malposition or malformation - oversize - secondary uterine inertia ```

Question 42

What is primary uterine inertia? | What are the causes?

Answer 42

- parturition fails to proceed | - due to over or undersized litters

Question 43

What is secondary uterine inertia? | What are the causes?

Answer 43

- normal delivery or part of the litter, then develops uterine fatigue - due to fetal or pelvic obstruction, fetal malposition, or fetal size

Question 44

What is found on physical exam of an animal with dystocia?

Answer 44

- lochia without delivery - obstructed canal on palpation - lack of uterine contraction in response to Ferguson's reflex

Question 45

How is dystocia treated?

Answer 45

- primary uterine inertia can be treated medically with oxytocin - manual manipulation of fetus - C-section

Question 46

What are the indications for a C-section?

Answer 46

- secondary uterine inertia - primary uterine inertia that failed medical treatment - systemic signs in bitch - fetal distress - planned for high risk patients

Question 47

Where is the incision made for a c-section?

Answer 47

midway between xiphoid and umbilicus to cranial pubis

Question 48

Describe the c-section procedure

Answer 48

- exteriorize uterus carefully - pack with sponges - perform hysterotomy - clamp umbilical cord - pass fetus to assistant - close with single or double layer 3/0 mono absorbable