Prolapes

Question 1

If it is a female that has a possible prolapse, what 3 questions do you need to ask the farmer/producer to determine what type of prolapse it is?

Answer 1

1. is she pregnant or have she recently calved?
2. which hole is it coming from?
3. is it long, short, smooth, or bumpy?

Question 2

What are (8) risk factors for rectal prolapses?

Answer 2

1. straining (tenesmus from colitis or coccidiosis; or dysuria/cystitis/uroliths/dystocia)
2. neuropathy – tail docking, alcohol epidural, spinal lymphoma
3. chronic coughing (resp dz)
4. genetics
5. neoplasia
6. diet (estrogenic feedstuff)
7. obesity
8. hormone treatment

Question 3

T/F: rectal prolaspse is an emergency

Answer 3

false – just should be addressed sooner rather than later.

Question 4

What is the prognosis of rectal prolapse?

Answer 4

it depends on the severity and chronicity
grade I and II: good with prompt tx
grade III and IV: there is risk for severe vascular injury to descending colon and these types require surgical correction.

Question 5

T/F: Type I and II rectal prolapses are uncommonly seen. When rectal prolapse occurs, its usually severe (type III or IV)

Answer 5

false – type I and II are most common

for reference:
(type I = prolapse of rectal mucosa only, small, intermittent; type II = prolapse of all layers (mucosa–>serosa); type III= prolapse of all layers and large colon; type IV = all layers, large colon, and anal sphincter is intact causing constriction of rectum and colon)

Question 6

If an animal has a rectal prolapse and they are still straining, what should you do?

Answer 6

Epidural analgesia with 2% lidocaine, lidocaine + xylazine, OR morphine.

An alcohol epidural is a salvage procedure and can predispose to prolapsing again. You would NOT want to do this if you want the animal around long-term.

Question 7

T/F: you should cull if a production animal experiences a rectal prolapse

Answer 7

true because its going to happen again.

Question 8

How do you treat rectal prolapse?

Answer 8

if the mucosa appears healthy, then lubricate it replace it and apply a purse string or umbilical tape. Ensure to leave 2-4 finger-wide space so that the animal can still defecate.
You might need to reduce the swelling first with hypertonic saline/dextrose/sugar.
The sutures should be removed in 5-10 days.

You can also inject iodine around the rectum to cause adhesions.

Question 9

If rectal prolapse replacement is NOT an option, how do you treat?

Answer 9

submucosal resection
or
place prolapse ring and band/suture to amputate the area (sloughs in 7-10d)

Question 10

What are the risk factors for vaginal prolapse?

Answer 10

1. advanced stage pregnancy (intraabdominal pressure, multiparous)
2. exposure to hyperestrogenic agents causing vaginal tissue relaxation (growth stimulants, mold, superovulation)
3. genetics/breed (herefords)

Question 11

Is vaginal prolapse an emergency?

Answer 11

no but should be evaluated promptly.

Question 12

How would you treat Grade I or II vaginal prolapse?

Answer 12

• grade I is characterized by small, intermittent protrusion of the mucosa, usually when the animal is lying down; tx is neglect or retention suture
• grade II is characterized by mucosa protruding continuously and therefore tx is to replace and apply retention suture

Question 13

How do you treat grade III or IV vaginal prolapses?

Answer 13

Grade III is characterized by the entire vaginal mucosa and cervix protruding continuously and therefore tx is cystocentesis (to relieve trapped bladder), replacement, and retention sutures; if shes pregnant, induce parturition

Grade IV is characterized by chronic eversion that has resulted in necrosis and fibrosis of the vaginal tissue; you could replace it and put the animal on antibiotics, but in most cases euthanasia is warrented.

Question 14

How could you prevent a late-gestation ewe from having vaginal prolapse?

Answer 14

INCREASE concentrate consumption
DECREASE hay consumption

MONITOR management factors (resp dz, improper dail docking, etc.)

Question 15

T/F: sugar is irritating to the vaginal mucosa and is not the best hydroscopic agent to use to reduce edema prior to replacement

Answer 15

true
better alternatives include hypertonic saline, epsom salt, glycerol, and dextrose

Question 16

What 2 things can be used in small ruminants to reduce vaginal prolapse from occuring– and what is the major difference between the 2?

Answer 16

1. retention harness – discourages straining, but MUST be removed PRIOR to lambing/kidding
2. prolapse paddle – tie to wool/hair and it will come out at lambing/kidding

Question 17

What short-term retention technique is best for non-pregnant animals that experience grade I vaginal prolapse during estrus?

Answer 17

caslicks suture

Question 18

What common short-term retention technique is best for advanced grade and/or chronic vaginal prolapses AND requires removal prior at parturition.

Answer 18

buhner stitch

Question 19

what are 2 permanent treatments for vaginal prolapse?

Answer 19

1. minchev and modified minchev vaginopexy
2. winkler technique for cervicopexy

Question 20

What type of prolapse is a true emergency?

Answer 20

uterine prolapse

Question 21

What type of prolapse is a common complication of 3rd stage labor?

Answer 21

uterine prolapse

Question 22

T/F: uterine prolapse is uncommon in pigs

Answer 22

true
most common in cows and ewes

Question 23

what are the risk factors for uterine prolapses?

Answer 23

1. multiparous animals
2. exposure to estrogenic substances (clover)
3. extreme weather changes and pasture composition
4. uterine inertia/hypocalcemia/recumbency
5. dystocia, retained fetal membranes, uterine tears.

Question 24

why is uterine prolapse an emergency?

Answer 24

risk of middle uterine artery rupture and bleeding out.

these animals should therefore NOT be transported. They should be restrained and a bag should be placed over the uterus.

Question 25

T/F: uterine prolapses have no genetic component

Answer 25

true

Question 26

How should you approach a uterine prolapse?

Answer 26

1. perform epidural 2. frog leg them if in recumbency 3. remove fetal membranes if possible but do not force them off. 4. apply lubricant, a hydroscopic agent, and a pressure bandage for 10-15 minutes. 5. begin reduction with nongravid horn 6. apply steady pressure at cervix/uterine body area using both hands with closed fists. 7. fullyinvert horns (might require probang) 8. provide animal with NSAIDs, antibiotics, oxytocin, and calcium 9. place retention suture if necessary

Question 27

When is uterine amputation indicated during uterine prolapse and what are the 2 approaches?

Answer 27

if there is severe ischemic necrosis and/or lacerations you can do an open approach (expensive and time consuming) or closed approach (ligation of entire organ to slough in 10-14d, cheap and easy, but viscera can be trapped and cause fatality.)

Question 28

T/F: preputial prolapse in bulls is genetic

Answer 28

true -- its associated with pendulous sheaths and excessive preputial skin polled bulls lack retractor prepuce muscles

Question 29

T/F: preputial prolapses can also be a result of injury during copulation

Answer 29

true

Question 30

What is the typical treatment for preputial prolapses?

Answer 30

most commonly surgical treatment. You can do conservative with grade I prolapse. The other grades require surgical tx and carry good through guarded prognoses for breeding. Grading has to do with the severity of edema, the presence of necrosis or lacerations, and fibrosis and abscess formation.

Question 31

If you are opting to perform medical management on a preputial prolapse grade I, how would you go about this?

Answer 31

1. sepsis control -- clean, flush, debride and then apply topical +/- systemic Abs 2. edema reduction -- apply an emmollient and bandage (ensure to leave area for urine drainage) 3. return damaged tissue to preputial cavity (note that repeat injury is common)

Question 32

What are the 3 surgical treatment options for preputial prolapses?

Answer 32

1. avulsion of prepuce 2. circumcision 3. preputial amputation