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Surgery > Reproductive > Flashcards

Reproductive Flashcards

1
Q

Considerations for when to recommend a spay?

A
  1. Orthopaedic disease - desex after growth plate closure for larger breeds
  2. Neoplasia: mammary neoplasia (0.5% after first oestrus, 8% at 2nd, 26% any oestrus after)
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2
Q

what orthopaedic diseases are potentially associated with early spays?

A
  1. Hip dysplasia

2. Cranial cruciate ligament disease

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3
Q

how do dog and cat mammary chains differ?

A
  • Dogs have significant cross-over midline between glands w/ lymphatic and blood supply + 5 pairs
  • Cats: limited crossing over midline + only have 4 pairs
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4
Q

% of malignant mammary neoplasia

A

35-50% in dogs

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5
Q

tumours with hormone receptors are…

A

benign - can lose hormone receptors = malignant transformation

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6
Q

how do hormones oestrogen and progesterone affect mammary tumours?

A

oestrogens - stim. ductal growth

Progesterone stim lobule-alveolar development

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7
Q

when can you consider a lumpectomy of a mammary mass?

A

if it is very small,

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8
Q

when can you consider a single mastectomy of a mammary mass?

A

only if benign (proven on biopsy)

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9
Q

margins of a unilateral mastectomy

A

1 fascial plane deep

+ 2cms lateral margins

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10
Q

benign mammary tumour types in dogs

A
  • adenoma, mesenchymal, mixed - small and not fixed to underlying tissue
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11
Q

malignant mammary tumour types in dogs

A

carcinoma, sarcoma - bigger and fixed

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12
Q

treatment of malignant mammary tumours in dogs

A

chain mastectomy - unilateral vs. staged bilateral

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13
Q

approach to treatment of an inflammatory mammary carcinoma on a dog

A

Surgery is contraindicated

- poorly differentiated very aggressive mass with a hopeless prognosis

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14
Q

characteristics of malignant mammary tumours with a worsened prognosis (dogs)

A
  • invasive and ulcerated
  • mass bigger than 3cm
  • present for longer than 6months
  • LNs contain neoplastic cells
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15
Q

what % of cat mammary tumours are malignant?

A

85% BUT always get a biopsy

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16
Q

most common feline mammary tumour type

A

adenocarcinoma - highly aggressive w/ rapid growth and mets –> prognosis poor <1y

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17
Q

Ddx for feline mammary adenocarcinoma

A

benign fibroadenomatous hyperplasia

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18
Q

treatment options for testicular neoplasia

A
  • closed orchiectomy

- scrotal ablation

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19
Q

which tumour type is most common in cryptorchid testes?

A

sertoli cell tumours

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20
Q

what do sertoli cells produce?

A

oestrogen production

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21
Q

what secondary findings occur dt sertoli cell tumours?

A

dt inc. oestrogen production

  • atrophy of contralat testicle
  • feminisation - enlarged nipples
  • alopecia
  • prostatic metaplasia
  • linear preputial erythema
  • myelotoxicosis
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22
Q

why perform a rectal on a cryptorchid dog?

A

cryptorchid dogs have a higher risk of sertoli cell tumours which met to sublumbar LNs (2-10%)

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23
Q

what do leydig cells produce?

A

testosterone

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24
Q

behaviour of leydig cell tumours?

A

more common in scrotal testes, smaller and met very rarely

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25
Q

common sequelae of leydig cell tumours

A

Perineal hernia dt inc. testosterone secretion

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26
Q

what is the most common testicular tumour type?

A

seminoma

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27
Q

behaviour of seminomas

A

large tumours in cryptorchid/scrotal testes, hormone production is rare and met 6-11% to sublumbar LNs

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28
Q

define phimosis

A

inability to extrude penis as preputial orifice is too small

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29
Q

tx of phimosis

A

wedge excision of cranio-dorsal orifice ***not ventral - will cause paraphimosis

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30
Q

cs of phimosis

A
  • urine pooling and irritation

- inability to mate

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31
Q

causes of paraphimosis

A
  • skin rolling inward

- orifice too small

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32
Q

tx of paraphimosis

A
  1. Dorsally enlarge preputial orifice
  2. Preputial advancement
  3. Phallopexy
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33
Q

types of penile neoplasias

A
  • TVT
  • SCC
  • MCT
  • Haemangiosarcoma
  • Papilloma
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34
Q

tx of TVT

A

vincristine

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35
Q

what causes benign prostatic hyperplasia?

A

enlargement under androgenic influence –> occurs in all older intact males

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36
Q

what causes cystic prostatic hyperplasia?

A

dysfunctional flow of prostate secretions

37
Q

cause of prostatic abscessation?

A

bacteria can establish dt isolation from vascular access secondary to cystic prostatic hyperplasia –> prostatitis

38
Q

Tx of benign prostatic hyperplasia

A
  1. Castration to remove androgenic influence
  2. Medical:
    - medroxyprogestone acetate (progestin)
    - finasteride (propecia) 5a-reductase inhibitor
    - deslorelin (suprelorin) (GnRH agonist)
39
Q

px for benign prostatic hyperplasia w/ castration and medical tx

A

prostate should involute w/in 4-12wks

40
Q

explain the pathogenesis of prostatic cysts

A

assoc. w/ BPH

oestrogens –> squamous metaplasia –> occludes ducts

41
Q

where do paraprostatic cysts originate from?

A

uterus masculinus

42
Q

bacteria associated with prostatitis/abscessation

A

E.coli

Brucella

43
Q

CS of prostatitis

A
  • rectal: asymmetrical prostatic enlargement
  • painful
    +/- purulent penile discharge
    +/- acutely sick - pyrexia, lethargy
    +/- oedema in HLs
44
Q

Dx approach to prostatic disease

A
  1. Rectal exam
  2. Abdo US: to ID appearance and fluid pockets
  3. US guided FNA: culture and cytology
45
Q

what surgical tx is appropriate for large, discrete fluid pockets in the prostate?

A

omentalisation

46
Q

prognosis of prostatitis

A

difficult to cure disease as often there are multiple small pockets

47
Q

behaviour of prostatic neoplasia

A

highly malignant (80% met (lungs, LN, bones) at Dx), mineralisation

48
Q

types of prostatic neoplasia

A

adenocarcinoma, SCC, TCC

49
Q

tx approach to prostatic carcinoma

A
  1. Sx generally not indicated as aggressive disease w/ high morbidity of sx (prostatectomy)
  2. Palliative care: NSAIDs, chemo, urethral stenting/urinary diversion (cystotomy tube)
  3. Prognosis <6m
50
Q

diagnosis of ovarian remnant syndrome

A
  1. Serum oestradiol or progesterone concentrations (dependent on cycle)
  2. Anti-mullerian hormone (independent of cycle)
51
Q

hormonal effects of progesterone on the female reproductive tract

A
  1. Proliferation and hypersecretion of glands
  2. Closure of cervix
  3. Inhibition of myometrial contractility
  4. Inhibition of local immune response
  5. Increases endometrial bacterial adherence
52
Q

what does CEHMEP stand for?

A
  1. CEH = Cystic endometrial hyperplasia
  2. M = Mucometra
  3. E = Endometritis
  4. P = Pyometra
53
Q

when does cystic endometrial hyperplasia occur?

A

periods of progesterone dominance causing hypersecretion of endometrial glands
NOTE: does not fully regress between cycles

54
Q

what causes mucometra?

A

hypersecretion of endometrial glands during periods of progesterone dominance –> endometrial glands dilate and fluid accumulates –> medium for bacterial growth

55
Q

what causes endometritis?

A

bacterial infection of the uterus through an open cervix

56
Q

define pyometra

A

pus in the uterus (4-8wks after oestrus)

57
Q

faecal flora associated with endometritis

A

Klebsiella, Pasteurella, Proteus, Pseudomonas, Enterobacter, Streptococcus

58
Q

which bacteria most causes 60-95% of endometritis cases?

A

E.coli

59
Q

how does E.coli cause polyuria?

A

the endotoxin interferes w/ ADH receptors + may cause glomerulonephritis

60
Q

what is your primary differential for any sick entire female dog?

A

pyometra

61
Q

describe the typical leukogram of a dog with closed pyometra

A
  1. Degenerative left shift w/ neutropaenia
62
Q

what is your imaging modality of choice when investigating pyometra?

A

ultrasound

63
Q

Pre-op stabilisation txs for pyometra

A
  1. Tx septic shock
  2. IVFT: isotonic crystalloids +/-colloids, azotaemia, metabolic acidosis
  3. Broad spec IV ABs: ampicillin (tx. E.coli)
64
Q

modifications of an ovariohysterectomy in pyo cases

A
  1. Maximum exposure
  2. Gently exteriorise
  3. Pack off w/ abdo sponges
  4. Independently ligate uterine arteries (dt inc. blood flow)
  5. Remove cervix
  6. Lavage stump
65
Q

how do functional and non-functional cystic ovaries differ?

A

functional = prolonged secretion of oestrogen

66
Q

gestation of dog

A

63 days from ovulation

67
Q

when are foetal skeletons radiographically visible?

A

42 days

68
Q

indicator that whelping will occur in next 12-24hrs

A
  • progesterone drop below 10nmol/L

- temp drop below 37.6C

69
Q

events of stage 1 labour

A
  • internal uterine contractions - no external pushing

- restlessness, anxiety, nesting, inapp

70
Q

events of stage 2 labour

A
  • abdominal contractions

- passage of foetus

71
Q

events of stage 3 labour

A
  • passage of placenta
72
Q

Dystocia criteria

A
  1. Prolonged gestation
  2. Temp drops below 37.6C w/ no signs of labour w/in 24h
  3. Temp decreases and then increases to 39.2C
  4. Vaginal discharge for more than 2-3hrs
  5. Strong, active abdominal contractions for 30mins w/out puppy
  6. Mb or part of foetus protruding from the vagina
  7. Signs of systemic illness
73
Q

compare primary and secondary uterine inertia

A 
primary = failure to expel a foetus from the uterus when no obstruction exists (more common)
secondary = exhaustion of uterine musculature after contracting against an obstruction
74
Q

methods of medical intervention of uterine inertia

A
  • Check glucose and ionised calcium (rare that this would need correction)
  • oxytocin 0.2 IU/5kg –> expect expulsion of puppy in 30mins

ONLY if NO EVIDENCE OF OBSTRUCTION OR FOETAL DISTRESS

75
Q

indications for immediate sx intervention w/ dystochia

A
  1. Canal obstruction or unresolvable malposition
  2. Foetal HR 150-170 (less than 1/2 of mothers HR x 2)
  3. > 4hrs since last puppy
  4. > 30min of abdo straining
  5. Green vaginal discharge
  6. Meconium or blood in vagina
  7. Systemic illness in the bitch
76
Q

Surgical approaches to C-section

A
  1. Hysterotomy
  2. Hysterotomy followed by OHE
  3. En-bloc OHE
77
Q

timeframe to remove all foetues from uterus w/ en-bloc OHE approach

A

~60 seconds

78
Q

neonatal care of pups post c-section

A
  1. Suction nasal cavity and oropharynx
  2. Rub vigorously
  3. Naloxone
  4. Warm
  5. Allow nursing
  6. Metoclopramide
79
Q

why is it controversial to give opioids to mother at c-section?

A

may decrease neonatal vigour

80
Q

what is an episioplasty?

A
  • excision of ‘hood’ covering vulva w/ recessed vulvas

- closure in 2 layers

81
Q

ddx for vaginal oedema

A
  • prolapse, neoplasia, cysts, congenital malformations
82
Q

when does vaginal oedema occur

A

young dogs in oestrus or proestrus

83
Q

tx of vaginal oedema

A
  • spay to prevent recurrent + induce regression
  • induce ovulation w/ GnRH + HCG
  • apply lube and prevent self-trauma
  • surgical resection is rarely required as it will regress overtime
84
Q

causes of vaginal prolapse

A
  • oestrogenic influence
  • forced separation during mating
  • weak pelvic tissues
85
Q

percentage of vaginal neoplasias that are benign

A

75-85%

86
Q

malignant vaginal neoplasias

A

TVT, carcinoma, sarcoma

87
Q

benign vaginal neoplasias

A

leiomyoma, fibroma, lipoma

88
Q

tx of vaginal neoplasias

A

resection via episiotomy

Surgery (22 decks)

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