Reproductive Surgery Flashcards
(285 cards)
1
Q
List the 3 surgical diseases of the ovary.
A
- ovarian cysts
- ovarian neoplasia
- ovarian remnant syndrome
2
Q
On routine OHE of an otherwise completely healthy cocker spaniel, you find an ovarian cyst. How should you continue on with this patient?
A
OHE is curative for nonfunctional ovarian cysts so continue on with the OHE. Submit the ovaries, including the cysts, for histopathology to confirm diagnosis of nonfunctional ovarian cysts.
3
Q
Functional ovarian cysts are hormone secreting cysts and can be follicular or luteal. A follicular cysts secretes ____________ and a luteal cyst secretes ___________
A
Follicular cyst: estrogen
Luteal cyst: progesterone
4
Q
Functional ovarian cysts are hormone secreting cysts. What signalment and clinical signs are typical of a functional ovarian cyst in dogs and cats?
A
Dogs - <3 years old
Cats - <5 years old
CS: prolonged estrus, vaginal bleeding (dogs), attractiveness to males, and standing heat
5
Q
Diagnosis of Functional Ovarian Cysts can be made by…
Which of the methods is best?
A
vaginal cytology (dogs) hormone levels (estrogen: >20pg/ml; progesterone: >2ng/ml) abdominal ultrasound (cysts are 10-50mm in size) - best diagnostic method
6
Q
Treating a functional ovarian cyst in a breeding animal differs from treatment in a non-breeding animal by…
A
Breeding animal: spontaneous resolvement, GnRH, HCG, Cyst removal, unilateral ovariectomy
Non-breeding animal: OHE is curative
7
Q
T/F: Ovarian neoplasia is a common form of neoplasm in small animal patients.
A
False.
Ovarian neoplasia is approximately 1% of neoplasia in small animal patients >10 years of age.
8
Q
What is the percent metastasis in ovarian neoplasia in small animal patients?
A
Ovarian neoplasia typically metastasizes in 20-30% of patients.
9
Q
50% of ovarian neoplasia is of epithelial origin. What is the malignant and benign form of this neoplasm?
A
Malignant: Adenocarcinoma
Benign: Adenoma
10
Q
40% of ovarian neoplasia is of stroll origin. What is the form of this neoplasm and how does it manifest??
A
Granulose Cell Tumor
Persistent pro-estrus because it is a functional hormone producing tumor that can lead to pyometra.
11
Q
A small percentage of ovarian neoplasia is of germ cell origin. What is the typical signalment for these neoplasms and what are the 2 types of neoplasms within this tissue of origin?
A
Patients are <5 years old at presentation.
- Dysgerminoma
- Teratoma
12
Q
What diagnostics would you implement in order to diagnose ovarian neoplasia?
A
Radiographs - see a space occupying lesion
Ultrasound - MOST SENSITIVE!
AVOID A FNA!
13
Q
After diagnosing an Ovarian Adenocarcinoma in a 9 year old female, intact West Highland Terrier, you take full body radiographs and determine there is no detectable metastasis. What treatment of choice do you offer your client?
A
Ovariectomy
Good prognosis if there is no metastatic disease.
14
Q
What is the most common surgical condition of the ovary?
A
Ovarian Remnant Syndrome
15
Q
What is the definition of Ovarian Remnant Syndrome?
A
recurrence of estrus following OHE/OVE most likely due to failure of removal of all ovarian tissue - poor technique!
16
Q
Ovarian remnant syndrome is more common in ______.
A
cats
17
Q
Cats require ___________ in order to evaluate their progesterone levels.
A
lutinization (HCG)
18
Q
In a cat with suspected ovarian remnant syndrome, diagnostic estrogen levels should read _________ and diagnostic progesterone levels should read _________.
A
estrogen levels > 15pgm/ml
progesterone levels > 2ng/ml
19
Q
Clinical signs typical of ovarian remnant syndrome are….
A
signs of estrus
20
Q
On vaginal cytology of a DOG with suspected ovarian remnant syndrome, you see….
A
what mimics a normal heat cycle
21
Q
Where is ovarian remnant usually located?
A
At the Caudal Pole of the Kidney
22
Q
What is the treatment of choice for ovarian remnant syndrome?
A
surgical removal
23
Q
When is surgery usually done for patients with ovarian remnant syndrome?
A
surgery is usually done during estrus - it is often a referral procedure
24
Q
List the 7 surgical diseases of the uterus.
A
- cystic endometrial hyperplasia
- pyometra
- metritis
- uterine torsion
- uterine rapture
- dystocia
- uterine neoplasia
25
Cystic endometrial hyperplasia is associated with....and can lead to ________.
excess and prolonged PROGESTERONE!
| Can lead to PYOMETRA!
26
Clinical signs of cystic endometrial hyperplasia include....
poor fertility
failure to conceive
vaginal discharge
PU/PD
27
The best/most sensitive diagnostic method for cystic endometrial hyperplasia is ___________ and the recommended treatment is ___________.
ultrasound; OHE
28
Diestrus results in progesterone secretion which results in endometrial hyperplasia. IF the bitch/queen is pregnant, the endometrial hyperplasia regresses post-parturition. If the bitch/queen is NOT pregnant, the resultant non-gravid uterus causes the endometrium to _____________, causing cystic hyperplasia which is susceptible to __________ and can ultimately lead to ______________.
...the resultant non-gravid uterus causes the endometrium to REMAIN HYPERPLASTIC, causing cystic hyperplasia which is susceptible to BACTERIAL CONTAMINATION and can ultimately lead to PYOMETRA.
29
Bacteria + Cystic Uterine Disease = ___________
PYOMETRA!
30
The definition of Pyometra is....
infection of the uterus
31
When does pyometra typically occur?
Pyometra occurs 4-8 weeks after the heat cycle.
32
Pyometra is more/less common in cats than dogs.
Pyometra is less common in cats than dogs.
33
Pyometra develops during what part of the heat cycle?
Diestrus
34
How does estrogen contribute to the development of pyometra?
estrogen increases/sensitizes progesterone receptors
35
The pathophysiology behind pyometra development begins with....
prolonged/elevated progesterone levels
36
The most common bacteria in a pyometra is...
| Others include...
E. Coli
| Pastuerella, Proteus sp., Pseudomonas
37
The bacterial spread in pyometra is via what 2 methods and which is most common?
Ascending (most common)
| Hematogenous
38
Why is pyometra less common in cats?
Cats are induced ovulates and therefore have a less chance of experiencing/accumulating excess progesterone.
39
Typical clinical signs of a pet with pyometra include...how many of these clinical signs do most pyometra cases have?
```
Most pyomtera cases present with 3 or more of the following clinical signs:
Lethargy
Vomiting
PU/PD
Vaginal discharge*
```
*Vaginal discharge may be the only clinical sign if the cervix is open.
40
What clinical sign may be the ONLY sign of pyometra with an open cervix?
Vaginal Discharge
41
What is often the most noticeable clinical sign of pyometra and why does it occur?
PU/PD is often the most noticeable clinical sign.
Pathophysiology: Bacterial toxins inhibit the concentrating ability (ADH) and causes glomerular damage.
42
What physical exam findings are expected in a patient with pyometra?
painful, distended abdomen
tachycardia
tachypnea
FEVER (a subnormal temperature is BAD NEWS!)
43
What TPR and CBC finding(s) are expected in a patient with SIRS and how often does SIRS occur in pyometra patients?
57% of patients with pyometra develop SIRS
T - >103.5 or <100
P - HR > 160bpm
R - >20 breaths/min.
WBC - >12,000; <4,000; or >10% bands
44
A chemistry panel in a patient with pyometra typically shows....
```
Hypoglycemia
Azotemia, Proteinuria
Anemia
Leukocytosis
Increased AST and ALP
```
45
Why does a patient with pyometra develop anemia?
There are RBCs lost in the vaginal discharge as well as a decrease in erythropoiesis.
Glomerular disease also decreases EPO production meaning you may need to RX: Whole Blood to your patient(s) if they have a low PCV.
46
On radiographs, a pyometra presents as....
large, fluid filled uterus
Ultrasound is a better diagnostic tool.
47
When can you rule out pregnancy in a patient with suspected pyometra?
You CANNOT rule out pregnancy until >42 days post ovulation...only then could you see the fetal skeletons.
48
On ultrasound, a pyometra presents as....
fluid filled uterus
thickened uterine wall
cystic endometrium
you can visualize the bladder (for a UTI) but DO NOT obtain a sample!
49
What type of antibiotics do you choose when treating a patient with pyometra?
Gram Negatives
| Ampicillin or Enrofloxacin
50
The treatment of choice for patients with pyometra is.....
OHE
51
List the complications associated with medically treating a patient with pyometra.
```
abdominal pain
emesis
tachycardia
dyspnea
systemic deterioration
```
52
It is very important to inform owners that choose to treat their pyometra pets medically....
the bitch/queen must whelp at their next cycle!
53
The definition of metritis is...
inflammation and/or infection of the uterus
54
When is an animal susceptible to developing metritis?
Metritis occurs postpartum - between 12 hours to 1 week postpartum.
55
The typical clinical signs associated with metritis include...
```
FOUL SMELLING REDDISH BROWN DISCHARGE
FEVER
Anorexia
Lethargy
DECREASED MILK PRODUCTION
```
56
When an owner complains that "the puppies are crying all of the time", you should suspect what disease?
metritis of the mom
57
Causes of metritis include (3)...
Dystocia
Devitalized uterus
Fetal/Placental retention
58
Treatment of choice for animals with metritis are...
antibiotics for breeding animals
| OHE**
59
T/F - An OHE will prevent a new mother from producing milk to feed her puppies.
FALSE! They still produce milk.
60
Uterine torsion is defined as....
uterine torsion is the twisting of the uterus along its long axis
61
Uterine torsion is associated with what 3 conditions?
Uterine torsion is associated with
1. dystocia
2. pyometra
3. cystic endometrial hyperplasia
62
The typical clinical signs associated with uterine torsion include...
acute abdomen
abdominal distension
shock
63
T/F - The diagnostic method of choice for uterine torsion is ultrasound.
FALSE - Ultrasound is non-diagnostic for uterine torsion.
| Final diagnosis is usually made on exploratory.
64
Treatment of a uterine torsion includes...
supportive care - fluids and analgesics
| OHE - do NOT derotate the tossed uterus; remove any puppies by c-section
65
The definition of uterine prolapse is...
uterine prolapse is the protrusion of uterine tissue outside of the vulva
66
Uterine prolapse is rare in both dogs and cats but is LESS RARE in ______.
Uterine prolapse is rare in dogs and cats but is LESS RARE in CATS.
67
When and why does uterine prolapse typically occur?
Uterine prolapse is a complication of parturition/dystocia and occurs <48 hours postpartum.
68
Clinical signs of uterine prolapse include...
vaginal discharge
straining
licking of the affected area
visible protruding mass
69
What are the treatment options for correcting a prolapsed uterus?
1. manual reduction - only if there is healthy, undamaged tissue
2. OHE
3. Ovary removal and uterine harm aputation via ventral celiotomy - when reduction cannot be accomplished
70
90% of uterine neoplasia in the dog is....
Leiomyoma
| the other 10% is Leiomyosarcoma
71
The uterine neoplasia found more in cats is....
Adenocarcinoma and likely metastatic!
72
The treatment of choice for uterine neoplasia is...
OHE
73
What is the prognosis of uterine neoplasia with OHE in the dog and cat?
Dog - good (benign tumors) to fair (malignant tumors)
Cat - guarded (higher metastatic potential)
74
The definition of dystocia is...
Dystocia is the inability to expel a fetus through the birth canal.
75
75% of dystocia cases are due to maternal causes. Maternal causes include...
Primary uterine inertia
Secondary uterine inertia
Birth canal obstruction due to a small pelvic canal or a malunion fracture.
76
25% of dystocia cases are due to fetal causes. Fetal causes include..
malposition
malformation
oversized neonates
secondary uterine inertia
77
Define primary uterine inertia.
Primary uterine inertia is with parturition fails to proceed - aka no neonates are born - and the birth canal, fetal size, and fetal presentation are all normal.
78
An oversized litter causes uterine _____________ to the point where it cannot contract, leading to PRIMARY UTERINE INERTIA.
An oversized litter causes uterine STRETCHING to the point where it cannot contract, leading to PRIMARY UTERINE INERTIA.
79
An undersized litter causes a decrease in uterine ______________, ultimately leading to PRIMARY UTERINE INERTIA.
An undersized litter causes a decrease in uterine STIMULATION, ultimately leading to PRIMARY UTERINE INERTIA.
80
The gestation period of dogs/cats is.....
63-68 days
81
Define secondary uterine inertia...
Secondary uterine inertia is a normal delivery of only PART of a litter due to the development of uterine fatigue.
82
Causes of secondary uterine inertia include...
1. fetal obstruction
2. pelvic obstruction
3. fetal malposition
4. fetal size
83
Clinical signs of secondary uterine inertia include...
prolonged interval between neonates (>4 hours)
| weak or absent uterine contractions
84
One of the most emergent clinical signs of dystocia - when you need to tell the owner to come in immediately - is.....
One of the most emergent clinical signs of dystocia is LOCHIA WITHOUT DELIVERY.
85
On physical exam, signs of dystocia include...
loch without delivery
obstructed canal on palpation
abnormal fetal presentation
lack of uterine contractions in response to Ferguson's reflex
86
How do you diagnose dystocia?
Radiographs
| Ultrasound
87
T/F - Primary uterine inertia can be treated medically.
TRUE!
Secondary uterine inertia can NEVER be treated medically but, primary uterine inertia can be treated medically.
88
What is the treatment plan for primary uterine inertia?
Admin. oxytocin and repeat in 30 minutes if necessary (make sure the cervix has dilated before administration).
Manually manipulate the fetus(es) in the vaginal vault if they are causing obstruction.
If no result, perform a C-section.
89
What are the indications for a C-section?
1. secondary uterine inertia
2. primary uterine inertia refractory to treatment
3. systemic signs in the bitch
4. fetal distress diagnosed by US
5. high risk patients
90
Where is your incision located for a C-section?
Incise midway between the xiphoid and umbilicus all the way to the cranial pubis.
91
Where do you clamp the umbilical cord?
Clamp the umbilical cord 2-6 cm from the abdominal wall.
92
When closing the uterus after a C-section of a breeding animal, what type of suture should you use and what suture pattern(s) are acceptable?
3/0 monofilament, absorbable
single layer or double layer with inversion
*If performing an OHE, there is no need for uterine closure.
93
What two drugs do you not want to use during neonatal resuscitation?
atropine or doxapram
94
What artery/arteries do the vagina and vestibule get their blood supply from?
vaginal artery from the internal pudendal artery
95
What are the surgical conditions of the vagina and vestibule?
Congenital Conditions:
vestibulovaginal stenosis
rectovaginal fistula
vaginal hyperplasia
vaginal prolapse
neoplasia
perivulvar dermatitis
96
What are the surgical procedures of the vagina and vestibule?
episiotomy
episioplasty
vaginectomy
97
What is an episiotomy?
Episiotomy - an approach to the caudal vagina in order to resect stenotic, hyperplastic or neoplastic lesions.
98
What is an episioplasty?
Episioplasty - the treatment for perivulvar dermatitis
99
What is a vaginectomy?
Vaginectomy - the treatment for vaginal hypoplasia, intrapelvic annular stenosis (referral procedure)
100
Where is your incision located for an episiotomy?
Incise through the perineal body to access the caudal vagina.
101
How many layers is the closure for an episiotomy?
3 layer closure:
| mucosa, muscle and skin
102
What is a rectovaginal fistula?
Communication between the rectum and vagina.
103
The only congenital abnormality of the vagina or vestibule that may be simply enough to surgically correct without referral is....
septal stenosis - a derivative of vestibulovaginal stenosis
All other congenital abnormalities of the vagina or vestibule should be referred for correction.
104
Septal stenosis is characterized by...
a band of tissue oriented dorsoventrally.
AKA - a double vagina
105
What is the treatment of choice for correcting septal stenosis?
Perform an episiotomy with mucosal resection at the attachments and suture the mucosa OR laser ablation.
106
In vaginal edema/hyperplasia, what happens to the vaginal tissue?
The vaginal tissue becomes severely edematous and protrudes from the vulva. There may be discharge or hemorrhage from the vulva and the animal may experience breeding difficulties.
107
What type of condition is vaginal edema/hyperplasia and what type of animals is it commonly seen in?
It is an uncommon, familial condition in large breed dogs <2 years of age in proestrus or estrus.
108
What are some of the non-specific indications of vulvar disease?
licking
dysuria
perineal enlargement
109
Medical treatment of vaginal hyperplasia/prolapse includes administration of what drugs and what do these drugs do?
Vaginal hyperplasia/prolapse resolves ar the end of estrus.
Gonadotropin releasing hormone or human chorionic gonadotropin will induce ovulation and shorten estrus.
110
What surgical procedure prevents recurrence of vaginal hyperplasia/prolapse?
ovariectomy will prevent recurrence
111
If the vaginal tissue is damaged, what surgical steps are taken to correct the vaginal hyperplasia/prolapse?
resect the prolapsed tissue at the base (via an episiotomy approach) and perform an ovariectomy
112
Treatment of choice for vaginal prolapse (very rare) is what?
Manual reduction and OHE
113
80% of vaginal neoplasia is benign and most commonly _______. Other benign vaginal neoplasia(s) are...
Leiomyoma - most common
Fibroma, polyps, and cysts
114
The most common malignant vaginal neoplasm is...
| Others include...
Leiomyosarcoma - most common
TVT, TCC
115
Treatment of benign vaginal neoplasia is...
local resection via episiotomy and recommend ovariohysterectomy
116
Treatment of malignant vaginal neoplasia is...
referral procedures!
| Aggressive resection with wide borders often requiring vulvovaginectomy and perineal urethrostomy.
117
What is the treatment of choice for TVT?
Medical treatment!
Vincristine
118
What type of abnormality is a recessed or hooded vulva?
conformational abnormality where the vulva is engulfed by skin
119
What is an episioplasty?
Episioplasty is a reconstructive procedure that excises skin folds around the vulva and draws the labia caudally.
120
What is an episioplasty used to alleviate and what must be under control before surgery?
Episioplasty alleviates perivulvular dermatitis and dermatitis must be controlled before surgery.
121
Define anorchism.
Anorchism - the absence of both testicles
122
Define monorchism.
Monorchism - the absence of one testicle
123
Define Cryptorchism/Cryptorchidism.
Cryptorchism/cryptorchidism - a developmental problem of the gubernaculum; one or both testicles not descended into the scrotum
124
At what age do the testicles typically descend in a young male? At what age can you diagnose a cryptorchid patient?
Most testicles descent within 30-40 days.
You can diagnose a cryptorchid patient if the testicles have not descended by 6 months of age.
125
What are the 3 classification categories of cryptorchidism?
Location - abdominal, inguinal, or prescrotal
Side - right or left
Type - unilateral or bilateral
126
T/F - Bilateral cryptorchidism is common in dogs.
FALSE!
| Cryptorchidism is more commonly UNILATERAL in dogs.
127
Why is a cryptorchid testicle sterile?
The temperature is too high for spermatogenesis in the cryptorchid testicle.
128
How does cryptorchidism affect the normal testicle?
The normal testicle will have suppressed spermatogenesis.
129
What does cryptorchidism predispose patients to?
neoplasia
| torsion
130
In the canine cryptorchid patient, you should also check for what other 4 diseases?
1. hip dysplasia
2. patellar luxation
3. penile or preputial defects
4. umbilical hernia
131
In the feline cryptorchid patient, you should also check for what other 4 diseases?
1. patellar luxation
2. shortened or kinked tail
3. tarsal deformities
4. eyelid agenesis
132
When performing a castration on a patient who has an abdominal cryptorchid testicle, what approach should you take?
Confirm the cryptorchid testes' location via US and then take a caudal paramedian abdominal approach OR move back to the ventral midline - between the umbilicus and cranial to the end of the prepuce (especially if you cannot locate the non-descended testicle on US).
133
During a castration on a patient who has an abdominal cryptorchid testicle, what anatomic structure should you follow in order to locate the cryptorchid testicle?
follow the testicular artery OR the vas deferens
134
Typically in an abdominal cryptorchid, the testicle can be located anywhere between what 2 anatomic structures?
the non-descended testicle can be anywhere between the caudal pole of the kidney and the inguinal ring
135
What clinical signs are typically indicative of testicular torsion?
anorexia, lethargy AKA the patient is ADR on presentation....
more specifically = acute abdomen, shock and death
136
What are the 2 diagnostic methods for diagnosing a patient with suspected testicular torsion?
Ultrasound - Dopple blood flow is absent
| Exploratory
137
What is the incidence of testicular neoplasia in small animal patients?
1-16%
| Rare in cats.
138
What are the 3 types of testicular neoplasia in small animal patients?
Interstitial Cell
Sertoli Cell
Seminoma
139
40% of the time, a testicular neoplasia is _______(unilateral/bilateral) and _____________ (of one origin/mixed).
40% of the time, a testicular neoplasia is bilateral and mixed.
140
T/F - A cryptorchid patient is at an increased risk for developing testicular neoplasia.
True!
141
Sertoli cell tumors produce what hormone?
estrogen
142
What are the clinical signs associated with a sertoli cell tumor?
```
feminization (40%)
bilateral symmetrical alopecia
gynecomastia
penile atrophy
squamous metaplasia of the prostate/prostatic cysts
```
143
What chemistry abnormalities do you expect to see in a patient with suspected sertoli cell tumor?
anemia and leukopenia
| *this is BAD - it is not always a reversible finding*
144
T/F - Sertoli Cell tumors have a high metastatic rate.
False!
Sertoli cell tumors have a low metastatic rate.
145
Interstitial cell tumors produce what hormone?
testosterone
146
What does an interstitial cell tumor predispose the patient to?
perineal hernia
perianal adenoma
anal gland adenocarcinoma
147
The treatment of choice for testicular neoplasia is...
castration/scrotal ablation - can be curative if there is no metastasis
148
What are the surgical diseases of the scrotum?
1. trauma
2. ulcerative dermatitis
3. sunburn
4. frostbite
5. infection/abscess
6. complications from orchiectomy
7. neoplasia - MST, melanoma, SCC
149
The treatment of choice for scrotal diseases that are nor amenable to medical management is....
SCROTAL ABLATION
150
When is a scrotal ablation indicated?
neoplasia
infection
trauma
castration of older, large breed dogs
151
How many layers of closure is involved in a scrotal ablation?
3 layer closure
152
What are the surgical conditions of the penis and prepuce?
1. hypospadias
2. trauma/fractures
3. paraphymosis
4. phimosis
5. neoplasia
153
What are the surgical procedures of the penis and prepuce?
1. penile amputation
2. preputial advancement
3. phallopexy
154
Trauma or strangulation of the penis can be managed by...
1. conservative management
2. catheterize if there is urethral trauma
3. penile amputation if the penis is necrotic
155
If there is a fracture of the os penis, you should manage it by..
1. conservative management possibly including urethral catheterization
2. wire or finger plate if there is a comminuted fracture
156
When is a penile amputation indicated?
1. gangrenous penis
| 2. severe urethral trauma
157
What are the tumors you may see of the penis/prepuce?
```
Papilloma
SCC
Osteosarcoma
MCT
TVT
```
158
What penile/preputial neoplasia should not be managed surgically?
TVT
159
For most penile/preputial tumors, the treatment of choice is....
surgical resection or partial penile amputation
160
Define paraphimosis.
Paraphimosis - inability to retract the penis into the prepuce.
161
Paraphimosis can lead to...
congestion, discoloration and necrosis
162
In a patient with paraphimosis, if the tissue is viable, how would you manage it?
Lubricants and hyperosmolar agents as well as reducing the edema with hyperosmotic agents or cold H20.
163
In a patient with paraphimosis, if the tissue is non-reducable due to 1. a narrow orifice or 2. a short prepuce, how would you manage it?
If the cause is a narrow orifice - preputiotomy
| If the cause is a short prepuce - preputial advancement
164
In a patient with recurrent or persistent paraphimosis, how would you manage it?
Phallopexy
165
In a patient with necrotic or gangrenous tissue due to persistent paraphimosis, how would you manage it?
penile amputation
166
Define Phimosis.
Phimosis - the inability to protrude the penis beyond the preputial orifice
167
Clinical signs of phimosis include...
unusual urine streams
Balanoposthitis from retention of urine
extremely fowl odor
168
Congenital phimosis is due to...
a distended prepuce
169
Acquired phimosis is due to...
preputial trauma or neoplasia
170
What are the appropriate treatment options for phimosis?
fish mouth - enlarging the preputial orifice
OR
surgically shortening the prepuce
171
What are the surgical diseases of the prostate?
1. benign prostatic hyperplasia
2. prostatic abscess
3. prostatic neoplasia
172
What are the surgical procedures of the prostate?
castration (part of the treatment for ALL prostatic diseases EXCEPT neoplasia)
drainage procedures
partial prostatectomy
total prostatectomy
173
Where is the nerve and blood supply of the prostate located?
on the dorsal aspect
174
The prostate encircles what anatomic structure?
the urethra
175
Prostatomegaly is a clinical sign of what prostatic disease(s)?
Prostatic hyperplasia
Prostatic abscess
prostatic cyst
prostatic neoplasia
176
T/F - A painful prostatic palpation is indicative of prostatic hyperplasia and/or prostatic cysts.
False.
| There will NOT be pain of palpation.
177
On prostatic cytology, hemorrhage is a sign of what 3 prostatic disease?
prostatic hyperplasia, prostatic cysts, and prostatic abscess*
*cytology of a prostatic abscess will also reveal inflammation and bacteria
178
Pyuria is a potential clinical sign of what 2 prostatic diseases?
prostatic abscess and prostatic neoplasia
179
What canine breed typically has really large prostates on physical exam?
Scottish Terriers
180
Benign Prostatic Hyperplasia is not neoplastic but can predispose the patient to....
prostatic cysts
181
T/F - Benign Prostatic Hyperplasia is an abnormal aging change.
False.
Benign prostatic hyperplasia is a NORMAL aging chance.
182
The cause of benign prostatic hyperplasia is due to...
an increased number and sensitivity of testosterone receptors
183
Clinical signs of benign prostatic hyperplasia include...
could be asymptomatic
dyschezia
ribbon-like feces
*it is unusual for this condition to cause urinary problems
184
On prostatic palpation on a patient with suspected benign prostatic hyperplasia, what would you expect?
Symmetrical enlargement, PAIN FREE
185
What is the treatment of choice for benign prostatic hyperplasia?
Castration - curative!
186
When an older castrated dog is presented with prostatic disease, what is the most common cause (with or without a prostatic abscess)?
NEOPLASIA
187
Clinical signs of prostatitis/prostatic abscess include...
```
dyschezia
PAINFUL URINATION
purulent discharge
FEVER
PAINFUL ASYMMETRICAL prostate
anorexia/lethargy
cardiac arrhythmias
sepsis, depression, death
```
188
In a patient with suspected prostatic abscess, bloodwork will show...
leukocytosis
| increased globulins
189
In mild cases of prostatic abscess, treatment options include...
castration
| systemic antibiotics - enrofloxacin or TMS
190
In severe cases of prostatic abscess, treatment options include...
supportive cafre
systemic antibiotics - enrofloxacin or TMS
prostatic drainage
castration
191
The proper prostatic drainage procedure is...why?
omentalization - it eliminates problems with other procedures by shortening hospitalization, no ascending infections, no peristomal dermatitis, LESS REOCCURRENCE, more appropriate drainage of all sites and BETTER SUCCESS
192
Define prostatic cysts.
Prostatic cysts - accumulation of glandular secretions within the prostate
193
What is the typical signalment of a patient with a prostatic cyst?
Older, IN TACT males
194
What are prostatic cysts associated with?
prostatic cysts are associated with benign prostatic hyperplasia and hormone imbalances
195
clinical signs of a prostatic cysts include...
```
caudal abdominal mass
may be asymptomatic
AFEBRILE
abdominal dissension
urinary incontinence and dysuria (unlike other prostatic disease)
```
196
T/F - Parenchymal prostatic cysts are uncommon.
False.
| Parenchymal prostatic cysts are COMMON.
197
T/F - Periprostatic cysts are uncommon.
TRUE!
198
Describe periprostatic cysts
periprostatic cysts are often large, adjacent to the prostate, and have the clinical effects of a mass lesion.
199
What signs are diagnostic for prostatic cysts?
elongated urethra on contrast rads.
"double bladder" sign on ultrasound
brown, watery fluid with NO microorganisms on FNA
200
Treatment options for small prostatic cysts include...
surgical resection
| castration
201
Treatment options for large cysts or cysts with capsular/urethral communication include...
partial resection
drainage
omentalization
castration
202
The most common prostatic disease in dogs who were castrated young is...
prostatic neoplasia
203
What is the most common prostatic neoplasia?
adenocarcinoma
204
Other than adenocarcinoma, what other neoplasia(s) affect the prostate?
TCC
| SCC
205
Clinical signs of prostatic neoplasia include...
```
dysuria
hematuria
STRAINING TO DEFECATE
ribbon-like feces
lameness (due to metastasis)
LARGE, ASYMMETRICAL PROSTATE
```
206
Treatment options for prostatic neoplasia include...
Treatment is often NOT pursued due to advanced disease.
Palliative Txt: tube cystotomy or urethral stent
If it is early detection or a small lesion: partial prostatectomy, complete prostatectomy +/- radiation therapy.
207
When is a subtotal prostatectomy indicated?
multilocular abscesses
recurrent abscesses
neoplasia (rarely)
208
When is a total prostatectomy indicated?
ONLY indicated for EARLY NEOPLASIA
209
What is the percentage of patients who end up incontinent following a total prostatectomy?
80% incontinence
210
What are the 5 paired mammary glands in the canine?
Cranial/Caudal thoracic
Cranial/Caudal abdominal
Inguinal
211
Where do the 3 cranial mammary glands of the canine get their blood supply from?
lateral thoracic
| Cranial superficial epigastric
212
Where do the 2 caudal mammary glands of the canine get their blood supply from?
caudal superficial perigastric
213
Lymph drainage in the canine for mammary glands 1 and 2 is via...
the axillary lymph nodes
214
Lymph drainage in the canine for mammary glands 4 and 5 is via...
the inguinal lymph nodes
215
Lymph drainage in the canine for mammary gland 3 is via...
the axillary lymph node
216
The 4 paired mammary glands of the feline are...
thoracic
cranial/caudal abdominal
inguinal
217
Lymph drainage in the feline for the thoracic and cranial abdominal* mammary glands is via...
the axillary lymph node
| *cranial abdominal can also drain into the inguinal
218
Lymph drainage in the feline for the caudal abdominal* and inguinal mammary glands is via...
the inguinal lymph node
| *caudal abdominal can also drain into the axillary
219
In the canine, the most common site for a mammary tumor is...
the 4th and 5th mammary glands
220
In the feline, 1/3 of all tumors are in the ________.
mammary glands
221
The type of mammary tumor in the feline patient is....
adenocarcinoma
222
What is the percent malignancy of mammary tumors in the dog? In the cat?
Dog - 35-50%
| Cat - >90%
223
To prevent mammary tumor development in both the canine and feline, what is recommended?
Early ovariectomy or ovariohysterectomy.
224
Surgical procedures for mammary tumor(s) in the canine patient include...
lumpectomy
mastectomy
regional mastectomy
full chain mastectomy
225
Surgical procedures for mammary tumor(s) in the feline patient include...
FULL CHAIN MASTECTOMY
226
Prognosis for mammary tumor(s) in the canine patient is....in the feline patient?
Canine - excellent to poor
| feline - guarded to poor
227
T/F - The most common sire of neoplasia in the female dog is the mammary gland.
TRUE!
42-70% of all tumors in the female dog are mammary gland tumors
228
If a dog undergoes an OHE before its 1st estrus, it's risk of developing mammary tumors is _____.
0.5%
229
If a dog undergoes an OHE before its 2nd estrus, it's risk of developing mammary tumors is ____.
8%
230
If a dog undergoes an OHE <2 years of age, it's risk of developing mammary tumors is _____.
26%
231
If a dog undergoes an OHE >2 years of age, it's risk of developing mammary tumors is _____.
there is no effect on the development of malignant tumors
232
Aside from the time a female dog undergoes an OHE, what other risk factors are there for the development of mammary tumors?
Obesity at <1 year old
administration of progestins
presence of benign tumors
233
50% of canine mammary tumors are benign and the types are....
mixed mammary tumor (fibroadenomas)
adenoma
benign mesenchymal tumors
234
50% of canine mammary tumors are malignant and the types are...
carcinoma/adenocarcinoma - the most common malignant tumor
sarcoma (<5%)
Carcinosarcoma - malignant mixed mammary tumor
inflammatory carcinoma
235
T/F - In the canine patient with a suspect mammary tumor, it is uncommon for multiple tumors to be present.
False.
It is COMMON for multiple tumors to be present in the canine.
236
What pair of glands have a higher incidence of developing mammary tumors in the canine?
The caudal (4th or 5th) glands.
237
What is the percentage of thoracic metastasis at the time of diagnosis in the canine patient with mammary tumors?
25-50% of dogs with malignant tumors
238
Benign tumors of the canine mammary glands express ____% of estrogen receptors.
Benign tumors of the canine mammary glands express 96% of estrogen receptors.
239
Malignant tumors of the canine mammary glands express ____% of estrogen receptors.
Malignant tumors of the canine mammary glands express 51% of estrogen receptors.
240
Benign tumors of the canine mammary glands express ____% of progesterone receptors.
Benign tumors of the canine mammary glands express 100% of progesterone receptors.
241
Malignant tumors of the canine mammary glands express ____% of progesterone receptors.
Malignant tumors of the canine mammary glands express 72% of progesterone receptors.
242
In dogs, the standard of practice in diagnosing mammary tumors in via __________.
Excision biopsy
243
In cats, diagnosing mammary tumors is via _____.
FNA
244
Treatment of choice for all mammary tumors is ____________ UNLESS:
Treatment of choice for all mammary tumors is SURGICAL RESECTION UNLESS:
1. inflammatory carcinoma
2. presence of distant metastasis
245
What are the benefits of an adjunct OHE with surgical resection in patients with mammary tumors?
OHE decreases the incidence of new BENIGN tumor formation (NOT MALIGNANT TUMORS).
Regression of normal mammary tissue - making tissue development easier to find.
246
When should you perform your OHE/Surgical resection in a patient with mammary tumors? Why?
Perform the OHE BEFORE surgically resecting the mammary tumors.
This avoids tumor seeding and decreases anesthesia time.
247
Define lumpectomy.
Lumpectomy - excision biopsy - removal of the tumor ONLY
248
Define simple or local mastectomy.
Simple of Local Mastectomy - removal of the tumor and its gland of origin.
249
Define regional mastectomy.
Regional mastectomy - removal of 2 or more glands with their associated lymphatic structures.
Ex: 4th and 5th glands of the canine
250
Define Full Chain/Radical Mastectomy.
Full Chain/Radical Mastectomy - removal of the entire chain and associated lymphatic structures.
251
When would you perform a Unilateral Mastectomy?
If the tumor(s) is confined to one mammary chain.
252
How would you perform a staged bilateral mastectomy?
With 6 week interval(s) between surgeries.
253
Ovariohysterectomy at the time of diagnosis of mammary tumors WILL....
eliminate hormonal influence on existing tumors and will prevent uterine disease.
254
Ovariohysterectomy at the time of diagnosis of mammary tumors WILL NOT...
prevent development of additional malignant mammary tumors.
255
If a patient presents with a mammary tumor of the 3rd gland, you should perform a....why?
FULL CHAIN MASTECTOMY
| The 3rd gland ALWAYS drains cranially and sometimes drains caudally.
256
If you have a small, freely moveable mass on the periphery of the gland, you should perform a...
lumpectomy.
257
If you have a mass that is central in the gland, you should perform a...
simple mastectomy.
258
If you have masses in both inguinal glands on one side of the patient, you should perform a...
regional mastectomy.
259
If you have masses in the cranial and caudal mammary glands, you should perform....
multiple simply mastectomy procedures
OR
chain mastectomy
260
Indications for a lumpectomy are...
small tumors <5cm
tumor is know to be benign
mass is between glands or near the edge
261
Contraindications for a lumpectomy are...
any COM
| a mass in the middle of a gland
262
Indications for a simple mastectomy are...
larger fixed solitary tumors 1-2cm
| centrally located tumors
263
Contraindications for a simple mastectomy are...
there is more than 1 COM
| a mass >2cm
264
Indications for a regional mastectomy...
multiple tumors
| larger tumors
265
If you have tumors in glands 1 and 2, you should remove...
glands 1, 2 and 3
266
If you have tumors in glands 4 and 5, you should remove...
glands 3, 4, and 5
267
If you have tumors in gland 3, you should remove...
you perform a CHAIN MASTECTOMY
268
What percentage of tumors in the feline are mammary tumors?
17% if all feline tumors are mammary tumors
269
What percentage of mammary tumors in the feline are malignant?
80% of feline mammary tumors are malignant (adenocarcinomas)
270
What percentage of mammary tumors in the feline have metastasis at presentation?
80% of feline mammary tumors have metastasis on presentation
271
What percentage of feline mammary tumors are multiple?
>50% of feline mammary tumors are multiple
272
If a cat undergoes an OHE at <6 months of age, it's risk of developing mammary tumors is _____.
10%
273
If a cat undergoes an OHE at <1 year of age, it's risk of developing mammary tumors is _____.
15%
274
T/F - In the feline patient, all 4 pairs of mammary glands are at equal risk for developing mammary tumors.
True
275
T/F - Feline mammary tumors are often firm and ulcerated.
True
276
What may be associated with development of malignant mammary tumors in cats?
Exogenous progesterone
277
In the feline patient with mammary tumor(s), treatment of choice is...
Chain Mastectomy regardless of the tumor.
278
T/F - In the feline patient, full chain mastectomy decreases risk of local recurrence of mammary tumors.
True
279
Define canine mammary hyperplasia.
Canine mammary hyperplasia - rapid development of small multiple masses after a heat cycle (progesterone)
280
T/F - Canine mammary hyperplasia is commonly symmetrical, painful, affects most glands and typically does not resolve with OHE.
False!
Canine mammary hyperplasia is commonly symmetrical, NON-PAINFUL, affects most glands and usually RESOLVES within weeks after OHE.
281
Fibroadenomatous hyperplasia is benign or malignant lesion in cats at what age?
Benign
| <2 years old
282
Fibroadenomatous hyperplasia is estrogen or progesterone dependent?
progesterone dependent
283
When is fibroadenomatous hyperplasia first seen?
after the first estrus
after progestin treatment
after pregnancy
284
define fibroadenomatous hyperplasia
fibroadenomatous hyperplasia - rapid proliferation and mammary gland enlargement
285
What is the treatment for fibroadenomatous hyperplasia?
OHE/OVE
Consider a flank approach
Resolves in weeks.
