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VMS4001 SEM 2 > Surgery of the female repro tract > Flashcards

Surgery of the female repro tract Flashcards

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1
Q

Give some Therapeutic/Diagnostic indications for surgery?

A
  • Pyometra
  • Dystocia
  • Neoplasia – ovarian/uterine
  • Uterine Torsion
  • Uterine Prolapse
  • Metritis/Mucometra
  • Intersexuality
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2
Q

What are some preventative/elective indications of surgery?

A

Prevention
of oestrus
Pregnancy
Pyometra
Uterine neoplasia
Ovarian neoplasia
Mammary neoplasia?

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3
Q

What are some Congenital causes fo diseases fo the ovary

A
  • agenesis, hypoplasia, supernumerary – incidenta
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4
Q

What are some acquired surgical diseases of the ovary

A
  • Ovarian cysts - prolonged oestrous, cystic mammary hyperplasia, fibroleiomyoma
  • Follicular – ↑ oestrogen
  • Luteal – ↑ progesterone
  • Parovarian – incidental – no Clinical Signs
  • Neoplasia - Abnormal oestroussymptoms in entire animals
  • Epithelial – adenoma or adenocarcinoma
  • Germ cell - dysgerminoma, teratoma, teratocarcinoma
  • Sex cord stroma tumours – granulosa cell tumours
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5
Q

What surgical diseases fo the uterus? Congenital

A
  • Uterus unicornis
  • Hypoplasia
  • Agensis
  • Atresia
  • Segmental aplasia
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6
Q

What acquired surgical dx of uterus?

A
  • Pyometra
  • Hydrometra/mucometra
  • Metritis
  • Torsion
  • Prolapse
  • Rupture
  • Neoplasia
  • Dystocia
  • Intersex
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7
Q

describe risk of mammary tumours & neutering

A

Before 2.5 years marked reduction

Neutering with mammary tumour removal or 2 yrs before diagnosis,
associated with longer survival and reduced risk of tumour recurrence

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8
Q

Mammary neoplasia in cats?

A

▪ Entire female cats 7 times more likely to get mammary neoplasia
▪ Induced ovulator, large litter sizes, multiple litters per year
➢ pregnancy prevention very important
» Median survival <1 year and 96% malignant

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9
Q

What other dx prevented by spaying?

A

Pyometra - potentially lfie threatening

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10
Q

Complications of spay?

A

HAEMORRHAGE
OVARIAN REMNANT SYDROME
URINARY INCONTINENCE
STUMP PYOMETRA
SPLENIC/ORGAN LACERATION
FISTULAS
WOUND BREAKDOWN/HERNIATION
URETERAL TRAUMA
OBESITY
BEHAVIOUR PROBLEMS

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11
Q

What do we do abotu haemorrhage as psot- op complication?

A

➢ Is the bitch bleeding-consider ultrasound
➢ Is there a coagulopathy?
➢ Stabilisation-fluid therapy
➢ Bandaging
➢ Ex lap when stable
➢ Use an assistant/abdominal retractors /lap swabs
➢ Colonic manoever/duodenal manoevre
➢ Check ovarian pedicles and cervical stumps
➢ Check for bleeding broad ligament
➢ Check other organs

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12
Q

Describe Diagnosis of Ovariant Remnent Syndrome

A

> vaginal cytology
* keratinisation of epithelial cells
* absence of polymorphonuclear leukocytes consistent with oestrogen secretion

> hormone assays
* serum progesterone ↑
* oestradiol ↑ than neutered bitch
* dynamic testing hcg or gnrh

> abdominal ultrasonography or CT

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13
Q

What used to be a good tool to diagnose ORS?

A

AMH

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14
Q

Describe Stump Pyometra

A

➢This is thought to be rare if no uterine tissue left
➢ More commonly granuloma secondary to suture material

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15
Q

Describe Ureteral Trauma

A

➢ More commonly reported at cervical end
➢This is why ovariectomy has become more popular

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16
Q

Describe urinary incontinence

A
  • common; middle-aged to olderspayed bitches
  • incidence 5-20%-> more in large breed dogs
  • medical treatment successfully controlssymptomsin 65-75% of dogs
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17
Q

Describe obesity risk

A

➢ Neutered animals = ↑ overweight
➢ It is not clear if age at neutering affectsthis
➢ some studies, neutered animals have ↓ metabolic rate
➢ others have found comparable metabolic rates
➢ There is evidence that neutered animals eat more and expend less energy

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18
Q

How can we avoid haemorrhage as complication?

A

➢ Increased risk in large dogs with lots of fat
- Ensure good visualisation
- Controlled rupture of suspensory lig
- Good lig technique -> double
- Check pedicles

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19
Q

What routine complications?

A

➢ Infection/wound dehiscence
➢ Seroma
➢ Incisional hernia

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20
Q

Why don’t we want to use cargut?

A

Stump granuloma/abscess - catgut

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21
Q

How can we decrease risk of ORS / stump pyo

A

➢ Good exposure
➢ Large incision
➢ Break suspensory ligament
➢ Palpate ovary when placing clamps – hold between thumb/forefinger of nondominant hand
➢ Place ligatures as deep as possible
➢ Inspect ovary at removal
➢ Open bursa and check intact

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22
Q

How to avoid iatrogenic pseudopreg?

A

Spat around 3 months post season

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23
Q

What do we call swab being left in?

A

Gossypyboma

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24
Q

How to avoid ureteral injuries

A

➢ Good exposure
➢ Know anatomy
➢ Ureteral injury at the ovaries or bladder
➢ Direct visualisation if pick up pedicle/place extra ligature after transection
➢ Empty bladder pre op

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25
Describe Pyometra
* CEM can precede pyometra but not always * Normal vaginal flora enters relaxed cervix * Progesterone → endometrial growth & secretions → thickened endometrium lined with cysts * inhibits immune response * supresses myometrial activity/contractions * Oestrogen – enhances effects of progesterone
26
CLS of Pyo?
* +/- vaginal discharge * PU/PD * Depression/Lethargy * Anorexia * Vomiting/Diarrhoea * +/-Pyrexia * 4-8 weeks post season
27
Diagnosis of Pyo?
- Hx & CLS - Abdo palp - Haem /Biochem - Acidosis - **ULTRASOUND** - Urine sample
28
Describe Haem and biochem for pyo?
> Haematology * Leucocytosis-Neutrophilia+left shift * Anaemia > Biochemistry * Hypoalbuminaemia * Hyperglobulinaemia * Azotaemia (prerenal)
29
Best tx for pyo?
OVH -> fluid therapy & antibiotics
30
What would medicalmanagement of pyo be?
* Reserved for bitches with high breeding value/unable to undergo GA/Sx * Not always successful * High rate of recurrence at next season * Delay in response – septic/peritonitis/closed cervix
31
describe uterine inertia?
= lack of sufficient uterine contractions to expel foetus ➢ large litter, small litter, hypocalcaemia, hypoglycaemia, obesity, septicaemia, fetal oversize (small litters/brachys), fetal mortality, pelvic obstruction, uterine torsion/rupture
32
Signs of Dystocia
* Gestation >70 days * Green vaginal discharge without delivery of a foetus * > two hours after foetal fluids released with no foetus delivered * > three to four hours since birth of last foetus * Bitch/queen exhibits extreme discomfort, systemic illness or exhaustion * >30 minutes of strong, regular contractions without delivery of foetus * Significant bloody discharge for more than 10 minutes
33
How to investigate dystocia?
➢ Vaginal examination ➢ PCV, TP,Electrolytes, blood glucose, iCa ➢ Ultrasound +/- Radiographs
34
Medical tx for dystocia?
➢ Oxytocin – 3 doses 30 min apart ➢ Correct hypoglycaemia, hypocalcaemia ➢ Lubrication ➢ Digital manipulation
35
Surgical tx of dystocia?
➢ Caesarean- incision in uterine body ➢ En bloc ovariohysterectomy
36
Indications for surgical intervention ?
37
How to do a C section? Pt 1
➢ Incise body of uterus ➢ Milk foetuses toward uterine body and out incision ➢ Clamp umbilical cord ➢ Remove placenta via gentle traction ➢ leave if firmly attached
38
C section pt 2?
➢ Pass neonate to non sterile assistant ➢ Repeat for each foetus ➢ check pelvic canal for foetus ➢ Check for uterine contractions – administer oxytocin
39
C section pt3
➢ Uterine closure; absorbable, monofilament in single or double continuous layer ➢ (1st appositional or inverting, 2nd inverting) ➢ Close abdomen routinely ➢ intradermal skin closure to avoid interference with nursing of neonates
40
How do we do a En bloc OVH?
* Isolate entire uterus * Manipulate foetuses away from cervix, back into uterine body * Place forceps across the ovarian pedicles and uterine body and transect routinely (as if OVH) * Pass entire uterus to non sterile assistant for rapid removal of neonates * Time from clamping to removal of neonates should be <60sec * Then ligate pedicles as previously described
41
Rescuc of neonates?
* Clear nares with towels or suction * Gentle rubbing and drying to stimulate breathing * Reverse opioid with naloxone * Mask oxygen if needed * Do not swing * No evidence for use of doxapram
42
How to care for neonates
* Keep neonates warm while dam is recovering * Reunite dam & litter as soon as safely possible under supervision * Clean mammary glands of surgical scrub prior to feeding * Return to home as soon as safely possible * Check regularly for signs of uterine haemorrhage or infection and that suckling and milk production is going smoothly
43
Choice. ofan ovariectomy. -why?
* Does not increase risk of pyometra (multiple studies, spanning decades) * Less traumatic * smaller incision and handle tissues less * Decrease chance of ureteral trauma * Still risk of uterine neoplasia development | No advantage if OVH over OVe in study
44
How to do an ovariectomy
1. Locate ovary 2. Fenestrate mesovariam caudal to the ovarian vessels 3. Place clamps between pedicle and ovary 4. Double ligate vessels by passing suture through fenestration 5. Ligate just cranial to uterine horn by passing suture through fenestration and around mesosalpinx (can clamp and crush) 6. Incise between the pedicle ligatures and ovary 7. Incise between uterine horn ligature and ovary 8. Gently release pedicle and uterine horn and check for bleeding
45
Describe Lap Spay?
- Min invasive - Dec pain post op - Quicker recovery - Reduces blood loss - No suture materials
46
What are some congenital vaginal abnormalities?
* Segmental vaginal aplasia/hypoplasia * Persistent hymen * Rectovaginal/rectovestibular fistula (with atresia ani)
47
What acquired vaginal abnormalities?
* Vaginal neoplasia * Vaginal hyperplasia/vaginal fold prolapse/vaginal prolapse/vaginal oedema * Vaginal prolapse
48
What types of neoplasia do we see from vagina?
* Most benign- leiomyomas, fibroleiomyoma, fibroma, lipoma * 30 % malignant- adenocarcinoma, squamous cell carcinoma, leiomyosarcoma * Transmissible venereal sarcoma exotic disease
49
CLinical signs of vaginal neoplasia?
* dysuria, stranguria, vaginal discharge, faecal tenesmus, bulging perineum or vulva or protruding mass
50
Describe Transmissible venreal sarcoma ?
▪ Transmitted during mating ▪ Exotic disease to the UK ▪ May be seen in imported dogs ▪ Can be treated with vincristine
51
Diagnosis of vaginal neoplasia?
* vaginal exam, location of the mass in relation to the urethral papilla * FNA/biopsy if neoplasia suspected * Rads/US/CT to see extent & staging
52
Tx of vaginal neoplasia?
* Surgical resection via episiotomy +/- ovariohysterectomy. * leiomyomas are hormonally dependent, spay prevents recurrence * Malignant; vulvovaginectomy + perineal urethrostomy reported
53
Describe vaginal hyperplasia?
* Excessive thickening & oedema of vaginal mucosa during oestrus * Ventral vagina, cranial to the urethral orifice, protrudes from the vulva
54
When / who do we see vagina hypeprlasi ain?
* During first three oestrous cycles * Spontaneously resolves * Brachycephalic and large breed dogs
55
Doe surethra usually protrude with vaginal hyperplasia?
* Urethra does not normally protrude * can be identified by lifting the protruding tissue
56
Tx for vaginal hyperplasia
* Keep clean and prevent trauma until resolution * Spay to prevent recurrence * will not hasten resolution during an episode * Surgery via an episiotomy indicated if larger or circumferential
57
Describe true vaginal prolapse?
» Rare » More common in brachys (Boston Terriers)
58
Tx for prolapse?
» Permanent tx = OVH » Conservative management » Resection if macerated/mutilated * Care with urethral orifice » Episiotomy to manually reduce
59
Compare and contrast vaginal hyperplasia, neoplasia, and prolapse
60
What are the surgical diseases fo the vulva?
* Anovulvar cleft * Clitoral hypertrophy (intersex) * Vulval hypoplasia/juvenile vulva * Vulval stenosis
61
Describe Vulval hypoplasia
▪ Neutered or juvenile bitches before first season ▪ Causes moist dermatitis, vaginitis and cystitis ▪ Allow at least one season prior to neutering, may resolve with oestrogen ▪ Otherwise resection via episioplasty
62
Describe hypertrophy
▪ with intersexuality or in normal females receiving anabolic steroids. ▪ causes discomfort when sitting or traumatised by excessive licking ▪ assess for intersexuality ▪ clitoris can be surgically removed
63
What are some surgical techniques for vaginal and vulval dx?
» Episiotomy » Episioplasty » Vaginectomy » Vaginourethroplasty
64
Considerations for vagina/vulva sx
* Epidural analgesia recommended * Purse string suture around anus * Hindlimb hanging posture on table * Tail taped forward
65
Episiotomy closure?
Close in 3 or 4 layers: Vaginal mucosa Vaginal muscle +/- Subcutis Skin
66
Describe episioplasty
Cut out folds causing dermatitis from vulval hypoplasia

VMS4001 SEM 2 (28 decks)

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