A logical approach to clinical disease of the reproductive tract in the dog and cat Flashcards
What is misalliance?
Inadvertent mating
What is the logical approach to suspect reproductive cases?
ASK:
Is it a manifestation of normal reproductive physiology?
OR
Is there clinical disease?
How do you diagnose repro cases?
History
Clinical signs
PE findings
Combination of some/all of above.
What history is important in repro cases?
Define owner's problem Age, breed, sex Netured/entire Females - last season (when, normal/abnormal, mating?), breeding history Current/planned use of animal Previous illnesses/surgeries Additional general info
How do you perform a clinical exam of a female dog?
General PE Vulva Mammary glands \+/- vaginal and rectal exam Response to pressure on rump
How do you perform a clinical exam of a male dog?
General PE Scrotum and testes Prepuce and penis \+/- mammary gland Rectal exam
What should be noted from the general PE?
BCS
Pyrexia?
Signs of anaemia/shock?
Lymphadenopathy?
What should be noted from abdominal examination?
Abdominal mass? Uterine enlargement? Fluid thrill? Visceral displacement? Pain?
What should mammary glands be checked for?
Enlargement, lactation (which nipples, discharge?), masses, pain
What should the scrotum be checked for?
Skin, presence of 2 testicles, testicular size, shape, consistency, mobility and pain
What should the vulva and prepuce be checked for?
Size, shape and position
Skin abnormalities
Discharge (colour, consistency, smell, inflammation)
Check MM and MCJ
Extrude penis (examine shaft and external urethral orifice)
What should you check on a rectal and vaginal exam?
Digital rectal exam usually well tolerated
Vaginal exam - usually resented in dogs, not possible in most cats
Use lube, gloves, be gentle, adequate restraint
RECTAL - anal sacs, urethra, prostate, vagina, dorsal LNs, pelvic diameter
VAGINAL - cannot feel so cranially and unable to palpate cervix
BIMANUAL EXAM may help (palpate abdomen at same time)
What are the signs of oestrus in the bitch?
Vulval enlargement
Standing on rump pressure +/- tail displacement
Haemorrhagic/ straw coloured discharge
Characteristic smell
What further diagnostic test can you run?
BLOODS - CBC/biochem, hormonal assay DIAGNOSTIC IMAGING - radiography (plain/contrast), ultrasound, cross-sectional ENDOSCOPY UA and urine culture/sensitivity PATHOLOGY - aspirate, cytology, biopsy
What would haematology and biochemistry allow you to do?
Detection of changes which may indicate: infection/sepsis azotaemia hypo/hypercalcaemia hypoglycaemia anaemia
Why is UR and urine bacteriology important?
UGTs are closely related (also infections in each)
When are hormonal assays useful?
detecting incompletely excised gonadal tissue
aid pregnancy diagnosis
predict ovulation and optimal mating times
When is diagnostic imaging useful?
investigation of pregnancy or disease of RPT.
CT is becoming increasingly important
When is ultrasound best used?
Imaging parenchymatous organs Distinguishing fluid from soft tissues Facilitating image guided centesis and biopsies Assessing viability of pregnancy Detecting free abdominal fluid Determining origin of organ enlargement Abdominal pathology/change
What is ultrasound not good at?
NOT GOOD AT:
imaging intrapelvic structures
detecting bony change
What is radiography useful for?
Imaging bony changes (foetal mineralisation, pelvic anatomy, injury to os penis)
Contrast studies - extent and location of luminal abnormalities
Thoracic - aid in detecting pulmonary metastases
When is endoscopy useful?
To visualise the lumen of the vagina
What equipment can be used for vaginal endoscopy?
vaginoscope, otoscope, anoscope. These short scopes are commonly used to examine the vestibule/caudal vagina and place urethra catheters in the female dog and cat. Examination of the entire vagina requires longer rigid or flexible endoscope.
What is a hysteroscopy?
In specialist reproductive medicine, a technique to examine the inside of the uterus.
What does endoscopy of vagina allow?
Vaginal mucosa changes in appearance wrt stage of oestrous cycle (breeding management)
Detection of disorders such as strictures, septae, neoplasia, FBs as well as biopsy and collection of discharge.
Why is it useful to asses vaginal cytology?
Assess stage of reproductive cycle in the bitch (proestrous, oestrous, metoestrous=dioestrus and anoestrous), can be applied to the queen but less useful.
How may biopsies be obtained? 4
Incisional
Excisional
Needle (core biopsy)
Grasping forceps
What other investigations can be made?
VAGINAL/PREPUTIAL BACTERIOLOGY - rarely useful or wise use of money, normal mixed commensal flora
COLLECTION OF EJACULATE - important for investigation of male infertility, rarely collected as part of investigation of clinical disease
PROSTATIC WASH - not a very specific test and eclipsed by ultrasound and guided aspirates
EXPLORATORY LAPAROTOMTY/ LAPAROSCOPY - useful but should be based on confirming DDx with a specific surgical plan following through investigation.
