A logical approach to clinical disease of the reproductive tract in the dog and cat

Question 1

What is misalliance?

Answer 1

Inadvertent mating

Question 2

What is the logical approach to suspect reproductive cases?

Answer 2

ASK:
Is it a manifestation of normal reproductive physiology?
OR
Is there clinical disease?

Question 3

How do you diagnose repro cases?

Answer 3

History
Clinical signs
PE findings
Combination of some/all of above.

Question 4

What history is important in repro cases?

Answer 4

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

Question 5

How do you perform a clinical exam of a female dog?

Answer 5

General PE
Vulva
Mammary glands
\+/- vaginal and rectal exam
Response to pressure on rump

Question 6

How do you perform a clinical exam of a male dog?

Answer 6

General PE
Scrotum and testes
Prepuce and penis
\+/- mammary gland
Rectal exam

Question 7

What should be noted from the general PE?

Answer 7

BCS
Pyrexia?
Signs of anaemia/shock?
Lymphadenopathy?

Question 8

What should be noted from abdominal examination?

Answer 8

Abdominal mass?
Uterine enlargement?
Fluid thrill?
Visceral displacement?
Pain?

Question 9

What should mammary glands be checked for?

Answer 9

Enlargement, lactation (which nipples, discharge?), masses, pain

Question 10

What should the scrotum be checked for?

Answer 10

Skin, presence of 2 testicles, testicular size, shape, consistency, mobility and pain

Question 11

What should the vulva and prepuce be checked for?

Answer 11

Size, shape and position
Skin abnormalities
Discharge (colour, consistency, smell, inflammation)
Check MM and MCJ
Extrude penis (examine shaft and external urethral orifice)

Question 12

What should you check on a rectal and vaginal exam?

Answer 12

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)

Question 13

What are the signs of oestrus in the bitch?

Answer 13

Vulval enlargement
Standing on rump pressure +/- tail displacement
Haemorrhagic/ straw coloured discharge
Characteristic smell

Question 14

What further diagnostic test can you run?

Answer 14

BLOODS - CBC/biochem, hormonal assay
DIAGNOSTIC IMAGING - radiography (plain/contrast), ultrasound, cross-sectional
ENDOSCOPY
UA and urine culture/sensitivity
PATHOLOGY - aspirate, cytology, biopsy

Question 15

What would haematology and biochemistry allow you to do?

Answer 15

Detection of changes which may indicate:
infection/sepsis
azotaemia
hypo/hypercalcaemia
hypoglycaemia
anaemia

Question 16

Why is UR and urine bacteriology important?

Answer 16

UGTs are closely related (also infections in each)

Question 17

When are hormonal assays useful?

Answer 17

detecting incompletely excised gonadal tissue
aid pregnancy diagnosis
predict ovulation and optimal mating times

Question 18

When is diagnostic imaging useful?

Answer 18

investigation of pregnancy or disease of RPT.

CT is becoming increasingly important

Question 19

When is ultrasound best used?

Answer 19

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

Question 20

What is ultrasound not good at?

Answer 20

NOT GOOD AT:
imaging intrapelvic structures
detecting bony change

Question 21

What is radiography useful for?

Answer 21

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

Question 22

When is endoscopy useful?

Answer 22

To visualise the lumen of the vagina

Question 23

What equipment can be used for vaginal endoscopy?

Answer 23

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.

Question 24

What is a hysteroscopy?

Answer 24

In specialist reproductive medicine, a technique to examine the inside of the uterus.

Question 25

What does endoscopy of vagina allow?

Answer 25

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.

Question 26

Why is it useful to asses vaginal cytology?

Answer 26

Assess stage of reproductive cycle in the bitch (proestrous, oestrous, metoestrous=dioestrus and anoestrous), can be applied to the queen but less useful.

Question 27

How may biopsies be obtained? 4

Answer 27

Incisional
Excisional
Needle (core biopsy)
Grasping forceps

Question 28

What other investigations can be made?

Answer 28

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.