Ch 109 - Ovaries and uterus Flashcards

1
Q

Where do the ovarian arteries arise from the aorta?

A

Caudal to renal arteries and cranial to deep circumflex iliac arteries

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2
Q

Where do the ovarian vein drain into?

A
  • Right ovarian vein drains into the caudal vena cava
  • Left ovarian vein drains into the renal vein
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3
Q

What are the layers of the uterus?

A
  • Serosa
  • Muscularis
  • Mucosa (endometrium)

Endometrium is the thickest layer

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4
Q

What are the 4 phases of the oestrus cycle?
How does the oestrus cycle differ in cats from dogs?

A
  • Proestrus
  • Oestrus
  • Diestrus
  • Anestrus

Cats:
- proestrus is much shorter and is not externally visible (feline vulva is not responsive to oestrogen)
- Formation of corpus lutea requires induction of ovulation, in non-pregnant cats will remain functional for 37d
- Dogs ovulate spontaneously, progesterone dominance seen for 60-100d in non pregnant bitches

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5
Q

How can parturition be predicted in a dog?

A
  • 64-66 d after LH peak
  • Preovulatory progesterone rise to 1.5ng/ml - 65 +/- 3d
  • Skeletons detectable by d42 (20-21d to parturition), pelvises by day 57
  • Progesterone drop to 2-3ng/ml 18-30hr
  • Body temp drops 10-14hr after progesterone drop, parturition imminent
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6
Q

List the three stages of parturition

A
  • Stage 1: Externally non-visible uterine contractions, behavioural changes. Lasts up to 24hr
  • Stage 2: Expulsion of a foetus
  • Stage 3: Expulsion of placenta

Stage 2 and 3 alternate and lasts up to 36hr. Active straining should not exceed 30 mins without expulsion of a pup and there should not be more than 4 hr between each puppy

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7
Q

How does pregnancy and parturition differ in cats?

A
  • Placental secretion of progesterone independant of the ovaries occurs in cats after day 40
  • In less than 1% of litters, parturition may be interrupted for up to 48hr
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8
Q

What % of intact bitches are reported to get pyometra?

A

24%

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9
Q

What are some consequences of OVH?

A
  • Increases risk of TCC, OSA, cardiac tumours, HSA
  • OSA more commin in Rottweilers spayed under 1yr
  • Viszlas increased risk of HSA and MCT
  • Increased risk of diabetes in cats
  • Increased risk of hypothyroidism in dogs
  • Spayed dogs 2x risk of obesity
  • USMI in up to 20% spayed bitches as compared to 0.2-0.3% of the intact population. Larger dogs 7x more likely than dogs under 15kg
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10
Q

What sized vessels and uterine bodies can be sealed with a Ligasure?
What sized vessels can be sealed with an ultrasonic sealing device?

A

Ligasure:
- 7mm vessels
- 9mm uterine body

Ultrasonic:
5mm vessels

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11
Q

What is the incidence of periop complications after OVH?

A
  • 7.5-19% dogs
  • 12% cats
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12
Q

How does aminocaproic acid work?

A

Inhibitory effects of plasminogen activators and plasmin, thererby inhibiting fibrinolysis

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13
Q

List the basic concepts of a laparoscopic spay

A
  • 15-degree Trendelenberg position
  • Pneumoperitoneum of 10-12mmHg
  • 3 post technique (30mm caudal to umbilicus, 30-50mm cranial to umbilicus and 30-50mm cranial to pubis)
  • Uterine bodies less than 9mm sealed with Ligasure have a median bursting strength of 237mmHg
  • Low complication rate approx 2%
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14
Q

What is a NOTES approach?

A

Natural Orifice Transluminal Endoscopic Surgery
- Has been describes experimentally for ovariectomy in 20 bitches

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15
Q

WHat is the reported incidence of ovarian remnant syndrome with lap ovariectomy?

A

0.5%

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16
Q

Can you FNA an ovarian mass?

A

Not recommended - high rate of seeding

17
Q

What are the most common ovarian tumours?

A

Dogs:
- Granulosa cell tumour - 50%
- Epithelial cell tumours (papillary adenoma/adenocarcinoma, cystadenoma, undifferentiated carcinoma) - 40-50%
- Dysgerminoma, teratoma, teratocarcinoma 6-12%
- Rhabdomyosarcoma

Cats:
- Granulose cell tumour - 50%
- Dysgerminoma
- Epithelial cell tumour - rare

18
Q

Which ovarian tumour:
- Produces oestrogen and/or progesterone
- May be bilateral
- May be calcified
- May cause bone marrow aplasia and irreversible pancytopaenia
- Arise from rete ovarii

A
  • Oestrogen/progesterone - granulosa cell tumour
  • Bilateral - papillary tumours
  • Calcified - teratoma
  • Bone Marrow aplasia - granulosa cell tumour
  • Rete ovarii - cystadenomas
19
Q

List the types of functional ovarian cysts
What are the treatment options?

A
  • Follicular cysts - lines with granulosa cells and produce oestrogen and prolong proestrus
  • Luteinised cysts - produce progesterone - prolonged diestrus

Tx options:
- May spontaneously resolve - nothing!
- GnRH or hCG
- Ovariectomy

Normal preovulatory follciles 4-9mm, functional cysts 10-15mm

20
Q

How can you diagnose ovarian remnant syndrome?

A
  • Serum estradiol over 15pg/ml and progesterone over 2ng/ml - likely
  • Single low LH concentration indicates functioning ovarian tissue
  • Anti-Mullerian hormone - benefit of being independant of the ovarian cycle

Ovarian neoplasia has been diagnosed in 5/21 and 2/7 animals with ovarian remnant - submit for histo

21
Q

How does an entire status increase the risk of pyometra?

A
  • Progesterone leads to cystic endometrial hyperplasia which predisposes to secondary infection
  • Oestrogen enhances endometrial response to progesterone
  • Progesteron stimulates glandular secretions and inhibits uterine contractions
  • Progesterone decreases the ability for proliferative mononuclear response in the uterus
22
Q

What is the most common bacteria isolated from pyometra?
What virulence factors are associated with canine pyometra?

A

E.Coli
- alphs-haemolysin
- P-fimbriae
- cytotoxic necrotising factor

Concurrent cystitis in up to 70% with identical E.Coli

23
Q

What % of dogs with pyometra also have SIRS?
What needs to be monitored in patients with SIRS?

A
  • 47%
24
Q

What causes anaemia of chronic disease (in this case during pyometra)?

A
  • Lactoferrin and other acute phase reactants mediate an iron sequestration within the myeloid cells in the bone marrow, withdrawing iron from normal erythropoiesis
25
Q

What are the acute phase proteins in bitches with pyometra?

A
  • CRP
  • Serum amyloid A
  • Haptoglobins
26
Q

List the mainstays of medical management of pyometra

A
  • ABx for atleast 14d
  • PGF-2a - causes contraction of myometrium and relaxation of cervix. 48-hr lag time
  • Dopamine agonists (cabergoline)
  • GnRH antagonists (Acyline)
  • Progesterone receptor antagonists (aglepristone)
27
Q

What is the mortality rate of pyometra?
What are some negative prognostic indicators?

A

Mortality rate 0-5% dogs, 8% cats
Negative prognostic indicators:
- Septic abdomen from uterine rupture
- Febrile dogs and high CRP - increased morbidity

28
Q

List DDx for pyometra

A
  • Cystic endometrial hyperplasia
  • Mucometra
  • Hydrometra
  • Haematometra
  • Metritis (postpartum rather than dioestrus)
  • Uterine torsion
29
Q

List the indications for a C-section

A
  • 4 hours between puppies
  • Contractions for 30 min
  • Lochia without foetal delivery
  • Obstructed birth canal
  • Abnormal foetal presentation
  • Lack of Ferguson reflex
  • Foetal HR 150-180 or less
  • Absent foetal movements or presence of bowel motion
  • Failed medical management of primary uterine inertian (30-40% successful)
30
Q

By what time should the foetus’ be removed after en-bloc OVH?

A

WIthin 60s of clamping uterine blood supply

31
Q

What are the most common uterine tumours of dogs and cats?

A

Dogs:
- 90% benign leiomyomas
- 10% leiomyosarcoma

Cats:
- Most commonly malignant adenocarcinoma
- More likely to have mets, prognosis guarded