Ch 109 Ovaries and uterus Flashcards

Question

Clinical Pathologic Parameters in Ovarian Disease

Answer 1

- Persistently high [estrogen] or a single, low serum [LH] in a bitch indicates an intact status or ovarian remnants if the animal was spayed more than 10 days earlier - Chronically increased plasma estrogen concentrations (>20 pg/mL) may be indicative of follicular cysts or estrogen-producing tumors

Answer 2

Not recommended - high rate of seeding

Answer 3

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 | Ultrasound is highly sensitive for the detection of ovarian masses

Answer 4

* Oestrogen/progesterone - granulosa cell tumour * Bilateral - papillary tumours * Calcified - teratoma * BM aplasia - granulosa cell tumour * Rete ovarii - cystadenomas

Answer 5

- very similar - single, nonmetastasized tumors are completely excised, the prognosis is good - estrogen-secreting granulosa cell tumors > bone marrow aplasia and pancytopenia

Answer 6

Follicular cysts - lines with granulosa cells and produce oestogen 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

Answer 7

- most often results from improper surgical technique, inexpereince - Ovarian tissue could also revascularize if dropped into the abdomen - Stump pyometra may also occur - In one study the ovarian remnant was found on the right side in 62%, on the left in 29%, and bilaterally in 10% - Visualization of ovarian remnants may be better during estrus or diestrus

Answer 8

* vaginal cytology: performed during standing heat, are indicative of estrogen dominance * 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 * ultrasound Ovarian neoplasia has been diagnosed in 5/21 and 2/7 animals with ovarian remnant - submit for histo

Answer 9

- Internally the dog has two ovotestes and normal uterine horns and body. - Externally, the dog has a prominent clitoris similar to a penile body

Answer 10

* Progesterone leads to cyctic endometrial hyperplasia which predisposed to secondary infection * Oestrogen enhances endometrial response to progesterone * Progesteron stimulates glandular secretions and inhibits uterine contractions * Progesterone decreases the ability for proliferative response of uterine mononuclear response

Answer 11

- Hormone stimulation alone does not result in pyometra, indicating that pyometra development is multifactorial and involves hormonal and bacteriologic aspects - route of infection of the uterus was suspected to be ascending, hematogenic, or lymphogenic - identical to the dominating E. coli population in feces of the affected dog, suggesting that the uterine strain originates from ascending perineal flora CS - polyuria (71%), lethargy (71%), vomiting or inappetence (75%), and vaginal discharge (52% to 85%) - cervix may spontaneously open or close during the disease, causing intermittent vaginal discharge or a sudden deterioration - inflammatory leukogram with marked increase in total white blood cell (WBC) count and usually a regenerative left shift - Marked increases in concentrations of C-reactive protein, serum amyloid A, pre-op - Dehydration corrected - ab's: cephalosporin or ampicillin - examination or laboratory findings are consistent with SIRS, more extensive supportive care

Answer 12

E.Coli - alphs-haemolysin - P-fimbriae - cytotoxic necrotising factor Concurrent cystitis in up to 70% with identical E.Coli

Answer 13

**57%** Hyperthermia, tachycardia, tachypnea, and neutrophilia or neutropenia

Answer 14

* 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)

Answer 15

- anesthetic complications, - hemorrhage, - peritonitis (13%) - incomplete removal of the ovaries, - wound swelling, wound infection, - fistulous tracts *Surgical and anesthetic complications can be decreased if severely ill bitches receive appropriate therapy to stabilize their condition before surgery*

Answer 16

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

Answer 17

* Cystic endometrial hyperplasia * Mucometra * Hydrometra * Haematometra * Metritis (postpartum rater than dioestrus) * Uterine torsion (various casue, 1% dystocia)

Answer 18

- United Kingdom, Boston Terriers, English Bulldogs, and French Bulldogs had cesarean sections rates of > 80% - Uterine inertia occurs for primary or secondary reasons. primary uterine inertia, parturition fails to proceed (unknown reasons) maternal causes - Primary inertia - birth canal obstruction - torsion, prolapse foetal causes - Malposition - malformation, oversize

Answer 19

* 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) > oxytocin (0.2 U/5 kg)

Answer 20

WIthin 60s of clamping uterine blood supply

Answer 21

- Puppy mortality rate was decreased when propofol and isoflurane were used - without premedication - If fetal heart rates are low, atropine is administered - soon after induction of anesthesia to minimize the neonatal respiratory depression associated with isoflurane administration. - ventral midline incision into the body of the uterus - Long umbilical cords provide ready access to the umbilical vein in case intravenous medications are required - Gentle traction is again applied to retained placentas before hysterotomy closure - Closure: single-layer continuous pattern or a two-layer closure (appositionaland continuous inverting outer layer (Cushing or Lembert pattern)) - If visible involution has not started during closure or if excessive hemorrhage is noted, oxytocin (0.5 to 5 Units IM) is given

Answer 22

- Brachycephalic puppies had a lower survival rate - hemorrhage, hypotension, and lacerations of the uterus, urinary tract, or gastrointestinal tract

Answer 23

Dogs: - 90% benign leiomyomas - 10% leiomyosarcoma Cats: - Most commonly malignant adenocarcinoma - More likely to have mets, prognosis guarded

Answer 24

- uterine tumors are usually diagnosed as an incidental finding - Ovariohysterectomy is the treatment of choice - if cervical resection is required concurrently, a urinary catheter should be placed to prevent damage to the urethra as it travels along the vaginal wall

Answer 25

The number of dogs that had intra-operative haemorrhages from pedicles ligated with constrictor knots (2/102; 3.9%) was less than those ligated with surgeon’s knots (10/102; 19.6%; p = 0.027). The rate of intraoperative haemorrhage from the ovarian pedicle was lower when a constrictor knot was used compared to a surgeon’s knot in dogs but not in cats.

Answer 26

6,018 dog owners responded to a web-based survey Longer exposure to gonadal hormones, regardless of reproductive status, was associated with reduced odds of general health problems and both problematic and nuisance behaviors Our most important finding was that longer duration that gonads were present, regardless of reproductive status, was associated with fewer general health problems and both problematic and nuisance behaviors. It was also associated with an increased lifespan. Our results were also consistent with previous studies indicating that the associated odds of cancer is significantly lower for sexually intact dogs than gonadectomized dogs

Answer 27

80 bitches undergoing CS and 45 bitches undergoing CSOVH were identified. There was no difference in anesthesia duration, intraoperative complications, postoperative complications, mothering ability, puppy survival to weaning, or other variables compared between groups.

Answer 28

33 client-owned dogs. Of the 17 dogs undergoing LapOSS, 5 of 17 (29%) underwent an elective OVE at a later date he mean follow-up time was 4.2 ± 1.8 years for the LapOSS group and 4.3 ± 2.0 years for the LapOVE group. No dogs developed stump pyometra Owners must be counseled prior to surgery regarding the consequences of gonadal hormone retention and multiple heat cycles both groups had cases of neoplasia develop

Answer 29

Our findings indicated that bitches and queens undergoing OHE for pyometra at older ages and without other severe health issues can expect to live their full life span. Veterinarians in private practice could expect similar outcomes

Answer 30

Thirty-eight cats received a flank OVE and 37 received a midline OVE. Duration of surgery, duration of anaesthesia and intraoperative complications did not vary significantly between the two groups with cats receiving a flank OVE having significantly higher pain scores compared with a midline OVE at 1 h postoperatively (P = 0.0004) and at discharge (P = 0.002). Swelling of the surgical wound (SDSswelling) was significantly higher in cats receiving a midline OVE at the time of discharge (P = 0.048), as well as at the 3 day (P <0.0001) and 10 day (P = 0.001) postoperative re-examinations Our study does not support advocating a preferred surgical approach for feline OVE within a teaching environment.

Answer 31

changes in 6-year-old cats by examining prospective data from a longitudinal cohort study four risk factors for owner-reported mobility changes at 6 years of age: entire neuter status at 6 months of age sustained trauma before 6 years of age, outdoor access at 6 years of age and overweight/obese status at 6 years of age neutering before 6 months of age appears to decrease that risk.

Answer 32

retrospective Fourteen female cats and five female dogs were included. Eleven (58%) exhibited clinical signs immediately, six (32%) had a median onset of clinical signs of 3 days (range 1 to 16 days) Five of seven animals with bilateral ureter injury presented with anuria. Three animals died or were euthanased without definitive surgery. Surgical repair included ureteroneocystostomy (eight cats, one dog), ureteronephrectomy (four cats, two dogs), subcutaneous ureteral bypass placement (three cats) and ureteral stent (one cat). Of the 16 operated animals, seven (44%) that were discharged from the hospital experienced major complications requiring one or more additional surgeries. Overall outcome was excellent in 13 (68%), good in one (5%), fair in one (5%) and poor in four (22%) animals. All seven animals (100%) that had a major complication had undergone a neoureterostomy surgery three of the cats with bilateral ureter injury also received an SUB for stabilisation at their initial surgery (alongside a subsequent ureteroneocystostomy), and all of them had the SUB removed at a further surgery. Clinical Significance: A key indicator of a ureteric injury is an animal failing to recover normally or becoming unwell shortly after ovariohysterectomy

Answer 33

Bipolar electrosurgical forceps were used for haemostasis in 3744 open surgeries including ovariectomies in bitches (n=1406) and queens (n=859) and castrations in dogs (n=1335). one case of haemorrhage associated with surgical technique

Answer 34

Prospective case series. ANIMALS 602 bitches Of 48 dogs with histologically confirmed ORS, 25 were positive for both AMH and P4 and 23 were positive for AMH or P4 or test results were inconclusive. No dogs with histologically confirmed ORS were negative for both AMH and P4. Results indicated that combined determination of AMH and P4 concentrations in a single serum sample can be an effective diagnostic test for spayed dogs suspected to have ORS.

Answer 35

Main Themes and Important Ideas/Facts: Breed-Specific Vulnerability: The most significant finding is the wide variation among breeds in their susceptibility to neutering-associated health risks. The study emphasizes that a "one-size-fits-all" approach to neutering age is not appropriate. "There were major breed differences in vulnerability to neutering, both with regard to joint disorders and cancers." "Thus, the research that had been undertaken revealed a wide range of breed-specific differences in disease vulnerability to neutering." Joint Disorders: Neutering before one year of age was often associated with increased risks of joint disorders, particularly in larger breeds, echoing findings from previous studies on Golden Retrievers, Labrador Retrievers, and German Shepherd Dogs. "In previous studies on the Golden Retriever, Labrador Retriever and German Shepherd Dog, neutering before a year of age was associated with increased risks of one or more joint disorders, 2–4 times that of intact dogs. The increase was particularly seen with dogs neutered by 6 months of age." Small-dog breeds generally did not show an increased risk of joint disorders with neutering. Giant breeds like Great Danes and Irish Wolfhounds also showed no indication of increased joint disorders with neutering. Cancers: The association between neutering and cancer risk also varied considerably by breed and sex. In some breeds, neutering at certain ages was linked to an increased risk of specific cancers. "In female Golden Retrievers, there was an increase in one or more of the cancers followed to about 2–4 times that of intact females with neutering at any age." Two small breeds, Boston Terrier and Shih Tzu, showed a significant increase in cancers with neutering. In contrast to joint disorders, vulnerability to cancers associated with neutering was not consistently linked to body size. Urinary Incontinence (UI): UI was primarily examined in females and was found to be a significant risk in some breeds when spayed early (e.g., Doberman Pinscher, West Highland White Terrier). "UI was a significant risk in females spayed at any age up to 2 years, ranging from 25 percent in the females spayed at < 6 mo. (p < 0.01) to 19 percent for those spayed between 1 and 2 years (p < 0.05) [in Doberman Pinschers]." Small vs. Large Breeds: The study highlights a general trend where small-dog breeds appear less vulnerable to neutering-associated joint disorders compared to larger breeds. Importance of Gonadal Hormones: The researchers suggest that the disturbance of long-bone growth plate closure due to the removal of gonadal hormones in early-neutered dogs is a likely mechanism for increased joint disorder risk. Mammary Cancer (MC): While early spaying is often promoted for MC prevention, the study notes that the evidence linking neutering to a reduced risk of MC is considered weak by a recent meta-analysis. The low occurrence of MC in intact females in their data, considering the study's age range limitations, suggests it might not be as common as sometimes perceived. Behavioral Considerations: The paper briefly touches upon the common concern that neutering after puberty might increase behavioral problems. However, it cites studies indicating that while neutering can reduce aggression in some males, neutering before puberty is not more effective than adult neutering in preventing or resolving these issues. Study Limitations: The study acknowledges limitations, including the fact that only 35 breeds were covered, and the reasons for neutering decisions were not recorded. The mean age of last entry in the hospital records also suggests that the data is more representative of early-occurring diseases. "There are at least two major limitations to this study. First, relatively few breeds are covered compared to those included in the various breed registries of kennel clubs and canine organizations. Second, no information is available as to the reasons the owners or others chose to neuter, or not to neuter their dogs."

Answer 36

Ovariectomy (OVE) vs. Ovariohysterectomy (OHE) in Females: The document explores the debate between removing only the ovaries (OVE) versus removing both the ovaries and the uterus (OHE) in female dogs. While OHE has been the traditional method in the US, OVE is increasingly popular, particularly with laparoscopic techniques. OVE Advantages: Proposed benefits include shorter surgical times, less potential for hemorrhage and urinary complications, smaller incisions, and potentially reduced postoperative pain due to a more cranial incision focused on the ovaries and less manipulation of the broad ligament. OHE Rationale: Historically, uterine removal was thought to prevent uterine disease. However, the author argues that the risk of cystic endometrial hyperplasia or pyometra is low after OVE as long as the hormone source is removed. The incidence of malignant uterine tumors is also stated to be very low (0.003%). Furthermore, the author notes that in most OHE procedures, the entire uterus, including the cervix, is not always removed, leaving behind endometrial tissue. Author's Preference: The author states a preference for OVE due to the lack of strong evidence supporting the necessity of uterine removal, while acknowledging OHE as an acceptable alternative. Controversies Surrounding the Timing of Gonadectomy: The document extensively discusses the ongoing debate regarding the optimal age for spaying or neutering dogs, driven by research linking the timing of gonadectomy to the risk of certain cancers, orthopedic diseases, and other miscellaneous conditions. Neoplasia: While early gonadectomy in females significantly reduces the risk of mammary, ovarian, and uterine cancers, and castration eliminates the risk of testicular tumors in males, studies suggest that it may increase the risk of other cancers in certain breeds. Examples include increased risks of lymphoma, mast cell tumors, hemangiosarcoma, and osteosarcoma in specific breeds and with particular neutering timelines. "Historic studies have shown that gonadectomy before the first heat essentially eliminates the risk of mammary neoplasia (0.05%)." "Conversely, castration appears to increase the risk for prostatic carcinoma, but this tumor is rare (0.29%-0.6%) and the risk seems to vary among breeds." Breed-specific studies (e.g., in Golden Retrievers, German Shepherds, Labrador Retrievers, Vizslas, Rottweilers) show varying effects of gonadectomy timing on the risk of different cancers. The author highlights the difficulty in interpreting these studies due to breed-specificity, study population biases (VMDB and breed club surveys), and the disproportionate number of neutered animals in the US population. A study on Golden Retrievers indicated that age, rather than reproductive status, was the most important factor in cancer-related mortality. Orthopedic Disease: Sex hormones play a crucial role in musculoskeletal development. Early gonadectomy can delay physeal closure, potentially leading to increased long bone growth and a predisposition to joint diseases like hip dysplasia, elbow dysplasia, and cranial cruciate ligament rupture. "It is well documented that sex hormones play an important role in musculoskeletal development. Gonadectomizing dogs before skeletal maturity delays physeal closure, leading to increased long bone growth, which may predispose some dogs to future joint disease." Breed-specific studies (e.g., in Boxers, German Shepherds, Golden Retrievers, Labrador Retrievers) reveal increased incidences of orthopedic diseases in gonadectomized dogs, with the risk varying significantly by breed and neutering age. For instance, Labrador Retrievers neutered before 6 months had a doubled risk of joint disorders. Miscellaneous Conditions: The timing of spay can also affect urinary incontinence, with larger breeds spayed before 3 months being at higher risk. Anecdotal evidence suggests that prepubertal spay might contribute to recessed vulvar conformation and perivulvar dermatitis. In males, castration impacts prostatic disease, perineal hernias, and perianal tumors. Castration eliminates benign prostatic hyperplasia but may increase the risk of rare prostatic carcinoma. Obesity is more common in neutered animals, though the role of neutering age is unclear. Gonadectomy generally reduces roaming, hormonal aggression, and urine marking, but its effects on noise phobias, fear, and anxiety are inconsistent. Longevity: Despite the potential increased risk of certain diseases, studies indicate that gonadectomized animals generally live longer than intact animals.