Chapter 109 Ovaries and Uterus Flashcards
Label the diagram:
Label the diagram
What 2 structures does the ovarian artery supply?
`with which vessel does it anastomose?
Ovarian artery supplies ovary and renal capsule .
Ovarian artery anastomoses with uterine artery caudally
Into which vessels do R and L ovarian veins drain?
R drains into CVC, L drains into L renal vein
What structure connects the peritoneal and uterine cavitities?
What is the normal width and lenght of this structure?
Uterine tube/oviduct
4-7cm long in both species
1-3 mm in diameter
What are the three layers of the uterus?
Serosa, muscularis (myometrium), mucosa (endometrium)
What is the arterial supply to the uterus?
Anastomosing ovarian and uterine arteries
(uterine artery = branch of vaginal = branch of internal pudendal = branch of internal iliac)
What is the sympathetic and parasympathetic supply to uterus?
Sympathetic via hypogastric n
Parasympathetic via pelvic n
Desribe oestrogen, LH and progesterone levels in relation to ovulatory cycle
Name a species difference in prooestrus.
And dioestrus
Cats have much shorter prooestrus and no externally visible signs (c.f. vulva swelling in dogs)
In cats, corpus luteum formation requires induction of ovulation, whereas dogs ovulate spontaneously
In non-pregnant bitches, how long does progesterine dominance last after ovulation?
60-100d
What is canine gestational lenght (when calculated from ovulation)
And when calculated from mating?
64 days
57-72 days i.e. a week either side!
What canine hormonal levels can be used to determine timing of ovulation?
- LH surge
- Unique pre-ovulatory rise in progesterone (>1.5 ng/mL)
By what age are canine foetuses radiographically visibile?
And feline?
42 d canine
1 week earlier (approx 35d)
What type of anaemia is present during pregnancy and why?
What is a normal PCV at full term?
Normochromic, normocytic due to haemodilution with increased plasma volume
<35%
What pre-partuition changes are seen in progesterone?
And body temperature?
- Progesterone fall: <2-3 ng/mL, 24 hrs before
- Body temp fall: < 37.8º, 12 hrs before
Define the 3 stages of partuition and normal durations,
Stage 1: No externally visible contractions, restless, anxious, pacing, vomit, nesting. 24 hours
Stage 2: Expulsion of foetus. <30mins before birth of puppy.
Stage 3: Explusion of placenta. Time between puppies <4 hours
Stages 2 and 3 alternate in dogs. Total time <36 hours
Re vaginal discharge, what is expected during involution
Lochia (odorless, green/dark red/brown/haemorrhagic) normal for 4-6 weeks.
Concerning if odorous or bitch is unwell
What is duration of pregnancy in cats based on plasma progesterone >2.5 ng/mL
And based on mating
63-66 d
56-69 d
In dogs, the ovary is the sole source of progesterone, how does this differ in cats?
After day 40 of gestation, placenta produces progesterne independent of ovaries in cats
What is usually duration of stage 2-3 labout in cats
Total 6 hours i.e. all kittens born.
(up to 48 hours reported though)
How long does it take for feline uterine involution?
25 d
what is the prevalence of pyometra in intact females?
and spayed?
24% intact
2% spayed
List 4 tumour types that have been overrepresented in gonadectomized animals
- TCC
- Osteosarc
- Cardiac tumours
- Hemangiosarc
e.g. osteosarc more common in rotties spayed <1 year of age
List conditions whose odds are increased after neutering
- Osteosarc in rotties spayed <1y
- Splenic haemangiosrac and MCT in vizlas spayed at any age
- Obesity
- USMI
- In cats, diabetes mellitus
- In female dogs, hypothyroidism
What is prevalence of USMI in spayed vs intact bitches
20% spayed
0.2% inact
At what age does hepatic microsomal cytochrome p-450 enxyme activity mature in dogs?
4.5 months
What 3 factors have been associated with increased rik for short term complications after OVHE?
- >2 years at spay
- Increasing surgery time
- Increasing BW
What 2 material have been implcated in ovarian pedicle granuloma?
Braided non-absorbable suture
Nylon cable tie
What is the max diameter uterus that a vessel sealing device can be used for?
9mm
Broadly speaking, in ovarion tumours, name the three cell orgin types
Epithelial
Germ cell
Sex cord
What type of overian tumour should eb suspected if calcification seen?
teratoma
Name 5 types of ovarian epithelail cell tumour
Collectively, what % of ovarian tumours do they make up?
- Papillary (only one that is occassionally bilateral)
- Adenoma
- Adenocarcinoma
- Cystadenoma
- Undifferentiated carcinoma
40-50% of ovarian tumour
Name the most common sex cord tumour
Granulosa cell tumour (50% of canine ovarian tumours).
Thecoma = granulosa cell tumour in which stroma predominates
IHC marker for granulosa cell tumour?
α - inhibin
What hormones can be produced by granulosa cell tumour
Oestrogen, progesterone or both
i.e. therefore may see persistent prooestrus, oestrus, endometrial hyperplasia, pyo
Name 3 types of germ cell tumour
What % of canine ovarian tumours do they make up (collectively
Teratoma
Dysgerminoma
Teratocarcinoma
5-10% of canine ovarian tumours
Whta is metastatic rate of granulosa cell tumour?
up to 20%
What type of ovarian tumour is most common in cats?
What % of granulosa cell tumours are malignant in cats?
Which is least common?
Sex cord stromal tumours.
50%
Epithelial cell tumours are rare in cats!
Ovarian cysts can be functional or non-functional. What are the two types of fuctional ovarian cyst?
- Follicular (–> oestrogen) –> prolonged pro-oestrus (and oestrus if some progesterone is present)
- Leutenized (–> progesterone –> prolonged dioestrus)
What age is typically associated with functional ovarian cysts
Young
dogs <3y
cats <5y
What is size of normal pre-ovulatory ovarian follicle in dogs?
And follicular cyst?
<10mm
>10
What vaginal cytology finding is consistent with oestrogen dominance?
>80% superficial cells
What serum oestradiol and progesterone concentrations are consistent with remnant ovary in dogs??
Namr an N.B. for each of them in cats
Oestradiol > 15 pg/mL
Progesterone >2 ng/mL
In cats:
High oestrogen may be due to adrenocortical problems
To use progesterone measurment in cats, leutenization has to be induced first (by administration of hCG or GNRH). Progesterone >2.5 ng/mL 5-7d after leutenization consistent with remnant ovary
Aside from oestradiol and progesterone levels, what alternative hormone level can be used to confirm functioning ovarian tissue in dogs?
A single low LH hormone in dogs!
Anti-müllerian hormone (independent of ovarian cycle)
During which stages of oestrus cycle are ovarian remnants better visualised and why?
Oestruc or dioestrus due to follicles or corpus luteum
What is the difference between hermaphrodite and chimera?
Hermaphrodite has testicular and ovarian tissue (in separate or same gonadal structure). XX chromosome constitution
Chimera female external appearance with enlarged clitoral tissue or hypoplastic penis. Chimeras fail to exhibit ovarian cycles. Usually XX/XY or XX/XXY.
How long does it take for embryos to become visible oon US?
20
(n.b. 42 for radiographically)d
How is progesterone involved in pyometra development?
Progesterone –> endometrial glandular secretion + supressed uterine contraction
What is most common bacteria in canine and feline pyo?
E.coli
(adheres to receptors in progesterone stimulated endometrium)
What 3 virulence factors are found in in higher frequency among pyo E.coli vs faecal e.coli
- α-haemolysin
- P-fimbriae
- Cytotoxic necrotizing factor
–> enhance severity of disease and increase binding to uterine epithelium
What % pf pyodogs have UTI?
70%
What % of pyo dogs had SIRS
57%
How is pyo thought to lead to azotameia?
Glomerular damage
What medications can be used in medical management of pyo?
- Dopamine agonist (cabergoline (galastop) + GnRH antagonist + abx –> 88% success
OR
- Abx
- PGF2α (can be intravaginal). 48 hr lag till effects seen
What % of pyo cases developed septic peritonitis?
13%
What is mortality rate of canine pyo?
And cats?
5% dogs
8% cats
What % of presumed pyometra cases had cystic endometrial hyperplasia (–> muco-/hydro/haematometra)
15%
What is a deciduoma?
Very organized endometrial hyperplasia
(develops as a very organized proliferative remodelling, with histo appearance similar to placentation sites)
What is the primary clinical sign of cystic endometrial hyperplasia?
What is tx?
Failure to conceive
Otherwise may be similar to pyo, except C.E.H cases usually only have one c/s vs pyo which has 3 or > clinical signs
Tx as for pyo
what condition are endometrial polyps often associated with?
cystic endometrial hyperplasia
Define dystocia
Inability to expel a fetus from the uterus through birth canal
What % of dystocia are of maternal vs foetal cause?
75% maternal
Primary inertia most common
What is the most common foetal cause of dystocia
malposition
One of the other questions lists 9 instances where dystocia requires c-section.
List 4 additional instances where dystocia can be diagnosed.
(N.B. Just dystocia! Not necessarily requiring c-section)
- Prolonged gestation
- Lack of progression to stage 2 within 24 hours
- Failure to deliver pups within 36 hours of temp drop <37.8
- >4 hours between neonates
What is fergusons reflex?
Abdo contractions in response to vaginal stimulation
How soon can foetal death be detected radiographically?
What is seen?
Within 6 hours of death
–> foetal iv gas
–> intrauterine gas and foetal skeleton collapse after several days
What is a normal HR of healthy foetus?
What HR is considered a sign of foetal distress (in awake dam)?
>220 bpm
<150-180
(also absence of foetal movement and foetal bowel movements)
Name instances in which primary uterine inertia can be diagnosed
i.e. cases that oudl benefit from medical management
- Delayed onset of stage 2 labour based on pre-partum monitoring
- LH surge
- Pre-ovulatory rise in progesterone
- Vaginal cytology
- Mating
- US
-
Peri-partum monitoring
- >24 hours stage 1
- Progesterone drop >30 hours ago
- Temp drop (<37.8º 36 hours ago)
- Lochia
-
Insufficient completion of birth
- i.e. make sure no hypoglycaemia/obstruction etc
List 9 scenarios when dystocia indicates need to c-section
HWta is the dose of oxytocin for management of primary uterine inertia?
0.2 U/5kg
q30 min s
Max 2 doses
What % of dystocia cases are successfully managed medically
40%
When shoudl planned c-section be performed in relation for LH surge?
63-65d later
SS dischchareg is normal for 6 weeks after partuition. What coudl be a causes of persistent haemorrhagic discharge?
And what is tx?
Subinvolution of placental sites
No known effective tx so OVHE if not resolving
Ddx: metritis, vaginitis proestrus, trauma, neoplasia coagulopathies
What are most common canine uterine tumour?
What %
Leiomyoma 90%
Leiomyosarcoma 10%
What is the syndrome affecteing GSDs…
What is the genetic mutation?
Bilateral renal cyst-adenocarcinoma, nodular dermatofibrosis + multiple uterine leiomyoma
FLCN gene
What are most common feline uterine tumours
adenocarcinomas
prognosis guareded as often metastatic disease
List 3 uterine congenital anomalies
- Unicornuate uterus
- Segmental uterine horn agenesis
- Uternie horn hypoplasia
N.B. ipsilateral renal agenesis in 1/3rd of cases with congenital uterine abnormalities
N.B.2 in unicornuate uterus, 2 ovaries are usually still present, may be abnormlly located eg by diaphragm!
List 6 ways to ‘diagnose’ overian remnant syndrome in dogs
- Oesradiol >15 pg/mL
- Progesterone >2 ng/mL
- Vaginal cytology suggestive of oestrogen dominance (superficial cells)
- Single low LH
- Anti-Müllerian hormone (independent of ovarian cycle)
- US to identify ovarian tissue
