Clinical Disease of SA Repro Tract 1 Flashcards
What are the 4 most important questions to ask when investigating vulval discharge?
- age, neuter status
- stage of repro cycle (esp metoestrus and pregnancy)
- colour
- discharge from uterus or urethra?
What does greeny black discharge in the bitch indicate?
placental separation
What colour is discharge seen associated with placental separation in the queen?
red/brown
What are the causes of white vaginal discharge?
- vaginitis
- early metoestrus
- open pyometra
- cystits
What are the causes of red vaginal discharge?
- proestrus/oestrus
- persistent ovarian follicle
- oestrogen secreting ovarian tumour
- vaginal trauma
- vaginal FB
- cystits
- urethral neoplasia
- coagulopathy
- placental separation
- subinvolution post partum
- vascular malformation
What are the causes of clear vaginal discharge?
normal
What are the causes of clearn wateryvaginal discharge?
amniotic/allantoic fluid
What are the causes of greeny black vaginal discharge?
- normal parturition
- dystocia
- separated placental membranes (may be normal or adnormal)
What are the causes of brown/red -> blackvaginal discharge?
Metritis
What are the causes of yellow vaginal discharge?
Inconcitnence
What are the 2 forms of vaginitis and how do they present?
- Juvenile/ prepubertal
- common in practice
- 2* to bacterial contamination and excess vaginal secretion
- usually resolves SPONTANEOUSLY at 1st season
- AVOID Abx ` - adult
- less common
- ID specific casue
- may respond to exogenous oestrogens (topical or oral)
When does pyometra usually preent?
Within 8 weeks of last season (associated with open cervix at season)
What are the 2 forms of pyometra?
- Open: open cervix -> mucopurulent vaginal discharge, mildly enlarged uterus
- Closed: closed cervix -> no discharge,uterus grossly enlarged, systemic illness
What factors are assicated with formation of pyometra/
Bacteria usually GIT (E. COli) , cystic endometrial hyperplasia, progesterone, open cervix
What clinical signs are seen associated with pyometra?
- depression, lethargy
- mucopurulent discharge
- pyrexia
- PUPD
- V+
- Collapse and shock
What would be seen on haem and biochem with pyometra?
- Neutrophilia with L shift
- Possible azotaemia
- Acidoisis
- Endotoxaemia
- Hypogylcaemia
- Anaemia
- Coagulation abnormalities
How is pyometra diagnosed?
- ultrasound
- radiography (cannot distinguish from mid-stage pregnancy)
What is the most common treatment for pyometra?
Surgical excision (overiohysterectomy) - medical trtmt possible
What are common causes of vaginal trauma?
- iatrogenic (contrast injection etc.)
- forced separation of mating dogs
- malicious wounding
What is the treatment for vaginal trauma?
- investigate and confirm origin
- supportive treatment (pack vaginal with swabs etc.)
- +- BS Abx
Are vaginal masses most common in neutered or unneturtered?
Most common in UN-neutered
What questions should be asked in relation to vaginal masses?
- contain a hole?
- within wall or within lumen?
- where in relation to external urethral orifice?
What are the commonest vaginal/vestibular neoplasia? Which dogs is this usually seen in?
Lyeiomyoma or leiomyosarcoma
- elderly entire bitches
How may vaginal masses present?
- visbale mass
- bulging perineum
- dysuria/dyschezia
What is the treatment for vaginal/vestibule neoplasia?
> surgical excision and OVH
- vie episiotomy (open vestibule)
- via pubic symphisiotomy and vaginal excision
chemo for TVT (transmissible venereal cell tumour, seen 3rd world countries)
What are the causes of tissue prolapsing out of the vagina? How may they be differentiated?
- Vaginal hyperplasia (excessive response of vaginal mucosa to oestrogens during follicular phase of oestrus cycle -> vaginal oedema and prolapse) Seen as a section of tissue ballooning out of vagina
- Vaginal prolapse - hole in the centre, vagina bulging out on all sides
> actually a difference?? look up
Which breeds are predisposed to vaginal hyperplasia and prolapse?
Brachycephalic breeds
How should vaginal prolapse be managed? What should owners be made aware of?
- conservative measures ie. keep moist, vulvar sutures to keep it in place
- surgical excision via episiotomy
- likely to reoccour next oestrus
> neuter or control pharmacologically
What is the cause of ambiguous genitalia?
- manifestation of intersexuality due to presence of androgens from testicular tissue +- ovarian tissue
What is the treatment for ambiguous gonads? What other investigation may be performed?
- removal of gonads (+ histopath)
- karyotyping (chromosomes)
- SRY gene testing (sex determining regionof Y)
- treatment of other abnormalilities if causing problems eg. reflux of urine into a uterine structure
- amputation of penis
When should partuition be a cause for concern?
- fetal fluids passed 2-3hrs, no birth
- dam straining 30mins, no birth
- greenish/reddish brown vulval discharge apparent with no birth 2-4hrs later
- weak/irregular straining 2-4hrs, no birth
- > 2-4hrs since last pup delivered no birth
- second stage labour lasting > 12hours
- dam sick
Give possible maternal causes of dystocia
> narrow birth canal - soft tissue - oseus > Disturned labour - uterine inertia - uterine spasm/tetany - inadequate abdo force > uterinae abnormalities - torsion - rupture - malformation - adhesions > prolonged pregnancy > psychogenic causes > extrauterine problems - sepsis > premature birth > prolonged parturition > idiopathic
What is the most common cause of dystocia?
- maternal
- uterine inertia
Which foetal causes may cause dystocia?
>^foetal size - litter size - genstational length - breed factors > foetal malpresenation [most common] > abnormal foetal development - hydrocephalus - foetal death
What are the 2 forms of uterine inertia? Which is most common?
- 1*: uterus fails to respond to foetal signals [most common]
- 2*: exhaustion of myometrium due to obstruction of birth canal
What are the causes of 1* inertia?
- small or very large litter
- systemic disease of the dam
- inherited predisposition
- nutrition
- obesity
- age
- failure neuroendocrine due to low levels of oxytocin
What medical management of partuition should be implemented and when?
- should only be implemented when NO EVIDENCE OF OBSTRUCTION
- exercise
- feathering the roof of the vaginal floor
- oxytocin (multiple small doses. NOT SINGLE LARGE DOSE)
- hypocalcaemia/hypoglycaemia trtmt
- tocospasmolytic drugs in combo with OT in Europe
What should be carried out if medical intervention in dystocia is unsusccessful?
C section
How much and how often should oxytocin be dosed?
30-40mins
- 0.2-0.4IU/kg
Why shuodl a single large dose of OT not be given?
- ^ no. stillbirths due to hypoxia
- placental compression and compromise
Give examples of congential abnormalities
- vulval stenosis
- anovolvular cleft
- rectovaginal fistula
- vestibulovagional stricture/band
Give examples of acquired abnomaltities
> vulval hypertrophy - juvenile prolonged proestrus - endogenous/exogenous oestrogens > recessed vulva > trauma > neoplasia
What are the potential pathological cuases of abdominal mass/distension?
- pyometra
- retained foetuses
- ovarian/uterine neoplasia
- segmental aplasia and mucometra (congenital abnormalilty, presents around time of first season due to build up of sterile mucous proximal to stricture)
Is ovarian neoplaisa common in the dog and cat?
No
What types of ovarian neoplasia are possible?
- granulosa cell
- cystadenoma
- adenocarcinoma
- teratoma
What clinical signs are seen associated with ovarian neoplasia?
- large mass
- +-ascites
- signs of proestrus if endocrinologically active (-> oestrus production)
- peritoneal cavity metastasis
What is the treatment of ovarian neoplasia? What does prognosis depend on?
Surgical excision, depends on pathology and stage of disease.
Is hydrometra/mucometra common? What type of pathology is this?
- rare
- congential
- often found incidentally
How is hydrometra diagnosed?
imaging and surgery
What reproductive pathology may cause systemic illness?
- closed pyometra
- uterine torsion or rupture
