Clinical Disease of the Female Reproductive Tract in Small Animals Flashcards
What are the possible causes of mucopurulent vulval discharge in small animals?
Vaginitis
Early metostrus
Open pyometra
Possible causes of red vulval discharge in small animals?
Proestrus Oestrus Persistent ovarian follicle Ovarian tumour Vaginal trauma Vaginal foreign body Cystitis Neoplasia Coagulopathy
Possible causes of clear mucoid vulval discharge in small animals?
Normal
Possible causes of clear watery vulval discharge in small animals?
Amniotic/allantoic fluid
Possible causes of greeny black vulval discharge in small animals?
Normal parturition
Dystocia
Possible causes of reddy brown to black vulval discharge in small animals?
Metritis
Possible causes of yellow vulval discharge in small animals?
Incontinence
Vaginitis:
- How does it present?
- Problems associated?
- What are the two types?
- Purulent discharge in healthy
- Causes of irritation and makes owners anxious
- Juvenile vaginitis:
- Secondary bacterial infection and excess vaginal secretion resolves spontaneously with first season
Adult vaginitis:
- Less common, treat the specific cause and may respond to exogenous oestrogens
When does pyometra usually present?
Within 8 weeks of last oestrus
Describe open and closed pyometra…
Open cervix - mucopurulent vaginal discharge and a mild-moderately enlarged uterus
Closed cervix - not associated with vaginal discharge, uterus is usually grossly enlarged and animal is systemically ill
What factors contribute to pyometra?
Bacterial infection
Cystic endometrial hyperplasia
Progesterone
Open cervix
What are the clinical signs of a pyometra?
LOTS! Depression, lethargy, pyrecxia Mucopurulent discharge PU/PD Vomiting/collapse/shock Neutrophilla with LS Endotoxaemia Hypoglycaemia Anaemia Coagulation abnormalities
Diagnosis of pyometra?
Ultrasound - turbid appearance
Radiography - can’t distinguish between early preg and pyo
Treatment of pyometra?
Medical
Surgical
Describe vaginal trauma
Uncommon
Causes:
Iatrogenic
Forced separation of mating dogs
Describe the general approach to vaginal masses…
Age and neutered status very important Stage of reproductive cycle: - Oestrus - Pregnancy Size, shape and consistency: - Does it contain a hole? - Within wall or lumen?
Vagino/vestibulo neoplasia:
- Most common type?
- Fast growing?
- Which animals is it most common in?
- Smooth muscle tumours:
- Leiomyoma/sarcoma - Slow growing
- 65% of entire bitches, may present with visible mass, bulging perineum or dysuria/dyschezia
How would you diagnose vaginal/vestibulo neoplasia?
History and PE
Endoscopy
Radiography
Biospy
How would you treat vaginal/vestibulo neoplasia?
Surgical excision combined with OVH
Chemotherapy
What does vaginal hyperplasia result from?
Excessive response of vaginal mucosa to oestrogens during follicular phase of oestrous cycle
BRACHY DOGS
What are the results of vaginal hyperplasia?
Vaginal oedema
Vaginal prolapse
How can you differentiate between vaginal hyperplasia and prolapse?
Hyperplasia = no hole Prolapse = hole
Diagnosis and treatment of vaginal oedema/hyperplasia?
Diagnose: Hx and PE Tx: Conserative e.g. keep moist and vulvar sutures Surgical excision Tens to reoccur so neuter
Common presentation of ambiguous genitalia in puppies?
Enlarge clitoris/underdeveloped penis
Indicates presence of androgens and therefore testicular material/ovarian tissue
How can you investigate ambiguous genitalia?
Evaluation of pelvic anatomy
Removal of gonads - histo
Karotyping
SRY gene testing
Treatment of ambiguous genitalia?
Removal of gonads
Possible partial penile amputation
Treatment of other abnormalities
What is dystocia?
Disturbances during parturition when normal delivery of the foetus through the birth canal is interrupted.
What signs show there is a problem with parturition?
Fetal fluids passed no more than 2-3 hours ago with no birth
Dam straining vigorously and regularly for 20-30mins with no birth
Green/reddish brown vulval discharge with no birth within 2-4 horus
Weak irregular straining 2-4 hours no birth
>2-4hours since last puppy born
Second stage labour >12hours
Sickness of dam
Maternal causes of dystocia in small animals…
Narrow birth canal Disturbed labour - Inertia - Spasm Uterine abnormalities Prolonged pregnancy Psychogenic status Extra uterine problems e.g. spesis Premature birth Prolonged parturition Idopathic
Foetal causes of dystocia in small animals..
Increased foetal size - Litter size - Gestation length Foetal malpresentation Abnormal foetal development
What is primary uterine inertia?
Uterus fails to respond to foetal signals
Causes of primary uterine inertia?
Small litter Very large litter Systemic disease of dam Inherited predisposition Nutritional Obesity Age Low oxytocin
What is the difference between partial and complete primary uterine inertia?
Partial = uterus initiate parturition but fails to complete normal delivery of all foetuses
Complete = failure of uterus to contract at full term
Medical management of dystocia in small animals?
Should only be considered when there is no evidence of obstruction!
- Exercising the dam
- Feathering roff of vaginal floor
- Oxytocin (IM 30 min intervals)
Treatment of hypocalcaemia/glycaemia if present
What can you do if medical management of dystocia is unsuccessful? Is this common?
Caesarean
Common
How should you use oxytocin when treating dystocia?
Repeated small doses 0.2-0.4IU/KG
Single large dose associated with prolonged myometrial contraction
Congenital vaginal abnormalities in small animals?
Vulval stenosis
Anovulvar cleft
Rectovaginal fistula
Vestibulovaginal stricture/band
Acquired vaginal abnormalities in small animals?
Vulval hypertrophy
- Juvenile prolonged proestrous
- Endogenous/exogenous oestrogens
Recess vulva
- Dermatitis
- Chronic inflammation
- Trauma
- Neoplasia
Causes of abdominal mass/distension associated with female pathology?
May be manifestation of normal physiology Pathological causes: - Pyometra - Retained foetus - Ovarian neoplasia - Uterine neoplasia - Segmental aplasia
Types of ovarian neoplasia…
Granulosa cell tumour Cystadenoma Adenocarcinoma Teratoma - May be endocrinologically active, treat via surgical excision
What is hydrometra/mucometra?
Sterile accumulations of fluid within the uterus.
Usually secondary to congenital abnormalities such as segmental aplasia or acquired abnormalities e.g. neoplasia
How can you diagnose a hydrometra?
Imaging and surgery
Female reproductive causes of systemic illness?
Closed pyometra
Uterine torsion
Uterine rupture
