Clinical Disease of the Female Reproductive Tract in Small Animals

Question 1

What are the possible causes of mucopurulent vulval discharge in small animals?

Answer 1

Vaginitis
Early metostrus
Open pyometra

Question 2

Possible causes of red vulval discharge in small animals?

Answer 2

Proestrus
Oestrus
Persistent ovarian follicle
Ovarian tumour
Vaginal trauma
Vaginal foreign body
Cystitis
Neoplasia
Coagulopathy

Question 3

Possible causes of clear mucoid vulval discharge in small animals?

Answer 3

Normal

Question 4

Possible causes of clear watery vulval discharge in small animals?

Answer 4

Amniotic/allantoic fluid

Question 5

Possible causes of greeny black vulval discharge in small animals?

Answer 5

Normal parturition

Dystocia

Question 6

Possible causes of reddy brown to black vulval discharge in small animals?

Answer 6

Metritis

Question 7

Possible causes of yellow vulval discharge in small animals?

Answer 7

Incontinence

Question 8

Vaginitis:

1. How does it present?
2. Problems associated?
3. What are the two types?

Answer 8

1. Purulent discharge in healthy
2. Causes of irritation and makes owners anxious
3. 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

Question 9

When does pyometra usually present?

Answer 9

Within 8 weeks of last oestrus

Question 10

Describe open and closed pyometra…

Answer 10

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

Question 11

What factors contribute to pyometra?

Answer 11

Bacterial infection
Cystic endometrial hyperplasia
Progesterone
Open cervix

Question 12

What are the clinical signs of a pyometra?

Answer 12

LOTS!
Depression, lethargy, pyrecxia
Mucopurulent discharge
PU/PD
Vomiting/collapse/shock 
Neutrophilla with LS
Endotoxaemia
Hypoglycaemia
Anaemia 
Coagulation abnormalities

Question 13

Diagnosis of pyometra?

Answer 13

Ultrasound - turbid appearance

Radiography - can’t distinguish between early preg and pyo

Question 14

Treatment of pyometra?

Answer 14

Medical

Surgical

Question 15

Describe vaginal trauma

Answer 15

Uncommon
Causes:
Iatrogenic
Forced separation of mating dogs

Question 16

Describe the general approach to vaginal masses…

Answer 16

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?

Question 17

Vagino/vestibulo neoplasia:

1. Most common type?
2. Fast growing?
3. Which animals is it most common in?

Answer 17

1. Smooth muscle tumours:
   - Leiomyoma/sarcoma
2. Slow growing
3. 65% of entire bitches, may present with visible mass, bulging perineum or dysuria/dyschezia

Question 18

How would you diagnose vaginal/vestibulo neoplasia?

Answer 18

History and PE
Endoscopy
Radiography
Biospy

Question 19

How would you treat vaginal/vestibulo neoplasia?

Answer 19

Surgical excision combined with OVH

Chemotherapy

Question 20

What does vaginal hyperplasia result from?

Answer 20

Excessive response of vaginal mucosa to oestrogens during follicular phase of oestrous cycle
BRACHY DOGS

Question 21

What are the results of vaginal hyperplasia?

Answer 21

Vaginal oedema

Vaginal prolapse

Question 22

How can you differentiate between vaginal hyperplasia and prolapse?

Answer 22

Hyperplasia = no hole
Prolapse = hole

Question 23

Diagnosis and treatment of vaginal oedema/hyperplasia?

Answer 23

Diagnose:
Hx and PE
Tx:
Conserative e.g. keep moist and vulvar sutures
Surgical excision
Tens to reoccur so neuter

Question 24

Common presentation of ambiguous genitalia in puppies?

Answer 24

Enlarge clitoris/underdeveloped penis

Indicates presence of androgens and therefore testicular material/ovarian tissue

Question 25

How can you investigate ambiguous genitalia?

Answer 25

Evaluation of pelvic anatomy Removal of gonads - histo Karotyping SRY gene testing

Question 26

Treatment of ambiguous genitalia?

Answer 26

Removal of gonads Possible partial penile amputation Treatment of other abnormalities

Question 27

What is dystocia?

Answer 27

Disturbances during parturition when normal delivery of the foetus through the birth canal is interrupted.

Question 28

What signs show there is a problem with parturition?

Answer 28

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

Question 29

Maternal causes of dystocia in small animals...

Answer 29

``` Narrow birth canal Disturbed labour - Inertia - Spasm Uterine abnormalities Prolonged pregnancy Psychogenic status Extra uterine problems e.g. spesis Premature birth Prolonged parturition Idopathic ```

Question 30

Foetal causes of dystocia in small animals..

Answer 30

``` Increased foetal size - Litter size - Gestation length Foetal malpresentation Abnormal foetal development ```

Question 31

What is primary uterine inertia?

Answer 31

Uterus fails to respond to foetal signals

Question 32

Causes of primary uterine inertia?

Answer 32

``` Small litter Very large litter Systemic disease of dam Inherited predisposition Nutritional Obesity Age Low oxytocin ```

Question 33

What is the difference between partial and complete primary uterine inertia?

Answer 33

Partial = uterus initiate parturition but fails to complete normal delivery of all foetuses Complete = failure of uterus to contract at full term

Question 34

Medical management of dystocia in small animals?

Answer 34

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

Question 35

What can you do if medical management of dystocia is unsuccessful? Is this common?

Answer 35

Caesarean | Common

Question 36

How should you use oxytocin when treating dystocia?

Answer 36

Repeated small doses 0.2-0.4IU/KG | Single large dose associated with prolonged myometrial contraction

Question 37

Congenital vaginal abnormalities in small animals?

Answer 37

Vulval stenosis Anovulvar cleft Rectovaginal fistula Vestibulovaginal stricture/band

Question 38

Acquired vaginal abnormalities in small animals?

Answer 38

Vulval hypertrophy - Juvenile prolonged proestrous - Endogenous/exogenous oestrogens Recess vulva - Dermatitis - Chronic inflammation - Trauma - Neoplasia

Question 39

Causes of abdominal mass/distension associated with female pathology?

Answer 39

``` May be manifestation of normal physiology Pathological causes: - Pyometra - Retained foetus - Ovarian neoplasia - Uterine neoplasia - Segmental aplasia ```

Question 40

Types of ovarian neoplasia...

Answer 40

``` Granulosa cell tumour Cystadenoma Adenocarcinoma Teratoma - May be endocrinologically active, treat via surgical excision ```

Question 41

What is hydrometra/mucometra?

Answer 41

Sterile accumulations of fluid within the uterus. | Usually secondary to congenital abnormalities such as segmental aplasia or acquired abnormalities e.g. neoplasia

Question 42

How can you diagnose a hydrometra?

Answer 42

Imaging and surgery

Question 43

Female reproductive causes of systemic illness?

Answer 43

Closed pyometra Uterine torsion Uterine rupture