Clinical disease of the reproductive tract in the dog and cat 1 - FEMALE Flashcards
When investigating vulval discharge, what should you consider? 4
Age, neutered status v important
Stage of repro cycle (esp metoestrus and pregnancy)
COLOUR OF DISCHARGE
Where is it coming from - uterus, vagina, urethra?
What are some causes of WHITE vaginal discharge? 4
vaginitis
early metoestrous
open pyometra
cystitis
What is normal vaginal discharge like?
Clear, mucoid
What might cause clear watery vaginal discharge?
amniotic/ allantoic fluid
When might you see GREENY BLACK vaginal discharge? 2
Normal parturition
Dystocia
When might you see BROWN/ RED–> BLACK vaginal discharge?
Metritis
When might you see YELLOW vaginal discharge?
Incontinence
When might you see red vaginal discharge?
Proestrus Oestrus Persistent ovarian follicle Ovarian tumour (oestrogen secreting) Vaginal trauma Vaginal FB Cystisi Urethral neoplasia Coagulopathy Placental separation Sub-involution post-partum Vascular malformation
What does vaginitis usually present as?
purulent discharge in the healthy bitch
What are the 2 types of vaginitis?
JUVENILE (PREPUBERTAL) VAGINITIS - secondary to bacterial contamination and excess vaginal secretion, usually resolves spontaneously with first season and ABs should be avoided
ADULT VAGINITIS - less common, aim to identify and treat specific cause, may respond to exogenous oestrogens (topical/oral)
What is pyometra?
V. important in SA practice - dogs and cats
Uterus fills with pus, life-threatening potential
Usually presents within 8 weeks of last oestrous
OPEN or CLOSED.
Distinguish open and closed cervix pyometra.
OPEN = associated with mucopurulent vaginal discharge and mild-moderately enlarged uterus CLOSED = not associated with vaginal discharge, uterus usually grossly enlarged and animal systemically ill
What 4 factors all need to be in place to lead to a pyometra?
Bacterial infection
Cystic endometrial hyperplasia
Progesterone
Open cervix - commonly E.coli but also Klebsiella enter
What signs may be seen with pyometra?
Depression, lethargy, mucopurulent vaginal discharge, pyrexia, PUPD, vomiting, collapse, shock
Neutropphilia with L shift, possible azotaemia, acidosis, endotoxaemia, hypoglycaemia, anaemia, coagulation abnormalities
What is cystic change?
Something that leads to pyometra where cysts develop within mucosa of uterus and is a substrate for bacteria to interact with.
How do you diagnose pyometra?
Ultrasound
Radiography
How do you treat pyometra?
Medical
Surgical - most common, OVH
What are the causes of vaginal trauma (uncommon)?
Iatrogenic
Forced separation of mating dogs
Malicious wounding
May bleed severely
How do you investigate vaginal trauma?
Confirm origin
Conservative/ supportive treatment usually all that is required +/- BS ABs
What history is important when investigating a vaginal mass?
Age, neutered status
Stage of cycle (especially oestrus, pregnancy)
Size, shape and consistency of mass (does it contain a hole, is it within the wall or within the lumen, where is ti in relation to the external urethral orifice?)
What is the commonest tumour in the bitch’s vaginal/vestibular area?
Smooth muscle tumours of the vagina/vestibule. Typically slow growing smooth muscle cell tumours - leiomyoma (commonest), leiomyosarcoma, other tumour types possible), 65% bitches entire, usually elderly, may present with visible mass, bulging perineum or dysuria/ dyschezia.
How do you diagnose vaginal/vestibular neoplasia?
Hx and PE
Endoscopy
Radiography
Biopsy
Treatment of vaginal/vestibulo neoplasia
Surgical excision combined with OCH (via episiotomy or via pubic symphysiotomy and vaginal excision).
Chemotherapy for TVT
Define episiostomy
cut betweeen vagina and anus
What is a pubic symphisiotomy?
split pubic symphysis (i.e. a controlled fracture)
What causes vaginal hyperplasia and vaginal prolapse?
Excessive response of vaginal mucosa to oestrogens during follicular phase of oestrus cycle resulting in vaginal oedema and vaginal prolapse.
Brachycephalic breeds predisposed
May interfere with mating
Exposed tissues traumatised
Diagnosis for vaginal oedema/hyperplasia?
Hx and PE
Treatment - vaginal oedema/hyperplasia?
Conservative measures such as keeping moist and vulvular sutures.
Surgical excision, usually via episiotomy
Does vaginal oedema/hyperplasia tend to reoccur?
Yes - control oestrous or neuter
What is ambiguous genitalia the manifestation of?
intersexuality = disorders of sexual sifferentiation
Many phneotypes possible
Commonest - enlarged clitoris/underdeveliped penis in a ‘female’ puppy
How do you investigate ambiguous genitalia cases?
Evaluate pelvic anatomy
Remove gonads - histopathology
[Karyotyping]
[SRY gene testing]
Treatment - ambiguous genitalia?
Gonadal removal
Possible partial penile amputation/removal of the penis possibly via an episiotomy
Treatment of other abnormalities if associated with clinical signs - e.g. incontinence secondary to reflux of urine into a uterine structure.
How is dystocia categorised?
MATERNAL
MATERNOFOETAL
FOETAL
What should be a cause of concern during parturition? 7
Foetal fluids passed >2-3 hours previously with no birth
Dam straining vigorously and regularly for 20-30 mins with no birth
Greenish/reddish brown vulval discharge apparent with no birth within 2-4 hours
Weak/irregular straining for 2-4 hours and no birth
>2-4 hours since last pup/kitten was delivered and more known/suspected to remain
Second labour stage > 12 hours
Sickness of dam
What are maternal causes of dystocia? 9
Narrow birth canal Disturbed labour Uterine abnormalities Prolonged pregnancy Psychogenic status Extra-uterine problems Premature birth Prolonged parturition Idiopathic
What do studies show about commonest cause of dystocia?
Maternal causes are most common (75% cases in bitches, 66% cases in queen)
Others suggest maternofoetal causes were as common as maternal causes
Commonest maternal cause is uterine inertia (i.e. disturbed labour)
What are foetal causes of dystocia?
Increased foetal sizze
Foetal malpresentation
Abnormal foetal development (e.g. hydrocephalus, other congenital abnormalities, foetal death)
What is the most common foetal cause of dystocia in dog and cat?
Malpresentation
Foetal oversize is also common
Foetomaternal - commonest is small litter size and large kittens
How is uterine intertia classified?
PRIMARY - most common, uterus fails to respond to foetal signals
SECONDARY - due to exhaustion of the myometrium, secondary to an obstruction of the birth canal
What are the causes of primary uterine intertia?
small litter very large litter systemic disease of the dam inherited predisposition obesity age failure of neuroendocrine regulation
Thought to be related to low levels of oxytoxin
COMPLETE (failure of uterus to contract at full term) or PARTIAL (uterus initiates parturition but fails to complete normal delivery of all foetuses)
When do you medically manage dystocia?
only when there is NO evidence of obstruction
How can dystocia be managed?
exercising the dam feathering the roof of the vaginal floor treatment with oxytocin treatment of hypocalcaemia/hypoglycaemia Tocospasolytic drugs used in combination with oxytocin in some countries.
C-section
How should oxytocin be given?
Repeat small dose (0.2-0.4 IU/kg)
Single large dose associated with prolonged myometrial contraction –> placental compression and compromise
Every 30-40 minutes
OXYT alon associated with increased stillbirths and hypoxic pups
How are vulval vaginal abnormalities classified?
Congenital or acquired.
What are congenital vulval vaginal abnormalities? 4
Vulval stenosis
Anovulvular cleft
Rectovaginal fistula
Vestibulovaginal stricture/band
What are some ACQUIRED vulval vaginal abnormalities? 4
Vulval hypertrophy (juvenile prolonged proestrous, excess oestrogens)
Recessed vulva
Traum
Neoplasia
What are pathological causes of abdominal masses/distensions?
Pyometra Retained foetus Ovarian neoplasia Uterine neoplasia Segmental aplasia and mucometra
What is mucometra?
an abdominal mass where uterine secretions accumulate proximal to the stricture, often and incidental finding, not same as puometra
Which reproductive diseases may show systemic illness?
Closed pyometra
Uterine torsion
Uterine rupture
