Exam 2: Lecture 13 + 14: Common reproductive & genital surgical procedures Flashcards
define pyometra
accumulation of purulent material within the uterus
What is sometimes referred to as a cystic endometrial hyperplasia-pyometra comlex
Pyometra
Define hydrometra
watery secretions from uterine distension
Define mucometra
mucoid secretions released from uterine distention
Define Hematometra
blood secretions from uterine distention
Define Stump pyometra
accumulation of purulent material in the vestiage of the uterus that remains after OHE
When does vaginal prolapse / hyperplasia occur and what is it?
occurs during estrus or proestrus as a result of endemantous enlargement of vaginal tissue
What is defined as involving the 360 degree protrusion of mucosa
vaginal prolapse
What is defined as may originating from a stalk of mucosa on the floor of the vagina
- both are usually cranial to the urethral papilla
Vaginal hyperplasia
Another name for uterine prolapse is?
uterine eversion
Define uterine proloase
eversion and protrusion of a portion of the uterus through the cervix into the vagina during or near parturition
T/F: Uterine prolpase occcurrence is NOT rare
false, occurence is rare
T/F: Testicular agenesis is rare
true
Monorhcism is?
one testicular agenesis
Anorchism is?
two testicular agenesis
Dogs and cats are considered to have _____ if there is no testicular descent by 2 months of age
cryptorchidism
Which type of cryptorchidism is more common?
unilateral cryptorchidism
What are the characteristics of retained testes?
- small
- soft
- misshapened (butterbean)
What is the treatment of choice for cryptorchidism
bilateral casteration
cryptorchidism is thought to be ______ linked autosomal recessive in dogs
sex-linked
Retained canine testes are predisposed to _______ (seminomas and sertoli cell tumors)
neoplasia
What structure is often palpable between the inguinal ring and the scrotum in the anesthesized patient
inguinal region
Large inguinal fat pads may obstruct palpation. Which structure may be mistaken for retined testicle?
inguinal lymph nodes
Non-palpable testes must be located. how?
- exploratory laparotomy
- laparoscopy
- laparoscopically assisted
- ultrasound
When trying to find cryptorchidism always look in which area?
look in the inguinal ring
Which testes should you remove first, the normal or retained?
retained
- do not remove the descended testicle if you cannot find the retained testicle
T/F: You can remove the descended testicle if you cannot find the retained testicle
false, do NOT remove
Where should your incision be during an exploratory cryptorchidism technique
ventral midline incision/entry
- umbilicus to pubis (curving around prepuce)
- paramedian incision next to prepuce with midline entry
During a exploratory cryptorchidism technique retroflex which organ?
urinary bladder
locate the _____ ______ dorsal to the neck of the bladder. Follow this structure to the testicle
ductus deferens
What technique should be discouraged as a means of population control?
vasectomy
Which technique inhibits male fertility while maintaining male behavioral patterns
- androgens continue to produce
- rarely recommended
Vasectomy
_______ males should be evaluated after the procedure to document azoospermic ejaculates before contact with intact bitches
vasectomized
Why is vasectomy rarely recommended?
- roaming, aggression, and urine marking persistent
- Reduction or hormonally associated disease does not occur
Which technique is performed in valuable breeding animals to assist with evaluating fertility problems?
testicular biopsy
Testicular biopsy techniques are?
- biopsy needle through scrotal skin
- wedge resection biopsy
(prescrotal incision)
(incise spermatic fascia and tunics)
What device can be used for nonpalpable mass deep within the parenchyma
ultrasound guided percutaneous
What technique is required for definitively diagnose prostatic disease
prostatic biopsy
Why are percutaneous techniques preferred for prostatic biopsy
- less invasive
- less expensive
- lower morbidity
Why are operative biopsy for prostatic biopsy useful
- larger samples
- more specific sites
what is the preferred method for percutaneous needle biopsies
- other options are trucut and guided by palpation
ultrasound guided
What are the 3 types of needle biopsies
- percutaneous
- trans-rectal fine needle aspiration
- open biopsies
What are two aspects of open biopsies
- using biopsy needle
- Wedge
How do you perform an open wedge prostatic biopsy
- perform a caudal midline abdominal incision
- retract the urinary bladder cranially using stay sutures
- Isolate the prostate from the remainder of the abdomen with sterile laparotomy pads
- palpate the prostate and select a biopsy site
- Dissect periprostatic fat from the desired site
- Excise a wedge of prostatic tissue using a #11 blade
- appose the edges of defect
- lavage the surgical site
- replace paraprostatic fat
- close abdominal in three layers
How do you appose the edges of defect during open wedge prostatic biopsy?
- monofilament, absorbale suture
- simple continuous
- Sutures placed in prostatic capsule
Which structure should be avoided during a prostatic biopsy
avoid damaging the prostatic urethra
Why should you submit specimes for prostatic biopsy?
- histopathology
- Culture
- Sensitivity
When should you STOP and NOT biopsy the prostate?
if an abscess or cyst is suspected
Define Episiotomy
incision of the vulvur orifice to expose the vulva and vagina
What are the indications for an Episiotomy?
- surgical exploration of the vagina
- repair lacterations
- modify congenital defects/strictures
- expose the urethral papilla
- facilitate manual fetal extraction
What does the following image show?
Episiotomy
________ to facilitate the surgical removal of a vaginal leiomyoma
Episiotomy
Define Episioplasty/ Vulvoplasty
reconstruction of the vulva
Episioplasty / vulvoplasty are commonly performed to excise excess skin folds around the vulva, which can cause?
- perivulvular dermitis
- recurrent UTI’s
The following image is of a 1 year old great dane positioned in a perineal (sternal) position with limbs supported. What surgery is this for?
Episioplasty
What procedure does the following image define?
Episioplasty
What is the goal of a cesarean section (C-section)?
remove all of the featus from the gravid uterus as quickly as possible via hysterotomy
- without hurting the fetuses
- without undue harm to the bitch
What are the 4 primary indications for cesarean section (C-section)?
- actual or potential dystocia
- small pelvic canal
- uterine inertia
- fetal putrification
With an actual or potential dystocia why would be choose a cesarean section (C-section)?
- oversized fetus / fetuses
- malpositioned fetus / fetuses
- maldeveloped fetus / fetuses
Breeds associated with cesarean section (C-section) commonly are?
- English bulldogs
- Boston terriers
- french bulldogs
- mastiffs
- scottish terriers
What are the 3 techniques for a cesarean section (C-section)?
- C-section without OHE
- C-section with OHE
- En Bloc Resection of the uterus
What type of cesarean section (C-section) technique will you do with breeding animals that will be bred again?
C-section without OHE
What type of cesarean section (C-section) technique does the following describe?
- Cannot obtain owner permission for OHE
- some clinicians prefer to perform the OHE at a later date
C-section without OHE
What type of cesarean section (C-section) technique does the following describe?
Patient prep
- clip and perform a perliminary abdominal prep before anesthetic induction to minimize time from induction to delivery
- once patient is anesthetized (position the patient in dorsal recumbency + apply a final aspectic scrub to the ventral abdomen)
C-section without OHE
What type of cesarean section (C-section) technique does the following describe?
Anesthesia
- pre-oxygenate the bitch or queen if possible before induction
- anesthetize the animal using a general or regional protocol that is appropriate for the bitch of queen and minimizes neonatal depression
C-section without OHE
What type of cesarean section (C-section) technique does the following describe?
Surgery
- ventral midline incision from just cranial to the umbilicus to near the pubis
- Elevate the external recuts sheath
- stab incision through the linea alba
- Exteriorize horns gently by lifting! (uterine walls tear easily + vessels avulse easily)
- isolate the uterus
- tent, the incise the ventral uterine body wall
- extend the incision with metzenbaum scissors to prevent tearing during extraction of the fetus
C-section without OHE
What type of cesarean section (C-section) technique does the following describe?
- Empty each horn my milking the fetus towards the uterine incision, then grasping and gently pulling the feets from the uterus
- repture the amniotic sac and clamp the umbilical cord with a curved mosquito forceps as each neonate is presented
- aseptically pass each neonate to an assistant for neonatal care
C-section without OHE
Avoid contaminating the abdomen and surgical field with ________?
amniotic fluid
What type of cesarean section (C-section) technique does the following describe?
Placenta
- at term, the placenta is often expelled with the neonate
- if the plasma has not seperated, gently pull it from the endomertrium
- do not forcibly seperate the placenta from the uterine wall, or severe hemorrhage may occur
- palpate the pelvic canal and remove any fetus from this location
C-section without OHE
What type of cesarean section (C-section) technique does the following describe?
Post-delivery
- uterine contraction usually begins when the fetuses are removed
- administer oxytocin or erogonovine maleate if contraction has not occured
- give oxytocin and compress the uterine walls if endometrial hemorrhage is severe
- lavage the external uterus to remove debris
C-section without OHE
What type of cesarean section (C-section) technique does the following describe?
Closure
- close uterine incision with 3-0 or 4-0 absorbable suture using
= an appositional pattern in a single layer simple continuous pattern
= a double layer appositional closure (mucosa and submucoa followed by musclularis layer)
= an appositional closure follwed by a second layer inverting pattern (cushing or lembert)
C-section without OHE
What type of cesarean section (C-section) technique does the following describe?
- Lavage the surgical site and replace contaminated towles, sponges, instrument and gloves
- insepect for uterine vessels avulsion and control hemorrhage
- lavage the abdomen if contamination or spillage of uterine contents has occured
- cover the uterine incison with omentum
C-section without OHE
What type of cesarean section (C-section) technique does the following describe?
- Appose the abdominal wall in three layers
- use subcuticular or intradermal skin closure to eliminate suture ends that may irritate neonates
- clean all antiseptics, blood, and debris from the ventral abdomen and mammae
C-section without OHE
______ can safely be performed with c-setion if the patient receives adequate fluid therapy
- fetuses are removed individually as described above
- routine OHE is performed
OHE
What type of cesarean section (C-section) technique does the following describe?
- minimal anesthesia time
- minimal potential for abdominal contamination
- population control without secondary surgery
En Bloc Resection of the gravid uterus
What type of cesarean section (C-section) technique does the following describe?
- neonatal survival this technique is similar to that for other techniques for managing dystocia
- not recommended if fetus are distressed, bradycardic, or hypotoxic
C-section by En Bloc Resection
What type of cesarean section (C-section) technique does the following describe?
- exterorize and isolate the ovarian pedicles
- seperate the broad ligament from the uterus to the point of the cervix
- Manipulate fetuses in the vagina or cervix back into the uterine body
- Double or triple clamp the ovarian pedicles and uterus (just cranial to the cervix)
En Block Resection OHE of the gravid uterus
What type of cesarean section (C-section) technique does the following describe?
- Quickly transect between the clamps, and remove the ovaries and uterus
- give the uterus to a team of assistants to open and resuscitate the neonates
En Block Resection OHE of the gravid uterus
The time from clamping the uterus to removal of the neonates should be less than?
60 seconds
What type of cesarean section (C-section) technique does the following describe?
- double ligate ovarian and uterine pedicles
- inspect for hemorrhage
- close the abdomen
= no skin sutures
En Block Resection oHE of the gravid uterus
most mammary tumors are prevented by _____ in the 1st year of life
OHE
T/F: Male mammary tumors are common and behave similar to those in females
false!! they are rare
When should all mammary tumors be evaluated
when first indentified
Tumors in dogs are benign or malignant; ____ % of those in cats are malignant
90%
Each mammary mass may have a different tumor, so what should you do?
remove them all
Which provided margins are obtained during the tumor excision technique and does not affect survival in the dogs
tumor free
which technique do you perform in cats with mamary tumors
chain mastectomy
Why do you not excise the inflammatory carcinomas?
prognosis is poor
T/F: Adjuvant therapy is not rountinely recommended for malignant tumors
true
What is the goal of mastectomy?
usually performed to remove tumors
define simple mastectomy
removal of one gland
Define regional mastectomy
removal of several glands
Define complete unilateral mastectomy
removal of entire chain
Define complete bilateral mastectomy
simultaneous removal of both mammary chains
- causes significant suture line tension
- should be avoided if possible
- staged procedures are advised to
= facilitate defect closure
= reduce patient discomfort
Which type of mastectomy should be avoided if possible
complete bilateral mastectomy
What does the following define?
- OHE during the same anesthesia is performed before surgery to prevent seeding the abdmoen with tumor cells
- if the tumor crosses midline, however, it may be excised first
- Clean instruments and gloves should be used for OHE
mastectomy
What does this image and description show?
mastectomy
T/F: Death usually pccurs without surgical or medical therapy with pyometra
true
What does the image on the left show?
pyometra
What does the image on the right show?
Hydrometra
T/F: treatment (OHE) should not be delayed more than is absolutely necessary
true
Does morbidity and mortality increase with an increase in concurrent metabolic abnormalities and organ dysfunction
increase
T/F: Surgical draining of the uterus without OHE is not recommended, but has been successfully in a few cases
true
T/F: Surgey should not be delayed more than few hours (especially in patients with closed pyometra)
true
What should be monitored preoperatively during a pyometra surgery
- urine output
- glucose
- arrhythmias
T/F: hydration, electrolytes, and acid-base imbalances can be corrected during surgery
false, they should be corrected before surgery if possible
T/F: The prognosis is improved when azotemia is corrected before a pyometra surgery
true
A braod spectrum antibiotic should be effective against ____ should be given IV while awating antibiotic susceptibility results
E. coli
_________ are nephrotoxic and not recommended because of the prevelance of renal dysfunction with pyometra
Aminoglycosides
Fluid input and urine output should be monitored to help assess which organ function during a pyometra surgery
renal function
for a pyometra surgery, expose the abdomen through a ventral midline incision beginning ______ caudal to the xiphoid and extending to the pubis
2 to 3 cm
- observe the abdomen and locate the distended uterus
Observe the surgical field for evidence of _____ (seroal inflammation, increased abdominal fluid and petechiation)
peritonitis
Obtain abdominal fluid for culture, evacuate the urinary bladder by _______ , and collect a urine specimen for culture and analysis if not previously submitted
cystocentesis
Carefully exteriorize the uterus without applying pressure or excessive traction. A fluid filled uterus is often ______; therefore, life rather than pull the uterus out of the abdomen
friable
T/F: do not use a spay hook to locate and exteriorize the uterus because it may tear
true
Do not correct uterine torsion because this will release?
bacteria and toxins
isloate the uterus from the abdomen with what 2 techniques during a pyometra surgery
- laparotomy pads
- Sterile towels
Place clamps ad ligatures are previously described for OHE ecept that the cervix may be resected in addition to which 3 structures?
- ovaries
- uterine horns
- Uterine body
Ligate the pedicles and enlarged vessels within which connective tissue with absorbale monofilament material
broad ligament
T/F: throughly lavage the vaginal stump, but do not oversew the cut edges
true
The following surgical techniques are important for?
- transcet at the junction of the cervix and vagina
- culture the contents of the uterus without contaminating the surgical field
- remove laparotomy pads, and replace contaminated instruments, gloves, and drapes
- lavage the abdomen and close the incision rountinely unless peritonitis is present
- submit the tract for pathologic evaluation
Pyometra surgery
T/F: complications associated with elective OHE may also occur following OHE for pyometra
true
______% of patients die despite appropriat therapy (57% after uterine rupture)
5-8%
Surgical complications including septicemia, endotoxemva, peritonitis, and cervical or stump pyometra may occur because which surgery?
pyometra
- stump pyometra may be associated with residula ovarian tissue
- the remaining stump should be excised and residual ovarian tissue removed
Most complications of pyometra surgery resolve within how much time?
2 weeks or surgery
the following defines?
- the mucosa is not truly hyperplasticity but enlarges because of edema
- the amount of edema and eversion is extremely variable
- severe edema causes vaginal tissue to protrude from the vula
vaginal prolase / hyperplasia / tumor
Although the protruding mass may be large, the origin of the mass is usually _______ and located on the vaginal floor cranial to the urethral orifice
small
What does the following image show?
Vaginal prolapse/hyperplasia/tumor
T/F: although rare, vaginal prolapse / hyperplasia is the least common in large breed dogs?
false!! it is the most common
Most common vaginal prolapse / hyperplasia occurs in young bitches (2 years old or younger) during one of the first _____ cycles
3
T/F: vaginal prolapse / hyperplasia is extremely rare in cats?
true
Perform an OHE and take a biopsy of the mass the rule out ?
neoplasia
The following is considered surgical treatment for?
- perform an episiotomy if necessary to allow biopsy
- replace the protruding mass into the vagina or vestibule
- lavage, lubercate, and reduce the prolapsed tissue by digital manipulation
- maintain reduction by placing two or three horizontal mattress sutures between the vulvular lips
vaginal prolapse / hyperplasia / tumor surgical treatment
What does the following show?
uterine prolapse and tearing
T/F: uterine prolapses are common
false, they are rare
Which disease is associated with parturition and involves the entire vaginal circumference
uterine prolapse
the _____ must be dilated for uterine prolapse to occur
cervix
uterine prolapse usually occurs with prolonged ______
labor
the following describes?
- the everted tissue is doughnut shaped and discolored from venous congestion, trauma, and debris
uterine prolapse
______ may tear the broad ligament and uterine artery
uterine prolapse
T/F: hemorrhage may lead to hypovolemic shock unless controlled quickly during uterine prolapse
true
the following surgical techniques can be done for?
- reduce prolapse manually
- lavage the protruding tissue with warm saline or wated and dilted antiseptic
- hypertonic agents (sugar) may reduce edema and facilitate reduction
- gently compress the mass to reduce edema while attempting to reduce the prolapse
- if necessary, perform an episiotomy to assist reduction
Uterine Prolapse
the following surgical techniques can be done for?
- insert a uterine catherter
- place horizontal mattress sutures between the vulvular lips to maintain reduction and prevent recurrence
- if necessary, perform a celiotomy to facilitate reduction by cranial uterine traction, ensure proper alignment of the uterine horns, and assess integrity of the vasculature
Uterine Prolapse
