Female Repro Flashcards
Anatomy of the female repro tract is supplied by the ______ from the ______ artery
Vaginal from the internal pudendal artery
What are the 3 types of Vestibulovaginal stenosis? What type of abnormality is Vestibulovaginal stenosis?
Vestibulovaginal stenosis is a congenital abnormality
- Septal stenosis
- Annular stenosis
- Vaginal hypoplasia
What are the clinical signs of Vestibulovaginal stenosis?
- Vaginitis
- UTI
- Painful breeding
- Hydrocolpos
_______:
distension of the vagina caused by accumulation of fluid due to congenital vaginal obstruction
Hydrocolpos
_____ ______:
Connection between the rectum and vagina. Describe what type of abnormality it is?
Rectovaginal fistula (congenital abnormality)
With use of contrast rads and sterile iodinated contrast media, Vestibulovaginal stenosis is confirmed as severe when it is this value or less
<0.2
What is the BEST diagnostic modality to determine Stenosis?
Vaginoscopy (bc direct visualisation, and can eval the entire urogenital tract and repro. tracts and look for ectopic ureters and neoplasia
You can treat stenosis with a _____
scope
What are the indications of treating Vestibulovaginal stenosis? what do you always do to the urethra?
- Breeding dogs
- Spayed dogs with CS
Always catheterise the urethra
Can digital breakdown of Vestibulovaginal stenosis to break up the narrowing with your finger work??
It’s ineffective!!!
Describe how the tissue band is oriented in a septal stenosis?
Dorsoventrally
What is the common name for septal stenosis?
Double vagina
How do you treat septal stenosis?
- perform episiotomy
- Mucosal resection at the attachments
- Suture mucosa
- LASER ABLATION
________:
a surgical cut made at the opening of the vagina during childbirth, to aid a difficult delivery and prevent rupture of tissues.
Episiotomy
_______:
Incision of vulvar orifice to all access to the vestibule and vagina
Episiotomy
Why would you do a Episiotomy?
- Explore the vagina
- Excise vaginal masses
- Repair lacerations
- Modify strictures
When you perform a Episiotomy they animal is in the ______ position and you place the instrument in the _____ ______. You incise from _____ _____ to the limits of the _______
perineal position
place the instrument in the vulvar fissure
Incise from dorsal commissure to limits of vestibule
What do you do to control the hemorrhage with an episiotomy (2)? and you close in ____ layers
Electrocautery; Doyen forceps
Close in 3 layers (mucosa, muscle, skin)
Describe the shaped lesion for annular stenosis?
V-v junction ring shaped lesion
Annular stenosis includes the _____ and +/- ______
mucosa and submucosa and +/- muscularis
Annular stenosis is manifested with an _____ ______, a congenital disorder where a hymen without an opening completely obstructs the vagina. It is caused by a failure of the hymen to perforate during fetal development.
Imperforate hymen
Describe the sx apporach to annular stenosis if caudal to the pelvis?
Dorsal approach (vaginal resection and anastomosis)
Describe the sx apporach to annular stenosis if intrapelvic to the pelvis?
Transpelvic approach (vaginectomy)
_______:
often used with annular stenosis, this is a surgery to remove all or part of the vagina. It is usually used as a treatment for vaginal cancer.
Vaginectomy
Vaginal Hypoplasia causes _____ of the _____ _____
narrowing of the vaginal vault
Where does vaginal hypoplasia occur between?
Occurs B/w the vestibulovaginal junction and cervix
Vaginal hypoplasia requires _____ along with ____ and may require a ____ approach
vaginectomy along with OHE; pubic
What are the indications for a vaginectomy? (3)
More extensive lesions
Intrapelvic annular stenosis
Vaginal hypoplasia
When performing a vaginectomy you may also perform a ______ ______ approach and ____
ventral abdominal; OHE
What is the conformational abnormality where the vulva is engulfed by skin and what sized breeds are predisposed
Recessed Vulva (hooded vulva) medium to large breeds, overweight
Does early spaying cause hooded vulvas??
Study proved no!!! so tell your clients its okay!!
What are the clinical signs of hooded vulvas? (4)
- Skin fold dermatitis
- Vaginitis
- Recurrent UTI
- Incontinence
What treatment options are there for recessed vulva?
- Cleansing regularly (prevent skin fold dermatits)
- Weightloss
- Episioplasty (vulvoplasty)
_______:
(also known as vulvoplasty) is a surgical procedure to remove excess folds of skin which form a curtain around or over the vulva
Episioplasty
Vaginal edema / hyperplasia occurs during _____ ____ and is due to high _____ levels. Seen most commonly in _____ ( < ___ years old) _____ breed dogs.
proestrus / estrus
high estrogen levels
<2 years old large breed
Vaginal edema / hyperplasia happens during this time and what do we see?
one of first 3 estrus cycles
Mucosa protrudes from the vulva
Where does the tissue arise from with Vaginal edema / hyperplasia and subject to _____ and _____
ventral vaginal floor subject to dessication and self trauma
What is the general medical treatment for Vaginal edema / hyperplasia
conservative management and use of lubricants and e collars
- reduce the exposed tissue
- recommend OHE to prevent reoccurrence
What is the surgical treatment of Vaginal edema / hyperplasia
Significant mucosal injury, OHE of the breeding animal, mucosal resection through EPISIOTOMY
Vaginal edema / hyperplasia resolves with this?
termination of estrus
______ ______:
very rare, often mistake for edema, the entire circumference prolapses and appears DONUT SHAPED
Vaginal prolapse
How do you treat vaginal prolapse?
manual reduction and OHE
_____ _____ ______:
takes place with recurrence of estrus cycle following OHE/OVE and is caused by these etiologies (3)?
Ovarian Remnant Syndrome
- Decreased visualisation
- Improper surgical technique
- Dropped ovarian tissue revascularizes
Ovarian Remnant Syndrome is more common in ____
cats
What are the clinical signs of Ovarian Remnant Syndrome (3)?
Vulvar enlargement (dog)
Attraction to males
Willingness to breed
Upon vaginal cytology in dogs with Ovarian Remnant Syndrome what does it mimic?
normal heat cycles
Ovarian Remnant Syndrome treatment is often _____ removal during _____ by a _____ surgeon. The remnant is usually at this location and why do you need to be carefuL?
- Surgical removal during estrus by referral surgean
2. Remnant usually at the caudal pole of the kidney careful to avoid the ureter
Ovarian Remnant Syndrome hormones are elevated (3)?
- estrogen
- progesterone
- Cats require lutinization to evaluate progesterone
______:
Inability to expel a fetus through the birth canal and _____ causes responsible for 75% and are these 3 reasons?
Dystocia; maternal
- Primary uterine inertia
- Secondary uterine inertia
- Birth canal obstruction (small pelvic canal, malunion fracture)
Dystocia due to fetal causes are from these 4 things?
- Malposition
- Malformation
- Oversized
- Fetal etiology can cause secondary uterine inertia
______ _____ ______:
os where parturition fails to proceed and the birth canal/ fetal size present normal?
Primary uterine Inertia
With Primary uterine Inertia are neonates born?
No neonates born
what is the etiology of Primary uterine Inertia
Oversized litters (uterine stretching)
Undersized litters (uterine stimulation)
What are the clinical signs of Primary uterine Inertia? (3)
- No signs of parturition
- Prolonged gestation > 68 days
- ***No puppies 36 hours after temp is <100 degrees F
Describe the 2 main components of Secondary uterine Inertia
Normal delivery of part of the litter
develops uterine fatigue!!!
What are the 4 etiologies of Secondary uterine Inertia
- Fetal obstruction
- Pelvic obstruction
- Fetal malposition
- Fetal size
What are the 2 clinical signs of Secondary uterine Inertia
- prolonged interval between neonates > 4 hours
2. Weak or absent uterine contractions from fatigue
_______:
the normal discharge from the uterus after childbirth.
Lochia
With a dystocia physical exam you will often see _____ without delivery and feel an obstructed canal on palpation from abnormal fetal presentation characterized by lack of _____ _____ in response to ______ ______
Lochia; uterine contractions; Fergusons reflex
Which type of uterine inertia can be treated medically?
Primary (NEVER secondary)
How do you medically treat primary uterine inertia? (4)
- Oxytocin and repeat in 30 min if necessary
- If positive results can contine to repeat oxytocic
- manual manipulation of fetus if in vaginal vaulta if obstructed
- Perform c section if no results?
Why would you do a C section? (5)
Secondary to uterine inertia
primary uterine inertia refractory to treatment
Systemic signs of bitch
fetal distress diagnosed by ultrasound
planned for high risk patients
WHere is the incision for C section compared to hysterotomy?
Be careful!!! Midway between xiphoid and umbilicus to cranial pubis
Hysterotomy Ventral midline into uterine body
With C sections what must you do carefully?
Exteriorize the uterus (vascular and friable)
What do you need todo during a c section and avoid? (3)
Avoid incison over fetus
milk fetus to incision
pull placenta releases
C section patients are packed off with these?
Pack off with laparotomy sponges
With C sections you first engage the _____ layer, and clamp the umbilical cord _____ cm from abdominal and then pass the fetus to assistant. Placent can pass naturally if….
Sub Q; 2-6; firmly attached
Describe the closure for c section and suture (check for?) (what type suture) (layers?) (what dont you penetrate)
Check uterus for more fetus
3/0 monofilament absorbable
single layer or double layer with inverting
holding layer
do not penetrate lumen
With c sections, if visible involution has not started or excessive hemorrhage what can you give?
Oxytocin IM
With c section, if you are finishing with a OHE there is no need for ______. (enbloc resection)
closure
What are the advantages of enbloc resection? (5)
- OHE
- Dystocia Tx
- Decreased anesthesia time
- Decreased abdominal contamination
- No increased fetal mortality
Describe the basic procedure for enblock resection? (5)
- Break down SUSPENSORY ligament**
- Triple clamp pedicles
- Transect
- Hand uterus to assitant
- Remove puppies < 60 seconds after clamps
______
a congenital condition in males in which the opening of the urethra is on the underside of the penis.
Hypospadius
