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RUSVM Small Animal Surgery 1 > Female Reproduction > Flashcards

Female Reproduction Flashcards

1
Q

What is the blood supply to the vagina?

A

Internal pudendal —> vaginal artery

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2
Q

What are two congenital abnormalities seen in the female vagina?

A 
Vesitbulovaginal stenosis (vv)
-septal/annular/vaginal

Rectovaginal fistula
-connection between rectum and vaginal

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3
Q

What are clinical signs associated with vesitublovaginal stenosis?

A

Vaginitis
UTI
Painful breeding
Hydrocolpos (fluid accumulation in vaginal wall)

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4
Q

How can you diagnose vestibulovaginal stenosis ?

A

Digital exam —> all dogs have some degree of narrowing (experiance)

Contrast radiographs —> sterile iodinated contrast media (if ratio between max and min is <0.2 = severe stenosis)

Vaginoscopy —> direct visualization

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5
Q

What is the best diagnostic modality to determine vestibulovaginal stenosis?

A

Vaginoscopy —> direct visualization

Evaluate entire UG and repro tracts
Can tree stenosis with scope

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6
Q

When is treatment for vestibulovaginal stenosis indicated?

A

Breeding dogs

Spayed dogs with clinical signs (eg vaginitis, UTI, hydrocolpos)

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7
Q

What are the types of lesions that can be seen with vestibulovaginal stenosis?

A

Septal stenosis - band of tissue oriented dorsoventrally (double vagina)

Annular stenosis -ring lesions at V-v junction

Hypoplasia - narrowing of vaginal vault (between vv junction and cervix)

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8
Q

What is the treatment for a septal stenosis vv?

A

Episiotomy —> incision of vulvar orifice to all access to the vestibule and vagina

Mucosal reception at attachments

Suture mucosa
OR
Laser ablation

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9
Q

What are the indications for an episiotomy?

A

Explore vagina
Excise vaginal masses
Repair lacerations
Modify strictures

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10
Q

How will you perform an episiotomy and control the hemorrhage?

A

Place animal in perineal position
Place instrument in vulvar tissue

Incise from dorsal commissure to limits of vestibule

Control hemorrhage
-Electrocautery/doyen forceps

Close in 3 layers -> mucosa, muscle, and skin

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11
Q

What is the treatment for vv due to annular stenosis if it is caudal to the pelvis?

A

Dorsal approach

Vaginal resection and anastomoses

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12
Q

What is the treatment for vv due to annular stenosis if it is intrapelvic?

A

Transpelvic approach

Vaginectomy

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13
Q

What is the treatment for vv due to vaginal hypoplasia?

A

Vaginectomy (more diffuse disease) along with OHE

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14
Q

What are the indications for vaginectomy?

A

More extensive lesions
Intrapelvic annular stenosis
Vaginal hypoplasia

  • may also perform ventral abdominal approach and OHE
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15
Q

What is the usual signalment for recessed (hooded) vulva?

A

Medium to large breed
Overweight
Early OHE (juvenile vulva)

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16
Q

Clinical signs of a hooded vulva?

A

Skin fold dermatitis
Vaginitis
Recurrent UTI
Incontinence

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17
Q

You have a overweight dog with a mild hooded vulva. How would you treat this animal?

A

Cleansing and weight loss

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18
Q

You have a patients with a 3/5 BCS and a severe hooded vulva. How would you treat?

A

Episioplasty - vulvoplasty

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19
Q

What condition occurs during proestrus/estrus due to high estrogen levels?

A

Vaginal edema/hyperplasia

20
Q

Signalment for vagnial hyperplasia?

A

Young
<2yrs

One of first 3 estrus cycles

21
Q

Presentation of vaginal edema/hyperplasia?

A

Mucosa protrudes from vulva

Tissue arise from ventral vaginal floor

22
Q

Treatment for vaginal hyperplasia?

A 
Conservative 
—> lubricants and Ecollar 
—> reduce tissue 
—> resolves with termination of estrus 
—> OHE to prevent reoccurrence

Surgical (if significant mucosal injury or in breeding animals)
—> mucosal resection through episiotomy

23
Q

How can you tell vaginal prolapse from vaginal hyperplasia?

A

Prolapse —> can see entire circumference of vaginal, appears donut shaped

Hyperplasia —> area of mucosa protrudes from vulva arising from ventral vaginal floor

24
Q

Treatment for vaginal prolapse?

A

Manual reduction and OHE

25
Q

What is ovarian remnant syndrome?

A

Exactly like it sounds… there is a remnant of ovary from a previous OHE..

Caused by
—> poor visualization
—> improper surgical technique
—> dropped ovarian tissue revascularizes

26
Q

You have recurrence of estrus in a dog after it was just spayed..
dx?

A

Ovarian remnant syndrome

27
Q

Clinical signs of ovarian remnant syndrome?

A

Vulvar enlargement - dog

Attraction to males

Willingness to breed

28
Q

Treatment for ovarian remnant syndrome?

A

Surgical removal

  • usually at caudal pole of kidney
  • surgery usually done during estrus
  • avoid ureter
29
Q

How can you confirm a case of ovarian remnant syndrome?

A

Vaginal cytology (dog) —> mimics normal heat cycle

Hormone levels
—> estrogen >15pg/ml
—>progesterone >2ng/ml
—> cats required lutinization (HCG) to evaluate progesterone

30
Q

What are maternal causes of dystocia?

A

Primary/secondary uterine inertia

Birth canal obstruction

  • small pelvic canal
  • malunion fracture
31
Q

What are fetal causes of dystocia?

A

Malposition
Malformation
Oversized

Fetal etiology can cause secondary uterine inertia

32
Q

What are clinical signs of primary uterine inertia?

A

No signs of parturition
Prolonged gestation > 68days
No puppies after 36h after temp <100F

33
Q

What is the etiology of primary uterine inertia?

A

Oversized litters —> uterine stretching

Undersized litters —> uterine stimulation

34
Q

What is primary uterine inertia?

A

Parturition fails to proceed

Birth canal/fetal size/presentation normal

No neonates born

35
Q

What is secondary uterine inertia?

A

Normal delivery of part of the litter

Develops uterine fatigue

36
Q

What is the etiology of secondary uterine inertia?

A

Fetal obstruction
Pelvic obstruction
Fetal malposition
Fetal size

37
Q

What are clinical signs so secondary uterine inertia?

A

Prolonged interval between neonates (>4hours)

Weak or absent uterine contractions

38
Q

What are possible PE findings you can have with dystocia?

A

Lucia (green tinged fluid) without delivery

Obstructed canal on palpation

Abnormal fetal presentation

Lack of uterine contractions in response to Fergusons reflex

39
Q

What can you see on radiographs that would indicate dystocia?

A

Fetal malposition
Pelvic obstruction
Retained fetuses
Fetal death -> intravascular gas

40
Q

T/F: Ultrasound cannot be used to determine number of fetuses but can be used to find fetal distress syndrome

A

True

—> fetal stress syndrome (low HR) associated with lack of O2 during parturition

41
Q

T/F: secondary uterine inertial can be treated medically with oxytocin

A

False

ONLY primary uterine inertia can be treated medically

42
Q

In a primary uterine inertia case, you treat with oxytocin but have no results, so you try manuals manipulation of fetus and still fail.. what should you do next?

A

C-section

43
Q

What are indications for C-section

A

Secondary uterine inertia

Primary uterine inertia -refractory to treatment

Systemic signs of bitch

Fetal distress diagnosed by US

Planned for high risk patients

44
Q

What are the steps in a C-section?

A

Incisions - midway between xyphoid and umbilicus to cranial pubis

Exterisorize uterus

Pack off with laparotomy sponges

Perform hysterotomy

  • ventral midline into uterine body
  • avoid incision over fetus
  • milk fetus into incision
  • pull until placenta releases

Clamp umbilical cord 2-6cm from abdominal wall

Close with 3/0 monofilament absorbable
Single or double layer with inverting
Holding layer

45
Q

What can you do if following C-section, involution has no started or there is excessive hemorrhage??

A

Administer oxytocin IM

46
Q

What are the advantages of an En block resection C-section

A

Treat dystocia
Decreased anesthesia time
OHE
Decreased abdominal contamination

47
Q

What is the procedure of an en bloc recsection c-section?

A

Break down broad ligament
Triple clamp pedicle
Transection

Remove puppies <60seconds after claps (no increased fetal mortality)

RUSVM Small Animal Surgery 1 (39 decks)

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