Genitourinary Flashcards

Question

What causes other than ectopic ureters should you rule out in young versus older patients prior to considering tests for ectopia?

Answer 1

- Behavioral (submissive) incontinence - Urge incontinence - Neurogenic incontinence - Hormonal responsive incontinence “Ureteral ectopia should be seriously considered in any young animal presented for incontinence or any older animal which has had incontinence since it was young. Behavioral incontinence is also common in young animals because of exaggerated submissiveness. Other causes of incontinence include urge incontinence (associated with inflammation or infection), neurogenic disorders (e.g., lower and upper motor neuron disorders or reflex dyssynergia), anatomic outflow obstruction (e.g., paradoxic incontinence), and urethral sphincter incontinence (e.g., hormone-responsive incontinence). Behavioral, urge, neurogenic, and hormone-responsive incontinence should be eliminated before tests for ectopia are considered in older animals.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 2

Phenylpropanolamine (alpha-adrenergic agonist, weak beta adrenergic agonist. Leads to the release of norepinephrine and inhibits norepinephrine reuptake in the postsynaptic membrane, thereby increasing smooth muscle tone) Ephedrine (Al[ha and beta adrenergic agonist, also promoting the release and inhibiting the reuptake of norepinephrine. POTENTIALLY LETHAL AT 10 MG/KG) Diethylstilbestrol (synthetic estrogen)

Answer 3

1) explore the entire abdomen, particularly the opposite kidney for evidence of disease 2) locate the contralateral ureter to make sure it is not inadvertently ligated 3) remove the entire ureter associated with the kidney being removed 4) handle the neoplastic kidney very carefully and ligate the renal vein first to prevent seating of neoplastic cells via the vasculature or a directly into adjacent tissue

Answer 4

Hemorrhage Urine leakage AKI in patients with pre-existing CKD Inadvertent ligation of the contralateral ureter

Answer 5

Ureteral outflow obstruction

Answer 6

“Although few cases have been reported in dogs, renal abscesses have been associated with pyelonephritis, hyperadrenocorticism, diabetes mellitus, and renal biopsy. Most renal cortical abscesses are unilateral and Staphylococcus spp. is the most commonly isolated causative agent in dogs and cats.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 7

Nephrectomy

Answer 8

“Urinary obstruction and uroperitoneum are medical emergencies, not surgical emergencies. Hyperkalemia associated with these conditions makes the animal prone to cardiac arrhythmias; therefore fluid and electrolyte abnormalities should be corrected before anesthesia.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 9

1) obtain a sample of mucosa for a bacterial culture 2) check the Apex for diverticulum and excise if present 3) Pass a urinary catheter down the urethra to verify patency

Answer 10

“Perform a caudal ventral midline abdominal incision and, if necessary, a pubic symphysiotomy or bilateral pubic and ischial osteotomy (see later). Locate the transected ends of the urethra and debride them. Minimize dissection around the urethra and bladder to prevent damage to the vascular or nerve supply to these structures (Fig. 25.11). Suture the ends with six to eight absorbable interrupted sutures over a transurethral catheter (preferably a Foley catheter or other soft catheter). Leave the catheter in place for 7 to 10 days. If the urethral tissues do not hold suture because of prolonged urine extravasation and subsequent tissue devitalization, delayed repair is indicated. Place a transurethral catheter to divert urine flow for 5 to 7 days. If a catheter cannot be placed from the penile orifice into the bladder, pass a catheter from the bladder into the traumatized tissue, tie it to a catheter placed from the penile urethral orifice, and use it to pull the penile catheter into the bladder. If the urethra does not heal completely in 7 to 10 days, or if stricture occurs, resect the urethral ends and suture them over a catheter, as described for primary repair. ” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 11

“Using 4-0 or 5-0 monofilment absorbable matetial, Place the first layer in the urethral mucosa and corpus spongiosum, then appose subcutaneous tissue and skin with simple interrupted sutures or a continuous subcuticular suture pattern.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 12

“Depending on the site of the lesion, ureterostomy can be prescrotal, scrotal, perineal, or prepubic in dogs.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 13

“The length of the urethral incision should be six to eight times its luminal diameter. ” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 14

“For perineal urethrotomy, make a midline incision over the urethra, midway between the scrotum and the anus. (A) Identify the retractor penis muscle, elevate it, and retract it. (B) Separate the paired bulbospongiosus muscles at their raphe to expose the corpus spongiosum. (C) Incise the corpus spongiosum to enter the urethral lumen. (D) Close the urethra with simple interrupted absorbable sutures. Place the first layer in the urethral mucosa and corpus spongiosum; appose subcutaneous tissue and skin with simple interrupted sutures or a continuous subcuticular suture pattern.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 15

Frequently causes unacceptable urine scalding The surrounding cavernous tissue is large at this location, and hemorrhage can be profuse The urethra is deep at this location, making it difficult to obtain a tension free closure between skin and mucosa (may result in dehiscence)

Answer 16

“Place a purse-string suture in the anus, and catheterize the penis if possible. Place the cat in dorsal or ventral recumbency. If the cat is placed in dorsal recumbency, pull the pelvic limbs forward to improve access to the perineal region. Dorsal recumbency allows for cystotomy and perineal urethrostomy without having to reposition the cat. Make an elliptical incision around the scrotum and prepuce, and excise them. Place an Allis tissue forceps on the end of the prepuce or around the catheter to help manipulate the penis. Free the penis and the distal urethra from the surrounding tissue on either side (Fig. 25.22A). Extend the dissection ventrally and laterally toward the penile attachments at the ischial arch. Elevate the penis dorsally, and sharply sever the ventral penile ligament. Then, transect the ischiocavernosus muscles (see Fig. 25.22B) and the ischiourethralis muscles at their insertion on the ischium to avoid damaging branches of the pudendal nerves and to minimize hemorrhage. Reflect the penis ventrally to expose the dorsal surface. Locate the bulbourethral glands proximal and dorsal to the bulbospongiosus muscle and cranial to the severed ischiocavernosus and ischiourethralis muscles (see Fig. 25.22C). Avoid excessive dorsal dissection to prevent damage to[…]” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 17

“Complications associated with ureteral anastomosis in the bowel include reabsorption of electrolytes and nitrogenous waste products, upper UTI, and neurologic dysfunction. Azotemia, hyperammonemia, hyperchloremia, and metabolic acidosis are also common after these procedures.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 18

“porcine small intestine submucosa grafts” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 19

If urethral continuity is not completely disrupted, the urethra will regenerate in as little as seven days. Urinary diversion via urethral catheter or tube cystostomy are indicated to avoid urine extravasation. Urine leakage, particularly if infected, can delay healing and promote periurethral fibrosis and stricture. When complete transaction of the urethra occurs, primary anastomosis over an indwelling catheter should be performed to decrease the likelihood of stricture formation. The catheter should be left in place for 3 to 5 days.

Answer 20

“Most sutures appear to lose tensile strength faster in alkaline urine (such as that seen with Proteus infections) than in infected acidic urine or sterile urine. Polyglycolic acid, polyglactin 910, and poliglecaprone 25 are rapidly degraded in infected urine; polydioxanone, polyglyconate, and glycomer 631 are acceptable for use in sterile bladders and in those infected with E. coli. However, use of any suture that is degraded via hydrolysis may be risky when the bladder is infected with Proteus spp. (see also p. 61) because monofilament absorbable sutures have been shown to degrade within 7 days in Proteus mirabilis-inoculated urine in vitro.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 21

“Immediate surgery is contraindicated in animals with uroabdomen that are hyperkalemic or uremic. In general, emergency surgery is rarely appropriate for animals diagnosed with uroabdomen. Patients should first be treated medically to normalize electrolytes and acid base, and to decrease circulating nitrogenous waste products. Intravenous fluids should be given and abdominal drainage and urethral catheterization performed (see p. 699). A large over-the-needle catheter (14-gauge) can be placed in the ventral abdomen under local anesthesia (sedate if necessary) to allow drainage for 6 to 12 hours. This will stabilize most animals with previously normal renal function.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 22

“Urea rapidly equilibrates across the peritoneal surface, whereas larger molecules (e.g., creatinine) cannot pass back into the bloodstream, and they remain concentrated in the abdominal fluid. “Diagnostic Creatinine: Abdominal fluid: peripheral blood ≥2 Suggestive Creatinine: Abdominal fluid: peripheral blood >1 but <2 Potassium: Abdominal fluid > peripheral blood” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 23

Uroabdomen: 3.6% Hemoabdomen: 32.5%

Answer 24

Phenoxybenzamine Diazepam

Answer 25

Possibly guarded because most of the urinary bladder may be necrotic

Answer 26

“UTIs with urease-producing bacteria are an important cause of struvite calculi in dogs. These bacteria split urea to ammonia and carbon dioxide. Hydrolysis of ammonia forms ammonium ions and hydroxyl ions, which alkalinize the urine and decrease struvite solubility. Bacterial cystitis also increases organic debris, which can serve as a nidus for crystallization. Female dogs tend to have more struvite-containing calculi than male dogs, most likely owing their propensity for UTIs. Feline struvite formation usually occurs without UTI.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 27

Defective tubular resorption of calcium Primary hyperparathyroidism Lymphoma Hypervitaminosis D Diet rich in oxalates (high carbohydrate content) Any condition leading to acidic urine or hypercalcemia

Answer 28

Dalmatians Ammonium acid urate is derived from metabolic degradation of endogenous purine ribonucleotides and dietary nucleic acids. A normal dogs these by products are converted into allantoin for excretion (>90%). Dalmatians have defective hepatic transport of uric acid, resulting in decreased production of allantoin and increased urinary excretion of uric acid. PSS can I also lead to urate calculi

Answer 29

Allopurinol Correct PSS

Answer 30

German shepherds and English Sheepdogs

Answer 31

“Double-contrast cystography/urethrography is probably the most sensitive method for finding stones (even better than ultrasound).” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 32

“Cystotomy plus scrotal urethrostomy (p. 689) may be the most effective treatment in preventing recurrence of clinical signs in Dalmatians with urate calculi. Recurrence is common when a cystotomy alone is performed.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 33

Dachshunds, basset hounds, English bulldogs and others D-penicillamine; “Penicillamine may inhibit wound healing and should not be initiated earlier than 2 weeks after surgery. ” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 34

20% (Grant, DC et al, JAVMA 2010)

Answer 35

“Without surgery, the prolapse will not spontaneously resolve. A 2014 study found a recurrence rate of 57%; the likelihood of recurrence was reduced when postoperative sedation was used (e.g., acepromazine or butorphanol).14 Postoperative hemorrhage occurred in 39% of dogs; hemorrhage was less common when a simple continuous pattern was used instead of a simple interrupted.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 36

“Rhabdomyosarcomas are uncommon, highly malignant tumors of striated muscle that may develop from pluripotent stem cells of the primitive urogenital ridge; they are remnants of the Müllerian or Wolffian ducts.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 37

“Most bladder tumors are malignant, and metastasis to the medial iliac lymph nodes and lungs is common. Local extension to the ureters and/or the urethra is also common.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 38

“other malignant bladder tumors include squamous cell carcinoma, adenocarcinoma, fibrosarcoma, leiomyosarcoma, neurofibrosarcoma, rhabdomyosarcoma, and hemangiosarcoma. Fibroma, leiomyoma, hemangioma, rhabdomyoma, myxoma, and neurofibroma are benign bladder tumors. ” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 39

“Proliferative urethritis and granulomatous inflammation of the urethra in female dogs may cause clinical signs similar to those of urethral neoplasia (e.g., stranguria, hematuria, pollakiuria, vaginal discharge, and/or urinary obstruction). Neoplasia and granulomatous inflammation may be differentiated by cytologic evaluation of urethral aspirates or surgical biopsies. The cause of granulomatous urethritis is unknown. Affected dogs may respond favorably to immunosuppressive therapy (e.g., prednisone or prednisone plus cyclophosphamide) plus antibiotics.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 40

Female dogs and male cats are at a higher risk for bladder cancer Shetland sheep dogs, beagles, collies and terriers, particularly Scottish terriers

Answer 41

“Lameness may be associated with hypertrophic osteopathy paraneoplastic syndrome in dogs with TCC” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 42

“Transurethral biopsy using a sterile urinary catheter is often diagnostic. First, insert a finger into the rectum. Then, advance the largest urinary catheter that easily passes through the urethra until the tip is digitally felt to advance just to the point where the thickening or mass is palpated. At that point, apply negative pressure. If urine is obtained, empty the bladder. After the bladder is emptied, or if negative pressure is present to begin with, establish 8 to 12 mL of negative pressure with a syringe that has 10 mL of sterile saline in it, while pulling the catheter tip back out through the thickened area. Once the catheter tip is clearly out of the affected area, remove the catheter from the urethra, place the tip in a clot tube, and blow the tissue fragments in the tip out by forcing saline out through the catheter. Examine the fluid, and retrieve tissue fragments and use them to make squash cytology preparations. In the case of female dogs with severe obstruction of the distal urethra, the most that may be possible is to insert a small, stiff polypropylene catheter a few millimeters into the urethra (which is as far as is possible[…]” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 43

“Transplantation of TCC to the subcutaneous tissue of the surgical incision has been reported in dogs; therefore the same instruments used for biopsy or resection of a bladder tumor should not be used on other tissues.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 44

“Because of the malignant nature of most lower urinary tract tumors, the prognosis is guarded. Reported median survival times do not exceed 1 year, regardless of treatment modality. With aggressive surgery, urethral tumors may have a better prognosis than bladder tumors. Chemotherapy may allow dogs with bladder tumors to survive for significantly longer periods than if they undergo surgery. Deracoxib and vinblastine have been shown to have antitumor activity against TCC in dogs.16,17 For most owners, piroxicam as monotherapy or in conjunction with other agents may be the most appropriate medical therapy. The benefits of radiation therapy and photodynamic therapy in dogs are still being evaluated. Cystostomy tube placement in dogs with known or suspected TCC typically resolves stranguria, and most owners are satisfied with the procedure. UTIs are a common complication.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 45

“In a case series of 10 dogs that underwent total cystectomy with urinary diversion to the prepuce or vagina, median survival was 385 days, and they had fewer gastrointestinal and neurologic complications associated with ureterocolonic anastomosis.4” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 46

Neurogenic abnormality or anatomic outflow obstruction (paradoxical or overflow incontinence) Hormone responsive (urethral sphincter mechanism incontinence) Inflammation (urge incontinence) Congenital abnormalities (ectopic ureters, congenital urethral sphincter incontinence) Behavioral

Answer 47

“Computed tomography (CT) excretory urography is the most sensitive method for diagnosis of ectopic ureters, and if available, should be considered the imaging modality of choice. ” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 48

“colposuspension, cystourethropexy, collagen injection, AUS, and trigonal reconstruction ” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 49

“Before performing surgery, place a large urethral catheter. Perform a caudal midline abdominal approach, and identify the vagina dorsal to the urethra. Use stay sutures or atraumatic forceps to manipulate the vagina cranially. Place two sutures of heavy gauge (0 to 2-0) nonabsorbable monofilament material through the vaginal wall on either side of the urethra to the prepubic tendon on either side of midline. Use the urethral catheter to prevent overtightening of the sutures, which may result in urethral obstruction. Close the abdomen routinely.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 50

“Recurrence of obstruction has been historically reported to occur in 20% to 35% of cases, regardless of the cause of obstruction. ” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 51

“α- and β-hemolytic Streptococcus spp. Staphylococcus spp. Proteus spp. Escherichia coli Bacillus spp. Bacteroides spp. Pasteurella spp. Anaerobic enterococci Mycoplasma” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 52

“Progesterone greater than 2 ng/mL is necessary to maintain pregnancy. Progesterone must fall below 2 ng/mL to initiate parturition;” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 53

“Positive contrast vaginography may help evaluate vaginal anomalies, masses, or injuries if digital examination does not adequately define the problem. Positive contrast vaginography using a Foley catheter and a water-soluble iodinated contrast agent is easily performed. ” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 54

“Radiographically, an enlarged gravid uterus can be detected within 31 to 38 days and fetal skeletal mineralization by 45 days after the LH peak (within a mean of 0.5 days of onset of estrus) ” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 55

“In cats, it is difficult to know when the LH peak has occurred because behavioral estrus is variable (1–21 days); therefore fetal skeletal mineralization, which is first detected at 25 to 29 days before parturition, is used to predict when parturition will occur.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 56

“pregnancy diagnosis by ultrasound is uncomplicated at 30 days of gestation” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 57

“Antibiotic choice should be based on culture and susceptibility or on expected pathogens in patients with pyometra, metritis, or bacterial prostatitis. Until culture results are available, antibiotics used to treat pyometra should be efficacious against Escherichia coli because this is the most common pathogen.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 58

“Antibiotic selection for prostatic diseases should be based on culture results and expected blood-prostate barrier penetration. Antibiotics should be lipid-soluble (usually nonionized), nonprotein bound, and have a high pKa (degree of drug ionization; high pKa = more basic). Those with a high degree of lipid solubility are best at crossing the blood-prostate barrier. Antibiotics with a high pKa are less ionized at physiologic conditions and concentrate in the prostate. Prostatic infections produce acidic prostatic fluid that helps trap antibiotics in the fluid. Basic antibiotics that concentrate in the prostate include erythromycin, clindamycin, and trimethoprim (Box 26.3). Enrofloxacin and doxycycline achieve high prostatic fluid concentrations and are effective against some resistant gram-negative urogenital pathogens.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 59

“The ovaries are located within a thin-walled peritoneal sac; the ovarian bursa is located just caudal to the pole of each kidney. The uterine tube or oviduct courses through the wall of the ovarian bursa. The right ovary lies further cranially than the left. The right ovary lies dorsal to the descending duodenum, and the left ovary lies dorsal to the descending colon and lateral to the spleen. Medial retraction of the mesoduodenum or mesocolon exposes the ovary on each side. Each ovary is attached by the proper ligament to the uterine horn and via the suspensory ligament to the transversalis fascia medial to the last one or two ribs. The ovarian pedicle (mesovarium) includes the suspensory ligament with its artery and vein, ovarian artery and vein, and variable amounts of fat and connective tissue. Canine ovarian pedicles contain more fat than feline ovarian pedicles, making it more difficult to visualize the vasculature. The ovarian vessels take a tortuous path within the pedicle. Ovarian arteries originate from the aorta. The left ovarian vein drains into the left renal vein; the right vein drains into the caudal vena cava. The suspensory ligament is a tough, whitish band of tissue[…]” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 60

Prostatic tumors are frequently metastatic at the time of diagnosis Prostatectomy frequently results in urinary incontinence

Answer 61

Body weight above 15 Kg (7 times more likely to become incontinent)

Answer 62

“Neonate mortality is most commonly associated with emergency surgery, large litters, brachycephalic bitches, and poor anesthetic choices.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 63

“The risk of mammary tumors for dogs spayed before their first estrus is 0.05%. This risk increases to 8% after one estrus cycle and 26% after the second estrus.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 64

Seven times

Answer 65

“Uterine neoplasia is rare in the dog, with a reported incidence of 0.4% of all canine tumors, and it is even less common in cats (0.29%). Most tumors are incidental findings at necropsy or during abdominal exploration.” “Leiomyoma and leiomyosarcoma are benign and malignant smooth muscle tumors, respectively, that may occur in the uterus. Uterine adenocarcinomas are malignant tumors of the uterine glands.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 66

“The prognosis following OHE is excellent for benign tumors and good for malignant tumors without evidence of metastasis or local infiltration. The prognosis for uterine adenocarcinomas is guarded because of its propensity to metastasize before diagnosis. The effectiveness of other treatment modalities for uterine tumors is unknown.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 67

“CEH and pyometra both develop during diestrus. Occasionally the diagnosis is delayed and unrecognized until anestrus. In dogs, the diestrual period of a normal, nongravid bitch lasts approximately 70 days. The uterus is influenced by progesterone produced by ovarian corpora lutea. Progesterone stimulates the growth and secretory activity of the endometrial glands and reduces myometrial activity. CEH is an abnormal uterine response that develops during diestrus (luteal phase of cycle) when there is high or prolonged ovarian production of progesterone or exogenously administered progesterone. Excessive progesterone influence or an exaggerated progesterone response causes the uterine glandular tissue to become cystic, edematous, thickened, and infiltrated by lymphocytes and plasma cells. Fluid accumulates in endometrial glands and the uterine lumen with CEH. Uterine drainage is hindered by progesterone inhibition of myometrial contractility. This abnormal uterine environment allows bacterial colonization to cause pyometra. Administration of estrogen increases the risk of pyometra during diestrus. The risk of an intact bitch developing pyometra before 10 years of age is nearly 25%.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 68

“Feline pyometra is less frequent than canine pyometra because development of luteal tissue requires copulation or artificially induced ovulation; however, cats treated with progestins for skin disease have an increased incidence of pyometra.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 69

“E. coli is the most common organism identified in canine and feline pyometra, but mixed infection is also common. E. coli has an affinity for the endometrium and myometrium. Bacterial invasion is thought to be opportunistic because the most commonly isolated organisms are also normal vaginal flora ” “Escherichia coli Staphylococcus aureusa Streptococcus spp.a Pseudomonas spp.a Proteus spp.a Pasteurella spp. Klebsiella spp. Haemophilus spp. Serratia spp. Moraxella spp.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 70

“Heart rate: >160 beats/min Temperature: >103.5°F (40°C) or <100°F (38°C) Respiration: >20 breaths/min or partial pressure of CO2 <32 mm Hg White blood cell count: >12,000/µL, <4000/µL, or >10% band neutrophils” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 71

“Patients with pyometra may have prerenal azotemia, primary glomerular disease, reduced tubular concentrating ability, tubular interstitial disease, reduced glomerular filtration, and/or concurrent renal disease unrelated to the pyometra. Prerenal azotemia is due to poor perfusion, dehydration, and shock. Primary glomerular disease occurs secondary to immune-complex glomerulonephritis. Bacterial antigens also interfere with renal tubular concentrating ability. Once the bacterial antigen is removed, these changes typically resolve and normal renal function returns. Reduced tubular concentrating ability is from inhibition of antidiuretic hormone at the level of the renal tubule by bacterial endotoxins, obligatory solute load from decreased glomerular filtration rate, and other unknown factors. Normal tubular concentrating ability usually returns 2 to 8 weeks after OHE. Hepatocellular injury may be secondary to intrahepatic cholestasis and retention of bile pigments, toxicity from sepsis and endotoxemia, and/or poor perfusion.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 72

“Anemia may be caused by chronic inflammation suppressing erythropoiesis, loss of red cells into the uterine lumen, hemodilution, or surgical blood loss. Nonregenerative anemia should spontaneously resolve a few weeks after OHE. ” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 73

“Cefazolin (Ancef, Kefzol) 22 mg/kg IV, SC, IM q8h Cefoxitin (Mefoxin) Dogs: 30 mg/kg IV q6–8h Cats: 22–33 mg/kg IV, IM q8h Amoxicillin Plus Clavulanate (Clavamox) Dogs: 12.5–25 mg/kg PO q12h Cats: 62.5 mg/cat PO q12h Ampicillin Plus Sulbactam (Unasyn) 50 mg/kg IV q8h Ampicillin 22 mg/kg IV, IM, SC q6–8h Enrofloxacin (Baytril) Dogs: 7–20 mg/kg PO, IV q24h (dilute and give slowly over 30 min if given IV) Cats: 5 mg/kg PO q24h ” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 74

“Although rare, vaginal prolapse/hyperplasia is most common in large-breed dogs. It most commonly occurs in young bitches (≤2 years) during one of their first three estrus cycles. ” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 75

“Fibroleiomyoma is the most common benign tumor. Fibroleiomyomas originate around the urethral papilla and are usually pedunculated, smooth, firm, and pale. ” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 76

Rupture of the uterine artery

Answer 77

“Dihydrotestosterone enhances growth in both prostatic stromal and glandular components. Testosterone declines with age, but estrogen levels remain the same and induce nuclear dihydrotestosterone receptors, which may increase the sensitivity of the prostate to dihydrotestosterone.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 78

Glandular hyperplasia, dogs as young as 1 year of age, peaks at 5-6 years Complex hyperplasia, dogs as young as 2 years, peaks at 8-9 years

Answer 79

“The prostate is considered enlarged if it is greater than 70% of the distance between the sacral promontory and the pubis on lateral radiographs” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 80

“Ultrasonographically, hyperplasia is seen as diffuse, symmetric prostatic involvement, often with multiple, small cysts. Overall glandular echogenicity is normal to increased. Small areas of decreased echogenicity may be seen if cystic hyperplasia is present. Typical features seem in CT images of BPH include symmetric prostatomegaly and heterogeneous prostatic parenchyma. ” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 81

“Definitive diagnosis of BPH requires histopathology, but typically a presumptive diagnosis is made based on historical information, physical examination findings, and ultrasonographic examination.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 82

Drainage or excision and castration

Answer 83

“Sertoli cell tumors predispose the prostate to squamous metaplasia, which can lead to prostatic cysts that can then abscess.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 84

“Finasteride is a synthetic steroid type II 5-alpha reductase inhibitor that significantly decreases dihydrotestosterone (approximately 58%) without affecting serum testosterone or semen quality, and reduces prostate diameter (approximately 20%) and volume (approximately 43%) (see Table 26.7); it is currently the drug of choice in dogs for which castration is not an option. Estrogen therapy reduces prostatic size but is not recommended because it causes infertility, squamous metaplasia, abscessation, and aplastic anemia. ” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 85

“Sertoli cell tumors or exogenous estrogens may cause squamous metaplasia, which occludes ducts, causing secretory stasis with progressive acinar dilation. Cysts coalesce as they enlarge and are surrounded by dense collagen that can ossify. Small cysts often become confluent, forming larger cavities.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 86

Parenchymal prosthatic cyst Paraprostatic (Periprostatic) cysts Neoplasia

Answer 87

LATUSH Leiomyosarcoma Adenocarcinoma Transitional cell carcinoma Undifferentiated carcinoma Squamous cell carcinoma Hemangiosarcoma Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 88

(0.2%–0.6%)

Answer 89

“Well-differentiated adenocarcinomas are found more frequently in sexually intact dogs, whereas histologic types with more anaplasia and TCC are more common in castrated dogs. ” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 90

“Prostatic carcinomas are locally invasive and metastasize early to regional lymph nodes (iliac, pelvic, and sublumbar), lung, and bone. They frequently invade bone, bladder, colon, and surrounding tissue by direct extension. Other metastatic sites include the liver, spleen, kidney, heart, adrenal glands, skeletal muscle, and subcutaneous tissue. Bone involvement may cause pain or pathologic fractures. Hypertrophic osteopathy has occasionally been associated with prostatic tumors. Prostatic enlargement causes compression and partial obstruction of the colon, rectum, and sometimes urethra. Pitting edema of the pelvic limbs may occur secondary to lymphatic invasion. Most tumors involve the trigone and urethra and have metastasized at the time of diagnosis. The behavior of feline prostatic tumors is unknown.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 91

“Prostatic neoplasia occurs in both intact and neutered males, but is more common in neutered males. Medium to large-breed dogs, such as doberman pinschers, Shetland sheepdogs, Scottish terriers, beagles, German shorthaired pointers, Airedale terriers, and Norwegian elkhounds are overrepresented. The average age of occurrence is 10 years. Prostatic tumors are very rare in cats.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 92

“Be sure to test for Brucella canis infection in dogs with unexplained scrotal or testicular disease.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 93

“familial predisposition has been suggested in Boston terriers. The defect is present at birth.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 94

“Displaced fractures may be splinted with an indwelling polypropylene urethral catheter spanning the os penis and sutured to the tip of the urethra. More comminuted fractures may be stabilized with small plates, or the penis may be amputated.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 95

“Bleeding from small penile punctures or lacerations during penile engorgement is minimized by suturing the tunica albuginea.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 96

“The bladder receives its blood supply from the cranial and caudal vesical arteries, which are branches of the umbilical and urogenital arteries, ” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 97

“Up to 50% of calcium oxalate uroliths recur within 3 years in dogs but only 7% recur in cats.” Excerpt From Veterinary Surgery: Small Animal Expert Consult Spencer A. Johnston VMD, DACVS & Karen M. Tobias DVM, MS, DACVS https://books.apple.com/us/book/veterinary-surgery-small-animal-expert-consult/id1250368401 This material may be protected by copyright.

Answer 98

54 to 82% completely continent (two studies) 86% client satisfaction

Answer 99

“Transabdominal needle biopsy of the ovaries is not recommended because of the propensity of many ovarian tumors to implant and grow on the peritoneal surface.21” Excerpt From Veterinary Surgery: Small Animal Expert Consult Spencer A. Johnston VMD, DACVS & Karen M. Tobias DVM, MS, DACVS https://books.apple.com/us/book/veterinary-surgery-small-animal-expert-consult/id1250368401 This material may be protected by copyright.

Answer 100

“Epithelial cell tumors include papillary adenoma and adenocarcinoma, cystadenoma, and undifferentiated carcinoma. These tumors constitute 40% to 50% of reported canine ovarian neoplasms” “The most common sex cord stromal tumor is the granulosa cell tumor, which accounts for approximately 50% of ovarian tumors in several reviews.218 These tumors may produce estrogen, progesterone, or both. They are usually unilateral, firm, and lobulated with cysts and can grow quite large.76,303 Up to 20% of granulosa cell tumors metastasize.218” Excerpt From Veterinary Surgery: Small Animal Expert Consult Spencer A. Johnston VMD, DACVS & Karen M. Tobias DVM, MS, DACVS https://books.apple.com/us/book/veterinary-surgery-small-animal-expert-consult/id1250368401 This material may be protected by copyright.

Answer 101

“Bitches with granulosa cell tumors may present with clinical signs of persistent proestrus or estrus, cystic endometrial hyperplasia, or pyometra. ” “granulosa cell tumors are often large and unilateral and produce hormones. They metastasize to peritoneum, lumbar lymph nodes, omentum, diaphragm, kidney, spleen, liver, and lungs” Excerpt From Veterinary Surgery: Small Animal Expert Consult Spencer A. Johnston VMD, DACVS & Karen M. Tobias DVM, MS, DACVS https://books.apple.com/us/book/veterinary-surgery-small-animal-expert-consult/id1250368401 This material may be protected by copyright.

Answer 102

“Dogs with estrogen-secreting granulosa cell tumors may develop bone marrow aplasia and, possibly, irreversible pancytopenia.” Excerpt From Veterinary Surgery: Small Animal Expert Consult Spencer A. Johnston VMD, DACVS & Karen M. Tobias DVM, MS, DACVS https://books.apple.com/us/book/veterinary-surgery-small-animal-expert-consult/id1250368401 This material may be protected by copyright.

Answer 103

“Ovarian follicular cysts are lined with granulosa cells. Follicular cysts that secrete significant amounts of estrogen produce prolonged proestrus; if a small amount of progesterone is also secreted, they produce signs of prolonged estrus. Luteinized cysts secrete only progesterone, resulting in prolonged diestrus. Functional ovarian cysts are more commonly seen in dogs younger than 3 years of age and cats younger than 5 years of age.” Excerpt From Veterinary Surgery: Small Animal Expert Consult Spencer A. Johnston VMD, DACVS & Karen M. Tobias DVM, MS, DACVS https://books.apple.com/us/book/veterinary-surgery-small-animal-expert-consult/id1250368401 This material may be protected by copyright.

Answer 104

“In dogs, follicular cysts are associated with vaginal bleeding and attractiveness to males beyond the normal 21 to 28 days of an ovarian cycle.84,130 If the cyst is also progesterone producing, persistent standing heat is evident. Cats often show persistent estrus when follicular cysts are present.129 Physical examination findings are consistent with persistent proestrus or estrus and include an enlarged vulva (dogs) and vaginal bleeding of uterine origin.” Excerpt From Veterinary Surgery: Small Animal Expert Consult Spencer A. Johnston VMD, DACVS & Karen M. Tobias DVM, MS, DACVS https://books.apple.com/us/book/veterinary-surgery-small-animal-expert-consult/id1250368401 This material may be protected by copyright.

Answer 105

“The diagnosis in dogs is based on a history of ovariohysterectomy and results of vaginal cytology that, if performed during standing heat, are indicative of estrogen dominance.130 Other diagnostic tests in dogs include hormone assays: remnant ovarian tissue is likely present if serum estradiol and progesterone concentrations exceed 15 pg/mL and 2 ng/mL, respectively.130 A single low luteinizing hormone concentration indicates functioning ovarian tissue in dogs.239 A high luteinizing hormone concentration is usually consistent with gonadectomy; however, false-positive results may occur.239 Anti-Müllerian hormone was recently shown to be diagnostic for ovarian remnant syndrome in an experimental canine model and useful for differentiating gonadectomy status in cats; it has the advantage of being independent of the ovarian cycle.16,374 In one study the location of the remnant was correctly identified in 9 of 12 animals on ultrasonography.18” Excerpt From Veterinary Surgery: Small Animal Expert Consult Spencer A. Johnston VMD, DACVS & Karen M. Tobias DVM, MS, DACVS https://books.apple.com/us/book/veterinary-surgery-small-animal-expert-consult/id1250368401 This material may be protected by copyright.

Answer 106

“Pyometra is common in middle-aged intact bitches, with an average age of 8 years.145 Incidence in intact bitches is high: the risk for a bitch to be affected within 10 years of age is estimated to be 23% to 24%.” Excerpt From Veterinary Surgery: Small Animal Expert Consult Spencer A. Johnston VMD, DACVS & Karen M. Tobias DVM, MS, DACVS https://books.apple.com/us/book/veterinary-surgery-small-animal-expert-consult/id1250368401 This material may be protected by copyright.

Answer 107

“Hormone stimulation alone does not result in pyometra, indicating that pyometra development is multifactorial and involves hormonal and bacteriologic aspects. In dogs and cats the predominant bacteria in most studies is Escherichia coli. Other isolates include Pasteurella multocida, Pseudomonas spp., Proteus spp., Klebsiella spp., Streptococcus canis, Enterobacter cloacae, and many others.” “Pyometra does not appear to be caused by prolonged or excessive progesterone production or changes in hormone receptors.” Excerpt From Veterinary Surgery: Small Animal Expert Consult Spencer A. Johnston VMD, DACVS & Karen M. Tobias DVM, MS, DACVS https://books.apple.com/us/book/veterinary-surgery-small-animal-expert-consult/id1250368401 This material may be protected by copyright.

Answer 108

“Cystitis may occur in almost 70% of dogs with pyometra, and E. coli isolated from urinary bladder and uterus of individual affected dogs are phenotypically and genetically identical.Although the urinary tract may serve as a bacterial reservoir for ascending contamination during a susceptible stage in the estrus cycle,it seems more likely that purulent drainage from the uterus secondarily infects the dependent-positioned urinary tract.” Excerpt From Veterinary Surgery: Small Animal Expert Consult Spencer A. Johnston VMD, DACVS & Karen M. Tobias DVM, MS, DACVS https://books.apple.com/us/book/veterinary-surgery-small-animal-expert-consult/id1250368401 This material may be protected by copyright.

Answer 109

“The most common clinical signs of pyometra in dogs include polyuria (71%), lethargy (71%), vomiting or inappetence (75%), and vaginal discharge (52% to 85%). In one study a majority of bitches (60%) showed three or more of these clinical signs. In another study, 47% of bitches with pyometra had gait abnormalities and lameness, as compared with 20% of the body-matched controls. Interestingly, the gait abnormalities resolved 2 to 4 days after ovariohysterectomy in most dogs.” Excerpt From Veterinary Surgery: Small Animal Expert Consult Spencer A. Johnston VMD, DACVS & Karen M. Tobias DVM, MS, DACVS https://books.apple.com/us/book/veterinary-surgery-small-animal-expert-consult/id1250368401 This material may be protected by copyright.

Answer 110

“Common laboratory findings in bitches with pyometra include an inflammatory leukogram with marked increase in total white blood cell (WBC) count and usually a regenerative left shift.l Leukocytosis was reported in 68% of dogs with pyometra, with band neutrophils exceeding 3% in 83% of dogs.145 Normocytic, normochromic anemia is also common and is thought to result from erythrocyte loss into uterine exudate and decreased erythropoiesis. With anemia of chronic disease, lactoferrin and other acute phase reactants mediate an iron sequestration within the myeloid cells in the bone marrow, withdrawing iron from the normal erythropoiesis.78 Platelet counts are often mildly decreased and were less than 200,000/µL in 37% of dogs in one study.145 Alterations of the canine immune system during pyometra have been demonstrated by lymphocyte transformation test, indicating inhibition of lymphocyte activity.” Excerpt From Veterinary Surgery: Small Animal Expert Consult Spencer A. Johnston VMD, DACVS & Karen M. Tobias DVM, MS, DACVS https://books.apple.com/us/book/veterinary-surgery-small-animal-expert-consult/id1250368401 This material may be protected by copyright.

Answer 111

“Increased AP, bilirubin, and serum cholesterol concentrations are thought to result from intrahepatic cholestasis.40 Increases in AST and LD concentrations are most likely derived from muscle breakdown, based on the fact that dogs with pyometra have increased concentrations of creatine kinase, a muscle enzyme, and decreased ALT concentrations, indicating that no hepatocellular damage has occurred.40,93,144,145,338 Additionally, liver biopsy specimens from dogs with pyometra have fatty infiltration and bile pigments, consistent with cholestasis, but no gross hepatocellular necrosis” Excerpt From Veterinary Surgery: Small Animal Expert Consult Spencer A. Johnston VMD, DACVS & Karen M. Tobias DVM, MS, DACVS https://books.apple.com/us/book/veterinary-surgery-small-animal-expert-consult/id1250368401 This material may be protected by copyright.

Answer 112

“The uterine stump should not be oversewn to avoid leaving compromised tissue and foreign material (suture) in an infected site.356” Excerpt From Veterinary Surgery: Small Animal Expert Consult Spencer A. Johnston VMD, DACVS & Karen M. Tobias DVM, MS, DACVS https://books.apple.com/us/book/veterinary-surgery-small-animal-expert-consult/id1250368401 This material may be protected by copyright.

Answer 113

“Hematometra should be treated by ovariohysterectomy if bleeding is clinically significant.” Excerpt From Veterinary Surgery: Small Animal Expert Consult Spencer A. Johnston VMD, DACVS & Karen M. Tobias DVM, MS, DACVS https://books.apple.com/us/book/veterinary-surgery-small-animal-expert-consult/id1250368401 This material may be protected by copyright.

Answer 114

“Ovariohysterectomy does not affect postpartum milk production.” Excerpt From Veterinary Surgery: Small Animal Expert Consult Spencer A. Johnston VMD, DACVS & Karen M. Tobias DVM, MS, DACVS https://books.apple.com/us/book/veterinary-surgery-small-animal-expert-consult/id1250368401 This material may be protected by copyright.

Answer 115

“Acute metritis may result in severe systemic illness similar to pyometra but is associated with the postpartum, rather than diestrus, period. Twelve hours after delivery, healthy bitches may develop a fever (<40°C [104°F]) that lasts for 24 to 48 hours; however, any clinical signs of illness within 1 week of partus may indicate acute metritis.380 Postpartum metritis may be associated with dystocia, obstetric manipulations, devitalized uterine tissue, or retention of a fetus or placenta.133Clinical signs include foul-smelling, reddish brownish vaginal discharge (in contrast to the normal nonodorous lochia), anorexia, lethargy, fever, decreased maternal behavior, and decreased milk production.111,343 Vaginal smears are not diagnostic because degenerative neutrophils and phagocytized bacteria can be seen in healthy postpartum dogs or those with metritis or vaginitis.133,296 Changes on CBC (i.e., leukocytosis with a left shift, or leukopenia if severely ill) are associated with inflammation. A chemistry panel reflects dehydration and occasionally sepsis.133Treatment consists of rapidly instituted systemic antibiotic therapy. Anterior vaginal swabs for culture are ideally obtained before antibiotic administration. Penicillins, clindamycin, erythromycin, and cephalosporins are safe to use in pregnant or nursing bitches.128 Amoxicillin or ampicillin is usually initiated while awaiting culture results[…]” Excerpt From Veterinary Surgery: Small Animal Expert Consult Spencer A. Johnston VMD, DACVS & Karen M. Tobias DVM, MS, DACVS https://books.apple.com/us/book/veterinary-surgery-small-animal-expert-consult/id1250368401 This material may be protected by copyright.

Answer 116

“the abdomen, perivulvar region, and prolapsed tissue can be surgically prepared and draped in. An ovariectomy is performed via midline laparotomy, and the mesometrium is disconnected from the uterus. The entire uterus is retracted out from the vulva and removed after ligation of the uterine body.33” Excerpt From Veterinary Surgery: Small Animal Expert Consult Spencer A. Johnston VMD, DACVS & Karen M. Tobias DVM, MS, DACVS https://books.apple.com/us/book/veterinary-surgery-small-animal-expert-consult/id1250368401 This material may be protected by copyright.

Answer 117

- prolonged gestation - lack of progression from stage 1 to stage 2 labor within 12 to 24 hours - failure to deliver pups within 36 hours of rectal temperature falling below 37.8°C (100°F) - signs of toxemia Excerpt From Veterinary Surgery: Small Animal Expert Consult Spencer A. Johnston VMD, DACVS & Karen M. Tobias DVM, MS, DACVS https://books.apple.com/us/book/veterinary-surgery-small-animal-expert-consult/id1250368401 This material may be protected by copyright.

Answer 118

“Normal fetal heart rate in healthy fetuses at term is 220 beats/min or higher382,403 at normal birth or 142 to 162 beats/min in an anesthetized dam.267 Fetal heart rate below 150 to 180 beats/min in an awake dam has been considered a sign of severe fetal distress128,403 Absent fetal motion and presence of fetal bowel movements are also indicators of fetal distress.403” Excerpt From Veterinary Surgery: Small Animal Expert Consult Spencer A. Johnston VMD, DACVS & Karen M. Tobias DVM, MS, DACVS https://books.apple.com/us/book/veterinary-surgery-small-animal-expert-consult/id1250368401 This material may be protected by copyright.

Answer 119

“Fetal numbers are accurately determined by radiologic examination in 93% of pregnancie” Excerpt From Veterinary Surgery: Small Animal Expert Consult Spencer A. Johnston VMD, DACVS & Karen M. Tobias DVM, MS, DACVS https://books.apple.com/us/book/veterinary-surgery-small-animal-expert-consult/id1250368401 This material may be protected by copyright.

Answer 120

“Contraindications to medical management include a history of more than 30 minutes of strong abdominal contractions without fetal expulsion, rectal or vaginal palpation findings indicative of obstruction, or diagnostic imaging indicative of fetal malformation or malposition. In addition, if ultrasonographic signs of severe fetal distress are present, a cesarean section should be performed without delay to avoid fetal death.” Excerpt From Veterinary Surgery: Small Animal Expert Consult Spencer A. Johnston VMD, DACVS & Karen M. Tobias DVM, MS, DACVS https://books.apple.com/us/book/veterinary-surgery-small-animal-expert-consult/id1250368401 This material may be protected by copyright.

Answer 121

“Of bitches with dystocia, 60% to 65% require cesarean section.28,83” Excerpt From Veterinary Surgery: Small Animal Expert Consult Spencer A. Johnston VMD, DACVS & Karen M. Tobias DVM, MS, DACVS https://books.apple.com/us/book/veterinary-surgery-small-animal-expert-consult/id1250368401 This material may be protected by copyright.

Answer 122

“Subinvolution primarily affects young bitches after their first or second litter. Usually, hemorrhagic vaginal discharge is the only abnormality found on physical examination and diagnostic testing. Diagnosis is partly based on ruling out other conditions that cause vaginal hemorrhage, such as metritis, vaginitis, proestrus, trauma, neoplasia, and coagulopathies. The presence of trophoblast-like cells on vaginal cytology may aid in diagnosis.394 If the bitch remains healthy and does not develop anemia, treatment is unnecessary, and the bitch remains fertile. No effective medical management has been reported; therefore bitches with persistent hemorrhage and anemia may require ovariohysterectomy.133” Excerpt From Veterinary Surgery: Small Animal Expert Consult Spencer A. Johnston VMD, DACVS & Karen M. Tobias DVM, MS, DACVS https://books.apple.com/us/book/veterinary-surgery-small-animal-expert-consult/id1250368401 This material may be protected by copyright.

Answer 123

“In animals with unicornuate uterus, both ovaries are usually present, but the ipsilateral ovary may be smaller than normal and abnormally located, possibly as far cranial as the diaphragm.258,356 Other anomalies reported include atresia, septate uterine body, double cervix, and cornual fusion.248,273,356” Excerpt From Veterinary Surgery: Small Animal Expert Consult Spencer A. Johnston VMD, DACVS & Karen M. Tobias DVM, MS, DACVS https://books.apple.com/us/book/veterinary-surgery-small-animal-expert-consult/id1250368401 This material may be protected by copyright.

Answer 124

“CEH and pyometra both develop during diestrus. Occasionally the diagnosis is delayed and unrecognized until anestrus. In dogs, the diestrual period of a normal, nongravid bitch lasts approximately 70 days.” “Pyometra usually occurs several weeks (1–4 weeks in cats, 4–8 weeks in dogs [mean, 5.7 weeks]) after estrus, or following mismating injections or exogenous administration of estrogens or progestins.”

Answer 125

“The uterus is influenced by progesterone produced by ovarian corpora lutea. Progesterone stimulates the growth and secretory activity of the endometrial glands and reduces myometrial activity. CEH is an abnormal uterine response that develops during diestrus (luteal phase of cycle) when there is high or prolonged ovarian production of progesterone or exogenously administered progesterone. Excessive progesterone influence or an exaggerated progesterone response causes the uterine glandular tissue to become cystic, edematous, thickened, and infiltrated by lymphocytes and plasma cells. Fluid accumulates in endometrial glands and the uterine lumen with CEH. Uterine drainage is hindered by progesterone inhibition of myometrial contractility. This abnormal uterine environment allows bacterial colonization to cause pyometra. Administration of estrogen increases the risk of pyometra during diestrus. The risk of an intact bitch developing pyometra before 10 years of age is nearly 25%.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 126

“The risk of an intact bitch developing pyometra before 10 years of age is nearly 25%.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 127

“Estrogen increases the number of uterine progesterone receptors, which may explain the increased incidence of pyometra after estrogens are administered to prevent pregnancy.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 128

“Feline pyometra is less frequent than canine pyometra because development of luteal tissue requires copulation or artificially induced ovulation; however, cats treated with progestins for skin disease have an increased incidence of pyometra.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 129

“ Hypoglycemia is common in canine pyometra. Sepsis and SIRS deplete glycogen stores, increase peripheral glucose use, and decrease gluconeogenesis. Transient hyperglycemia occasionally occurs because of excessive catecholamine and glucagon release. Progesterone-induced growth hormone production may cause persistent hyperglycemia and glucosuria. Judicious insulin treatment may be required in patients with persistent hyperglycemia (i.e., greater than 300 mg/dL) after appropriate medical and surgical treatment.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 130

Hypoglycemia Renal dysfunction Hepatic dysfunction Anemia Cardiac arrhythmias Coagulation abnormalities Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 131

“Leukopenia may indicate overwhelming infection and septicemia or uterine sequestration of neutrophils, and has been shown to be associated with an 18-fold increase in the likelihood of peritonitis in dogs with pyometra.7” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 132

“Surgery should not be delayed more than a few hours while medical therapy (i.e., fluid therapy) is instituted, especially in patients with closed pyometra. Urine output, glucose, and arrhythmias should be monitored preoperatively. Hydration, electrolyte, and acid-base imbalances should be corrected before surgery, if possible (the prognosis is improved when azotemia is corrected before surgery). A broad-spectrum antibiotic effective against E. coli (e.g., cefazolin, cefoxitin, enrofloxacin, ampicillin plus sulbactam, and ticarcillin plus clavulanate; Box 26.21) should be given IV while awaiting antibiotic susceptibility results. Aminoglycosides are nephrotoxic and not recommended because of the prevalence of renal dysfunction with pyometra. Fluid input and urine output should be monitored to help assess renal function. Diuretics (e.g., furosemide [Box 26.22], 2–4 mg/kg IV, intramuscular [IM], or subcutaneous or 20% dextrose IV) may be administered in volume-overloaded patients with reduced urine production. Administration of antiarrhythmics may occasionally be necessary.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 133

“Fibroleiomyoma is the most common benign tumor. Fibroleiomyomas originate around the urethral papilla and are usually pedunculated, smooth, firm, and pale. The most common malignant tumors are TVTs. These tumors tend to be broad-based, irregular, friable, and bleed easily. Malignant vulvar-vaginal tumors are often locally invasive and metastasize early to local lymph nodes. ” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 134

“Uterine prolapse may tear the broad ligament and uterine artery. Hemorrhage may lead to hypovolemic shock unless controlled quickly.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 135

“A fornix will be identified by inserting a probe or finger along the protruding mass if it is a vaginal mass or prolapse, but not if it is a uterine prolapse. The animal may be stable or show signs of hemorrhagic shock (e.g., pale mucous membranes, tachycardia, and weak pulses).” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 136

“Catheterize the urethra during uterine amputation to prevent traumatizing it or the urethral papilla.” Excerpt From Small Animal Surgery E-Book Theresa Welch Fossum DVM, MS, PhD, Dipl ACVS https://books.apple.com/us/book/small-animal-surgery-e-book/id1367916984 This material may be protected by copyright.

Answer 137

Overall 80% response. Incontinence can recite within 6 months but tends to respond to medical management. - Cystoscopically-guided laser ablation was associated with fewer complications Dekerle, B, Maurice, E, Decambron, A, Viateau, V, Maurey, C, Manassero, M. Outcomes of 25 female dogs treated for ectopic ureters by open surgery or cystoscopic-guided laser ablation. Veterinary Surgery. 2022; 51( 4): 568- 575. doi:10.1111/vsu.13807

Answer 138

Before: 24% @ 463 days After: 13% @ 476 days

Answer 139

1) Engorgement of the cavernosus bodies of the penis, as a result of increased arterial flow and decreased venous drainage 2) Compression of the dorsal penile vein against the ischial arch as a result of contraction of the ischiocavernosus and bulbospongiosum muscles

Answer 140

Hypospadias Failure of fusion of the urogenital folds and incomplete formation of the penile urethra Glandular, penile, scrotal, perineal, anal Surgical reconstruction is not recommended because the remaining urethra cranial to the orifice is typically abnormal. Excision of prepucial/penile remnants, bilateral orchiectomy with enlargement or maintenance of a current orifice in the scrotal or perineal region can be attempted in severe cases.

Answer 141

Attempt to pass a urinary catheter beyond the fracture, bridging the entire length of the os penis. Keep the catheter in place for seven days. If passing a urinary catheter is not possible, open reduction, and internal fixation with a plate will be necessary. Ultimately a pre scrotal urethrostomy And penile amputation might be necessary if signs of urethral obstruction persist. This may occur as a result of the fracture itself, or due to bone formation. Prognosis with conservative management tends to be very good. Salvage procedures also tend to be effective.