Ovaries and uterus Flashcards
Where do the ovarian arteries arise from the aorta?
Caudal to renal arteries and cranial to deep circumflex iliac arteries
Where do the ovarian vein drain into?
- Right ovarian vein drains into the caudal vena cava
- Left ovarian vein drains into the renal vein
What are the layers of the uterus?
- Serosa
- Muscularis
- Mucosa (endometrium)
Endometrium is the thickest layer
What are the 4 phases of the oestrus cycle?
How does the oestrus cycle differ in cats from dogs?
- Proestrus
- Oestrus
- Diestrus
- Anestrus
Cats:
- proestrus is much shorter and is not externally visible (feline vulva is not responsive to oestrogen)
- Formation of corpus lutea requires induction of ovulation, in non-pregnant cats will remain functional for 37d
- Dogs ovulate spontaneously, progesterone dominance seen for 60-100d in non pregnant bitches
How can parturition be predicted in a dog?
- 64-66 d after LH peak
- Preovulatory progesterone rise to 1.5ng/ml - 65 +/- 3d
- Skeletons detectable by d42 (20-21d to parturition), pelvises by day 57
- Progesterone drop to 2-3ng/ml 18-30hr
- Body temp drops 10-14hr after progesterone drop, parturition imminent
List the three stages of parturition
- Stage 1: Externally non-visible uterine contractions, behavioural changes. Lasts up to 24hr
- Stage 2: Expulsion of a foetus
- Stage 3: Expulsion of placenta
Stage 2 and 3 alternate and lasts up to 36hr. Active straining should not exceed 30 mins without expulsion of a pup and there should not be more than 4 hr between each puppy
How does pregnancy and parturition differ in cats?
- Placental secretion of progesterone independant of the ovaries occurs in cats after day 40
- In less than 1% of litters, parturition may be interrupted for up to 48hr
What % of intact bitches are reported to get pyometra?
24%
What are some consequences of OVH?
- Increases risk of TCC, OSA, cardiac tumours, HSA
- OSA more commin in Rottweilers spayed under 1yr
- Viszlas increased risk of HSA and MCT
- Increased risk of DM in cats
- Increased risk of hypothyroidism in dogs
- Spayed dogs 2x risk of obesity
- USMI in up to 20% spayed bitches as compared to 0.2-0.3%. Larger dogs 7x as likely as dogs under 15kg
What sized vessels and uterine bodies can be sealed with a Ligasure?
What sized vessels can be sealed with an ultrasonic sealing device?
Ligasure:
- 7mm vessels
- 9mm uterine body
Ultrasonic:
5mm vessels
What is the incidence of periop complications after OVH?
- 7.5-19% dogs
- 12% cats
How does aminocaproic acid work?
Inhibitory effects of plasminogen activators and plasmin, thererby inhibiting fibrinolysis
List the basic concepts of a laparoscopic spay
- 15-degree Trendelenberg position
- Pneumoperitoneum of 10-12mmHg
- 3 post technique (30mm caudal to umbilicus, 30-50mm cranial to umbilicus and 30-50mm cranial to pubis)
- Uterine bodies less than 9mm sealed with Ligasure have a median bursting strength of 237mmHg
- Low complication rate approx 2%
What is a NOTES approach?
Natural Orifice Transluminal Endoscopic Surgery
- Has been describes experimentally for ovariectomy in 20 bitches
WHat is the reported incidence of ovarian remnant syndrome with lap ovariectomy?
0.5%
Can you FNA an ovarian mass?
Not recommended - high rate of seeding
What are the most common ovarian tumours?
Dogs:
- Granulosa cell tumour - 50%
- Epithelial cell tumours (papillary adenoma/adenocarcinoma, cystadenoma, undifferentiated carcinoma) - 40-50%
- Dysgerminoma, teratoma, teratocarcinoma 6-12%
- Rhabdomyosarcoma
Cats:
- Granulose cell tumour - 50%
- Dysgerminoma
- Epithelial cell tumour - rare
Which ovarian tumour:
- Produces oestrogen and/or progesterone
- May be bilateral
- May be calcified
- May cause BM aplasia and irreversible pancytopaenia
- Arise from rete ovarii
- Oestrogen/progesterone - granulosa cell tumour
- Bilateral - papillary tumours
- Calcified - teratoma
- BM aplasia - granulosa cell tumour
- Rete ovarii - cystadenomas
List the types of functional ovarian cysts
What are the treatment options?
- Follicular cysts - lines with granulosa cells and produce oestogen and prolong proestrus
- Luteinised cysts - produce progesterone - prolonged diestrus
Tx options:
- May spontaneously resolve - nothing!
- GnRH or hCG
- Ovariectomy
Normal preovulatory follciles 4-9mm, functional cysts 10-15mm
How can you diagnose ovarian remnant syndrome?
- Serum estradiol over 15pg/ml and progesterone over 2ng/ml - likely
- Single low LH concentration indicates functioning ovarian tissue
- Anti-Mullerian hormone - benefit of being independant of the ovarian cycle
Ovarian neoplasia has been diagnosed in 5/21 and 2/7 animals with ovarian remnant - submit for histo
How does a entire status increase the risk of pyometra?
- Progesterone leads to cyctic endometrial hyperplasia which predisposed to secondary infection
- Oestrogen enhances endometrial response to progesterone
- Progesteron stimulates glandular secretions and inhibits uterine contractions
- Progesterone decreases the ability for proliferative response of uterine mononuclear response
What is the most common bacteria isolated from pyometra?
What virulence factors are associated with canine pyometra?
E.Coli
- alphs-haemolysin
- P-fimbriae
- cytotoxic necrotising factor
Concurrent cystitis in up to 70% with identical E.Coli
What % of dogs with prometra also have SIRS?
What needs to be monitored in patients with SIRS?
- 47%
What causes anaemia of chronic disease?
- Lactoferrin and other acute phase reactants mediate an iron sequestration within the myeloid cells int eh BM, withdrawing iron from normal erythropoiesis
What are the acute phase proteins in bitches with pyometra?
- CRP
- Serum amyloid A
- Haptoglobins
List the mainstays of medical management of pyometra
- ABx for atleast 14d
- PGF-2a - causes contraction of myometrium and relaxation of cervix. 48-hr lag time
- Dopamine agonists (cabergoline)
- GnRH antagonists (Acyline)
- Progesterone receptor antagonists (aglepristone)
What is the mortality rate of pyometra?
What are some negative prognostic indicators?
Mortality rate 0-5% dogs, 8% cats
Negative prognostic indicators:
- Septic abdomen from uterine rupture
- Febrile dogs and high CRP - increased morbidity
List DDx for pyometra
- Cystic endometrial hyperplasia
- Mucometra
- Hydrometra
- Haematometra
- Metritis (postpartum rater than dioestrus)
- Uterine torsion
List the indications for a C-section
- 4 hours between puppies
- Contractions for 30 min
- Lochia without foetal delivery
- Obstructed birth canal
- Abnormal foetal presentation
- Lack of Ferguson reflex
- Foetal HR 150-180 or less
- Absent foetal movements or presence of bowel motion
- Failed medical management of primary uterine inertian (30-40% successful)
By what time should the foetus’ be removed after en-bloc OVH?
WIthin 60s of clamping uterine blood supply
What are the most common uterine tumours of dogs and cats?
Dogs:
- 90% benign leiomyomas
- 10% leiomyosarcoma
Cats:
- Most commonly malignant adenocarcinoma
- More likely to have mets, prognosis guarded
