Ovariohysterectomy (OVH) Flashcards
What is an Ovariohysterectomy?
- Surgical removal of the ovaries and uterus
- Complete removal of female reproductive tract
- Oviducts, ovaries, uterine horns, uterus
What is an ovariectomy?
- Surgical removal of the ovaries only
Which is a quicker procedure, a ovariohysterectomy or a ovariectomy?
Ovariectomy
What is a hysterotomy?
Caesarian Section
- Open Gravid uterus and surgically removing feti
What is a pyometra related to?
Hormonal influnence
What is the way to prevent pyometra?
Ovariohysterectomy
Why do we spay animals?
- Sterilization/ Population Control
- Disease Control/treatment ( prolongs life span)
- Decrease incidence of hereditary defects.
How much longer does a female dog live after spay vs. if she was intact?
23%
How much longer does a male dog live after neuter vs. if he was intact?
18 %
How much longer does a female cat live after spay vs. if she was intact?
39%
How much longer does a male cat live after neuter vs. if he was intact?
62%
What is a routine/ electove spay? Who is it normally preformed in?
Why would you perform a spay for medical treatment?
What is reduced by spaying before 1st heat?
- Reduces incidence of mammary tumors, as well as development of a pyometra
What is the age you typically spay female dogs?
- 6 months- 2 years.
- May be specific to the breed) Always spay when able.
What is a benefit for waiting to spay a dog? Why?
Some breeds have benefits to waiting because sometimes longer exposure to hormones can decrease hip issues.
What age would you spay a female cat?
6 months and up
What are cystic ovaries? What causes them? What hormone is involved? What are signs of this condition externally? What can you see within the oviduct itself?
This is fluid filled structures that develop within the ovaries.
- They are caused by prolonged secretion of estrogen.
- Externally you can see prolonged attractiveness to males and continued signs of estrus/ proestrus.
- Internally you will see fluid filled cysts on the ovaries.
What is a prolapsed uterus?
Uterus has inverted itself and exited the vagina
What is seen in this image?
Prolapsed uterus
What is seen in this image?
Cystic ovaries
When do you normally see a prolapsed uterus?
Common after birth
What can you do to stabilize a patient with a prolapsed uterus for spay?
If tissue is viable lavage lavage
lavage!
REMEMBER – DILUTION IS THE SOLUTION TO POLLUTION!
- Reduce swelling with dextrose
- Manually replace tissue and then spay!
What if tissue isn’t viable or you
are unable to replace it?
- Amputation and then spay
What is Cystic endometrial hyperplasia? What is typically the cause?
Influenced by progesterone. Progesterone causes uterine lining to thicken (preparing for pregnancy), when no pregnancy occurs it will cause lining to thicken and this can lead to cysts in the endometrial lining. These cysts will leak into the uterus causing hydrometra -> mucometra -> pyometra.
What kind of fluid is seen with a hydrometra?
Sterile clear fluid, if not resolved it will become mucometra.
What is a mucometra?
Fluid and mucus
What are the clinical signs for a hydrometra or a mucometra?
- No clinical signs usually incidental
What is a potential consequence for hydrometras and mucometras?
Becoming a pyometra.
What is a pyometra? What animals does it happen in? What are the types? What are your diagnostics/ what should you do to rectify the situation?
- Accumulation of pus (WBC and bacteria) in uterus
- Usually intact female mature animals.
- Closed pyo or open pyo
- Radiographs/ Ultrasound
- Stabilize then cut.
What are closed pyometras? What are your clinical signs?
Closed pyometra: No vaginal discharge
Clinical Signs: PU/PD, lethargy, pale mm, abdominal distention, usually sicker.
What are open pyometras? What are your clinical signs?
Open pyometra -> Vaginal discharge.
Clinical signs: Vaginal distention, vomiting, diarrhea, anorexia, PU/PD, pale mm
What is seen in this image?
Pyometra
When do pyometrass normally occur?
Usually after a heat cycle.
What bacteria is the most common cause of pyometras?
ECOLI
Then next: Staphylococcus, streptococcus, proteus
What is uterine torsion?
- Uterus rotation around its long axis, usually between
cervix and horn - Patient is clinically sick (anorectic, febrile, lethargic, painful)
What is seen in this image?
Uterine Torsion
What is metritis?
Post partem infection of uterus
- Same bacteria as pyometra
- Signs: Vaginal discharge, lethargy, anorexia, neglecting offspring (prominant mammae, lactation, enlarged nipples, are hints animal is post partem) Sometimes large flaccid uterus can be palpated.
What is the differnce between a pyo and metritis?
Pyo -> right after heat
metritis -> post partum
What is ovarian/ uterine neoplasias?
- Leiomyomas – tumor that develops from smooth muscle
cells of uterus - Endometrial Adenocarcinoma
What are the mammary gland neoplasias? How can we prevent them? When is it seen?
- Tumor associated with mammary tissue
- Seen in un-spayed animals after their first heat cycle
- Likelihood of developing decreases if spayed before first estrus
- Adenomas (benign), carcinomas
(malignant), and adenocarcinomas
(malignant)
What is the percent of decrease in chance of mammary tumor development is patients that were neutered before heat cycle?
- 98-99% reduction
Do pets show clinical signs for mammary gland tumors?
Many pets do not show clinical signs until MGT has metastasized or ulcerated
If a mammary gland tumor is ulcerated in a cat what can you conclude?
It has likely alreadt metastasized.
What percent of mammary tumors in dogs are malignant?
50 %
What percent of mammary tumors in cats are malignant?
90%
Which ovary is higher?
Right ovary
What is the proper ligament?
Connects uterine horn to ovary
What is the suspensory ligament?
Ovary -> body wall
What is mesovarium? what does it contain?
- Portion of broad ligament of uterus that supports ovaries
- Contains ovarian vessels +/- fat
What is mesometrium? What does it contain?
- Portion of broad ligament of uterus that supports
uterine horns and uterine body - Contains uterine vessels +/- fat
Where can you find the ovaries?
located at caudal pole of kidneys
Where are uterine horns found?
Doral lateral in the body cavity
Where is the uterine body located?
Uterine body is located between urinary bladder and
colon and is adjacent to ureters
Label the parts of this image
How do you prepare for a spay? Where should you clip hair? What would you scrub with?
If you want to preform a ventral midline approach in a medium sized dog spay where would you make your incision? Where do you extend you incision from?
If you want to preform a ventral midline approach in a cat or neonate. where would you make your incision? Where do you extend you incision from?
What is the most difficult thing to expose in a cat?
Uterine body
What is the most difficult thing to expose in a dog?
Ovary
What is the lateral flank approach? When would you want to use this? Where is this used commonly?
- Used when there’s excessive mammary development
- Secondary to lactating vs. mammary gland
hyperplasia - Done more in the UK
Where do you incise in a canine for a lateral flank approach spay?
Where do you incise in a feline for a lateral flank approach spay?
In a canine spay, what is your first step to incise your skin and sub Q tissue?
What must you expose when making your SQ tissue incision? What should you limit? Why?
What is the linea alba? Is it painful to cut into it?
Linea alba has no nerve endings/ vessels so it is not painful.
- Thick, white fibrous line that runs
vertically down midline of abdomen
- Palpates as depressed area between paired rectus abdominis muscles
How wide is the linea alba in dogs? Is it larger or smaller in cats? Where is it easiest to see? Hardest to see?
What is the holding layer of abdominal incisions? How can you prevent dehiscence?
How do you incise the linea alba?
How do you use the spay hook to find the uterine horn? What must you do in order to continue the spay? What may you get instead of the uterine horn? What should you do if you are pulling on the uterus and it is very tense?
If its too tense it may not be uterine horn, drop it and try again.
Once ovary is found, what is your next step?
Why do you break down the suspensory ligament? How do you break down the suspensory ligament?
How do you ligate the ovarian pedicle?
What technique do you use to clamp the pedicle ? How do you do this? What ligatures can you use?
Where should you transect the ovarian pedicle?
What is the first ligature you place on the pedicle? What ligatures are used?
What is the second ligature you place? What must you do for secure ligatures? Where should you be transecting the ovarian pedicle?
What is seen in this image?
Mesometrium with uterine vessels.
What is a reason a ligature can fail when you have the broad ligament still attached?
If there is alot of tissue you could have ligature failure from excess tissue.
Why do we cut/tear the broad ligament? What should we do in dogs that are obese or in heat?
How do you remove the uterine body?
For removing the uterine body, where would you place your clamps and ligatures?
What should you do if you drop a pedicle during a spay?
Dont panic, finish spay, giving fluid bolus to replace losses, once uterus is out it will be easier to find the bleeder.
After you remove the uterine body what are your next steps?
Double check pedicles for bleeders
Check gutters
Close.
What will you see if your pedicle is bleeding?
Pooling of blood in abdomen in abnormal. If bleeding is noted then you need to extend incision cranially.
What is a sign of active bleeding?
- Very dark red blood, filling abdomen?
How do you check your gutters during a spay?
Clamp gauze in hemostat. Feed hemostat in gutters to see if there is alot of blood. If it comes up relatively clean you are goo
How do you close the body wall of a spay? Subcutaneous tissue? Skin?
What are the recommendations for post op care for a canine spay?
Which is easier, canine spay or feline spay?
Feline Spay
Tissues are more delicate though
How do you prepare the skin for a feline spay?
What is the process for incising the SQ tissue and skin for a feline spay?
- Find linea alba and make stab incision through all muscle layers
- Using spay hook and locate L uterine horn
What do you do after you make your incision into the abdomen for a feline spay? Do you clamp the ovarian pedicle? What should you use if you clamp the ovarian pedicle? What ligatures should you place? What do you do after placing your ligatures and before transecting your pedicle?
How do you remove the ovarian body in a cat? Should I use clamps? Why or why not? What ligatures do you use? Where is the uterus ligated and transected?
What is another way you could ligate your pedicle instead of clamping and placing individual ligatures?
How do you close the body wall, SQ tissue and Skin in a feline spay?
What are your post op instructions for feline spays?
What is hemorrhage? When does it happen? Why does it happen? How can you treat it?
What is dehiscence? When does it happen? Why does it happen? How can you treat it?
What is seroma? When does it happen? Why does it happen? How can you treat it?
What can you see with ureter ligation? When does it happen? Why does it happen? How can you treat it?
What is recurrent estrus? When does it happen? How can you test for it? Why does it happen? How can you treat it?
What is a uterine stump pyometra ? When does it happen? Why does it happen? How can you treat it?
What is a uterine stump granuloma ? When does it happen? Why does it happen? How can you treat it?
What are spay complications that can be seen long term in patients?
Obesity
Perivulvar dermatitis
Prinary incontinence.
What causes obesity post spay?
Decrease in sex hormone casuses decrease in metabolic rate and an increase in weight
What causes perivulvular dermatitis in spayed dogs?
Recessed vulva -> Reccurent UTI/ Pyodermas
What causes urinary incontinence in spayed dogs? When does this occur? What is it called ?
Also called spay incontinence. Can occur 2-3 years post spay. Essentially urethral sphincter is incontinent due to loss of estrogen. Estrogen helps lower urinary tract sphincter tone, since that estrogen decreases so does the sphincter one and function.
What are the potential spay complications?
- Hemorrhage
- Dehiscence
- Seroma
- Ligation of Ureter
- Recurrent Estrus
- Uterine Stump Pyometra
- Urterine Stump Granuloma
PUSHED G
What are the reasons we spay for medical conditions?
Ovarian Disease/ Cystic Ovaries
Uterine Prolapse
Cystic endometrial hyperplasia
Hydrometra
Mucometra
Pyometra
Torsion
Metritis
Neoplasia (Ovary/Uterine)
Mammary Tumor
MONTH PMPM
