PATHOLOGY - Female Reproductive Disease Flashcards
What is a recessed vulva in the bitch?
A recessed vulva is where the vulva is sunken and partially or completely engulfed by the surrounding skin folds
What are the other names used to describe a recessed vulva?
Hooded vulva
Juvenile vulva
What are the risk factors for a recessed vulva?
Obesity
Pre-pubertal neutering
How does pre-pubertal neutering increase the risk of a recessed vulva?
During sexual maturity, hormones will influence the development of secondary sexual characteristics, including the proper development of the vulva. Pre-pubertal neutering may result in a vulva that doesn’t fully mature, which can lead to a recessed vulva
What are the potential consequences of a recessed vulva?
Vaginitis
Cystitis
Skin fold dermatitis
What are the two main treatment options for a recessed vulva?
Medical management
Surgical management
How can you medically manage a recessed vulva?
Weight loss in obese animals
Cleaning the skin folds
Prevent cystitis
Which surgery can be done to correct a recessed vulva?
Episioplasty
What are the possible causes of clitoral hypertrophy in the bitch?
Excessive licking
Hermaphroditism
Hyperadrenocorticism (Cushings disease)
Androgen treatment
Masculanised bitches
Give an example of a use of androgen treatment in dogs
Racing dogs are often treated with androgens to prevent oestrus
What can cause bitches to be masculanised?
If dams are treated with progestagens or androgens during pregnancy, this can cause masculanisation of the puppies
How can you treat clitoral hypertrophy?
Treat underlying cause (however be aware it may still persist)
Surgical clitoridectomy
(T/F) Juvenile vaginitis has an infectious aetiology
FALSE. Juvenile vaginitis has an inflammatory aetiology, and this antibiotics are not indicated in this condition
What is the typical signalement for juvenile vaginitis?
Pre-pubertal bitches (more than 8 weeks old but less than a year old)
What are the clinical signs of juvenile vaginitis?
Mucoid to mucopurulent vaginal discharge
Excessive licking
Systemically well
How do you treat juvenile vaginitis?
Juvenile vaginitis should resolve after the first season
Should you spay bitches with juvenile vaginitis before their first season?
No, it is contraindicated to spay bitches with juvenile vaginitis before their first season as it could result in a adult persistent vaginitis
What can cause primary adult vaginitis in bitches?
Primary vaginitis is rare
Herpes virus
Overgrowth of commensal bacteria
What can cause secondary adult vaginitis?
Hermaphroditism
Anatomical abnormalties (i.e. recessed vulva)
Ectopic ureter
Cystitis
Trauma
Foreign body
Pyometra/endometritis
Neoplasia
Diabetes mellitus
Hyperadrenocorticism (Cushing’s disease)
What are the clinical signs of adult vaginitis?
Excessive licking
Mild vulval discharge
Male attention outside of oestrus
Perivulvar dermatitis
How do you diagnose adult vaginitis?
Vaginal cytology (sample from high up in the vagina)
Vaginal scope
How do you treat adult vaginitis?
Treat the underlying cause
Describe the pathogenesis of vaginal hyperplasia and prolapse
Vaginal hyperplasia is a normal process seen in oestrous, however there can be excessive vaginal hyperplasia and oedema which can cause prolapse of the vagina
What is the typical signalement of vaginal hyperplasia and prolaspe?
Intact bitches at their second or third season
This condition will recur in subsequent seasons
What is type I vaginal hyperplasia and prolapse?
Type I vaginal prolapse is the mild to moderate prolapse of the vaginal floor, originating from the floor cranial to the urethral papilla, with no protrusion of the vaginal tissue through the vulval lips
What is a type II vaginal hyperplasia and prolapse?
Type II vaginal prolapse is prolpase of the vaginal floor and lateral walls, protruding beyond the vulval lips
What is a type III vaginal hyperplasia and prolapse?
Type III vaginal prolapse is where the entire circumference of the vagina has prolapsed beyond the vulval lips
Where is the urethral orifice located in vaginal hyperplasia and prolapse?
The urethral orifice is located ventrally in a prolapsed vagina
How do you treat vaginal hyperplasia and prolapse in the bitch?
Ovariohysterectomy to remove the oestrogen as this is what triggers the excessive hyperplasia and prolapse. For type I prolapses, wait until the bitch is out of oestrus and then spay. For type II and III, keep the exposed tissue moist and clean (provide owners with saline and KY jelly and really emphiasise the importance of keeping this clean) and spay when the bitch is out of oestrus. Be aware you may have to surgically resect any damaged tissue or if the tissue doesn’t regress following spay
What are the potential causes of a true vaginal prolapse in bitches?
A true vaginal prolapse is rare, hyperplasia and prolpase is more common
Parturition
Forcible seperation during mating
How do you treat a true vaginal prolapse?
A true vaginal prolapse usually requires surgical resection
What is the typical signalement of vaginal neoplasia?
Older intact bitches
(T/F) Vaginal neoplasia is usually malignant
Vaginal neoplasia is second most common reproductive tumour after mammary
FALSE. Vaginal neoplasia is usually benign
What are the clinical signs of vaginal neoplasia?
May show no clinical signs
Intravaginal mass
Perineal swelling
Vulval discharge
Tenesmus
Urinary tract problems
How do you diagnose vaginal neoplasia?
Rectal and vaginal examination
Vaginal scope
Fine needle aspirate (FNA)
Biopsy
How can you treat vaginal neoplasia?
Surgical removal
Ovariohysterectomy (as they are often hormonally driven)
Chemotherapy
Depends on the type and location of the tumour
What is a transmissible venereal tumour (TVT)?
Seen in imported dogs in the UK
Transmissible venereal tumours (TVT) are highly contagious round cell tumours spread through direct contact between dogs via mating, sniffing, licking and biting
What is the typical appearance of a transmissible venereal tumour (TVT)?
Single to multiple pedunculated/lobulated, ‘cauliflower’ like mass found on the vulva, vestibule, prepuce, penis, nasal and/or oral mucosa
How can you diagnose transmissible venereal tumour (TVT)?
Impression smear (press smear agaisnt tumour as it exfoliates very easily)
Fine needle aspirate (FNA)
How should you treat transmissible venereal tumour (TVT)?
Surgical removal
Chemotherapy
Neutering to reduce mating
Which chemotherapy drug should you use for transmissible venereal tumour (TVT)?
Vincristine
What is cystic endometrial hyperplasia?
Cystic endometrial hyperplasia is a condition where the walls of the uterus become hyperplastic and cystic due to altering oestrogen and progesterone influences
Which species is more prone to cystic endometrial hyperplasia?
Cats
How can you diagnose cystic endometrial hyperplasia?
Ultrasound
What are the potential consequences of cystic endometrial hyperplasia?
Infertility
Increased risk of pyometra
How do you treat cystic endometrial hyperplasia?
Ovariohysterectomy
Describe the pathogenesis of a pyometra
During metoestrus, progesterone levels will rise and peak, resulting in immunosuppression, endometrial gland secretion, decreased myometrial contractility and eventual closure of the cervix (to try and prevent infection however this can end up trapping bacteria and preventing drainage), creating an ideal environment for bacterial growth, especially ascending E.coli
What is the difference between an open and closed pyometra?
An open pyometra is where the cervix is open and a closed pyometra is where the cervix is closed
What is the signalement for pyometras?
Entire bitches and queens, typically 4 to 8 weeks following a season
How do you diagnose pyometras?
History
Clinical signs
Haematology and Biochemistry
Diagnostic imaging
Which key history question should you ask if you suspect a pyometra?
Is the patient neutered? (be aware owners may be under the impression that they are neutered when they aren’t so make sure to quiz them)
What are the clinical signs of a pyometra?
Clinical signs can be very variable
PUPD
Anorexia
Acute vomiting
Lethargy
± Vulval discharge (depending on if an open or closed pyometra)
± Pyrexia
± Hypothermia (in some severe cases)
± Abdominal distension
± Signs of sepsis
What are the typical haematology findings for a pyometra?
Neutrophilia ± left shift
Leukopenia (possibly)
Thrombocytopenia
Normocytic normochromic anaemia
What are the typical biochemistry findings for a pyometra?
Azotaemia (due to dehydration)
Hyperglobulinaemia
Hypoglycaemia
Which diagnostic tests can you do to diagnose a pyometra if you are financially constrained?
Blood smear
Total protein
Blood glucose
How do you treat pyometras?
Stabilisation
Ovariohysterectomy
Be aware not all owners will agree to the spay :(
Which stabilisation procedures should you carry out for pyometras?
IV fluid therapy
IV antibiotics pre- and perioperatively
What should you be aware of when doing an ovariohysterectomy for a pyometra?
Make a larger ventral laparotomy incision than you would for a routine spay
Larger vessels
More friable tissues
Flush abdomen at the end of surgery (200ml/kg warm saline or hartmann’s)
How can you medically manage a pyometra if owners won’t agree to the ovariohysterectomy?
Stabilisation (IV fluids and antibiotics)
Culture and sensitivity for antibiotics (as they will be antibiotics for a while)
Progesterone antagonists
Prostaglandins
Dopamine agonists
10 days of broad spectrum antibiotics post resolution
What is the purpose of progesterone antagonists in medical management of pyometras?
Progesterone antagonists prevent the action of progesterone and mimic the effects of luteolysis and softens the cervix, allowing it to reopen to allow for drainage
Can be used in combination with prostaglandins
What is the purpose of prostaglandins antagonists in medical management of pyometras?
Prostaglandins will cause active luteolysis, reducing progesterone production and allow for softening and opening of the cervix as well as myometrial contractions to allow for drainage
Can be used in combination with progesterone antagonists or dopamine agonists
What should you be aware of when using prostaglandins in medical management of pyometras?
Prostaglandins can have side effects such as vomiting, diarrhoea and panting
Synthetic prostaglandins have less side effects than natural ones
What is the purpose of dopamine agonists in the medical management of pyometras?
Dopamine agonists inhibit prolactin secretion which in turn lowers progesterone secretion, allowing for softening and opening of the cervix for drainage
What should you monitor closely for during medical management of a pyometra?
You need to monitor for purulent discharge to ensure the cervix has opened. If this doesn’t occur within the first 24 - 48 hours, the patient should go for an ovariohysterectomy
Hospitalise these patients to monitor and because you can’t allow owners to adminster these drugs due to the risk of abortion
What is a contraindication to medical management of a pyometra?
Uterine rupture
How should you monitor for resolution of a pyometra with medical management?
Use repeat clinical examination, baseline and repeat haematology and biochemistry to allow for monitoring of clinical status and ultrasound to monitor for resolution
What should you advise owners if they opt for medical management of a pyometra over an ovariohysterectomy?
Advise owners that the medical management will take longer and may be unsuccessful with the patient requiring an ovariohysterectomy anyway. Furthermore, there is a high risk of recurrence in the subsequent metoestrus even with resolution with medical management, however they can have successful pregnancies following a pyometra so it might be advisable to breed them in their next season to prevent a pyometra (if the owners want to breed)
What is the typical treatment of choice for a queen pyometra?
Stabilisation and ovariohysterectomy
How can you medically manage a queen pyometra?
You can medically manage the queen in the same way as the bitch however be aware the no progesterone antagonists or prostaglandins are licensed for this purpose in the cat
What is a mucometra/hydrometra?
Thin walled uterus filled with clear, watery fluid
Which species are more prone to mucometras/hydrometras?
Cats (this is very rare in the bitch)
(T/F) Patients with mucometra/hydrometra are systemically well
TRUE. They may have a distended abdomen but other than that are usually systemically well
These are often incidental findings
How can you diagnose mucometra/hydrometra?
Ultrasound
How do you treat mucometra/hydrometra?
Ovariohysterectomy
(T/F) Uterine neoplasia is very common
FALSE. Uterine neoplasia is very rare
What are the clinical signs of follicular cysts?
Prolonged oestrus
Pain
Infertility
What are the clinical signs of luteal cysts?
Prolonged anoestrus
Pain
Infertility
How can you diagnose ovarian cysts?
Ultrasound
How do you treat ovarian cysts?
Ovariohysterectomy
What is the most common ovarian tumour?
Granulosa cell tumour
How do you treat granulosa cell tumours?
Ovariohysterectomy
