Prolapses

Question 1

what is a prolapse?

Answer 1

“to fall out of place”

a condition where organs fall down or slip out of place, can be referring to the rectum of the vagina, or heart valves

Question 2

uterine prolapse always occurs within _____ post partum

Answer 2

24 hrs

Question 3

which cattle are more likely to get a uterine prolapse?

Answer 3

pluriparous cattle (who have multiple babieslike twins)

Question 4

what is the lay term for uterus

Answer 4

calf bed

Question 5

what disease often leads to uterine prolapses and why?

Answer 5

hypocalcemia; makes the uterus atonic and delays involution of the cervix which predisposes to prolapse

Question 6

clinical signs of a uterine prolapse?

Answer 6

often very dramatic, can see placentomes/caruncles and fetal membranes and some exposed endometrium hanging out of the cow’s vagina.

the cow may be in shock or have signs of hypocalcemia

may contain intestines or the bladder

Question 7

true or false, a uterine prolapse is an emergency

Answer 7

true! risk of trauma, contamination, edema, uterine artery rupture, etc

Question 8

what is the best way to restrain a cow with a uterine prolapse?

Answer 8

can cast them, tie legs back

chemical restraint with a ketamine stun or xylazine, an epidural to help with straining

Question 9

before you decide to treat a uterine prolapse cow, what things should you consider?

Answer 9

is she hypocalcemic? is she in shock? has the placenta been removed and lavaged? evaluate tissues contents that are exposed

Question 10

what are some ways you can restore perfusion to a prolapsed uterus?

Answer 10

keep it elevated, get help, or use a sling or other devices to keep it up and not hanging out! While massaging it inwards you hav to hold it up!

Question 11

why do you need to be careful manipulating the caruncles through the vulva?

Answer 11

if they tear off they can hemorrhage

Question 12

what is the number one thing you need to do when a cow has a prolapsed uterus?

Answer 12

DO NOT MOVE THE COW

Question 13

one way to help treat a uterine prolapse is hoisting up the cow’s hindquarters. Pros and cons of doing this>

Answer 13

pros: effective if the cow is sedated and you’re careful, works for situtations where advantage is needed

cons: risk MSK injury or tearing of the uterine artery

Question 14

when you are reducing a uterine prolapse, why do you want to use open hands?

Answer 14

because the uterus is friable and easily ruptured! can use oven mitts according to the slide???

Question 15

proper way to shove the uterus back in???

Answer 15

begin kneading inward at the base and work to the apex. once youre at the apex you can use a fist and your body weight to put it back in

Question 16

what are some ways you can ensure complete inversion once youve shoved the uterus back in?

Answer 16

passive infusion of warm water OR diluted iodine, can use a bottle to extend your arm

Question 17

why do you give the cow oxytocin IM after youve shoved the uterus back in? Can you give it before you shove it back in?

Answer 17

causes uterine muscle contractions to help the uterus involute. giving it before reduction increases the risk of perforation

Question 18

after you have reduced the uterus back inside the cow, what are some things you can do to prevent recurrence?

Answer 18

make sure to treat any uterine atony or tenesmus (her pushing it out), do a Buhner suture (tie that thaaaang shut)

could consider calcium or oxytocin, or an epidural

Question 19

what kind of medications do you want to give to a cow after youve fixed her prolapsed uterus?

Answer 19

antibiotics either systemic or intrauterine, and analgesics

Question 20

what are some possible complications of a prolapsed uterus?

Answer 20

peritonitis, metritis, re-prolapse, uterine tears, damage to other organs trapped in the prolapse, hemorrhage, uterine damage or failure to reduce

Question 21

what can you do if the uterus tears after a prolapse?

Answer 21

you can try to close it with an inverting suture pattern or euthanize the cow

Question 22

what is one salvage procedure you can do for a uterine prolapse?

Answer 22

a uterine amputation. this is a poor prognosis

Question 23

what is the prognosis for a uterine prolapse?

Answer 23

depends on time to treat and handling, but most survive. although, there are some future fertilty concerns. They usually do not reoccur

Question 24

what causes a vaginal prolapse?

Answer 24

pre partum risk factors:
being fat, pelvic injury or laxity, being in last trimester, increased intra abdominal pressure, excessive straining or irritation. can be caused by ovarian cysts and mycotoxins as well.

Question 25

are vaginal prolapses likely to reoccur?

Answer 25

yes

Question 26

a vaginal prolpase can include the vagina as well as..

Answer 26

cervix, bladder, or intestines

Question 27

which breeds are predisposed to vaginal prolpases?

Answer 27

brahman, brahman crossbreeds, herfords

if this happens in these breeds it is hereditary and needs to be culled

Question 28

why do vaginal prolpases happen in the last trimester?

Answer 28

estrogenic influence of late gestation (idk what this means)

Question 29

clinical signs of a vaginal prolpase?

Answer 29

protrusion of pink/redded mucosa, straining, and some edema, inflammation, or necrosis

Question 30

what is the cycle of vaginal prolpase?

Answer 30

prolapse, irritation, exposure damage, vaginitis, tenesmus, prolpase, etc

Question 31

briefly describe the grading for a vaginal prolpase

Answer 31

grade 1: intermittent prolpase, usually when laying down
grade 2: continuous prolpase, bladder may be involved
grade 3: continuous prolpase of vagina, bladder, and cervix
grade 4: a grade 2 or 3 with trauma, infection, or necrosis of the vaginal wall

Question 32

what things would you like to investigate when you’re presented with a cow with vaginal prolapse? what treatment options do you have to consider?

Answer 32

check for any ovarian cysts, consider mycotoxins if it’s a herd issue, check for history of dystocia, check for pelvic injuries, could do a Buhner suture, and cull the cow once the calf is weaned. make sure her environment is nice with good bedding.

Question 33

if you put in a Buhner suture in a cow that has NOT calved, what is one thing you MUST do?

Answer 33

take it out before calving, OR do a barth blow out stitch

Question 34

when you first see a cow with vaginal prolapse, what should your next steps be?

Answer 34

clean and evaluate the tissues, are there other organs involved? give an epidural and try to reduce edema using sugardyne or glycerine, compression, or massage

Question 35

proper way to reduce a vaginal prolapse?

Answer 35

use your body weight to lean into open hands while cradling the prolapse. use firm constant pressure to decrease edema, and maintain pressure once reduced

Question 36

best way to maintain reduction of a vaginal prolapse?

Answer 36

most commonly a buhner stitch, blow out stitch, vaginalpexy, cervicopexy, etc. analgesics and possibly antimicrobials

Question 37

decribe a buhner stitch

Answer 37

use umbillical tape, go from ventral commisure to dorsal, across to the other side, back down to the ventral comissure. Tie a square knot if post partum, or a bow or barth blowout if prepartumm and leave a 2 finger opening

Question 38

what is a shoelace suture?

Answer 38

used for prepartum cattle and the idea is that the sutures rip out during calving if forgotten. sutures more likely to pull out with straining

Question 39

complications of a vaginal prolapse?

Answer 39

sutures come out (if a farmer tries to fix it without an epidural)
suture site infection
dystocia if forgotten in prepartum cattle

Question 40

describe the classes of rectal prolapse types 1-4

Answer 40

type 1: prolpase of rectal mucosa only
type 2: complete prolapse of all layers of rectum
type 3: prolapse of rectum WITH prolapse of the large colon
type 4: prolapse except that the anal sphincter is intact causing constriction of the rectum and colon

Question 41

type 1 and 2 rectal prolapses treated via
type 3 and 4 rectal prolpases treated via

Answer 41

reduction

surgical resection

Question 42

how do you reduce a rectal prolapse if the rectal mucosa is viable?

Answer 42

give an epidural, ensure mucosa is viable. If mucosa is viable, do a purse string suture with umbillical tape and serp needle, and leave a small opening so the cow can poop. leave this in for 5-10 days.

Question 43

how do you reduce a rectal prolapse if the rectal mucosa is NOT viable

Answer 43

do a mucosal resection and anastomosis: submucosa and serosa remains in tact, preserves blood supply, and is rarely done

surgical amputation: more frquently done

Question 44

how do you do a rectal prolapse amputation?

Answer 44

give an epidural, place a hollow tube inside the prolapse, place 2 x pins at right angles through the prolapse and tube. this keeps the tube/rectal tissue in place. dissect the tissue 1cm from healthy mucosa and dissect down to serosa of inner wall around the circumference. Suture the cut ends using cruciate pattern with absorbable suture, then remove the tube and put the cow on analgesica and antibiotics

Question 45

complications of rectal prolapse?

Answer 45

recurrence, constipation, dehiscence, prolapse of other organs, abscess, peritonitis, death

Question 46

are “prolapse tubes” good to use?

Answer 46

NO they are associated with poor prognosis and worse complications do not use it

Question 47

what else besides NSAIDs can you use to reduce inflammation?

Answer 47

dexamethasone :)