repro & perineal sx Flashcards
what are the 3 types of ovarian neoplasia in dogs? which one is the most common?
- sex cord stromal tumor (granulosa cell tumor = most common)
- epithelial cell tumor (adenoma/adenocarcinoma)
- germ cell tumors
what is the typical signalment and prognosis for ovarian neoplasia in dogs?
mid to older age, good prognosis when you remove the ovary.
You have a dog with an ovarian tumor. why is it important to remove it?
can seed peritoneum
what are the C/S of a granulosa cell tumor in a dog?
produce E2, P4, or both
- estrus or proestrus, cystic endometrial hyperplasia, pyometra
what are the 2 types of ovarian neoplasia in cats? what is the most common?
- sex cord stroma tumor (granulosa cell tumor = most common, 50% are malignant)
- germ cell tumor (dysgerminomas)
A 5yo shepherd mix presents to your clinic. She was spayed before the owners got her as a rescue, and for the past 6 months, her mammary glands have been developing. On PE, you note enlargement of the mammary glands and vulvar swelling. What is your top differential?
ovarian tumor, most likely a granulosa cell tumor (producing E2)
What is ovarian remnant syndrome?
signs of estrus/heat due to elevated E2 levels after being spayed, due to failing to remove all ovarian tissue
how do you diagnose ovarian remnant syndrome?
AMH (anti-mullerian hormone) and P4 levels
You have a dog with dystocia. Describe (generally) the procedure to get the puppies out and save the mom.
- huge incision on ventral midline (between xiphoid and umbilicus to pubis pretty much)
- get puppies outta there (im not going into detail about this lol)
- if not OHE: close uterus in 2 layers (simple continuous, then inverting overtop. don’t go through endometrium) then give OXYTOCIN!!! (helps involute/contract)
- if OHE: after all puppies out, this is the preference
Pyometra is usually caused by _____ (organism). What is the treatment?
E. coli
OHE
what is the difference b/t open and closed pyometra?
cervix open or closed.
open is technically better (pus comes out), but both are life threatening situations
what is important to know about pyometra surgery?
- do it RIGHT AWAY AT DIAGNOSIS!! they will get septic and die quickly
- be gentle!!
- remove entire uterine body (ligatures will be in cervix)
uterine neoplasia: common or rare?
- what is most common in dogs?
- what is most common in cats?
rare!
dogs: leiomyomas
cats: adenocarcinomas
what are the C/S and signalment typical for hooded vulvas/recessed vulvas?
large to medium breed dogs
perivulvular dermatitis, recurrent UTIs
you can see it lmaooooo but the above C/S are when you need to treat I guess
how do you treat hooded/recessed vulvas?
vulvoplasty or episoplasty
goal of episoplasty is to lift and exposure vulva to alter local tissue environment (lower moister and lower bacteria)
what causes vaginal edema/hyperplasia? what is the treatment?
late proestrus and estrus (hormones)
OHE and/or resection of tissue
how do you tell the difference b/t vaginal prolapse and vaginal hyperplasia/edema?
hyperplasia is more of a stalk coming from deeper. can feel a mass with a base
prolapse looks like a donut. can feel circumferential area protruding
how do you treat vaginal prolapse?
manual reduction and OHE or hysteropexy
when do you diagnose cryptorchidism? why?
after 6 mo
there is variation in testicular descent (breed, individual, etc) but after 6 mo, they should all be descended
what are the 3 types of testicular neoplasia? what is the typical signalment?
older dogs (mean age = 10 years), cryptorchidism increases incidence by 10%
Leydig cell (interstitial cell), Sertoli cell, Seminoma
testicular neoplasia is ___ (common/rare) in cats.
rare
what are the C/S of a Sertoli cell tumor in a dog?
feminization syndrome… THEY PRODUCE ESTROGEN!!!!
bilaterally symmetrical alopecia, gynecomastia (man boobs), anemia, leukopenia, thrombocytopenia (BM suppression)
estrogen causes what in the bones?
bone marrow suppression
how do you treat Sertoli cell tumors in dogs?
orchiectomy
unless mets, then also medical mgmt
what are the C/S of a Leydig cell tumor in a dog?
they can produce testosterone
concurrent perineal hernias, perianal adenomas/adenocarcinomas (all bc of higher testosterone)
how do you treat Leydig cell tumors in dogs?
castration and scrotal ablation
what is hypospadia? what is the typical signalment?
developmental anomaly, Boston terriers!
failure of fusion of urogenital folds –> incomplete formation of penile urethra
the urethra is not located at tip of penis like normal. can be located anywhere along length of penis
how do you treat penis strangulation/trauma?
surgical treatment depends on extent of trauma. may require penile amputation and scrotal urethrostomy
Penis neoplasia is more common in _____ (dogs vs cats). what is the most common?
dogs
transmissible veneral tumor (TVT)
what are the C/S of transmissible venereal tumors? how do you dx?
licking at penis, serosanguineous preputial d/c
PE, cytology, biopsy
what is paraphimosis?
when the penis protrudes from the prenuptial sheath and cannot be replaced to its normal position
can’t retract.
severe damage can result if prolonged
how do you treat paraphimosis?
goal: replace penis within prepuce
pain mgmt!!
ice, hyperosmolar solutions (sugar), lubricants
sx if medical mgmt doesn’t work:
- enlarge preputial opening (temporary or permanent)
- phallopexy if recurrent
what is phimosis?
inability to extrude penis beyond preputial orifice
penis can’t come out :(
which is more common, phimosis or paraphimosis?
paraphimosis
what are the C/S of phimosis?
congenital or acquired
inability to pass urine other than in drops or thin stream, licking, dribbling
it looks like the picture here
how do you treat phimosis?
sx to enlarge preputial opening
what is important to know about prostate anatomy?
- surrounds proximal urethra and located at neck of bladder
- bi-lobed
- prostatic artery, prostatic veins, urethral veins
- drains to iliac Las
what are the C/S of benign prostatic hyperplasia
- tenesmus
- hematuria
- dysuria
- urine retention and azotemia
- ± urethral bleeding
- ribbon like stools (thin poopies)
what are the ddx for an enlarged prostate?
- benign prostatic hyperplasia
- prostatic cyst
- paraprostatic cyst
- prostatitis
- neoplasia
- abscess
You have a canine patient who presents with hematuria, tenesmus, and ribbon like stools. You do a rectal exam and think you note an enlarged prostate. What further diagnostics can you do to rule in/out ddx?
rads and U/S
U/S is better than rads
- rads cannot differentiate b/t neoplasia, cysts, abscess
cysts and abscesses = hypo echoic
inflamamtory/neoplastic processes = hyper echoic
can also do prostatic fluid analysis
tell me the pathophysiology and epidemiology of prostatitis and abscessation
middle to older aged dogs, rarely in castrtaed dogs (most likely in intact males)
may begin with cystic changes/hyperplasia: abnormal flow of prostatic secretions may allow bacteria to set up a nidus of infection
most common is E. coli, but Brucella canis can be there too
if communicating with urethra, pus will drain out of penis
may be walled off and can rupture into peritoneum or retroperitonium
what are the C/S of a prostatic abscess?
- prostatomegaly (not symmetrical), leading to: dyschezia, pain on defecation, pain on urination
- purulent or sanguineous penis d/c
- general signs: anorexia, pyrexia, lethargy
- rectal or abdominal palpation = likely uncomfortable
how do you diagnose a prostatic abscess?
US: hypo echoic mass
rads: prostatomegaly
aspiration: but be careful coz could cause leakage into abdomen = peritonitis
leukocytosis, elevated AlkP, ALT, globulin, BUN, hypoglycaemia
UA: leukocytes, RBCs, microorganisms
how do you treat a prostatic abscess?
castration! required for resolution
Abx: fluoroquinolone, TMS, chloramphenicol
referral sx for other options
how do you diagnose a prostatic/paraprostatic cyst?
PE + rectal, BW (azotemia maybe), rads, U/S (“second bladder”)
how do you treat a prostatic/paraprostatic cyst?
castration
percutaneous drainage (may recur with this tho)
sx (take it out if paraprostatic)
what is the most common type of prostatic neoplasm in dogs? is it common in cats? what signalment of dog is most likely to have prostatic neoplasia?
adenocarcinoma –> aggressive!! both local and mets
older dogs, median age of 10
rare in cats
how do you treat prostatic neoplasia
usually palliative, survival 1-3 mo
prostatectomy (rare)
radiation (short term relief)
what signalmen is anal sacculitis and abscessation most common in ?
small dogs (chihuahuas and poodles)
what are the C/S of anal sacculitis?
scooting, licking, biting at tail area, draining tract if abscess as ruptured
thought to be sequelae to chronic impaction or dermatologic disease
how do you treat anal sacculitis?
- impaction treated by expression
- sacculitis treated by cannulation and infusion with Abx ± steroids
- abscessation treated by incision and drainage with parenteral Abx
recurrent issues may be indication for anal sacculectomy
what is the neoplasm associated with the anal sac
Anal Sac Adenocarcinoma
tell me about the behaviour of anal sac adenocarcinomas. what signalment is most likely to have this?
highly malignant and invasive. 50% of dogs have mets at time of fx
10-11 yr old dogs
what are the C/S of anal sac adenocarcinoma?
perineal swelling, rectal exam finding, paraneoplastic processes (hypercalcemia causing PU/PD)
may have no clinical signs and it’s an incidental finding on rectal palp!!
You have an 11 year old lab who presents for a yearly physical examination. You do a rectal exam and note enlarged anal sacs. You are worried that the dog might have anal sac adenocarcinoma. How will you work up this case?
blood work: ionized Ca2+
abd U/S: LN’s
thoracic rads: mets
how do you treat anal sac adenocarcinoma?
surgical excision of mass ± regional LN’s, chemo, radiation
what are the complications of anal sacculectomy?
infection (close to butthole, ew, yuck)
fecal incontinence
damage to external rectal sphincter and/or nerves
Rectal prolapse is usually secondary to: ?
tenesmus
This is protruding from a dog’s butthole. the dog recently had Giardia. what is going on?
rectal prolapse
how do you treat rectal prolapse?
reduction and purse string placement (just to narrow, don’t want to close orifice) for 3-5 days + medical mgmt
resection + anastomosis if tissue is traumatized, devitalized
what is the most common perineum neoplasm? What should you do if these patients present with this disease?
1) intact male
2) castrated male
3) female
adenoma from circumanal glands
1) castration and surgical excision. related to androgen (testosterone) levels
2) and 3) eval for Cushing’s
perineal hernias occur because of…?
weakness and separation of pelvic diaphragm components
- sphincter ani externus (external anal sphincter)
- obturatorius internus (internal obturator)
- levator ani
common in older intact male dogs. muscles weaken as dog ages, and then they poop and then oopsies! hernia
what are the C/S of perineal hernias?
swelling of perineum, straining to defecate, constipation, stranguria (with bladder retroflexion)
how do you dx and tx perineal hernias?
dx: PE!!!
tx: bladder retroflexion, perineal herniorrhaphy, castration afterwards!!
