Reproduction Flashcards
What are the types of mammary gland diseases we will see?
Tumors, hyperplasia, carcinoma
How many pairs of mammary glands do dogs have?
5
T/F: Mammary tumors are the most common neoplasm in intact female dogs
True. 70%
T/F: Mammary tumors in male dogs is common
False.
How often are mammary tumors malignant in a dog?
50%
T/F: The glandular area is most commonly the origin of neoplasm
True
Which glands of the mammary are most commonly affected?
4 and 5
T/F: Watch and wait is the best way to deal with mammary tumors
False
What do you do to pre-op a CMT?
bloodwork, radiographs (for mets), ultrasound/imaging
What is the only way to differentiate a malignant from a benign mammary tumor?
Biopsy
T/F: you want to perform an incisional biopsy for diagnostic purposes
False. Excisional
What are the criteria of malignancy (COM)?
Rapid growth, size, fixation in skin, circumscribed, ulceration/inflammation
How wide do you want to make your marginal excision?
2-3 cm
T/F: A benign mass can become a malignant one
True
What is a lumpectomy?
Removal of a small solitary mass with 1 cm margin
What should you do if the mass suited for a lumpectomy is in the middle of a gland?
Remove the entire gland (simple mastectomy)
When would you perform a simple mastectomy?
When there is a solitary mass 1-2 cm within the gland
How wide are your margins in a simple mastectomy?
2-3 cm
What shape is your incision for a simple mastectomy?
Elliptical
What would have to happen is the mass is greater than 2 cm, has multiple COM, or the 2-3 cm for a simple mastectomy is not enough?
Removal of multiple glands
What glands are to be removed, if a mass affects glands 1 and/or 2?
Glands 1-3
What glands are to be removed, if a mass affects glands 4 and/or 5?
Glands 3-5
What lymph node is removed along with gland 5 in a regional mastectomy?
Superficial inguinal lymph node
What are the chances a dog with a mass on one side will have recurrence on the other side?
60%
If gland 3 is affected, what do you do?
Chain mastectomy
How long do you wait to perform another chain mastectomy after the first one?
4-6 weeks
What is the mean survival time of a malignant CMT with no metastasis?
1-2 years
What are the most common sites of metastasis with CMT?
Lung, liver, bone, lymph node, kidney, spleen
What can you do to prevent CMT?
Spay your dog
What is the cutoff age for prophylactic spay for CMT?
2 years
If you had to do both a spay and a mastectomy, which would you do first?
Spay
How do you treat canine mammary hyperplasia?
You don’t. It’s physiologic (progesterone) and will regress on its own
What signs do you see with inflammatory carcinoma?
Edema, erythema pain, multiple firm glands
What is the mean survival time for inflammatory carcinoma?
<1 month
What surgery do you use to treat inflammatory carcinoma?
Not recommended to do surgery
How might you treat inflammatory carcinoma?
NSAIDs may help
T/F: Feline mammary tumors are more common than canine
False
T/F: Feline mammary tumors are usually benign
False
What is usually the type of cancer from a mammary tumor?
Adenocarcinoma
T/F: Male cats get mammary tumors more often than male dogs
True
How many pairs of mammary glands do cats have?
4
When would you not want to perform surgery on a mammary tumor?
If metastasis is present
What surgery do you do for every feline mammary tumor?
Chain mastectomy, regardless of number or size
What is the mean survival time for a feline mammary tumor that is <2 cm? >3 cm?
3 years; 6 months
What molecule is fibroadenomatous hyperplasia of the mammary gland dependent on?
Progesterone
What age of cat most commonly has fibroadenomatous hyperplasia of the mammary gland
<2 years
How can you definitively diagnose fibroadenomatous hyperplasia in a cat?
Histopathology
How would you treat fibroadenomatous hyperplasia of the mammary tumor?
Spay, with a flank approach
T/F: Nonfunctional ovarian cysts are typically incidental findings
True
What is the best way to deal with a nonfunctional or functional ovarian cyst?
surgical excision with histopathology
What type of functional ovarian cyst is most common?
follicular cyst, estrogen
How old are the animals when affected by a functional ovarian cyst?
Dogs <3
Cats <5
What hormone is dominant during proestrus and what happens to the dog?
estrogen, enlarged vulva, attractive to males
What hormone surges and activates ovulation during estrus?
Luteinizing hormone
What hormone is dominant during diestrus?
Progesterone
What would you see with a ovarian tumor with stromal origin?
Pyometra
How do you diagnose an ovarian tumor?
Radiographs, ultrasound
T/F: Metastasis is common with ovarian neoplasia
false
What causes ovarian remnant syndrome?
Surgical error. Ovarian tissue is left behind
T/F: Ectopic tissue is reported in dogs
False. Reported in cats
How do you diagnose ovarian remnant syndrome?
Cytology of vagina while in heat, hormone assays
What is an ovariectomy and is it an acceptable form of spay?
Removal of only the ovary. It is acceptable
When would you perform a unilateral ovariectomy?
To treat cystic disease only
What forms after ovulation and what does that make?
Corpus luteum makes progesterone
What does progesterone do to the endometrial glands?
Increases number and secretion
What can occur with abnormal progesterone exposure?
Cysts, neoplasia, remnants
What is cystic endometrial hyperplasia caused by and what is it filled with?
excess progesterone.
filled with aqueous material, mucus, or blood
How do you diagnose cystic endometrial hyperplasia?
Ultrasound
T/F: Cystic endometrial hyperplasia is a medical emergency
False.
How do you treat CEH?
Spay
What hormone causes pyometra?
Progesterone via uterine secretions
What is most common bacteria isolated in pyometra?
E. coli
How do bacterial toxins cause PU/PD? know this
Inhibition of ADH
If an intact female is sick, what is immediately on your rule out list?
Pyometra
What will you see on PE for a dog with pyometra?
fever, painful abdomen, vaginal discharge
What’s the CBC for a dog with pyometra?
left shift neutrophilia, thrombocytopenia, hypoalbuminemia, mild cholestasis
When would you medically treat pyometra?
not systemically ill or if owner does not want to spay
How would you medically treat pyometra?
Prostaglandins, systemic antibiotics
For surgical treatment of pyometra, do you want to ligate before or after you place your clamps?
Before
What clamps do you use for pyometra?
Doyen clamps
When does metritis occur?
12 hours to 1 week postpartum
What could you see with an animal with metritis?
foul-smelling reddish-brown vaginal discharge, signs of systemic illness
How would you diagnose metritis?
Based on timing following parturition
How do you treat metritis?
Antibiotics that are safe for nursing, or surgical exploration
How do you surgically treat metritis?
Spay, or hysterotomy
What suture material and size do you use to close a metritis surgery?
3-0 or 4-0 absorbable monofilament
T/F: Do not penetrate the mucosa when suturing after a metritis
True
What is most commonly associated with uterine torsion and how do you treat it?
Dystocia, spay or C-section
How would you treat a uterine prolapse?
Spay
T/F: Uterine neoplasia is usually an incidental finding
True
T/F: During parturition, it is normal for the temperature to >100 F
False. <100F
How long does labor have to be before diagnosing dystocia?
24 hours, or >4 hours between puppies
What breed is predisposed to dystocia?
Brachycephalics
How do you medically treat dystocia?
Oxytocin
When is medical treatment contraindicated for dystocia?
Active contractions, fetal malposition or size, fetal distress
How do you surgically treat dystocia?
C-section (hysterotomy)
Where do you cut with a C-section?
Linea alba
How do you position the fetus to the incision with a hysterotomy?
“milk” them towards it. do NOT cut your way to them
What should you do to the uterus after removing all the fetuses, before closing it?
Lavage
What suture material and size do you use to close a hysterotomy?
3-0 or 4-0 absorbable monofilament
What needle type do you use to suture after a hysterotomy?
taper needle
When should you perform an elective C-section?
63-65 days after the LH surge
What are the two surgical approaches with vaginal surgery?
Episiotomy (vaginal lesions) or ventral approach (very invasive)
What should you expect when cutting into a episiotomy and what can you do to prevent it?
moderate hemorrhage. prevent via electrocautery
How many layers do you need to close for an episiotomy?
- Mucosa/submucosa, muscle/SQ, skin
What clamps would you use for an episiotomy?
Doyen. non-crushing
What risks are associated with the transpelvic approach?
damaging the obturator nerve and/or the blood supply near of the local viscera
What types of lesions can you see with vestibulovaginal stenosis?
vertical septal, annular fibrotic, hypoplastic
What structures are included in a septal vestibulovaginal stenosis?
Mucosa only
What structures are included in a septal vestibulovaginal stenosis?
Mucosa and submucosa. May or may not contain muscularis
What are some clinical signs associated with V-v stenosis?
recurrent vaginitis, UTI, urinary incontinence
T/F: Fixing the vestibulovaginal stenosis will not fix the incontience
True
How would you diagnose a V-v stenosis?
digital exam, contrast vaginourethrogram, vaginoscopy
What contrast agent do you use for a vaginourethrogram?
Iodinated contrast (NOT BARIUM)
What does a ratio of min:max in vaginal diameter <0.2 indicate?
Severe stenosis
What is the best way to image the lower urinary and repro tracts?
Vaginoscopy
How do you treat a septal V-v stenosis?
Episiotomy or endoscopy with laser ablation
How do you treat an annular V-v stenosis?
If caudal to pelvis - vag resection and anastomosis with dorsal approach
if intrapelvic - vaginectomy with ventral abdominal + transpelvic approach
T/F: a dorsal approach enters the lumen of the vaginal vault
False
How do you treat a hypoplastic v-v stenosis?
Vaginectomy with ventral approach. Spay if not already done
How do you diagnose a recessed vulva?
You look at it
What are some clinical signs of a recessed vulva?
Skin fold dermatitis or vaginitis. Urine pooling
How do you treat a recessed vulva?
Clean the area.
Surgery with episioplasty if needed
T/F: Episioplasties often have complications
False
What is an episioplasty?
Resection of the skin around the vulva. Treats recessed vulvas
What happens to the mucosa with vaginal edema/hyperplasia?
It becomes edematous and protrudes from the vulva
How do you treat vaginal edema?
It resolves at the end of the estrus cycle, but spay will prevent recurrence.
Can also resect the mucosa
Vaginal prolapse is usually secondary to what?
Dystocia, constipation, forced separation
How do you treat a vaginal prolapse?
Manual reduction or spay
What type of dogs are usually affected by neoplasm in the vagina/vulva?
Intact females < 10 years old
What signs can you see with vaginal neoplasia?
discharge, dysuria, tenesmus
How do you definitively diagnose vaginal neoplasia?
Biopsy
T/F: Most vaginal neoplasias are benign
True
What is the most common type of vaginal neoplasm?
Leiomyoma
How do you treat a vaginal neoplasm?
Excisional biopsy via episiotomy
If malignant, what is the most common type of vaginal neoplasia?
Leiomyosarcoma
T/F: Leiomyosarcomas of the vagina are low risk of metastasis but are locally invasive
True
How far are the margins of resection with leiomyosarcomas of the vagina?
2-3 cm
What type of surgery do you perform to treat vaginal leiomyosarcomas?
Vulvovaginectomy
Where you do cut open for a vulvovaginectomy and what else do you need to do?
Ventral approach, requires perineal urethrostomy
What are some testicular or scrotal diseases for surgical management?
Cryptorchidism
testicular torsion
testicular neoplasia
scrotal ablation
At what age do the testicles usually descend?
30-40 days
At what age of the dog can you definitively diagnose cryptorchidism?
6 months
T/F: Cryptorchidism is genetic
True
Where are the origin and insertions of a testicle?
Caudal pole of the kidney and scrotum respectively
Can you palpate an abdominal cryptorchidism?
No, you must use an ultrasound or exploratory laparatomy
Where do you incise for a prescrotal cryptorchid procedure?
Directly over the testicle, it’s at the prescrotal area
Where do you incise for an abdominal cryptorchid procedure?
Caudal celiotomy - skin adjacent to prepuce, then open the abdomen and follow the artery or vas deferens
What fatal condition can occur if the cryptorchid testicle is left untreated?
Testicular torsion
What types of testicular neoplasia can occur?
Interstitial cell, sertoli cell, seminoma
What is feminism syndrome caused by?
Sertoli cell tumor releasing excess estrogen. Alopecia
What causes excess testosterone and perineal hernia and adenoma/carcinoma?
Interstitial cell tumor of the testicles
Why do you run X-rays on a do with testicular neoplasia?
To check for mets
How often do mets occur in dogs with testicular neoplasia?
<10%
T/F: Testicular disease is often secondary to scrotal abnormalities
False. Scrotum secondary to testicles
How would you treat testicular neoplasia?
Bilateral castration with scrotal ablation
What hormone is still intact with a vasectomy?
Testosterone
What structure is ligated with a vasectomy?
Vas deferens (double-ligation)
What breed is most commonly affected by hypospadias?
Boston Terriers
What are some potential locations for hypospadias?
Glandular, penile, scrotal, perineal, anal
How do you treat hypospadias?
Urethrostomy proximal to the abnormality (upstream)
Also, excise the exposed mucosa
What is paraphimosis?
Inability to retract the penis into the prepuce
What causes acquired paraphimosis?
Trauma, infection, priapism
How do you medically treat paraphimosis?
Reduce the swelling with hyperosmolar solution or cold packs, lube
When would you surgically treat paraphimosis?
If the condition is recurrent or the opening is too small, necrosis
What surgical treatments are available for paraphimosis?
Preputial advancement, phallopexy
How do you perform a preputial advancement for paraphimosis?
Half circle incision cranial to prepuce, suture preputial muscles together to shorten and extend the prepuce
How do you perform a phallopexy?
Make dorsal midline incisions on penis and prepuce, then suture together
What suture pattern and material is used for a phallopexy?
3-0 or 4-0 absorbable monofilament, simple pattern (interrupted or continuous)
What surgical procedure is most indicated with penile trauma or neoplasia?
Penile amputation
What is the most commonly reported neoplasia of the prepuce?
Mast cell tumor
Which of the tumor types is not usually treated surgically?
TVT
What is surgically done with a penile amputation?
Urinary catheter placed for urethra identification, urethrostomy proximal to resection (2-3 cm margins), tuck stump into SQ of caudal abdomen
When would you have to perform a penile amputation with disease on the prepuce?
When there are large tumors on the prepuce
T/F: Benign prostatic hyperplasia is painful and assemtrical
False
How do you treat benign prostatic hyperplasia?
Castration
What is the most common organism with prostatic abscesses?
E. coli
How does the prostate get infected?
Ascending infection from the urethra
How do you diagnose prostatitis?
palpation, ultrasound, cytology
How do you treat mild cases of prostatitis?
antibiotics, fluids, castration
How do you treat severe cases of prostatitis?
antibiotics, exploratory, omentalization, castration
T/F: omentalization is very successful for prostatitis
True
How do you diagnose a prostatic cyst?
U/S (double bladder), fluid aspiration (brown and watery)
How do you treat large cysts that communicate with the urethra?
Partial resection with omentalization
What do you do regardless of the cyst size?
Castration
What is a potential complication and cause with surgical treatment of a prostatic cyst?
Urinary incontinence caused by anatomic changes in the urethra
T/F: Prostatic neoplasia is usually benign
False
T/F: Prostatic neoplasia is usually metastatic
True
What is the type of cancer with prostatic tumors?
Adenocarcinoma
How does castration help with prostatic neoplasia?
It doesn’t, increases incidence, risk of metastasis
How does prostatic neoplasia lead to lameness?
Metastasis of bone
What is a palliative treatment option for prostatic neoplasia?
Tube cystostomy, urethral stent
