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SA Surgery Final > Reproduction Lecture Objectives > Flashcards

Reproduction Lecture Objectives Flashcards

1
Q

Green

How does progesterone/estrogen concentrations vary at different cycle stages (and during pregnancy) in dogs?

A
  • Know this, from the notes

- Estrogen peaks for a short time before the LH peak, and then progesterone ie elevated until close to whelping

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2
Q

Green

What hormone concentrations can be measured to predict parturition before mating?

A
  • 64-66 days from the LH peak

- 62-68 days after progesterone >1.5 ng/mL

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3
Q

Green

What hormone concentrations can be measured to predict parturition close to parturition?

A
  • Within 30 hours after progesterone levels are less than or equal to 2-3 ng/mL
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4
Q

Green How can diagnostic imaging be used in pregnancy diagnosis and to help determine gestation length in dogs?

A
  • Enlarged gravid uterus within 31-38 days (rads)
  • Fetal skeletal mineralization by 45 days after LH peak (rads)
  • Ultrasound: As early as 19-20 days after LH surge in dogs but uncomplicated at 30 days of gestation

o Canine fetal movement and heart rate by day 31-32 after LH peak (u/s)

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5
Q

Green How can diagnostic imaging be used in pregnancy diagnosis and to help determine gestation length in cats?

A
  • Fetal skeletal mineralization first detected at 25-29 days before parturition to predict when it will occur (rads)
  • Detect fetal pole 15-17 d post-coitus (u/s)
  • Ulrasonographically can be detected as early as 15-17 days postcoitus in cats; uncomplicated at 30 days
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6
Q

Green Which antibiotics penetrate the blood-prostate barrier and why?

A
  • These are lipid soluble and usually nonionized, non-protein bound, and have a high pKa
  • Erythromycin
  • Clindamycin
  • Trimethoprim
  • Enrofloxacin
  • Doxycycline
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7
Q

Green What is the surgical anatomy of the uterus and ovaries?

A
  • Ovaries located within a thin-walled peritoneal sac
  • Right ovary is further cranial
  • Right ovary lies dorsal to the descending duodenum
  • Left ovary lies dorsal to the descending colon and lateral to the spleen
  • Medial retraction of the mesoduodenum or mesocolon exposes the ovary on each side
  • Each ovary is attached by the proper ligament to the uterine horne and via the suspensory ligament to the trasnversalis fascia medial to the last one or two ribs
  • Ovarian pedicle (mesovarium) includes the susepsnory ligament with its artery and vein, ovarian artery and vein, and fat and connective tissues
  • Left ovarian vein drains into the left renal vein; the right vein drains into the caudal vena cava
  • Broad ligament is the peritoneal fold that suspends the uterus
  • Round ligament travels in the free edge of the broad ligament from the ovary through the inguinal cnanal with the vaginal process
  • Uterine arteries and veins supply blood to the uterus
  • Cervix is the constricted caudal part of the uterus and is thicker than the uterine body and vagina
  • Vagina is long and connects with the vaginal vestibule at the urethral entrance
  • The clitoris is broad, flat, vascular, infiltrated with fat, and lies on the floor of the vestibule near the vulva
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8
Q

Green When does testicular descent occur?

A

2 months of age by dogs and cats

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9
Q

Green Be able to do an “air” nonpalpable cryptorchid castrtion. (the palpable one will come later)

A
  1. Ventral midline incision from umbilicus to pubis or paramedian incision adjacent to the prepuce when an exploratory laparotomy is performed.
  2. Find the testicles by retroflexing the bladder, locating the ductus deferens dorsal to the neck of the bladder.
  3. If the ductus deferens travels into the inguinal ring and the testicle cannot by manipulated into the abdomen, perform an inguinal incision.
  4. Avulse the ligament of the tail of the epididymis.
  5. Double ligate the testicular artery and vein, and ductus deferens separately
  6. Transect and remove the testicle.
  7. Inspect for hemorrhage and close the abdomen in three layers.
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10
Q

green? Be able to do an “air” CS without OHE

A
  1. Clip and perform a preliminary abdominal prep before anesthetic induction to minimize time from induction to delivery.
  2. Preoxygenate the bitch or queen if possible before induction. Anesthetize the animal using general or regional protocol that minimizes neonatal depression.
  3. Position in dorsal recumbency. Apply a final aseptic scrub to the ventral abdomen.
  4. Make a ventral midline incision from just cranial to the umbilicus to near the pubis. Elevate the external rectus sheath before making a stab incision through the linea alba to prevent inadvertent laceration of the uterus.
  5. Exteriorize the gravid uterine horns by carefully lifting rather than pulling them out of the abdomen, as uterine vessels are easily avulsed, and the uterine wall readily tears.
  6. Isolate the uterus from the remainder of the abdomen with sterile towels or laparotomy pads.
  7. Tent and then incise the ventral uterine body to prevent lacerating the neonate. Extend the incision with a metzenbaum scissors in either a longitudinal direction along the ventral aspect of the uterine body or a U-shaped incision from one uterine horn to the other.
  8. Empty each horn by gently squeezing cranial to each fetus to move it toward the incision, then grasping and gently pulling it from the uterus.
  9. Rupture the amniotic sac and clamp the umbilical cord with two curved Mosquito forceps and cut in-between as each neonate is presented.
  10. Avoid contaminating the abdomen and surgical field with amniotic fluids.
  11. Aseptically pass each neonate to an assistant.
  12. At term, the placenta is often expelled with the neonate; however, if the placenta has not separated, gently pull it from the endometrium. Do not forcibly separate the placenta and uterine wall, or severe hemorrhage may occur.
  13. Palpate the pelvic canal and remove any fetus from this location.
  14. Administer oxytocin or ergnoovine maleate if contraction has not occurred. Give oxytocin and compress the uterine walls if endometrial hemorrhage is severe.
  15. Lavage the external uterus to remove debris.
  16. Close the uterine incision with 3-0 or 4-0 absorbable suture using an appositional pattern in a single layer simple continuous pattern, a double layer appositional closure (mucos anad submucosa followed by muscularis and serosa), or an appositional closure followed by a second layer inverting pattern (Cushing or Lembert).
  17. Lavage the surgical site and replace contaminated towels, sponges, instruments and gloves.
  18. Inspect for uterine avulsion and control hemorrhage. Lavagge the abdomen if contamination or spillage of uterine contents has occurred.
  19. Cover the uterine incision with omentum.
  20. Appose the abdominal wall in three layers (rectus fascia, SC tissue, and skin). Use an intradermal skin closure to eliminate suture ends that may irritate neonates.
  21. Clean all antiseptics, blood, and debris from the ventral abdomen and mammae.
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11
Q

Green Which are the options for performing OHE in conjunction with a cesarean section (CS)?

A
  • C-section and then routine OHE

- En bloc OHE where you take out the uterus first, and then give that to assistants to exteriorize the puppies

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12
Q

Green Possible Complications with OHE

A
  • Dehiscence
  • Hemorrhage
  • Infection
  • Fistula
  • Adhesions
  • Urinary incontinence
  • Transected ureter
  • Ovarian remnant
  • Pain
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13
Q

Green Which complications of OHE are always results of errors in surgical technique?

A
  • Hemorrhage
  • Ovarian remnant
  • Transected ureter
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14
Q

Green Which of the 9 complications can you influence by using correct surgical technique and choice of correct suture material?

A
  • Fistulous tracts (if nonabsorbable multifilament suture material is used)
  • Hemorrhage
  • Ovarian remnant
  • Transected ureter
  • Adhesions
  • Dehiscence
  • Infection
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15
Q

Green Which surgery types are options for mammary tumors?

A
  • Radical gland removal
  • Lumpectomy (if mass <1-2cm)
  • SImple mastectomy (one gland)
  • Regional mastectomy (1-4 glands in one chain)
  • Unilateral/bilateral radical mastectomy; entire chain
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16
Q
  • Green* What is the fraction of malignant mammary tumors in dogs?
A
  • Approximately half are benign

- of the half that are malignant, only about half tend to metastasize

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17
Q
  • Green* What is the fraction of malignant mammary tumors in cats?
A
  • 90% are malignant
  • 10% are benign
  • Often are aggressive and prone to metastasis to LN and lungs
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18
Q

Green How does the risk of mammary neoplasia change depending on age of OHE in dogs?

A
  • Greatly increased risk in intact females
  • OHE prior to first heat is a 0.05% risk
  • OHE risk after one cycle is 8% risk
  • OHE risk after 2 cycles is 26%
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19
Q

Green How does the risk of mammary neoplasia change depending on age of OHE in cats?

A
  • OHE <6 months reduces risk 91%
  • <1 year reduces risk 84%
  • > 1 year no reduction in risk
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20
Q

Green What are three benign mammary tumors in dogs?

A
  • Adenoma
  • Benign mixed tumors (fibroadenomas)
  • Benign mesenchymal tumors
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21
Q

Green What are the three types of malignant mammary tumors in dogs?

A
  • Adenocarcinoma (most malignant tumors)
  • Sarcoma (high metastasis rate)
  • Inflammatory carcinoma (bad; do not operate; locally invasive, DIC, metastasis)
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22
Q

Green What is by far the most common mammary tumor type in cats, and what % are malignant?

A
  • Adenocarcinoma; 90% are malignant
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23
Q

Green How does prognosis change depending on the size of the mammary tumor in cats?

A
  • In general, if the tumor is <1 inch, median survival 4.5 years
  • If >1 in., median survival is 6 months
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24
Q

What is the incidence of mammary neoplasia in the canine and feline?

A
  • 50% of all neoplasms in the canine

- 20% of all neoplasms in the feline

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25
Q

Staging/Tumor size of canine tumors and survival

A
  • T1 <3cm (better survival)
  • T2 3-5cm
  • T3 >5 cm (>6 months increased risk for LN metastasis)
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26
Q

What is one of the most important factors affecting survival for mammary tumors in cats?

A
  • Size
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27
Q

Where can mammary tumors metastasize?

A
  • Anywhere
  • Brain, spleen, liver
  • LUNGS
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28
Q

What are characteristics of feline mammary tumors?

A
  • Metastasize to LN and lungs
  • Grow rapidly
  • Local recurrence
  • Body wall invasion
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29
Q

Benign mammary tumors in felines

A
  • 10%

- Includes fibroepithelial hyperplasia - progesterone induced

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30
Q

Green LO What are 2 classical physical examination findings in inflammatory carcinomas?

A
  • Diffusely swollen with poor demarcation between normal and abnormal tissue
  • Ulcerated
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31
Q

Green LO Which diagnostic imaging SHOULD ALWAYS be done to stage animals with mammary tumors?

A

3 view thoracic chest radiographs

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32
Q

Green LO Which diagnostic imaging may in addition need to be performed?

A
  • Abdominal ultrasound
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33
Q

What is considered appropriate diagnostic evaluation of mammary tumors?

A
  • Mammary chain palpation: number, site, and size of lesions
  • Regional LN palpation
  • Minimum data base
  • 3 view thoracic radiographs** (Abdominal ultrasound if extensive)
  • FNA of mammary masses and LNs
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34
Q

Why FNA mammary masses and LNs?

A
  • Look for signs of a sarcoma

- MCTs are the great pretender

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35
Q

What is the regional LN for the caudal mammary chains?

A
  • External inguinal LN
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36
Q

What is the regional LN for the cranial mammary chains?

A
  • Axillary
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37
Q

Green LO How does surgical type influence survival in dogs vs cats?

A
  • In dogs, it doesn’t matter what surgery type as long as you get the tumor with good margins (>2 cm)
  • In cats, the best survival is with staged radical bilateral mastectomy
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38
Q

What is the treatment of choice for mammary tumors?

A
  • SURGERY
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39
Q

When might surgery not be indicated for mammary tumors in dogs?

A
  • Inflammatory carcinoma

- Significant distant metastasis

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40
Q

Green LO How much tissue is removed with each surgery type in dogs, and what are the indications for each of the 5 types?

A
  • ANY is indicated in dogs depending on what is needed to remove the mammary tumor with >2 cm margins
    1. ) Lumpectomy if mass is <1-2 cm
    2. ) Simple mastectomy (one gland)
    3. ) Regional mastectomy (1-4 glands in one chain)
    4. ) Unilateral mastectomy (entire chain on one side)
    5. ) Bilateral mastectomy, staged (both chains)
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41
Q

Green LO What surgical resection technique is indicated in cats?

A
  • Staged BILATERAL (radical) mastectomy is recommended
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42
Q

Why is radical mastectomy recommended in cats?

A
  • Aggressive disease with high rate of local recurrence
  • Multiplicity of tumors
  • Intergland spread
  • Interchain spread
  • Improves prognosis
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43
Q

What is pyometra?

A
  • Purulent metritis

- Accumulation of purulent material within the uterus

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44
Q

Green LO What pathophysiology is thought to be the cause of pyometra in dogs and cats?

A
  • Length of diestrus

- Physiologically pregnant (diestrus) for 60-70 days even if not impregnated

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45
Q

Green LO Which hormone is thought to play a major role in formation of pyometra in dogs, and say what it does to increase the risk for disease (4 main factors)?

A
  • Progesterone decreases myometrial activity and closes the cervix
  • Progesterone also causes increased secretions from the uterine glands
  • Progesterone inhibits uterine immune system
  • Progesterone stimulates K-receptors to which E. coli adheres
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46
Q

Green LO What role does the bacterial component play in the formation of pyometra in dogs?

A
  • Uterus during diestrus is a favorable environment for anogenital bacteria which enter the uterus during estrus
  • 60-90% E. coli
  • Progesterone stimulates K-receptors to which E. coli adheres
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47
Q

Green LO Why is pyometra less common in cats than dogs?

A
  • They are induced ovulators so development of luteal tissue requires copulation or artificially induced ovulation
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48
Q

Green LO When does pyometra present in relation to estrus in dogs?

A
  • 5.4 weeks since last estrus
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49
Q

Signalment of pyometra

A
  • Intact dogs (although don’t forget about ovarian remnant syndrome!!!)
  • Mean age is 7 years
  • Illness is usually 8-13 days
50
Q

Green LO What are the clinical signs of pyometra (list 10)?

A
  • Abdominal pain on palpation (~75%)
  • Vomiting (~75%)
  • Fever (50%)
  • Depression (~70%)
  • PU/PD (~70%)
  • Vaginal discharge (50%)
  • Notcuria
  • Diarrhea
  • Hypothermia
  • Shock
  • Dehydration
51
Q

Green LO List the 3 most common CBC findings in a dog with pyometra

A
  • Leukocytosis (often over 100,000/µL)

- Left shift with band or toxic neutrophils (very toxic animals may have a low WBC which is a bad sign)

52
Q

Green LO List the 3 most common Chem panel findings in a dog with pyometra

A
  • Hypoalbuminemia (negative acute phase protein)
  • Hyperglobulinemia (positive acute phase protein)
  • Elevated Alk P (intrahepatic biliary stasis with inflammation)
53
Q

Green LO What concurrent abnormalities are common or important in pyometra (list 7)?

List pathophys if indicated

A
  • SIRS (~50% of animals; not as bad prognosis as other septic animals)
  • Hyperglycemia (progesterone induced growth hormone production)
  • Renal dysfunction (prerenal azotemia from poor perfusion, dehydration, shock; immune-complex glomerulonephritis; tubular concentrating ability because ADH blocked by endotoxin)
  • 70% have UTI
  • Hepatic dysfunction
  • Anemia
  • Cardiac arrhythmias
  • Coagulation abnormalities
54
Q

How do you obtain urine samples in a dog with a possible pyometra?

A
  • Ultrasound guided cystocentesis
55
Q

Dfdx for pyometra if the uterus is not draining?

A
  • Pregnancy
  • CEH/hydrometra or mucometra
  • Diabetes mellitus
  • Hyperadrenocorticism
  • Hepatic disease
56
Q

Dfdx for pyometra if the uterus is draining?

A
  • Pyometra should be your absolute first diagnosis
57
Q

Green LO Radiographic findings of pyometra

A
  • Abdominal radiographs or ultrasound will show a large, fluid-filled tubular structure in the caudal abdomen, between the bladder and the colon
  • May have poor serosal detail if uterine rupture is present
  • Rule out pregnancy too
58
Q

Green LO Abdominal ultrasound findings of pyometra

A
  • Fluid filled uterus
  • Preferred as it provides more detailed information about the uterine tissues and fludi within the lumen
  • Uterine blood flow velocities can help differentiate between CEH and CEH with pyometra
  • Rule out pregnancy too
59
Q

Green LO What is the recommended timing (after diagnosis) to pursue surgical management of pyometra?

A
  • Do not delay more than is absolutely necessary
60
Q

Green LO What is the optimum treatment for pyometra?

A
  • Surgery is the most optimum and recommended in all cases except valuable breeding animals
61
Q

How do you stabilize the patient prior to surgery? List broadly 2 types of treatment.

A
  • Correct at least 50% of dehydration through IV fluid therapy (but do not delay surgery more than a few hours)
  • Perioperative/therapeutic antibiotics
62
Q

Green LO What are reasonable empiric antibiotic choices? What are you directing your antibiotics towards with pyometra?

A
  • Gram negative (E. coli)
  • Reasonable choices: Cefazolin, Cefoxitin, Amoxicillin plus clavulanate, Ampicillin plus sulbactam, ampicillin, enrofloxacin
63
Q

What about aminoglycosides for pyometra?

A
  • Not helpful because these dogs are often dehydrated, and there is risk of kidney damage in dehydrated animals given aminoglycosides
64
Q

Green LO How is the surgical technique different to the standard OHE technique?

A
  • Bigger incision
  • NO spay hook
  • Suspensory ligaments often do not have to be strummed
  • GENTLE
  • Pack off!
  • Ligate mesometrium
  • Lavage!
  • Ruptured? Drains?
65
Q

Why do we lavage for pyometra even if the dog hasn’t ruptured?

A
  • There is a connection to the bursa, so you lavage even without
  • Regional peritonitis could occur with the omental bursa
66
Q

Prognosis for pyometra with and without surgery

A
  • Following surgery - GOOD - if no abdominal contamination, shock and sepsis controlled, and renal damage reversed (>90% recovery)
  • Death usually occurs without treatment (“don’t let the sun set on a pyometra”; recurrence common with medical therapy)
67
Q

Tatum is a pregnant 4 yo Yorkie. She has radiographs indicating one single puppy, and has had abdominal contractions intermittently for the last 4 hours. The contractions are weak and irregular, with many minutes between them. What is a likely diagnostic/therapeutic strategy for Tatum?

A
  • Oxytocin treatment

- Weak irregular contractions are most helpful

68
Q

Tinkerbelle, a 3 yo miniature schnauzer bred 67 days ago, presents with intense abdominal contractions, which according to the owner have been present for 45 minutes. What is likely to be your diagnostic/therapeutic strategy?

A
  • Immediate C-section

- Oxytocin would be contraindicated here

69
Q

Molly, a 2 yo Rottweiler was bred 67 days ago but has not yet showed signs of labor. The owner is absolutely sure she saw the water breaking (i.e. amniotic fluid) in Molly’s bed 2 hours ago, and insists on immediate C-section. What is likely to be an appropriate diagnostic/therapeutic strategy in Molly’s case?

A
  • Progesterone determination

- Dog doesn’t show any signs of labor

70
Q

What is the first question you should ask for dystocia?

A
  • Are there signs of labor?
71
Q

Next steps if no signs of labor

A
  • Is labor due?

- Answer with progesterone

72
Q

What if labor isn’t due?

A
  • WAIT!
73
Q

What is the diagnosis if labor is due and there are no signs of labor?

A
  • Complete primary uterine inertia
74
Q

Treatment for complete primary uterine inertia

A
  • Medical (oxytocin)

- +/- C-section

75
Q

What is the next step if labor started but ended prematurely?

A
  • Determine if there is a detectable reason
76
Q

Diagnosis and treatment if no detectable reason that labor started but ended prematurely

A
  • Partial primary uterine inertia

- Medical (oxytocin) +/- C-section

77
Q

What are some reasons why labor could have started but ended prematurely?

A
  • Obstruction, retained fetus, toxemia, etc.
78
Q

Diagnosis and treatment if labor started but ended prematurely due to a detectable reason (e.g. obstruction, retained fetus, toxemia, etc.)

A
  • Secondary uterine inertia

- C-section but stabilize first!

79
Q

Why is it best to wait if the dog isn’t due?

A
  • Surfactant develops quite late in fetuses

- They can die if you’re even a week off

80
Q

What is the most common cause of dystocia in pregnant bitches?

A
  • Partial primary uterine inertia
81
Q

What happens during Stage 1 labor, how long does it last, and what are clinical signs?

A
  • Uterus is contracting
  • <24 hours
  • Nesting behavior, anxiety, panting, etc.
82
Q

What happens during stage 2-3 labor, how long does it last, and what are the clinical signs?

A
  • Expulsion of the fetus and placenta
  • <4 hours of visible weak contractions before the pup, <30 minutes if strong
  • 5-60 minutes between puppies
  • <15 minutes between the pup and placenta
  • In total <24 hours
83
Q

How long should it take between the puppy and the placenta?

A
  • <15 minutes
84
Q

What happens during stage 4 labor, how long does it last, and what are the clinical signs?

A
  • Involution of the uterus
  • <12 weeks occasionally
  • Normally <6 weeks
  • Bitch is healthy
85
Q

What is the only normal type of discharge during whelping?

A
  • Clear mucoid discharge close to the onset of parturition
86
Q

What is abnormal for dystocia in dog and cats?

A
  • Toxicity of the dam (48-72 hours post fetal death)
  • Strong abdominal contractions >30 minutes
  • Weak abdominal contractions >4 hours
  • Time between puppies >4 hours, kittens >24 hours (only 1%)
  • Prolonged gestation of more than 71 days post breeding (dog: >64 days from ovulation)
  • Stillborn puppies
  • Abnormal vulvar discharge; Lochia prior to first puppy
87
Q

(NOT COVERED) Partial primary uterine inertia

A
  • Labor started but ended prematurely
  • Inability to contract and expel in light of normal fetus and normal birth canal
  • Breed predisposition is dachshunds, Scottish terriers, toy, and giant breeds
  • Uterine overstretching from large litter
  • Decreased uterine stimulation from small litter
  • Lower PGF-alph and higher progesterone
88
Q

(NOT COVERED) Underlying causes for secondary uterine inertia - % maternal vs % fetal factors?

A
  • 75% maternal factors

- 25% fetal factors

89
Q

(NOT COVERED) Underlying causes for secondary uterine inertia - maternal factor examples

A
  • Vulvar or pelvic obstruction
  • Uterine torsion
  • Toxemia
  • Hypocalcemia or hypoglycemia (unusual)
90
Q

(NOT COVERED) Underlying causes for secondary uterine inertia - fetal factor examples

A
  • Oversized/malpositioned fetus

- Dead fetus

91
Q

(NOT COVERED) Workup for dystocia

A
  • History
  • PE
  • Vaginal palpation (sterile! check for Ferguson’s reflex)
  • CBC/Chem/UA
  • Radiographs (# of pups? malposition? fetal death?
  • Ultrasound (fetal heart rate; what is normal? when should you cut?)
92
Q

Medical management for dystocia - what is required of your patient?

A
  • HEALTHY AND NOT OBSTRUCTED
93
Q

Medical management for dystocia (NOT COVERED)

A
  • Correct dehydration
  • Correct hypocalcemia and hypoglycemia
  • Oxytocin repeat once in 30 minutes
  • Calcium gluconate seldom indicated
  • Assisted vaginal delivery with lots of lube
94
Q

Oxytocin effects (NOT COVERED)

A
  • Increased uterine contractions
  • Increased uterine involution
  • Decreased fetal membrane retention
  • Increased premature placental separation
  • Leads to fetal hypoxia
  • If no response after 2 doses, C-section
95
Q

C-section approach from class (NOT COVERED)

A
  • Ventral midline approach (wide incision; need lots of room to remove gravid uterus without tearing)
  • Exteriorize uterine horns and body (hard to do if pups in uterus or vagina; may have to push that one out or remove first)
  • Incise ventral uterine horn on or near body
  • Try to make only one incision and move pups to that incision
  • Make incision gently if over a puppy
96
Q

Green LO What are the four major differentials for prostatomegaly?

A
  • Benign prostatic hyperplasia
  • Prostatitis or prostatic abscess
  • Prostatic neoplasia
  • Prostatic cysts: parenchymal or periprostatic
97
Q

Green LO What causes the prostatic enlargement of benign prostatic hyperplasia?

A
  • As dogs increase in age, they get decreased testosterone and estrogen stays the same
  • Relative estrogen excess and increased sensitivity to dihydrotestosterone
98
Q

Green LO How common is BPH?

A
  • About 80% of intact male dogs >6 years of age will get it
99
Q

Green LO What are the potential causes of BPH (list 3)?

A
  1. Abnormal ratio of androgens to estrogens
  2. Increased number of androgen receptors
  3. Increased tissue sensitivity to androgens
100
Q

Green LO Which is the primary hormone involved in the pathophysiology of BPH?

A
  • Dihydrotestosterone (and increased sensitivity)
  • It enhances growth in both prostatic stromal and glandular components
  • It is the relative excess of estrogen due to declining testosterone with age that is thought to lead to an increased sensitivity to dihydrotestosterone
101
Q

Green LO How do age-related changes in these hormones contribute to BPH?

A
  • Decline of testosterone thought to lead to a relative increase in estrogen
102
Q

Green LO What clinical signs could substantial enlargement of the gland lead to (list 4)?

A
  • Tenesmus
  • Hematuria
  • Urethral bleeding
  • Altered stool shape
103
Q

Green LO but skipped Describe specific physical exam findings consistent with BPH

A
  • Prostatomegaly
  • Symmetric prostatic enlargement
  • No pain on prostatic palpation or fluctuant prostate
104
Q

Green LO Which is the best treatment for BPH?

A
  • Castration!
105
Q

Green LO How fast does csatration lead to prostate involution?

A
  • 50% reduction in 3 weeks
106
Q

Which disorders of the following are commonly treated surgically, and with which surgery?

A. BPH
B. Prostatitis/abscess
C. Prostatic neoplasia
D. Prostatic cysts; parenchymal or periprostatic

A

A. if clinical
B. Prostatitis/abscess
D. Prostatic cysts

Castration!

107
Q

Green LO Answer if BPH is yes/no for the following:

  1. Smooth symmetric enlargement
  2. Asymmetric smooth enlargement
  3. Asymmetric “lumpy bumpy” enlargement
  4. Pain on palpation
A
  1. Yes
  2. no
  3. No
  4. No
108
Q

Green LO Answer if Prostatitis/abscess is yes/no for the following:

  1. Smooth symmetric enlargement
  2. Asymmetric smooth enlargement
  3. Asymmetric “lumpy bumpy” enlargement
  4. Pain on palpation
A
  1. +/- (not as much)
  2. Yes it’s possible
  3. Yes it’s possible
  4. +/-
109
Q

Green LO Answer if a non-infected cyst is yes/no for the following:

  1. Smooth symmetric enlargement
  2. Asymmetric smooth enlargement
  3. Asymmetric “lumpy bumpy” enlargement
  4. Pain on palpation
A
  1. +/- (not as much)
  2. Yes
  3. Not as much
  4. No
110
Q

Green LO Answer if Neoplasia is yes/no for the following:

  1. Smooth symmetric enlargement
  2. Asymmetric smooth enlargement
  3. Asymmetric “lumpy bumpy” enlargement
  4. Pain on palpation
A
  1. +/-
  2. Not as much
  3. Yes it’s possible
  4. +/-
111
Q

Methods to differentiate prostatic disease?

A
  • Signalment, history, PE, diagnostic testing
  • Intact/castrated?
  • healthy? Sick? Obstructed?
  • Rectal palpation
  • Imaging
  • Needle aspirate/Prostatic wash
  • Culture and sensitivity
112
Q

Describe pathophysiology for parenchymal prostatic cysts (different from periprostatic cysts)

A
  • Increase in age leads to decreased testosterone and plateau estrogen
  • Relative estrogen excess leads to squamous metaplasia and cyst formation
113
Q

Describe pathophysiology for prostatitis +/- prostatic abscess

A
  • Increase in age leads to decreased testosterone and plateau estrogen
  • Relative estrogen excess leads to squamous metaplasia and cyst formation
  • In combination with a urinary disorder like a UTI, there is microabscessation in the prostate
  • This leads to prostatitis and possible prostatic abscess
114
Q

Which of the following are for intact males?

  • BPH
  • Prostatitis
  • Prostatic neoplasia
  • Prostatic abscess
  • Parenchymal cysts
  • Periprostatic cysts
A
  • All but prostatic neoplasia
115
Q

Which of the following are for castrated males?

  • BPH
  • Prostatitis
  • Prostatic neoplasia
  • Prostatic abscess
  • Parenchymal cysts
  • Periprostatic cysts
A
  • Prostatic neoplasia
116
Q

Which of the following need additional treatments besides surgery?

  • BPH
  • Prostatitis/Prostatic abscess
  • Prostatic neoplasia
  • Prostatic cysts; parenchymal or periprostatic
A
  • Prostatitis/prostatic abscess
  • Prostatic neoplasia
  • Prostatic cysts;parenchymal or periprostatic
117
Q

If you want to go back and do lecture objectives for the BPH, prostatitis, and prostatic neoplasia, you can!

A
  • Priority for later
118
Q
  • Green LO* Give 4 reasons (3 medical and one practical) a cryptorchid animal should always be castrated
A
  • Cryptorchid testes are 13.6 times more likely to develop testicular neoplasia
  • Hereditary (autosomal recessive)
  • Secondary disorders include prostatic disease and perineal hernia (hormone producing but sterile gonad)
  • Behavior will mean they act like they are intact
119
Q
  • Green LO* If you are unsure if an animal is castrated, based on lack of scrotal testicles, how could you determine if the animal is cryptorchid (if no scar is visible) in cats and dogs?
  • List 3 ways by physical exam
A
  • Penile spines in a male cat
  • Palpate or image the prostate (well-developed if cryptorchid)
  • Palpate carefully in the inguinal region (look for the area just cranial to the pectineus for the inguinal canal)
120
Q
  • Green LO* If you are unsure if an animal is castrated, based on lack of scrotal testicles, how could you determine if the animal is cryptorchid (if no scar is visible) in cats and dogs?
  • List 1 way by laboratory work
A
  • AMH test

- Plasma testosterone after hCG or GnRH stimulation (substantial increase if cryptorchid)

121
Q
  • Green LO* Be prepared to do an air cryptorchidtectomy for abdominal testicles
A
  • Advance unilateral, mobile inguinal testicles to the prescrotal incision and remove.
  • Remove nonmobile testicles by making an incision over the inguinal ring.
  • Dissect through subcutaneous fat and mobilize and remove the testicle.
  • Maximally exteriorize the sepermatic cord by reflectning fat and fascia from the parietal tunic with a gauze sponge.
  • Place traction on the testicle while the fibrous attachments between the spermatic cord tunic and scrotum are torn.
  • Place a hemostat across the cord just distal to the testicle.
  • Place an encircling ligature (e.g. 2-0 or 3-0 absorbable) around the entire spermatic cord and tunics. Pass the needle of a second ligature through the cremaster muscle, or between structures within the tunic, for a transfixation ligature proximal or distal to the first.
  • Transect the cord between the most distal ligature and the hemostat, and inspect for hemorrhage.
  • Advance the second testicle into the incision and remove as described previously.
  • Close SC tissue with a continuous pattern.
  • Appose skin with an intradermal or an external simple interrupted suture pattern in the skin.
  • Submit the testicles for histologic examination to verify removal of testicular tissue and to rule out neoplasia.

SA Surgery Final (19 decks)

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