Reproductive Flashcards
Considerations for when to recommend a spay?
- Orthopaedic disease - desex after growth plate closure for larger breeds
- Neoplasia: mammary neoplasia (0.5% after first oestrus, 8% at 2nd, 26% any oestrus after)
what orthopaedic diseases are potentially associated with early spays?
- Hip dysplasia
2. Cranial cruciate ligament disease
how do dog and cat mammary chains differ?
- Dogs have significant cross-over midline between glands w/ lymphatic and blood supply + 5 pairs
- Cats: limited crossing over midline + only have 4 pairs
% of malignant mammary neoplasia
35-50% in dogs
tumours with hormone receptors are…
benign - can lose hormone receptors = malignant transformation
how do hormones oestrogen and progesterone affect mammary tumours?
oestrogens - stim. ductal growth
Progesterone stim lobule-alveolar development
when can you consider a lumpectomy of a mammary mass?
if it is very small,
when can you consider a single mastectomy of a mammary mass?
only if benign (proven on biopsy)
margins of a unilateral mastectomy
1 fascial plane deep
+ 2cms lateral margins
benign mammary tumour types in dogs
- adenoma, mesenchymal, mixed - small and not fixed to underlying tissue
malignant mammary tumour types in dogs
carcinoma, sarcoma - bigger and fixed
treatment of malignant mammary tumours in dogs
chain mastectomy - unilateral vs. staged bilateral
approach to treatment of an inflammatory mammary carcinoma on a dog
Surgery is contraindicated
- poorly differentiated very aggressive mass with a hopeless prognosis
characteristics of malignant mammary tumours with a worsened prognosis (dogs)
- invasive and ulcerated
- mass bigger than 3cm
- present for longer than 6months
- LNs contain neoplastic cells
what % of cat mammary tumours are malignant?
85% BUT always get a biopsy
most common feline mammary tumour type
adenocarcinoma - highly aggressive w/ rapid growth and mets –> prognosis poor <1y
Ddx for feline mammary adenocarcinoma
benign fibroadenomatous hyperplasia
treatment options for testicular neoplasia
- closed orchiectomy
- scrotal ablation
which tumour type is most common in cryptorchid testes?
sertoli cell tumours
what do sertoli cells produce?
oestrogen production
what secondary findings occur dt sertoli cell tumours?
dt inc. oestrogen production
- atrophy of contralat testicle
- feminisation - enlarged nipples
- alopecia
- prostatic metaplasia
- linear preputial erythema
- myelotoxicosis
why perform a rectal on a cryptorchid dog?
cryptorchid dogs have a higher risk of sertoli cell tumours which met to sublumbar LNs (2-10%)
what do leydig cells produce?
testosterone
behaviour of leydig cell tumours?
more common in scrotal testes, smaller and met very rarely
common sequelae of leydig cell tumours
Perineal hernia dt inc. testosterone secretion
what is the most common testicular tumour type?
seminoma
behaviour of seminomas
large tumours in cryptorchid/scrotal testes, hormone production is rare and met 6-11% to sublumbar LNs
define phimosis
inability to extrude penis as preputial orifice is too small
tx of phimosis
wedge excision of cranio-dorsal orifice ***not ventral - will cause paraphimosis
cs of phimosis
- urine pooling and irritation
- inability to mate
causes of paraphimosis
- skin rolling inward
- orifice too small
tx of paraphimosis
- Dorsally enlarge preputial orifice
- Preputial advancement
- Phallopexy
types of penile neoplasias
- TVT
- SCC
- MCT
- Haemangiosarcoma
- Papilloma
tx of TVT
vincristine
what causes benign prostatic hyperplasia?
enlargement under androgenic influence –> occurs in all older intact males
what causes cystic prostatic hyperplasia?
dysfunctional flow of prostate secretions
cause of prostatic abscessation?
bacteria can establish dt isolation from vascular access secondary to cystic prostatic hyperplasia –> prostatitis
Tx of benign prostatic hyperplasia
- Castration to remove androgenic influence
- Medical:
- medroxyprogestone acetate (progestin)
- finasteride (propecia) 5a-reductase inhibitor
- deslorelin (suprelorin) (GnRH agonist)
px for benign prostatic hyperplasia w/ castration and medical tx
prostate should involute w/in 4-12wks
explain the pathogenesis of prostatic cysts
assoc. w/ BPH
oestrogens –> squamous metaplasia –> occludes ducts
where do paraprostatic cysts originate from?
uterus masculinus
bacteria associated with prostatitis/abscessation
E.coli
Brucella
CS of prostatitis
- rectal: asymmetrical prostatic enlargement
- painful
+/- purulent penile discharge
+/- acutely sick - pyrexia, lethargy
+/- oedema in HLs
Dx approach to prostatic disease
- Rectal exam
- Abdo US: to ID appearance and fluid pockets
- US guided FNA: culture and cytology
what surgical tx is appropriate for large, discrete fluid pockets in the prostate?
omentalisation
prognosis of prostatitis
difficult to cure disease as often there are multiple small pockets
behaviour of prostatic neoplasia
highly malignant (80% met (lungs, LN, bones) at Dx), mineralisation
types of prostatic neoplasia
adenocarcinoma, SCC, TCC
tx approach to prostatic carcinoma
- Sx generally not indicated as aggressive disease w/ high morbidity of sx (prostatectomy)
- Palliative care: NSAIDs, chemo, urethral stenting/urinary diversion (cystotomy tube)
- Prognosis <6m
diagnosis of ovarian remnant syndrome
- Serum oestradiol or progesterone concentrations (dependent on cycle)
- Anti-mullerian hormone (independent of cycle)
hormonal effects of progesterone on the female reproductive tract
- Proliferation and hypersecretion of glands
- Closure of cervix
- Inhibition of myometrial contractility
- Inhibition of local immune response
- Increases endometrial bacterial adherence
what does CEHMEP stand for?
- CEH = Cystic endometrial hyperplasia
- M = Mucometra
- E = Endometritis
- P = Pyometra
when does cystic endometrial hyperplasia occur?
periods of progesterone dominance causing hypersecretion of endometrial glands
NOTE: does not fully regress between cycles
what causes mucometra?
hypersecretion of endometrial glands during periods of progesterone dominance –> endometrial glands dilate and fluid accumulates –> medium for bacterial growth
what causes endometritis?
bacterial infection of the uterus through an open cervix
define pyometra
pus in the uterus (4-8wks after oestrus)
faecal flora associated with endometritis
Klebsiella, Pasteurella, Proteus, Pseudomonas, Enterobacter, Streptococcus
which bacteria most causes 60-95% of endometritis cases?
E.coli
how does E.coli cause polyuria?
the endotoxin interferes w/ ADH receptors + may cause glomerulonephritis
what is your primary differential for any sick entire female dog?
pyometra
describe the typical leukogram of a dog with closed pyometra
- Degenerative left shift w/ neutropaenia
what is your imaging modality of choice when investigating pyometra?
ultrasound
Pre-op stabilisation txs for pyometra
- Tx septic shock
- IVFT: isotonic crystalloids +/-colloids, azotaemia, metabolic acidosis
- Broad spec IV ABs: ampicillin (tx. E.coli)
modifications of an ovariohysterectomy in pyo cases
- Maximum exposure
- Gently exteriorise
- Pack off w/ abdo sponges
- Independently ligate uterine arteries (dt inc. blood flow)
- Remove cervix
- Lavage stump
how do functional and non-functional cystic ovaries differ?
functional = prolonged secretion of oestrogen
gestation of dog
63 days from ovulation
when are foetal skeletons radiographically visible?
42 days
indicator that whelping will occur in next 12-24hrs
- progesterone drop below 10nmol/L
- temp drop below 37.6C
events of stage 1 labour
- internal uterine contractions - no external pushing
- restlessness, anxiety, nesting, inapp
events of stage 2 labour
- abdominal contractions
- passage of foetus
events of stage 3 labour
- passage of placenta
Dystocia criteria
- Prolonged gestation
- Temp drops below 37.6C w/ no signs of labour w/in 24h
- Temp decreases and then increases to 39.2C
- Vaginal discharge for more than 2-3hrs
- Strong, active abdominal contractions for 30mins w/out puppy
- Mb or part of foetus protruding from the vagina
- Signs of systemic illness
compare primary and secondary uterine inertia
primary = failure to expel a foetus from the uterus when no obstruction exists (more common) secondary = exhaustion of uterine musculature after contracting against an obstruction
methods of medical intervention of uterine inertia
- Check glucose and ionised calcium (rare that this would need correction)
- oxytocin 0.2 IU/5kg –> expect expulsion of puppy in 30mins
ONLY if NO EVIDENCE OF OBSTRUCTION OR FOETAL DISTRESS
indications for immediate sx intervention w/ dystochia
- Canal obstruction or unresolvable malposition
- Foetal HR 150-170 (less than 1/2 of mothers HR x 2)
- > 4hrs since last puppy
- > 30min of abdo straining
- Green vaginal discharge
- Meconium or blood in vagina
- Systemic illness in the bitch
Surgical approaches to C-section
- Hysterotomy
- Hysterotomy followed by OHE
- En-bloc OHE
timeframe to remove all foetues from uterus w/ en-bloc OHE approach
~60 seconds
neonatal care of pups post c-section
- Suction nasal cavity and oropharynx
- Rub vigorously
- Naloxone
- Warm
- Allow nursing
- Metoclopramide
why is it controversial to give opioids to mother at c-section?
may decrease neonatal vigour
what is an episioplasty?
- excision of ‘hood’ covering vulva w/ recessed vulvas
- closure in 2 layers
ddx for vaginal oedema
- prolapse, neoplasia, cysts, congenital malformations
when does vaginal oedema occur
young dogs in oestrus or proestrus
tx of vaginal oedema
- spay to prevent recurrent + induce regression
- induce ovulation w/ GnRH + HCG
- apply lube and prevent self-trauma
- surgical resection is rarely required as it will regress overtime
causes of vaginal prolapse
- oestrogenic influence
- forced separation during mating
- weak pelvic tissues
percentage of vaginal neoplasias that are benign
75-85%
malignant vaginal neoplasias
TVT, carcinoma, sarcoma
benign vaginal neoplasias
leiomyoma, fibroma, lipoma
tx of vaginal neoplasias
resection via episiotomy
