SA - Female Reproductive Disease 1 Flashcards
What are two abnormal vulvar presentations that a female can have?
Recessed or ventrally displaced vulva and a hooded vulva
What causes abnormal vulvar presentations?
redundant perineal skin and fat
What can abnormal vulvar anatomy predispose the female to?
Moist perivulvar dermatitis, chronic or recurrent vaginitis, and/or recurrent UTI
What is the treatment for abnormal vulvar anatomy?
vulvoplasty
What an cause clitoral hypertrophy?
Disorders of sexual development or masculinized conditions
True or False: Females with clitoral hypertrophy may or may not have an os clitoris
true
What are some clinical signs of clitoral hypertrophy?
Licking, exposure, irritation, self trauma, or vulvar discharge depending on the severity
What disease process may clitoral hypertrophy be associated with?
recurrent UTIs
How can clitoral hypertrophy be treated?
surgical excision
What is a vaginal septum?
An abnormal vertical band of tissue spanning the vaginal vault
Where is the most common location of a vaginal septum?
near the vestibulovaginal junction
What clinical signs are associated with a vaginal septum?
Pain upon natural mating Difficulty obtaining vaginal cytology Persistent vulvar discharge and/or vaginitis Attractiveness to males Recurrent UTIs
How is a vaginal septum diagnosed?
Vaginoscopy or digital palpation
How is a vaginal septum treated?
Endoscopic laser ablation, manual dilation
If you choose not to treat a vaginal septum, how do you breed this animal?
advanced breeding management and/or elective c-section
What is ovarian remnant syndrome?
A complication following an ovariohysterectomy
What is the etiology of ovarian remnant syndrome?
Incomplete excision of one or both ovaries
Ectopic ovarian tissue (cats)
Revascularization of dropped ovarian tissue
What is a differential to consider with ovarian remnant syndrome?
exposure to exogenous hormones - estrogen, testosterone, or progesterone
When is the onset of clinical signs of ovarian remnant sydnrome?
may begin months to years after spay
What clinical signs are associated with ovarian remnant syndrome?
Vulvar edema, cyclical serosanguinous vulvar discharge, chronic vulvar discharge, attractiveness to males, mammary development and/or lactation
What are the diagnostic methods for ovarian remnant syndrome if the dog is demonstrating signs of estrus?
Vaginal cytology, progesterone level, and AMH level
What will you see on cytology if a patient is showing clinical signs of estrus and you suspect ovarian remnant syndrome?
Increased cellularity with cornification of vaginal epithelial cells consistent with estrogen exposure
What is AMH produced from?
ovarian granulosa cells
What does a high AMH level suggest?
There is ovarian tissue present
What are the diagnostic methods for ovarian remnant syndrome if the dog is demonstrating signs of diestrus?
Progesterone (<2 ng/mL) and AMH level
What are the diagnostic methods for ovarian remnant syndrome if the dog is demonstrating signs of anestrus?
AMH level - gold standard
GnRH/hCG stimulation test (preferred in cats)
What GnRH/hCG level is consistent with ovarian tissue?
A 2 fold increase
Is ultrasound helpful in diagnosing ovarian remnant syndrome? Why or Why not?
It can be helpful in IDing the presence and location of the remnant but it is frequently non-diagnostic due to the difficulty locating the remnants
What is the treatment for ovarian remnant syndrome?
Exploratory laparotomy to look for the dropped tissue and removal
What is adult vaginitis?
Presence of vaginal and vestibular inflammation in post pubertal females
What females is adult vaginitis the most common in?
spayed females
What are the clinical signs of adult vaginitis?
Increased vulvar discharge, increased licking, +/- perivulvar dermatitis and inflammation, +/- attractiveness to males
What are the differentials for adult vaginitis?
Atopy or dermatologic related disease, stump pyometra, urinary abnormalities, vaginal neoplasia, and Brucellosis
How is adult vaginitis diagnosed?
Vaginal cytology, digital vaginal examination, vaginoscopy, and potentially vaginal biopsy
What will you find on vaginal cytology in a patient with adult vaginitis?
neutrophilic inflammation
If you decide to do a vaginal culture in the case of adult vaginitis, when should you treat the female?
If you have an overgrowth of a single organism - there are a lot of commensals in the vagina
How is adult vaginitis treated?
Address any underlying structural conditions, address any underlying disease process, vaginal lavage with dilute betadine, and/or estrogenic therapy to improve the flora and elasticity
What can you give for estrogen therapy in adult vaginitis cases?
Diethystilbestrol or Incurin
What treatment is not recommended in cases of adult vaginitis?
antibiotics
What is juvenile vaginitis?
Inflammation of the vagina and/or vestibulum prior to the first estrous cycle
What clinical signs are associated with juvenile vaginitis?
presence of mucopurulent to purulent vulvar discharge, increased licking, +/- perivulvar dermatitis
There are no systemic signs
How is juvenile vaginitis diagnosed?
Presence of clinical signs and vaginal cytology
What will you find on vaginal cytology in a patient with juvenile vaginitis?
suppurative inflammation
How is juvenile vaginitis treated?
Benign neglect until first heat
Vaginal lavage with dilute betadine
ALLOW TO GO THROUGH AT LEAST ONE ESTROUS CYCLE
What treatment is discouraged in cases of juvenile vaginitis?
systemic antimicrobials
What can cause vaginal hyperplasia and vaginal prolapse?
proliferation of vaginal epithelium in an exaggerated response to estrogen
What will vaginal hyperplasia look like?
bulge of pink tissue - typically from the ventral floor of the vagina
What will vaginal prolapse look like>?
Extension of circumferential tissue or donut
Can vaginal hyperplasia and vaginal prolapse recur?
Yes - at the time of parturition
What is the treatment for vaginal hyperplasia and vaginal prolapse?
Ovariohysterectomy in non-breeding females
Ovulation induction
Keep moist
Monitor urination/stranguria
What breeding strategies should you use for a patient with vaginal hyperplasia or vaginal prolapse?
AI, TCI, and/or C-section
When may vaginal hyperplasia and vaginal prolapse increase in severity?
on subsequent estrous cycles
What is cystic endometrial hyperplasia (CEH) due to?
A cumulative effect of progesterone on the uterine endometrium
What is CEH?
proliferation of endometrial glands during diestrus
What happens throughout the life of a female that has CEH?
Complete uterine remodeling becomes impaired
Progressive glandular proliferation leads to progressive glandular dilation, fibrosis, and endometrial thickening - cysts (micro- or macroscopic)
What do cystic changes in patients with CEH cause?
Irregular glandular secretion, poor uterine clearance, and poor embryo transport and nutrition
How is cystic endometrial hyperplasia diagnosed?
Histopathology and/or transabdominal ultrasonography
How is CEH treated?
Milbolerone - allows for uterine remodeling
What is the CEH-Pyometra complex?
Cumulative progesterone leads to the following:
Glandular hyperplasia leading to glandular cysts over time
Impairs uterine clearance
Promotes cervical closure
Inhibits local immunity
Why does the CEH often lead to pyometra?
Because it allows for the perfect environment for bacterial infection - typically ascending - E. Coli is the most common cause
What is the signalment for dogs with pyometra?
Older intact females
____% of intact female dogs will develop pyometra prior to 10 years of age.
25%
When is pyometra most commonly seen in the estrous cycle?
4-8 weeks after estrus
If a cat has pyometra, when is it most commonly seen in relation to the estrous cycle?
1-4 weeks after estrus
Use of what exogenous hormone increases the likelihood of the development of pyometra?
estrogen
What are the clinical signs of pyometra?
+/- vulvar discharge, depression, anorexia, vomiting and diarrhea, PU/PD, febrile or hypothermic, dehydration, and abdominal distension
What will the vulvar discharge be like in patients with pyometra?
Mucopurulent, red/brown to yellow/green, and foul smelling
What does the presence of vulvar discharge indicate?
There is an open cervix which means open pyometra
What CBC findings will you see in patients with pyometra?
Profound neutrophilic leukocytosis (mature neutrophilia with degenerative left shift and toxic changes) and mild, normocytic, normochromic anemia
What chemistry findings will you see in patients with pyometra?
Azotemia, hyperglobulinemia, hyperalbuminemia, and possible DIC signs in cases with severe endotoxemia
From this card on is from the second disease lecture. I just wanted to finish pyo in this one.
Carry on
How is pyometra diagnosed?
abdominal ultrasound, radiographs, cytology, and possible culture
What will an abdominal ultrasound show in a patient with pyometra?
Intraluminal fluid accumulation, uterine distension, and commonly thickened uterine walls +/- cystic endometrium
What will radiographs show in patients with pyometra?
Detects severe uterine enlargement and distension - craniodorsal displacement of small intestine and soft tissue opacity in the caudoventral abdomen
What culture is best for pyometra diagnosis?
uterine culture
What will you find on vaginal cytology in patients with pyometra?
Suppurative inflammation +/- bacteria in open pyometras
How is pyometra treated?
surgical ovariohysterectomy or medical management
What are the advantages to surgical treatment of a pyometra?
Rapid elimination of organism and inflammation, >80% recovery rate, and permanent resolution
What are the disadvantages to surgical treatment of a pyometra?
Lost future fertility and surgical risk in potentially unstable dog
What are the advantages to medical management of pyometra?
Up to 95% recovery rate, surgery not necessary, and fertility is spared
What are the disadvantages to medical management of pyometra?
Recurrence rate of about 25% on each cycle and extensive treatment protocol/hospitalization
What is a major indication for medical management of pyometra?
Breeding females or females too unstable for immediate surgical correction
How can you medically treat for pyometra?
Broad spectrum abx, PGF2alpha, prolactin antagonist, progesterone antagonist, and supportive care
What is the purpose of using prostaglandin in open pyometras?
To promote luteolysis and cause uterine contractions for uterine evacuation
What is the purpose of using prostaglandin in closed pyometras?
To cause cervical dilations and luteolysis - doses are then increased for luteolysis and uterine evacuation
What is TECT?
Transcervical endoscopic uterine lavage
What are the benefits to using TECT to treat pyometra?
May hasten response and recovery rate during medical management and allows for uterine culture
What are the risks to using TECT for treating pyometra?
uterine rupture and/or peritonitis
How is an OHE performed to treat pyometra?
Carful midline incision to avoid accidental incision of the uterus
Carful handling of the uterus to avoid rupture
Meticulous ligation due to large blood supply
Routine ovarian ligature
What is the uterine stump closure for treatment of pyometra?
Ligate the vessels on either side of the cervix
Don’t penetrate the lumen
Circumferential suture proximally - DO NOT TRANSFIX
Pack off and lavage
What is the benefit to doing a uterine stump closure for treatment of pyometra?
prevents retrograde leakage
What is stump pyometra?
infection and fluid accumulation within the uterine remnant in a spayed female
When does stump pyometra occur?
Only in the presence of hormones - ovarian remnant or ectopic hormonal exposure
How is stump pyometra diagnosed?
Abdominal ultrasound, hormonal testing for remnant, and exploratory surgery
What is the treatment for stump pyometra?
removal of the remaining uterine body and/or removal of the ovarian remnant
