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Disturbances in Reproduction > SA - Female Reproductive Disease 1 > Flashcards

SA - Female Reproductive Disease 1 Flashcards

1
Q

What are two abnormal vulvar presentations that a female can have?

A

Recessed or ventrally displaced vulva and a hooded vulva

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2
Q

What causes abnormal vulvar presentations?

A

redundant perineal skin and fat

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3
Q

What can abnormal vulvar anatomy predispose the female to?

A

Moist perivulvar dermatitis, chronic or recurrent vaginitis, and/or recurrent UTI

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4
Q

What is the treatment for abnormal vulvar anatomy?

A

vulvoplasty

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5
Q

What an cause clitoral hypertrophy?

A

Disorders of sexual development or masculinized conditions

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6
Q

True or False: Females with clitoral hypertrophy may or may not have an os clitoris

A

true

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7
Q

What are some clinical signs of clitoral hypertrophy?

A

Licking, exposure, irritation, self trauma, or vulvar discharge depending on the severity

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8
Q

What disease process may clitoral hypertrophy be associated with?

A

recurrent UTIs

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9
Q

How can clitoral hypertrophy be treated?

A

surgical excision

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10
Q

What is a vaginal septum?

A

An abnormal vertical band of tissue spanning the vaginal vault

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11
Q

Where is the most common location of a vaginal septum?

A

near the vestibulovaginal junction

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12
Q

What clinical signs are associated with a vaginal septum?

A 
Pain upon natural mating
Difficulty obtaining vaginal cytology
Persistent vulvar discharge and/or vaginitis
Attractiveness to males
Recurrent UTIs
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13
Q

How is a vaginal septum diagnosed?

A

Vaginoscopy or digital palpation

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14
Q

How is a vaginal septum treated?

A

Endoscopic laser ablation, manual dilation

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15
Q

If you choose not to treat a vaginal septum, how do you breed this animal?

A

advanced breeding management and/or elective c-section

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16
Q

What is ovarian remnant syndrome?

A

A complication following an ovariohysterectomy

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17
Q

What is the etiology of ovarian remnant syndrome?

A

Incomplete excision of one or both ovaries
Ectopic ovarian tissue (cats)
Revascularization of dropped ovarian tissue

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18
Q

What is a differential to consider with ovarian remnant syndrome?

A

exposure to exogenous hormones - estrogen, testosterone, or progesterone

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19
Q

When is the onset of clinical signs of ovarian remnant sydnrome?

A

may begin months to years after spay

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20
Q

What clinical signs are associated with ovarian remnant syndrome?

A

Vulvar edema, cyclical serosanguinous vulvar discharge, chronic vulvar discharge, attractiveness to males, mammary development and/or lactation

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21
Q

What are the diagnostic methods for ovarian remnant syndrome if the dog is demonstrating signs of estrus?

A

Vaginal cytology, progesterone level, and AMH level

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22
Q

What will you see on cytology if a patient is showing clinical signs of estrus and you suspect ovarian remnant syndrome?

A

Increased cellularity with cornification of vaginal epithelial cells consistent with estrogen exposure

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23
Q

What is AMH produced from?

A

ovarian granulosa cells

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24
Q

What does a high AMH level suggest?

A

There is ovarian tissue present

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25
Q

What are the diagnostic methods for ovarian remnant syndrome if the dog is demonstrating signs of diestrus?

A

Progesterone (<2 ng/mL) and AMH level

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26
Q

What are the diagnostic methods for ovarian remnant syndrome if the dog is demonstrating signs of anestrus?

A

AMH level - gold standard

GnRH/hCG stimulation test (preferred in cats)

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27
Q

What GnRH/hCG level is consistent with ovarian tissue?

A

A 2 fold increase

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28
Q

Is ultrasound helpful in diagnosing ovarian remnant syndrome? Why or Why not?

A

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

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29
Q

What is the treatment for ovarian remnant syndrome?

A

Exploratory laparotomy to look for the dropped tissue and removal

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30
Q

What is adult vaginitis?

A

Presence of vaginal and vestibular inflammation in post pubertal females

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31
Q

What females is adult vaginitis the most common in?

A

spayed females

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32
Q

What are the clinical signs of adult vaginitis?

A

Increased vulvar discharge, increased licking, +/- perivulvar dermatitis and inflammation, +/- attractiveness to males

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33
Q

What are the differentials for adult vaginitis?

A

Atopy or dermatologic related disease, stump pyometra, urinary abnormalities, vaginal neoplasia, and Brucellosis

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34
Q

How is adult vaginitis diagnosed?

A

Vaginal cytology, digital vaginal examination, vaginoscopy, and potentially vaginal biopsy

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35
Q

What will you find on vaginal cytology in a patient with adult vaginitis?

A

neutrophilic inflammation

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36
Q

If you decide to do a vaginal culture in the case of adult vaginitis, when should you treat the female?

A

If you have an overgrowth of a single organism - there are a lot of commensals in the vagina

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37
Q

How is adult vaginitis treated?

A

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

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38
Q

What can you give for estrogen therapy in adult vaginitis cases?

A

Diethystilbestrol or Incurin

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39
Q

What treatment is not recommended in cases of adult vaginitis?

A

antibiotics

40
Q

What is juvenile vaginitis?

A

Inflammation of the vagina and/or vestibulum prior to the first estrous cycle

41
Q

What clinical signs are associated with juvenile vaginitis?

A

presence of mucopurulent to purulent vulvar discharge, increased licking, +/- perivulvar dermatitis

There are no systemic signs

42
Q

How is juvenile vaginitis diagnosed?

A

Presence of clinical signs and vaginal cytology

43
Q

What will you find on vaginal cytology in a patient with juvenile vaginitis?

A

suppurative inflammation

44
Q

How is juvenile vaginitis treated?

A

Benign neglect until first heat
Vaginal lavage with dilute betadine
ALLOW TO GO THROUGH AT LEAST ONE ESTROUS CYCLE

45
Q

What treatment is discouraged in cases of juvenile vaginitis?

A

systemic antimicrobials

46
Q

What can cause vaginal hyperplasia and vaginal prolapse?

A

proliferation of vaginal epithelium in an exaggerated response to estrogen

47
Q

What will vaginal hyperplasia look like?

A

bulge of pink tissue - typically from the ventral floor of the vagina

48
Q

What will vaginal prolapse look like>?

A

Extension of circumferential tissue or donut

49
Q

Can vaginal hyperplasia and vaginal prolapse recur?

A

Yes - at the time of parturition

50
Q

What is the treatment for vaginal hyperplasia and vaginal prolapse?

A

Ovariohysterectomy in non-breeding females
Ovulation induction
Keep moist
Monitor urination/stranguria

51
Q

What breeding strategies should you use for a patient with vaginal hyperplasia or vaginal prolapse?

A

AI, TCI, and/or C-section

52
Q

When may vaginal hyperplasia and vaginal prolapse increase in severity?

A

on subsequent estrous cycles

53
Q

What is cystic endometrial hyperplasia (CEH) due to?

A

A cumulative effect of progesterone on the uterine endometrium

54
Q

What is CEH?

A

proliferation of endometrial glands during diestrus

55
Q

What happens throughout the life of a female that has CEH?

A

Complete uterine remodeling becomes impaired
Progressive glandular proliferation leads to progressive glandular dilation, fibrosis, and endometrial thickening - cysts (micro- or macroscopic)

56
Q

What do cystic changes in patients with CEH cause?

A

Irregular glandular secretion, poor uterine clearance, and poor embryo transport and nutrition

57
Q

How is cystic endometrial hyperplasia diagnosed?

A

Histopathology and/or transabdominal ultrasonography

58
Q

How is CEH treated?

A

Milbolerone - allows for uterine remodeling

59
Q

What is the CEH-Pyometra complex?

A

Cumulative progesterone leads to the following:
Glandular hyperplasia leading to glandular cysts over time
Impairs uterine clearance
Promotes cervical closure
Inhibits local immunity

60
Q

Why does the CEH often lead to pyometra?

A

Because it allows for the perfect environment for bacterial infection - typically ascending - E. Coli is the most common cause

61
Q

What is the signalment for dogs with pyometra?

A

Older intact females

62
Q

____% of intact female dogs will develop pyometra prior to 10 years of age.

A

25%

63
Q

When is pyometra most commonly seen in the estrous cycle?

A

4-8 weeks after estrus

64
Q

If a cat has pyometra, when is it most commonly seen in relation to the estrous cycle?

A

1-4 weeks after estrus

65
Q

Use of what exogenous hormone increases the likelihood of the development of pyometra?

A

estrogen

66
Q

What are the clinical signs of pyometra?

A

+/- vulvar discharge, depression, anorexia, vomiting and diarrhea, PU/PD, febrile or hypothermic, dehydration, and abdominal distension

67
Q

What will the vulvar discharge be like in patients with pyometra?

A

Mucopurulent, red/brown to yellow/green, and foul smelling

68
Q

What does the presence of vulvar discharge indicate?

A

There is an open cervix which means open pyometra

69
Q

What CBC findings will you see in patients with pyometra?

A

Profound neutrophilic leukocytosis (mature neutrophilia with degenerative left shift and toxic changes) and mild, normocytic, normochromic anemia

70
Q

What chemistry findings will you see in patients with pyometra?

A

Azotemia, hyperglobulinemia, hyperalbuminemia, and possible DIC signs in cases with severe endotoxemia

71
Q

From this card on is from the second disease lecture. I just wanted to finish pyo in this one.

A

Carry on

72
Q

How is pyometra diagnosed?

A

abdominal ultrasound, radiographs, cytology, and possible culture

73
Q

What will an abdominal ultrasound show in a patient with pyometra?

A

Intraluminal fluid accumulation, uterine distension, and commonly thickened uterine walls +/- cystic endometrium

74
Q

What will radiographs show in patients with pyometra?

A

Detects severe uterine enlargement and distension - craniodorsal displacement of small intestine and soft tissue opacity in the caudoventral abdomen

75
Q

What culture is best for pyometra diagnosis?

A

uterine culture

76
Q

What will you find on vaginal cytology in patients with pyometra?

A

Suppurative inflammation +/- bacteria in open pyometras

77
Q

How is pyometra treated?

A

surgical ovariohysterectomy or medical management

78
Q

What are the advantages to surgical treatment of a pyometra?

A

Rapid elimination of organism and inflammation, >80% recovery rate, and permanent resolution

79
Q

What are the disadvantages to surgical treatment of a pyometra?

A

Lost future fertility and surgical risk in potentially unstable dog

80
Q

What are the advantages to medical management of pyometra?

A

Up to 95% recovery rate, surgery not necessary, and fertility is spared

81
Q

What are the disadvantages to medical management of pyometra?

A

Recurrence rate of about 25% on each cycle and extensive treatment protocol/hospitalization

82
Q

What is a major indication for medical management of pyometra?

A

Breeding females or females too unstable for immediate surgical correction

83
Q

How can you medically treat for pyometra?

A

Broad spectrum abx, PGF2alpha, prolactin antagonist, progesterone antagonist, and supportive care

84
Q

What is the purpose of using prostaglandin in open pyometras?

A

To promote luteolysis and cause uterine contractions for uterine evacuation

85
Q

What is the purpose of using prostaglandin in closed pyometras?

A

To cause cervical dilations and luteolysis - doses are then increased for luteolysis and uterine evacuation

86
Q

What is TECT?

A

Transcervical endoscopic uterine lavage

87
Q

What are the benefits to using TECT to treat pyometra?

A

May hasten response and recovery rate during medical management and allows for uterine culture

88
Q

What are the risks to using TECT for treating pyometra?

A

uterine rupture and/or peritonitis

89
Q

How is an OHE performed to treat pyometra?

A

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

90
Q

What is the uterine stump closure for treatment of pyometra?

A

Ligate the vessels on either side of the cervix
Don’t penetrate the lumen
Circumferential suture proximally - DO NOT TRANSFIX
Pack off and lavage

91
Q

What is the benefit to doing a uterine stump closure for treatment of pyometra?

A

prevents retrograde leakage

92
Q

What is stump pyometra?

A

infection and fluid accumulation within the uterine remnant in a spayed female

93
Q

When does stump pyometra occur?

A

Only in the presence of hormones - ovarian remnant or ectopic hormonal exposure

94
Q

How is stump pyometra diagnosed?

A

Abdominal ultrasound, hormonal testing for remnant, and exploratory surgery

95
Q

What is the treatment for stump pyometra?

A

removal of the remaining uterine body and/or removal of the ovarian remnant

Disturbances in Reproduction (49 decks)

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