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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
What are the diagnostic methods for ovarian remnant syndrome if the dog is demonstrating signs of diestrus?
Progesterone (<2 ng/mL) and AMH level
26
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)
27
What GnRH/hCG level is consistent with ovarian tissue?
A 2 fold increase
28
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
29
What is the treatment for ovarian remnant syndrome?
Exploratory laparotomy to look for the dropped tissue and removal
30
What is adult vaginitis?
Presence of vaginal and vestibular inflammation in post pubertal females
31
What females is adult vaginitis the most common in?
spayed females
32
What are the clinical signs of adult vaginitis?
Increased vulvar discharge, increased licking, +/- perivulvar dermatitis and inflammation, +/- attractiveness to males
33
What are the differentials for adult vaginitis?
Atopy or dermatologic related disease, stump pyometra, urinary abnormalities, vaginal neoplasia, and Brucellosis
34
How is adult vaginitis diagnosed?
Vaginal cytology, digital vaginal examination, vaginoscopy, and potentially vaginal biopsy
35
What will you find on vaginal cytology in a patient with adult vaginitis?
neutrophilic inflammation
36
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
37
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
38
What can you give for estrogen therapy in adult vaginitis cases?
Diethystilbestrol or Incurin
39
What treatment is not recommended in cases of adult vaginitis?
antibiotics
40
What is juvenile vaginitis?
Inflammation of the vagina and/or vestibulum prior to the first estrous cycle
41
What clinical signs are associated with juvenile vaginitis?
presence of mucopurulent to purulent vulvar discharge, increased licking, +/- perivulvar dermatitis There are no systemic signs
42
How is juvenile vaginitis diagnosed?
Presence of clinical signs and vaginal cytology
43
What will you find on vaginal cytology in a patient with juvenile vaginitis?
suppurative inflammation
44
How is juvenile vaginitis treated?
Benign neglect until first heat Vaginal lavage with dilute betadine ALLOW TO GO THROUGH AT LEAST ONE ESTROUS CYCLE
45
What treatment is discouraged in cases of juvenile vaginitis?
systemic antimicrobials
46
What can cause vaginal hyperplasia and vaginal prolapse?
proliferation of vaginal epithelium in an exaggerated response to estrogen
47
What will vaginal hyperplasia look like?
bulge of pink tissue - typically from the ventral floor of the vagina
48
What will vaginal prolapse look like>?
Extension of circumferential tissue or donut
49
Can vaginal hyperplasia and vaginal prolapse recur?
Yes - at the time of parturition
50
What is the treatment for vaginal hyperplasia and vaginal prolapse?
Ovariohysterectomy in non-breeding females Ovulation induction Keep moist Monitor urination/stranguria
51
What breeding strategies should you use for a patient with vaginal hyperplasia or vaginal prolapse?
AI, TCI, and/or C-section
52
When may vaginal hyperplasia and vaginal prolapse increase in severity?
on subsequent estrous cycles
53
What is cystic endometrial hyperplasia (CEH) due to?
A cumulative effect of progesterone on the uterine endometrium
54
What is CEH?
proliferation of endometrial glands during diestrus
55
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)
56
What do cystic changes in patients with CEH cause?
Irregular glandular secretion, poor uterine clearance, and poor embryo transport and nutrition
57
How is cystic endometrial hyperplasia diagnosed?
Histopathology and/or transabdominal ultrasonography
58
How is CEH treated?
Milbolerone - allows for uterine remodeling
59
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
60
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
61
What is the signalment for dogs with pyometra?
Older intact females
62
____% of intact female dogs will develop pyometra prior to 10 years of age.
25%
63
When is pyometra most commonly seen in the estrous cycle?
4-8 weeks after estrus
64
If a cat has pyometra, when is it most commonly seen in relation to the estrous cycle?
1-4 weeks after estrus
65
Use of what exogenous hormone increases the likelihood of the development of pyometra?
estrogen
66
What are the clinical signs of pyometra?
+/- vulvar discharge, depression, anorexia, vomiting and diarrhea, PU/PD, febrile or hypothermic, dehydration, and abdominal distension
67
What will the vulvar discharge be like in patients with pyometra?
Mucopurulent, red/brown to yellow/green, and foul smelling
68
What does the presence of vulvar discharge indicate?
There is an open cervix which means open pyometra
69
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
70
What chemistry findings will you see in patients with pyometra?
Azotemia, hyperglobulinemia, hyperalbuminemia, and possible DIC signs in cases with severe endotoxemia
71
From this card on is from the second disease lecture. I just wanted to finish pyo in this one.
Carry on
72
How is pyometra diagnosed?
abdominal ultrasound, radiographs, cytology, and possible culture
73
What will an abdominal ultrasound show in a patient with pyometra?
Intraluminal fluid accumulation, uterine distension, and commonly thickened uterine walls +/- cystic endometrium
74
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
75
What culture is best for pyometra diagnosis?
uterine culture
76
What will you find on vaginal cytology in patients with pyometra?
Suppurative inflammation +/- bacteria in open pyometras
77
How is pyometra treated?
surgical ovariohysterectomy or medical management
78
What are the advantages to surgical treatment of a pyometra?
Rapid elimination of organism and inflammation, >80% recovery rate, and permanent resolution
79
What are the disadvantages to surgical treatment of a pyometra?
Lost future fertility and surgical risk in potentially unstable dog
80
What are the advantages to medical management of pyometra?
Up to 95% recovery rate, surgery not necessary, and fertility is spared
81
What are the disadvantages to medical management of pyometra?
Recurrence rate of about 25% on each cycle and extensive treatment protocol/hospitalization
82
What is a major indication for medical management of pyometra?
Breeding females or females too unstable for immediate surgical correction
83
How can you medically treat for pyometra?
Broad spectrum abx, PGF2alpha, prolactin antagonist, progesterone antagonist, and supportive care
84
What is the purpose of using prostaglandin in open pyometras?
To promote luteolysis and cause uterine contractions for uterine evacuation
85
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
86
What is TECT?
Transcervical endoscopic uterine lavage
87
What are the benefits to using TECT to treat pyometra?
May hasten response and recovery rate during medical management and allows for uterine culture
88
What are the risks to using TECT for treating pyometra?
uterine rupture and/or peritonitis
89
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
90
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
91
What is the benefit to doing a uterine stump closure for treatment of pyometra?
prevents retrograde leakage
92
What is stump pyometra?
infection and fluid accumulation within the uterine remnant in a spayed female
93
When does stump pyometra occur?
Only in the presence of hormones - ovarian remnant or ectopic hormonal exposure
94
How is stump pyometra diagnosed?
Abdominal ultrasound, hormonal testing for remnant, and exploratory surgery
95
What is the treatment for stump pyometra?
removal of the remaining uterine body and/or removal of the ovarian remnant

Disturbances in Reproduction (49 decks)

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