Small Animal - Female Flashcards
What is very important to established with vulval discharge?
Age
Neutered status
Stage of reproductive cycle - metoestrus, pregnancy
What is an important clue in the cause of vulval discharge?
Colour
What is a creamy white vulval discharge?
Mucopurulent discharge
What is a red vulval discharge?
Haemorrhagic
What does a greeny black vulval discharge suggest in the bitch?
Placental separation
What does a reddy brown vaginal discharge suggest in the queen?
Placental separation
What are the six main colours of vulval discharge?
Creamy white Red Greeny black Clear watery Clear brownish mucoid Reddy brown
What should you always make clear with vulval discharge?
Is it coming from uterus/vagina or urethra?
What are some DDx with white vaginal discharge?
Vaginitis
Early metoestrus
Open pyometra
Cystitis
What are some DDx with a red vaginal discharge?
Proestrus Oestrus Persistent ovarian follicle Ovarian tumour Vaginal trauma Vaginal foreign body Cystitis Urethral neoplasia Coagulopathy Placental separation Sub involution post partum Vascular malformation
What colour is normal vaginal discharge?
Clear mucoid
What would a clear watery vaginal discharge suggest?
Amniotic/allantoic fluid
What would a greeny black vaginal discharge suggest?
Normal parturition
Dystocia
What is the DDx with a brown/red to black vaginal discharge?
Metritis
What would a yellow vaginal discharge suggest?
Incontinence
What does vaginitis usually present as in the healthy bitch?
Purulent discharge
What may vaginitis cause?
Irritation
Owners usually more anxious than dog
Describe juvenile (prepubertal) vaginitis
Secondary to bacteria contamination
Secondary to excess vaginal secretion
Usually resolves spontaneously with first season
Antibiotics should be avoided
What should be the aim with adult vaginitis?
Identify and treat specific causes
What may adult vaginitis respond to?
Exogenous oestrogens (topical/oral)
Essentially, what is pyometra?
Uterus fills with pus
Results in life threatening illness
When does pyometra usually present?
Within 8 weeks of last oestrus
What are the two ways that pyometra can be described?
Open
Closed
What is usually associated with an open pyometra?
Mucopurulent vaginal discharge
Mild-moderately enlarged uterus
What is usually associated with a closed pyometra?
No vaginal discharge
Grossly enlarged uterus
Systemic illness
What four things need to occur for pyometra to occur?
Bacterial infection
Cystic endometrial hyperplasia - substrate for bacteria to interact with
Progesterone - downplays natural immunity
Open cervix
Which type of pyometra is easier to diagnose?
Open pyometra
What may you see on haematology/biochemistry with pyometra?
Left shift neutrophilia Azotaemia Acidosis Endotoxaemia Hypoglycaemia Anaemia Coagulation abnormalities
What is a general first sign of closed pyometra? How can this progress?
PU/PD
Leads to vomiting
Finally shock and collapse
What two ways is pyometra diagnosed?
Ultrasound - tells pregnant or fluid present
Radiography - enlarged uterus
What is the most common treatment for pyometra?
Surgery - ovarohysterectomy
What are three ways vaginal trauma can occur?
Forced separation of mating dogs
Malicious wounding
Iatrogenic
What may occur with vaginal trauma?
Severe bleeding
What needs to be investigated with vaginal trauma?
Origin of bleeding
What is usually all that is required with vaginal trauma?
Conservative/supportive treatment
May or may not need broad spectrum antibiotics
What is important in vaginal mass problems?
Age
Neutered status - rarely get masses in neutered animals
Stage of reproductive cycle - oestrus, pregnancy
What gives important clues about vaginal masses?
Size Shape Consistency Does it contain a hole? In wall or in lumen? Where is it in relation to external orifice?
What are the commonest tumours in the bitch?
Smooth muscle tumours of the vaginal/vestibule
What are the typical smooth muscle tumours found?
Slow growing smooth muscle tumours - leiomyoma, leiomyosarcoma, other tumour types possible
Which dogs is vaginal neoplasia most common in?
Entire bitches
Usually elderly
How does vaginal/vestibulo neoplasia present?
Visible mass
Bulging perineum
Dysuria
Dyschezia
What can be used to diagnose vaginal/vestibulo neoplasia?
History Physical exam Endoscopy Radiography Biopsy
What is the treatment for vaginal neoplasia?
Surgical excision combined with ovariohysterectomy - episiotomy, pubic symphysiotomy with vaginal excision
Chemotherapy for transmissable venereal tumour - not UK
What is vaginal hyperplasia essentially?
Excessive response of vaginal mucosa to oestrogens during follicular phase of oestrus cycle
What two things can vaginal hyperplasia result in?
Vaginal oedema
Vaginal prolapse
Which breeds are most predisposed to vaginal hyperplasia?
Brachycephalic breeds
What problems can occur with vaginal hyperplasia?
May interfere with mating
Exposed tissue may get traumatised
How can vaginal hyperplasia be diagnosed?
History
Physical exam
What is the most conservative measure for treating vaginal hyperplasia?
Keep prolapse moist
Push back into vagina
Ensure sutures remain long enough
What needs to be done with vaginal hyperplasia if tissue is traumatised or non-viable?
Excise surgically
Episiotomy
What is ambiguous genitalia?
Manifestation of intersexuality
What is the most common presentation of ambiguous genitalia?
Enlarged clitoris/underdeveloped penis in the “female” puppy
What does ambiguous genitalia indicate?
Presence of androgens
Testicular material with varying levels of ovarian tissue
What investigations are useful in ambiguous genitalia?
Evaluation of pelvic anatomy
Removal of gonads with histopathology
Karotyping
SRY gene testing
What is the treatment for ambiguous genitalia?
Removal of gonads
Partial penile amputation
Treat other abnormalities if associated with clinical signs
What is dystocia defined as?
Disturbance during parturition when normal delivery of the foetus through the birth canal is interrupted
What is a common reproductive problem in both dogs and cats?
Dystocia
What are the three classifications of dystocia?
Maternal
Maternofoetal
Foetal
What should be a cause of concern during parturition?
Fluids passed more than 2-3 hours previously but no birth
Dam been straining regularly with no birth
Greenish/reddish brown vulval discharge with no birth within 2-4 hours
Weak straining for 2-4 hours with no birth
More than 2-4 hours since last pup/kitten and more known to remain
Second stage of labour longer than 12 hours
Dam is sick
What are the maternal causes of dystocia?
Narrow birth canal - soft tissue, osseous
Disturbed labour - uterine inertia, uterine spasm/tetany, inadequate abdominal forces
Uterine abnormalities - torsion, rupture, malformation, adhesions
Prolonged pregnancy
Psychogenic status
Extra uterine problems - sepsis, other
Premature birth
Prolonged parturition
Idiopathic
What are the most common causes of dystocia?
Maternal causes - uterine inertia
What are foetal causes of dystocia?
Increased foetal size - litter size, gestational length, genetic/breed factors
Foetal malpresentation
Abnormal foetal development - hydrocephalus, other congenital abnormalities, foetal death
What is the most common foetal cause of dystocia?
Malpresentation
What are the two types of uterine inertia?
Primary - uterus fails to respond to foetal signals
Secondary - myometrium is exhausted
What can causes of primary uterine inertia be?
Small litter Very large litter Systemic disease of dam Inherited predisposition Nutritional imbalance Obesity Age Failure of neuroendocrine regulation
When should medical management of dystocia only be considered?
When there is no evidence of obstruction
What are the medical ways to manage dystocia?
Exercise the dam Feathering the roof of the vaginal floor Treat with oxytocin Treat hypocalcaemia/hypoglycaemia Tocospasmolytic drugs
What is required with dystocia if medical treatment is unsuccessful or inappropriate?
Caesarean section
What is important in oxytocin use?
Repeated small doses 0.2-0.4 IU/kg
What are single large doses of oxytocin associated with?
Prolonged myometrial contraction
Leads to placental compression and compromise
What is the dosage interval with oxytocin?
Every 30-40 minutes
What is treatment with oxytocin alone associated with?
Increased number of stillborn and hypoxic pups
What are four congenital abnormalities in the female?
Vulval stenosis
Anovulvar cleft
Rectovaginal fistula
Vestibulovaginal stricture
What are four acquired abnormalities of the female?
Vulval hypertrophy - juvenile prolonged proestrous, endogenous/exogenous oestrogens
Recessed vulva
Trauma
Neoplasia
What are pathological causes of abdominal distension with the reproductive tract?
Pyometra Retained foetus Ovarian neoplasia Uterine neoplasia Segmental aplasia and mucometra - incidental finding, part hasn't developed, sterile mucoid exudate
What are the tumour types with ovarian neoplasia?
Granulosa cell tumour
Cystadenoma
Adenocarcinoma
Teratoma
What does ovarian neoplasia often present with?
Large mass
Sometimes ascites
What is the treatment for ovarian neoplasia?
Surgical excision
What is hydrometra/mucometra?
Sterile accumulations of fluid within the uterus
What is hydrometra/mucometra secondary to?
Congenital abnormalities
What are the three reproductive causes of systemic illness?
Closed pyometra
Uterine torsion
Uterine rupture
