Soft Tissue Surgery: Female Reproductive Tract Flashcards
What are the indications for ovariohysterectomy?
- Eliminate unwanted pregnancies
- Eliminated inconvenience of oestrus
- Decreased risk of mammary neoplasia
Prevent/treat
* Pyometra
* Metritis
* Ovarian/uterine neoplasia
* Subinvolution of placental sites
* Vaginal hyperplasia
* Vaginal prolapse
* Uterine torsion
What are the advantages and disadvantages of ovariohysterectomy before 1st season?
What are the contraindications?
Adv
* Reduced risk of mammary neoplasia
* Uterine and ovarian vessels small > less haemorrhage
* Reduced surgical/anaesthesia
* Reduced inconvenience
Dis
* Anaesthesia
* Juvenile behaviour?
* Juvenile/hypoplastic vulva?
* Obesity?
Contraindications
* Juvenile vaginitis
* Juvenile urethral sphincter mechanism incompetence
What affects timing of OVH?
- Between seasons- anoestrus (3 months after oestrus)
- > 6-8 weeks post partum
- Combined with C-section
Avoid if
* Increased size of uterine vessels
* Uterine turgidity
* Increased risk of haemorrhage
Describe how cystic endometrial hyperplasia can lead to pyometra?
- Cystic endometrial hyperplasia develops during luteal phase
- Progesterone stimulates growth and activity of endometrial glands, reduced myometrial activity and suppresses local immune response
- Colonisatoin of abnormal uterus with bacteria redults for pyometra
- Pyo- usually E.coli
What are the clinical signs of pyometra?
- PUPD
- Lethargy
- Inappetance
- Vomiting
- Pyrexia
- Dehydration
- Abdominal pain
- Vaginal discharge
- Gait abnormalities
How is pyometra diagnosed?
How is it treated?
- History
- Haematology
- Serum biochemistry
- Imaging- US, radiography
Treatment
* Prompt and aggressive
* IV fluids to correct dehydration and acid base statment
* Broad spectum ABs- cefuroxime or amoxicillin/clavulanic acid
* Ovariohysterectomy
When can a pyometra be medically managed?
Not recommended
* If open and high breeding value
- Uterine emptying- ABs for at least 14 days
- PGF2a: side effects, pain, vomiting, hypersalivation
What causes a uterine stump pyometra?
- Must have progesterone source
- Clinical signs, diagnosis and treatment as for pyo
- Inspect ovarian pedicel scars remove obvious abnormal tissue
What is ovarian remnant syndrome
How is it treated?
When some ovary not removed during OVH
* Signs of recurrent oestrus
* Diagnosis: history, vaginal cytology, hormone assays
Exploratory coeliotomy: preferably in oestrus
Excise tissue from pedicles and submit for histopathology
What causes uterine stump granuloma?
- Poor aseptic technique
- Use of non-absorbable suture material for ligatures
- Excessive remaining uterine body
- Resect uterine body and cervix
What may happen with innapropriate choice of suture material?
Fistulae
* Draining tracts on flank, inguinal region, medial thigh
* ABs- temporary
* Exploratory coeliotomy- recsect ligatures and reactive tissue
- What causes a vaginal hyperplasia prolapse?
- What are the ddxs?
- How is it treated?
- Oedematous enlargment of vagina during prooestrus/oestrus under the influence of oestrogen
- Oedema, prolapse, neoplasia, clitoral hypertrophy
- Oedema: conservative managment, will resolve after with termination od oestruss-high recurrence OVH
Apply lubricant, reduction (suture)
Large masses requires resection
What is episiotomy?
What are the indications?
- Incision of the vulva orifice to approach vaginal or vestibular lesions
Indications
* Surgical exploration of the vagina
* Excision of vaginal masses
* Repair of vaginal lacerations post-mating
* Treatment of strictures/congenital defects
* Exposure of urethral papilla
* Facillitation of manual foetal extraction
What is episioplasty?
When is it indicated?
- Reconstructive procedure to remove excess skin folds around the vilva
- Excess skin folds > peri-vulvular dermatitis- rare consequence of early spay
What ovarian neoplasia can affect usually entire dogs?
- Germ cell
- Epithelial
- Sex cord stromal
Usually mineralised
