Spay Flashcards
What is the difference between an ovariohysterectomy (OVH), ovariectomy, and hysterotomy?
OVH: surgical removal of the ovaries and uterus, the complete removal of the female reproductive tract (including oviducts, ovaries, uterine horns, and uterus)
O: surgical removal of the ovaries only (quick)
H: opening of the uterus to remove its contents
In what 2 situations are hysterotomies done
- Caesarian section
- opening gravid uterus to remove fetuses
What are the 3 main reasons for performing spays?
- sterilization - population control
- disease control/treatment - prolongs life span
- decreases the incidence of hereditary defects
What’s the difference between routine/elective spays and those done for medical treatment?
ROUTINE: young, happy, healthy patients with no clinical signs
MEDICAL: patients with some sort of disease process typically involving ovaries, uterus, and/or mammary glands
When is it recommended to spay healthy canines and felines?
CANINE: 6 months to 2 years (breed and lifestyle specific)
FELINE: 6 months+
What diseases/conditions are commonly treated with a spay?
- ovarian disease: cystic ovaries
- prolapsed uterus
- uterine disease
- uterine torsion
- metritis
- uterine/ovarian neoplasia
- mammary gland neoplasia prevention
What are cystic ovaries? What are 2 clinical signs?
fluid-filled structures develop on ovaries and, upon rupture, secrete estrogen
- continued signs of proestrus or estrus
- prolonged attractiveness to males
What hormones are responsible for regulating heat cycles and pregnancy?
- estrogen
- progesterone
When is it common for a uterus to prolapse? What are the 2 ways it can be treated?
after birth
- VIABLE TISSUE: lavage (dilution is the solution to pollution), reduce swelling with dextrose, manually replace tissue, spay (happens once, will likely happen again)
- NONVIABLE TISSUE: amputation then spay
What hormone typically influences uterine disease? What are 4 common uterine diseases treated with bt spaying?
progesterone
- cystic endometrial hyperplasia - thickening of uterine tissue
- hydrometra
- mucometra
- pyometra - sick, endotoxemia, sepsis
What is pyometra? When does it typically occur? What 4 bacteria are most commonly found in this infection?
accumulation of pus (WBCs and bacteria) in the uterus
after heat cycle in intact mature adults
E. coli, Staphylococcus spp., Streptococcus spp., Proteus spp.
Pyometra can be hormone-related. What is a common cause in this situation?
remnant ovarian tissue
- incomplete removal of ovary
What is the difference between closed and open pyometra? Which one is easier to treat?
CLOSED: no vaginal discharge, PU/PD, lethargy, pale mucous membranes, abdominal distension, sicker!
OPEN: vaginal distention and discharge, vomiting, diarrhea, anorexia, PU/PD, pale mucous membranes
open pyometra - exudate is leaving the uterus
What is uterine torsion? How do patients present?
uterus rotation around its long axis between the cervix and horn
clinically sick
- anorexia
- fever
- lethargic
- painful
What is metritis? What are 5 common symptoms?
postpartum infection of the uterus
- vaginal discharge
- lethargy
- anorexia
- neglecting offspring
- large, flaccid uterus may be palpates
What are the 2 most common uterine/ovarian neoplasias?
- leiomyomas - develop from smooth muscle cells of the uterus
- endometrial adenocarcinomas
When are mammary gland neoplasias most common? What can decrease the likelihood of development?
intact animals after their first heat cycle
spay before the first estrus
What are the 3 types of mammary gland neoplasias?
- adenomas (benign)
- carcinomas (malignant)
- adenocarcinomas (malignant)
When do pets tend to develop clinical signs of mammary gland neoplasia? What is the rate of malignancy compare in canines and felines?
once the tumor has metastasized or ulcerated
CANINE: 50%
FELINE: 90%
How does the placement of the ovaries differ?
right = higher than the left one
Reproductive tract:
Abdominal anatomy:
What is the proper ligament of the ovary? Suspensory ligament?
PROPER: connects uterine horn to the ovary
SUSPENSORY: connects ovary to the body wall
What is the mesovarium? Mesometrium?
MESOVARIUM: portion of the broad ligament of the uterus that supports ovaries, containing ovarian vessels +/- fat
MESOMETRIUM: portion of the broad ligament of the uterus that supports the uterine horns and uterine body, containing uterine vessels +/- fat
Where are the ovaries, uterine horns, and uterine body located?
OVARIES: at the caudal pole of the kidneys (right is more caudal than the left
UTERINE HORNS: dorsal-lateral in the body cavity
UTERINE BODY: between the urinary bladder and colon, adjacent to ureters
Spay, giant schnauzer:
Spay:
What are the 7 general steps of a spay?
- cut skin, subcutaneous tissue, and body wall
- find uterine horn and expose ovary
- break down the suspensory ligament
- clamp, ligate, and cut ovary/ovarian pedicle (2x)
- clamp, ligate, and cut uterine body/uterine vessels (2x)
- check “gutters”
- close up incision
What are the 3 general guidelines for clipping hair to prepare for a spay?
- avoid razor burn
- clip from xiphoid to pubis
- width of clip should be to the level of the mammary chain or beyond
How does the ventral line approach for spaying compare in canines and felines?
CANINE: just caudal to the umbilicus in the cranial 1/3 of the abdomen and extend the incision caudally
FELINE: incision caudal to the umbilicus in the middle 1/3 of the caudal abdomen and extend the incision caudally
- middle point between umbilicus and brim of the pelvis
Ventral midline approach:
puppy location = cat location
When is the lateral flank approach used for spaying?
excessive mammary development, typically secondary to lactation or mammary gland hyperplasia
Where is the incision for the lateral flank approach for a spay done?
incision made in the dorsoventral direction starting caudal to the midpoint between the last rib and the iliac crest
How is the skin and subcutaneous tissue cut to begin a spay?
use non-dominant hand to apply tension across the incision site and cut smoothly with a 10-15 blade with firm pressure
- mosquitos and gauze can be used to control subcutaneous bleeders
How is the subcutaneous tissue incision extended? What is the point of extending the incision? Why must we be careful to not excise too much tissue?
blade or Metzenbaum’s (no Mayo)
expose the external rectus fascia and identify the linea alba
removal of too much tissue will increase dead space
What is the linea alba? How does it compare in dogs and cats?
thick, white fibrous line (aponeurosis of abdominal muscles lacking vasculature) that runs vertically down the midline of the abdomen that palpates as a depressed area between the paired rectus abdominis muscles
DOGS: 2-3 mm wide
CATS: wider and more transparent
Where is the linea alba thickest? Thinnest?
at the umbilicus
near the pubis
What is the holding layer of abdominal muscle incisions?
external rectus fascia
- must be included in each suture to avoid dehiscence
How is the linea alba incised?
- grasp linea alba with thumb forceps and make a tent to create distance between the body wall and the internal organs
- make a stab incision through all muscle layers with the scalpel blade facing up
- extend the incision using thumb forceps and a blade/Mayo scissors
How is the spay hook used to grasp the uterine horn and externalize the ovaries?
- tent body wall using fingers or thumb forceps
- place spay hook into the body wall and point with the tip away from the body contents (start on the left side)
- once you hit the bottom of the body wall, rotate the spay hook 180 degrees, raise up, and engage the uterine horn
- once you have identified the uterine horn, follow it cranially to the ovary
- exteriorize the ovarian pedicle so you can clamp them
What should be done once the ovary is identified?
- clamp a curved mosquito over the proper ligament between the ovary and the uterine horn to manipulate the ovary
- identify the suspensory ligament that connects the ovary to the body wall
Why do we break the suspensory ligament? How is it done?
allows for the elevation of the ovary out of the body to expose the ovarian pedicle
digital breakdown (strumming guitar string) lateral to medial
- less likely to disrupt the ovarian pedicle
How does the clamp on the proper ligament help with breaking the suspensory ligament?
helps pull ovary in a caudomedial direction to create tension on the suspensory ligament
What happens after the suspensory ligament is broken down?
the ovary is exteriorized and vessels in the ovarian pedicle can be appreciated by making a window in the avascular portion of the broad ligament
- remove the clamp on the proper ligament
What is the 3 clamp technique?
- 3 hemostats are applied proximal to the ovary on the pedicle (curved hemostats upward toward ovary)
- 1st circumferential ligature placed in the crush of the first clamp
- 2nd transfixing/circumferential ligature
- ovarian pedicle is transected between the middle and distal hemostat
Where is the first ligature placed on the ovarian pedicle?
placed on the crushed tissue once the proximal hemostat is removed
- circumferential: Miller’s or modified Miller’s
Where is the second ligature placed on the ovarian pedicle?
placed between the 1st ligature and the middle hemostat by loosening the forceps while the first 2 throws are being secured (flash) and then re-clamping
- circumferential: Miller’s or modified Miller’s
- transfixing
Where is the ovarian pedicle transected after the ligatures are placed?
between the middle and distal hemostat
Where in the mesometrium are the uterine vessels located?
lateral aspects
How is the broad ligament broken down? What is the purpose of doing this?
cut or tear
allows for more exposure of the uterine body
When is it recommended to ligate the uterine vessels while breaking the broad ligament?
in obese dogs or those in heat
- will bleed a lot, may become anemic
How is the uterine body removed?
ligate and transect uterus cranial to the cervix
- 3 clamp technique
How should the 3 hemostats be placed on the uterine body? Where do the ligatures go?
- distal hemostat should be at least 1 cm away from the cervix
- 2nd hemostat should be 5 mm away from the proximal and distal one
- circumferential ligature in the crush of the proximal clamp
- 2nd ligature in front of the middle clamp + flash (modified transfixation, transfixation, circumferential)
What is the modified transfixation sometimes done in the second ligature on the uterine body?
separate ligatures are placed around each uterine vessel (L and R)
What should happen when the ovaries and uterine body are removed?
- double check pedicles for bleeders
- check gutters with gauze on a hemostat
- ready to close
What should happen if pedicle bleeding is noted? What happens if you can’t find the bleeder?
extend incision cranially - some oozing is normal
if you can’t find within 2-3 minutes, give a fluid bolus and continue on with the spay
What is the holding layer for the body wall? What kind of bites should be taken?
external rectus fascia
difficult to not get muscle, do not take full thickness bites into it —> will increase inflammation and post-op pain
What is the point to closing subcutaneous tissue separately?
decreases dead space
What patterns are typically used to close the body wall, subcutaneous tissue, and skin?
BODY WALL: simple interrupted, continuous, cruciate
SQ: simple continuous
SKIN: intradermal, simple interrupted, cruciate
What are the 4 important aspects to post-op care after spays?
- exercise restriction for 7-14 days
- suture removal at day 10-14
- E-collar for at least a week
- NSAIDs (Rimadyl, Metacam) and Gabapentin/Trazadone to go home
How does the feline spay compare to the canine spay?
- easier
- tissues are more delicate
What is important to note when making incisions through the subcutaneous layer in a feline spay?
cats do not have much subcutaneous tissue, so do not take too much, or it will make too much dead space
How should the feline ovarian pedicle be clamped and ligatured if decided to do so?
1 or 2 hemostats on the ovarian pedicle below the ovary
- 1 circumferential ligature on the crush if 2 hemostats are placed
- if 1 is placed, place the ligature below the hemostat
- +/- 2nd ligature circumferential below the middle/second hemostat
What should be done before transecting the ovarian pedicle in a feline spay?
place hemostat on the proper ligament (distal to the ovary) and transect above the proximal hemostat
It’s debated to clamp the uterine body in a feline spay. What should you do if you decide to do so? What ligatures are placed?
only place 1-2 —> feline uterus is friable, since they tend to be in heat more often
1-2 Miller’s or modified Miller’s
- transfixing not common for cats
Where is the feline uterus ligated and transected?
at the caudal 1/3 of the uterine body —> cervix not and pronounced
How are the uterine vessels ligated in a feline spay?
NOT CLAMPED - make a window in the broad ligament and perform and autoligation pedicle tie
What patterns are recommended for the body wall, subcutaneous tissue, and skin closed in a feline spay?
BODY WALL: simple interrupted, simple continuous, cruciate
SQ: simple continuous
SKIN: intradermal (good option for patients with owners unlikely to return to their post-op appointment), simple interrupted, cruciate
What are the 5 important considerations for post-op care following feline spays?
- exercise restriction for 7-10 days
- suture removal at day 10-14
- E-collar depending on the patient
- NSAIDs - Robenacoxib (Onsior), Meloxicam (Metacam, off-label in cats)
- Gabapentin - calming, neuropathic pain
What is the most fatal complication to spays? When does it most commonly happen?
hemorrhage - intraoperative or post-operative abdominal bleeding (ovarian pedicle)
How are hemorrhages following a spay treated?
abdominal exploratory - typically due to ligation failure, go back and re-ligate pedicle
What are the 2 most common causes of dehiscence after a spay? How is it treated?
- linea alba not properly closed
- failure to restrict exercise (stitches pop)
lavage abdomen, debride, reclose
What is a seroma? How are they treated?
fluid accumulation at incision area
cold or warm compresses
What is commonly accidentally ligated during a spay? How does it present?
ureter
- uncomfortable patient
- hydroureter
- hydronephrosis
How are ligated ureters treated? How can this be prevented?
exploratory surgery and removal of the ligature or kidney
- careful identification of uterus before ligating
- ensuring the bladder is empty
What causes recurrent estrus after a spay? How is it diagnosed and treated?
failure to remove all of the ovarian tissue (AKA remnant ovarian syndrome)
Anti-Mullerian test +
go back in and remove remaining ovarian tissue
What is uterine stump pyometra? What are 4 common causes? How is it treated?
inflammation and bacterial infection of remnant uterine tissue
- poor aseptic technique
- suture reaction
- devitalized tissue at stump
- residual infection if pyometra is present
removal of all remaining tissue
What is a uterine stump granuloma? What are 2 causes?
focal inflammation of remnant uterine tissue
- using multifilament, nonabsorbable sutures
- poor aseptic technique
What are 3 possible (debated) complications that can present after a spay?
- obesity - decreased hormones = decreased metabolic rate
- perivulvar dermatitis
- urinary incontinence - estrogen affects lower urinary tract muscle tone, especially in the urethral sphincter
