Spays Flashcards
1
Q
This is the term used to describe the surgical removal of the ovaries and uterus.
A
Ovariohysterectomy (OVH)
2
Q
An Ovariohysterectomy is characterized by the _______ removal of female reproductive
tract, which includes?
A
complete
Oviducts, ovaries, uterine horns, uterus
3
Q
An __________ is the surgical removal of the ovaries only and is a ______ procedure.
A
Ovariectomy, quicker
4
Q
A _________ is also referred to as a Caesarian section. You are opening _____ uterus surgically and removing _____.
A
Hysterotomy, gravid, feti
5
Q
List the reasons you would spay your patient.
A
- Sterilization
- Population control - Disease control/treatment
- Prolongs life span - Decrease incidence of hereditary defects
6
Q
SPAY
1. _______/______
- Usually _____, ______, ______ patients
- ____ clinical signs
2. Medical treatment
- Patients with some sort of disease process; Typically involving?
3. Clinical signs relate to _______ disease
process
A
Routine, Elective, young, happy, healthy, No, ovaries, uterus, and/or mammary glands, underlying
7
Q
List the situations in which you would spay your patient.
A
- Happy/healthy patient
- Ovarian disease
- Prolapsed uterus
- Uterine disease
- Pyometra
- Uterine torsion
- Metritis
- Uterine and Ovarian Neoplasia
- Mammary gland neoplasia prevention
8
Q
When spaying happy Healthy Pets, remember:
- In canines:
- Common between ___ months – __ years; _______ specific: Large breed dogs with hip issues (closer to __-__ years)
- Always spay!
- In Felines: studies show ___ difference for cats; so spay _____
- __ months+ ?
A
6, 2, Breed, 1-2, no, whenever, 6
9
Q
Ovarian Disease - Cystic Ovaries
- _____ filled structures that develop within _____
- Leads to:
1. A ________ secretion of estrogen
2. Continued signs of _______ or _____
3. Prolonged ________ to males
A
Fluid, ovary, prolonged, proestrus, estrus, attractiveness
progesterone and estrogen are the main players for female heat cycles and pregnancies.
10
Q
A Prolapsed Uterus is common after _____. - - Remember, if tissue is viable ______ !
- REMEMBER – ______ IS THE SOLUTION TO POLLUTION!
- Reduce swelling with _______
- Manually _______ tissue and then _____!
–> What if tissue isn’t viable or you are unable to replace it?
A
birth, lavage, DILUTION, dextrose, replace, spay
Amputation and then spay
If tissue is black and green = not viable
11
Q
How does dextrose help reduce swelling of a prolapsed uterus?
A
Reduce swelling using dextrose because osmotically draws out fluid from edematous tissue.
Same with rectal and vaginal prolapses
12
Q
What condition can be seen in this image?
A
Cystic ovaries
13
Q
What condition can be seen in this image?
A
Prolapsed uterus
14
Q
Uterine Disease is usually influenced by _____________. Several examples include?
A
progesterone
1. Cystic Endometrial Hyperplasia
- Thickening of uterine tissue
- Results: cysts leak fluid into uterus; typically will see a hydrometra; fluid filling up (water usually) so no infection; if does not get resolved, becomes a mucometra –> pyometra .
2. Hydrometra: clincial signs absent
3. Mucometra: clincial signs absent
3. Pyometra: clinical signs; endotoxemia risk and sepsis when there is rupture of pyometra; body ends up attack itself.
15
Q
What condition can be seen here?
A
Hydometra
16
Q
What condition can be seen here?
A
17
Q
Pyometra is an accumulation of _______ (WBC and bacteria) in ______. This usually occurs ______ a heat cycle and can be a _____ threatening condition
A
pus, uterus, after, life
Left = cat pyo
Right = dog pyo
open pyo is a bit better because infection is going somewhere; closed pyo infection is stagnant and greater risk for rupture.
18
Q
What is the most common bacteria isolated from a pyometra? List some other bacterium that can be found here as well.
A
E. coli is the most common bacteria isolated here , Staphylococcus spp., Streptococcus spp., Proteus spp.
19
Q
Pyometras are most common in?
A
Intact female mature adults
20
Q
A closed pyometra is characterized by:
1. ___ vaginal discharge,
2. ____/____
3. __________
4. ____ mm
5. Abdominal _______
6. Usually ______ compared to an open pyometra.
A
No, PU, PD, lethargy, Pale, distention, sicker
21
Q
An open pyometra is characterized by:
1. Vaginal _________
2. _________
3. _________
4. _________
5. ____/_____
6. ____ mm
A
distention, Vomiting, diarrhea, Anorexia, PU, PD, Pale
22
Q
In the case of a pyometra, radiographs and ultrasound reveal _______ uterus. Always ________ first and then cut!
A
enlarged, stabilize
23
Q
What condition can be seen here?
A
Pyometra
24
Q
Uterine Torsion occurs when the uterus has rotated ________ its _____ axis, usually between the _____ and ____. The patient is ________ sick (Signs?)
A
around, long, cervix, horn, clinically, anorectic, febrile, lethargic, painful
25
What condition can be seen here?
Uterine torsion?
26
Metritis is a _____ partum infection of the _______.
post, uterus
Abdominally you should be able to feel a flabby? uterus, lactating from nipples, etc.
27
What bacteria can be found in a patient suffering from metritis?
Bacteria isolated is the same for a pyometra
28
List the characteristic signs of metritis?
-. Vaginal discharge, lethargy, anorexia, neglecting offspring
- Sometimes large flaccid uterus can be palpated
- Stabilize and then cut
29
Uterine and Ovarian Neoplasia
- ___________ are tumors that develop from smooth muscle cells of uterus.
- ______________ ____________
Leiomyomas, Endometrial Adenocarcinoma
30
Mammary Gland Neoplasia Prevention
- Mammary gland neoplasia is a tumor(s) associated with _______ tissue
- This condition is seen in ____-______ animals after their ______ heat cycle.
mammary, un-spayed, first
Decrease by 99.99% if you spay patient before first heat cycle.
Malignancy rate for mammary tumos: 50% benign 50% malignant in dogs; cats = 90% malignant
In cats, once it has ulcerated, the likelihood of it metastatizing to the chest is very high; not as high in dogs.
Very painful; need pain meds on board
31
The likelihood of an animal developing __________ _________ neoplasia decreases if spayed before first estrus.
mammary gland
32
Are adenomas benign or malignant?
Benign
33
Are carcinomas benign or malignant?
Malignant
34
Are adenocarcinomas benign or malignant?
Malignant
35
Many pets do not show clinical signs
until mammary gland tumor has ?
metastasized or ulcerated
36
What condition can be seen in the image below?
Mammary gland tumor
37
Label accordingly
38
The right ovary is ______, so it will be more difficult to get to
higher
39
Label the image accordingly.
40
What is the Proper Ligament's function?
Connects uterine horn to ovary
41
What is the Suspensory Ligament's function?
Connects ovary to body wall
42
What is the Mesovarium's function? What does it contain?
1. Portion of broad ligament of uterus that supports ovaries
2. Contains ovarian vessels +/- fat
43
What is the function of the Mesometrium? What does it contain?
1. Portion of broad ligament of uterus that supports uterine horns and uterine body
2. Contains uterine vessels +/- fat
44
The ovaries are located at the ______ pole of kidneys
caudal
45
The Uterine horns are _____-_____ in body cavity
dorsal, lateral
46
The Uterine body is located between the _______ _____ and _____ and is adjacent to the ________.
urinary bladder, colon, ureters
47
What can be seen in this image?
48
What can be seen in this image?
49
Describe the spay procedure step by step.
¡ Cut skin/sq/body wall
¡ Find uterine horn and expose ovary
¡ Break down suspensory ligament
¡ Clamp, ligate, and cut ovary/ovarian
pedicle (2x)
¡ Clamp, ligate, cut uterine body/uterine
vessels
¡ Check “gutters”
¡ Close up
50
SPAY PREP
1. ______ technique
2. Clip hair _______
- Avoid razor ____
- Clip from ______ to ____
- Make sure razor isn't _______.
- Width of clip should be to the level
of the ________ ____ or _____
3. _______ + _____ skin prep
Aseptic, carefully, burn, xiphoid, pubis, pubis, mammary, chain, beyond, Chlorhexidine, alcohol
51
What approach is being used in the image below? What is the difference between the two ?
Ventral midline approach
Top = adult dog
Bottom: peds / cat
in dog: ovary is hardest part to expose
cat = uterine body
52
Things to remember about using the ventral midline approach in the dog:
1. Incision is ____ _____ to the umbilicus
2. _________ __/___ of the caudal abdomen
3. Extended incision _________
- Small incisions are great but remember longer incisions (when extending cranially) allow more _________.
What are some important things to remember in big, barrel chested dogs? Older dogs?
just, caudal, Cranial 1/3, caudally, exposure
Think about how big the dog is, barrel chested, etc.
The older and the bigger, stick to caudal. If younger, typically do where cat incision is
53
Things to remember about using the ventral midline approach in the cat:
1. Incision is ______ to the umbilicus
2. _______ __/__ of caudal abdomen
- Middle point between _______ and brim of ________.
3. Extend incision _________.
caudal, Middle 1/3, umbilicus, pelvis, caudally
54
What approach is being used in the image below? Name the species in each photos.
1. Ventral midline approach
2. cat, dog, puppy
55
The lateral flank approach is used when there's _______ mammary development. This usually occurs secondary to ________ vs. mammary gland _________.
excessive, lactating, hyperplasia
literature: applied more to cats than dogs
56
Things to remember when using the lateral flank approach in dogs:
1. The Incision should be made in a ____________ direction.
2. Start _________ to the midpoint between the _____ rib and ______ _____.
dorsoventral, caudal, last, iliac, crest
57
Things to remember when using the lateral flank approach in cats:
1. Incision should be made in a _________________ direction
2. Start ________ to the midpoint between the _____ rib and ________ ______.
dorsoventral, caudal, last, iliac crest
58
In the canine spay, it is important to pick the appropriate incision _________ depending
on patient.
- Use a 10-15 blade to incise ?
- Use ____-_____ hand to apply tension
across incision site, cut smoothly with _____
pressure.
- __________ sometimes used to control
subcutaneous bleeders; ______ works too
- Can also use ______ and ____ to control
subcutaneous bleeders.
placement, skin and subcutaneous tissue.
non-dominant, firm, Mosquitos, cautery, gauze, dab
59
Extend subcutaneous tissue incision to expose ________ rectus fascia
- You can either use ____ or _________.
- Removal of too much subcutaneous tissue increases __________ _________
- Be careful with ______ subcutaneous fat dissection. Removing too much will increase _______ _____. There is a limit to what is necessary to remove to identify the _______ ________.
external, Blade, Metzenbaum's, dead space, lateral, dead space, linea alba
60
The Linea alba is a _____, ____ ____ line that runs vertically down ______ of the abdomen. Upon palpation, it feels like a ________ area between _________ ________ ________ muscles
thick, white, fibrous, midline, depressed, paired rectus abdominis
It is an aponeurosis where are abdominal muscles meet; not really any vasculature there, so it is not as painful to cut through.
61
How wide is the linea alba in dogs? Cats? Difference between the two?
2-3 mm wide in dogs; wider and
more transparent in cats
62
The linea alba is the thickest and easiest to see at the __________ and thinner and harder to identify near the _______.
umbilicus, pubis
63
The _________ _______ ________ is the holding
layer of abdominal incisions.
External rectus fascia
64
The _________ _________ _________ must be included in each suture to avoid dehiscence
External rectus fascia
65
What can be seen in this image
The linea alba
66
What can be seen in this image?
67
During the spay procedure, you want to grasp the linea alba with thumb ______ and create a ____. This creates distance between body ____ and internal _____. Then, make stab incision through ____ muscle layers with scalpel blade facing ____. Once you have made it through all muscle layers _____ incision using thumb _____ and ______ OR ______ scissors
forceps, tent, wall, organs, all, up, extend, forceps, blade, Mayo
Tent = stab incision with blade; blade pointed upwards, stab throguh linea, used to make sure you are not hitting any underlying organs.
68
Surgeons usually go for ___ ovary first because it is easier to get to.
left
69
What can be seen in the image below?
Linea alba
70
When using the spay hook, ____ body wall using fingers or thumb forceps. Place spay hook into the ______ _____ and point tip _____ from body contents Start with the ____ uterine horn. Once you hit ________ of body wall rotate spay hook ____ degrees, raise ___, and engage uterine ___. Once you have identified the uterine horn, follow it ________ to the ovary. You now have to exteriorize __________ ________ so you can place clamps and ligatures.
tent, body wall, away, left, bottom, 180, up, horn, cranially, ovarian pedicle
Hold body wall gently because it gets angry quickly
71
What can be seen in this image below?
Spay hook going against body wall. Go down until reach gutters, switch hook over towards organs and then pull up.
If you feel much tension, you may be grabbing kidney/ureter, take spay hook out and try again.
72
Once the ovary is identified, place a _______ on the _______ ligament to manipulate ovary. Use a _______ ______ or other type of hemostat and place it between ______ and uterine ______. Then, identify the _________ ligament
clamp, proper, Curved, mosquito, ovary, horn, suspensory
73
What can be seen in this image?
74
Label the image accordingly
75
suspensory ligament, ovary, also have ovarian pedicle (ovarian artery and vein) be careful because when breaking down suspensory ligament can cause damage to ovarian pedicle.
76
The suspensory ligament is broken down to elevate the _______ out of body and expose ________ ________. Can use either the ______ breakdown or “strumming ______ string" method with ______ to ______ force.
ovary, ovarian pedicle, digital, guitar, Lateral, medial
77
Placing a hemostat on the proper ligament helps pull ovary in a ____________ direction and will create tension on the _____________ ligament [SL]
caudomedial, suspensor
78
After breaking down suspensory ligament, the ovary should be ____________, and vessels (?) should be appreciated. Make a window in the ________ ligament _______ to ovarian pedicle (in _________ area) to put clamps; if put clamps in vascular area, you are going to have to tie it off. You can remove clamp on _______ ligament. Next place __________.
exteriorized, ovarian pedicle, broad, caudal, avascular, proper, hemostats
79
____ hemostats are applied _______ to the
ovary on pedicle. If using curved hemostats make sure they are pointing ________ towards ______.
- ____ ligatures are applied
- 1st ligature = ____________ (in ______ of __ st clamp)
- 2nd ligature = _________ (only on most ______ ligature) vs circumferential
The ________ _________ is then transected between _____ and ____ hemostat. Why?
3, proximal, upwards, ovary, 2, Circumferential, crush, 1, Transfixing, distal, Ovarian pedicle, middle, distal
b.c if there is oozing and bleeding, still have clamps in there to fix that ligature.
Hemostats: proximal, middle distal.
Pointing towards ovary, not body (up)
80
The 1st Ligature is placed on “_________” tissue once _______ hemostat is removed. The suture patterns that can be used are?
crushed, proximal
Circumferential, Miller's knot, Modified miller’s knot
81
The 2nd Ligature is placed between the ligature and _______ hemostat. It is important to ______ forceps while first ___ throws of ligature are being secured (aka “______") and then __-_____. The suture patterns that can be used here are?
1st, middle, loosen, 2, flash, re-clamp
¡ Circumferential - Miller's knot, Modified miller’s knot
¡ Transfixing - Only applied on most distal ligature
Flash: when you place transifizng, want to loosen middle clamp for the first two throws and then reclamp b/c if you have a fatty pedicle, if you are too clos4 ot it or it is stil ckamped off, suture will not fall as nicely and potentially fall off.
82
There is always going to be ____ clamps on the pedicle.
two
83
OVARIES ARE REMOVED...NOW WHAT?
Need to remove _______ body.
Remember ___________ has uterine vessels on lateral aspects
uterine, mesometrium
Right uterin atery and vein on lateral aspects.
84
BREAKING BROAD LIGAMENT
- ___ vs ____
- Allows from more _______ of uterine body
- In obese dogs or dogs in heat _______ vessels
Cut, tear, exposure, ligate
won't typically do this in cats
85
UTERINE BODY
- Ligate and transect uterus ______ to cervix
- Use the __ clamp technique
cranial, 3
86
Uterine body
Use the ___ clamp technique.
Place the distal hemostat at least ___ ___ away from cervix. Place the 2 nd hemostat
___ ___ away from proximal one and same for the ____ one.
Place a Circumferential ligature within ______ of most ________ clamp. Place the 2 nd ligature, which can be either _________ vs. __________ vs. modified ___________
3, 1 cm, 5 mm, distal, crush, proximal, circumferential, transfixation, transfixation
87
Modified transfixation = __________ ligatures are placed around _____ uterine vessel (L and R)
separate, each
88
Label the image accordingly.
89
Once everything is out, double check _______ for bleeders. If bleeding is noted, you will need to extend incision _________.
You do no want _______ pooling of blood; if that is the case, extend _______ becasue blood is usually coming from ovarian ______ and check the gutters with hemostats and gauze --> if see dark, blood = ____. Now you are ready to close!
pedicles, cranially, active, cranially, pedicle, BAD
if can't find bleeder in 2-3 minutes, finish spay and go back.
90
The _________ _________ _______ is the holding layer for body wall. When closing, it is difficult to not get muscle, but do not take _____ thickness bites into muscle because this will only increase ________ and post-op -____.
external rectus fascia, full, inflammation, pain
91
What suture patterns would you use to close the body wall?
Simple interrupted vs continuous vs cruciate
92
What suture patterns would you use to close the subcutaneous tissue space? Closing the subcutaneous space holds what purpose?
Subcutaneous tissue closure
- Simple continuous = common
- Decreases dead space
93
Label the image accordingly
94
When closing the skin, what suture patterns should you use?
¡ Intradermal = go for an intradermal if patient is not going to show u to recheck exam rather than doing a suture you need to remove
¡ Simple interrupted
¡ Cruciate
95
Describe the post-op care procedure for spays.
1. Exercise restriction
- 7-14 days ideal
- Suture removal at day 10-14
2. E-collar
- Keep on at least 1 week!
3. NSAID’s to go home (~5-7 days)
- Rimadyl
- Metacam
4. +/- Gabapentin
if happy and comfortable, do not have to do 7 days
96
The feline spay is _______ than dog spay, however, tissues are more ________.
easier, delicate
97
Feline Spray prep
- ______ technique
- Clip hair ______ to avoid ?
- Clip from ______ to _____
- Width of clip should be to the _____
of the mammary chain or beyond
- ________ + ______ skin prep
Aseptic, carefully, razor burn, xiphoid, pubis, level, Chlorhexidine, alcohol
Excise a small amount of sub cu because they do not have a lot; if take too much = seroma
98
For the feline spay, pick appropriate incision placement depending on ______. Use a 10 – 15 blade incise ?
Use ____-_____ hand to apply tension
across incision site, cut smoothly with
firm pressure
patient, skin and subcutaneous tissue, non-dominant
99
Dogs tend to have a lot more at around ?
ovaries and pedicle
100
Label the following image accordingly.
Find linea alba and make stab incision through all muscle layers
¡ Using spay hook and locate L uterine horn
101
You can cut suspensory ligament with _____ or _______. If clamping place 1 or 2 hemostats on the _________ _______ _____ the ovary.
1 circumferential ligature is placed on the _______ if __ hemostats placed. If only 1 hemostat place, ligature ______ hemostat
+/- __ nd ligature circumferential below
middle/2nd hemostat
Before transecting place hemostat on ________ ligament ( _______ to ovary) and
transect above ______ hemostat
blade, scissors, ovarian pedicle, below, crush, 2, below, 2, proper, distal, proximal
102
Label the images accordingly.
103
OVARIAN BODY
To clamp or not to clamp?
- If you clamp only place ?
If you place ligatures, what suture pattern will you use?
Uterus is ligated and transected at the ________ __/___ of uterine body
1-2, Circumferential (Miller’s or Modified Miller’s), 1 vs. 2 ligatures, caudal 1/3
Uterus is more friable, so be careful when clamping with kitties
104
Label the image accordingly
105
Use __________- on the ovarian body.
- Instead of clamping and placing individual ligatures you make a window in the _____ ligament and perform a pedicle tie.
autoligation, broad
106
What suture pattern would you use to close the Body wall in a feline spay?
Simple interrupted vs. continuous
vs. cruciate
107
What suture pattern would you use to close the subcutaneous tissue in a feline spay?
Subcutaneous tissue closure
- Decreases dead space
- Simple continuous
108
What suture pattern would you use to close the skin in a feline spay?
Skin closure
Intradermal
Simple interrupted
Cruciate
109
Feline spay post op care ?
1. Exercise restriction
¡ 7-10 days ideal
¡ Suture removal at day 10-14
2. E-collar
¡ +/- depends on patient
¡ NSAID’s to go home (~5-7 days)
¡ Robenacoxib (Onsior)
¡ Meloxicam (Metacam) --> off label for cats but still works!
3. +/- Gabapentin
110
List all of the spay complications?
1. Hemorrhage
2. Dehiscence
3. Seroma
4. Ligation of Ureter
5. Recurrent Estrus
6. Uterine stump pyometra
7. Uterine stump granuloma
8. Obesity?
9. Perivulvar dermatitis?
10. Urinary incontinence?
111
Describe the spay complication - hemorrhage
1. Hemorrhage
¡ Most fatal complication
¡ Intraoperative or immediate post op abdominal bleeding
¡ May need abdominal exploratory
¡ Pedicle ligation failure
¡ Go back in a re-ligate pedicles
112
Describe the spay complication - dehiscence
2. Dehiscence
¡ Abdominal vs. subcutaneous vs. skin
¡ Linea alba was not closed appropriately
¡ Failure to restrict exercise
¡ Lavage abdomen debride and reclose incision
113
Describe the spay complication - seroma
¡ Seroma
¡ Fluid accumulation at incision area
¡ Cold vs. warm compress depending on who you ask.
114
What can be seen in this image?
A seroma
115
Describe the spay complication - ligation of ureter
¡ Ligation of Ureter
¡ Uncomfortable patient
¡ Hydroureter +/- hydronephrosis
¡ Exploratory surgery and removal of ligature or kidney
¡ Prevent by careful identification of uterus before ligating
+ having empty bladder
116
Describe the spay complication - recurrent estrus
¡ Recurrent Estrus
¡ Remnant ovarian syndrome
¡ Failure to remove all of ovarian tissue
¡ Go back in and remove ovarian tissue
117
Describe the spay complication - Uterine Stump Pyometra
¡ Inflammation and bacterial infection of remnant uterine tissue aka “stump”
¡ Can be do to poor aseptic technique, suture reaction, devitalized tissue at stump, residual infection (if pyo present)
¡ Remove all remaining tissue
118
Describe the spay complication - Uterine Stump Granuloma
¡ Focal inflammation of remnant uterine tissue
¡ Associated with using multifilament nonabsorbable sutures or poor aseptic technique
119
SPAY COMPLICATIONS
Describe the spay complication - Obesity?
when lose sex hormones --> decrease metabolic rate --> obeses
120
Describe the spay complication - Perivulvar dermatitis?
--> some vulva regress --> dermatitis in that area --> UTIs
121
Describe the spay complication -Urinary incontinence?
--> associated with spayed dogs about 2-3 years after spay; urethral sphincter mechanism inconctinence; estrogen helps LUT deal wtih sphicnter muscle tone, so decrease in estrogen that should have been here reduces bladders ability to hold as much urine --> involuntary leaking.
122
Test Questions taken from here:
* Define ovariohysterectomy, ovariectomy, and cesarian section
* State disease processes where a spay would be indicated as medical treatment
* State benefits of a spaying patients
* Be knowledgeable of ages when patients should be spayed
* Name and identify important structures associated with canine and feline spay
* Cite steps and have a general understanding of a routine spay surgical procedure
* State post operative care associated to spay
* Cite surgical complications
