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RUSVM Small Animal Surgery > Surgery of Ovaries and Uterus > Flashcards

Surgery of Ovaries and Uterus Flashcards

1
Q

common surgical diseases of the ovaries

A

ovarian cysts

ovarian neoplasia

ovarian remnant syndrome

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2
Q

T/F nonfunctional ovarian cysts are typically and incidental finding and OHE is curative

A

True

still submit for histopathology

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3
Q

functional folluicular ovarian cysts secrete _____

A

estrogen

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4
Q

functional luteal ovarian cysts secrete ______

A

progesterone

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5
Q

clinical signs of functional ovarian cysts are dependent on _____

A

which hormone is being secreted

prolonged stage of estrus, vaginal bleeding (dog), attractiveness to male, standing heat

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6
Q

diagnosis of functional ovarian cyst

A

vaginal cytology (dog)

hormone levels: estrogen >20pg/ml; progesterone >2ng/ml

abdominal ultrasound

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7
Q

treatment of functional ovarian cysts

A

breeding - may resolve on its own, GnRH, HCG, cyst removal, unilateral ovariectomy

non breeding - OHE is curative

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8
Q

clinical signs of ovarian neoplasia

A

often incidental finding

sometimes palpable

granulosa cell tumor - persistent proestrus, pyometra

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9
Q

T/F the prognosis after ovariectomy is good if there is no metastatic disease

A

True

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10
Q

what is ovarian remnant syndrom

A

recurrence of estrus following OHE/OVE

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11
Q

what is the cause of ovarian remnant synrome

A

inadequate visualization - keyhole incision

poor technique

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12
Q

what is the treatment for ovarian remnant syndrome

A

surgical removal - remnant usually at the caudal pole of the kidney

usually done during estrus

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13
Q

cystic endometrial hyperplasia is associated with

A

excess and prolonged progesterone

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14
Q

what happens with cystic endometrial hyperplasia

A

glandular tissue becomes cystic

uterus fills with fluid - hydrometra, mucometra, hematometra

can lead to pyometra

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15
Q

clinical signs of cystic endometrial hyperplasia

A

failure to conceive

vaginal discharge

PU/PD

most patients are alert (67%)

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16
Q

how is cystic endometrial hyperplasia be diagnosed

A

ultrasound - most sensitive (fluid filled uterus)

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17
Q

what happens when you combine bacteria with cystic uterine disease

A

PYOMETRA!

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18
Q

when do pyometras occur

A

4-8 weeks after heat cycle

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19
Q

bacteria associated with pyometra

A

E. coli - most common

pasteurella, Proteus, Pseudomonas

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20
Q

clinical signs of pyometra

A

lethargy

vomiting

PU/PD (bacterial toxins, inhibit concentrating ability (ADH))

vaginal discharge

most cases have 3 or more of these signs

21
Q

T/F approximately 57% of pyometras present with SIRS (Systemic Inflammatory Response Syndrome)

A

True

abnormal cytokine regulation, hyer or hypothermic (BAD-about to die bad); WBC >12,000 or <4,000 (BAD- like hypothermia, about to die) or >10% bands

22
Q

what can be seen on physical exam with pyometra

A

painful distended abdomen

fever

tachycardia

tachypnea

23
Q

clinical pathology findings with pyometra

A

hypoglycemia - sepsis, SIRS

azotemia, proteinuria - BacT emdotoxins, inhibit ADH, glomerular damage

anemia - RBC loss in discharge, decreased erythropoeisis (renal damage)

leukocytosis - left shift

increased AST and ALK - hepatocellular damage

24
Q

While doing an ultrasound to check for pyometra, you observe a fluid filled uterus with thickened wall and cyctic endometrium. You visualize the bladder and see signs of a UTI. Should you perform a cyctocentesis to obtain a sample?

A

NO! Do not do that!

25
Q

treatment for pyometra

A

stabilize patient - dehydration, electrolytes, acid base, antibiotics (gram neg; ampicillin/enrofloxacin)

OHE

26
Q

how can you avoid a septic abdomen with pyometra

A

dont delay surgery

no pre-op cyctocentesis

handle uterus gently - friable

pack off abdominal cavity

use non-crushing (doyen) clamps on uterus

dont oversew uterine stump

27
Q

indications for medical management of pyometra

A

not systemically ill

open pyometra

high breeding value

28
Q

medical treatment of pyometra

A

PGF2α

antibiotics for 10-14 days

29
Q

what is metritis

A

inflammation/infection of the uterus

occurs postpartum (12 hrs - 1 week)

30
Q

causes of metritis

A

dystocia

devitalized uterus

fetal/placental retention

31
Q

clinical signs of metritis

A

foul smelling reddish brown discharge

fever

anorexia

lethargy

decreased milk production

32
Q

A dog presents 24 hrs postpartum with metritis. You treat with antibiotics and perform an OHE. Will the puppies need to be put on milk replacers?

A

No - the bitch will still produce milk

33
Q

what is uterine torsion

A

twisting of uterus along long axis

associated with: dystocia, pyometra, CEH

34
Q

T/F ultrasound is the best modality to diagnose uterine torsion

A

False

ultrasound is non-diagnostic

35
Q

when does uterine prolapse occur

A

complication of parturition/dystocia - < 48 hours

36
Q

treatment for uterine proloapse

A

manual reduction

OHE

if cant reduce - may amputate uterine horns then remove ovaries by ventral celiotomy

37
Q

what can cause a uterine rupture

A

dystocia

HBC

post c-section

pyometra

38
Q

how is uterine rupture diagnosed

A

+/- ultrasound

often diagnosed on exploritory

39
Q

T/F prognosis for dogs and cats with uterine cancer is good with OHE

A

False

  • Dogs - benign tumors = good; malignant tumors with no metastasis = fair*
  • cats - guarded; most have higher metastatic potential*
40
Q

maternal causes of dystocia

A

primary or secondary uterine inertia

birth canal obstruction - small pelvic canal, malunion fracture

41
Q

fetal causes of dystocia

A

malposition

malformation

oversize

secondary uterine inertia

42
Q

clinical signs of primary uterine inertia

A

no signs of parturition

prolonged gestation (>68 days)

no puppies 36hr after temperature <100ºF

43
Q

causes of primary uterine inertia

A

oversized litters - uterine stretching

undersized littlers - uterine stimulation

44
Q

what is secondary uterine inertia

A

normal delivery of part of the litter

develop uterine fatigue

45
Q

clinical signs of secondary uterine inertia

A

prolonged interval between neonates (>4 hours)

weak or absent uterine contractions

46
Q

T/D primary and secondary uterine inertia can be treated medically

A

False

primary uterine inertia can be treated medically, secondary cannot

47
Q

treatment of primary uterine inertia

A

oxytocin - repeat in 30 minutes if needed

positive result - continue to repeat oxytocin

perform c section if no results

48
Q

indications for c section

A

secondary uterine inertia

primary uterine inertia refractory to treatment

systemic signs in bitch

fetal distress diagnosed by U/S

planned for high risk patients (bulldogs)

49
Q

advantages of en bloc resection

A

OHE

dystocia treatment

decreased anesthesia time

decreased abdominal contamination

no increased fetal mortality

RUSVM Small Animal Surgery (41 decks)

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