Surgery of Ovaries and Uterus Flashcards
common surgical diseases of the ovaries
ovarian cysts
ovarian neoplasia
ovarian remnant syndrome
T/F nonfunctional ovarian cysts are typically and incidental finding and OHE is curative
True
still submit for histopathology
functional folluicular ovarian cysts secrete _____
estrogen
functional luteal ovarian cysts secrete ______
progesterone
clinical signs of functional ovarian cysts are dependent on _____
which hormone is being secreted
prolonged stage of estrus, vaginal bleeding (dog), attractiveness to male, standing heat
diagnosis of functional ovarian cyst
vaginal cytology (dog)
hormone levels: estrogen >20pg/ml; progesterone >2ng/ml
abdominal ultrasound
treatment of functional ovarian cysts
breeding - may resolve on its own, GnRH, HCG, cyst removal, unilateral ovariectomy
non breeding - OHE is curative
clinical signs of ovarian neoplasia
often incidental finding
sometimes palpable
granulosa cell tumor - persistent proestrus, pyometra
T/F the prognosis after ovariectomy is good if there is no metastatic disease
True
what is ovarian remnant syndrom
recurrence of estrus following OHE/OVE
what is the cause of ovarian remnant synrome
inadequate visualization - keyhole incision
poor technique
what is the treatment for ovarian remnant syndrome
surgical removal - remnant usually at the caudal pole of the kidney
usually done during estrus
cystic endometrial hyperplasia is associated with
excess and prolonged progesterone
what happens with cystic endometrial hyperplasia
glandular tissue becomes cystic
uterus fills with fluid - hydrometra, mucometra, hematometra
can lead to pyometra
clinical signs of cystic endometrial hyperplasia
failure to conceive
vaginal discharge
PU/PD
most patients are alert (67%)
how is cystic endometrial hyperplasia be diagnosed
ultrasound - most sensitive (fluid filled uterus)
what happens when you combine bacteria with cystic uterine disease
PYOMETRA!
when do pyometras occur
4-8 weeks after heat cycle
bacteria associated with pyometra
E. coli - most common
pasteurella, Proteus, Pseudomonas
clinical signs of pyometra
lethargy
vomiting
PU/PD (bacterial toxins, inhibit concentrating ability (ADH))
vaginal discharge
most cases have 3 or more of these signs
T/F approximately 57% of pyometras present with SIRS (Systemic Inflammatory Response Syndrome)
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
what can be seen on physical exam with pyometra
painful distended abdomen
fever
tachycardia
tachypnea
clinical pathology findings with pyometra
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
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?
NO! Do not do that!
treatment for pyometra
stabilize patient - dehydration, electrolytes, acid base, antibiotics (gram neg; ampicillin/enrofloxacin)
OHE
how can you avoid a septic abdomen with pyometra
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
indications for medical management of pyometra
not systemically ill
open pyometra
high breeding value
medical treatment of pyometra
PGF2α
antibiotics for 10-14 days
what is metritis
inflammation/infection of the uterus
occurs postpartum (12 hrs - 1 week)
causes of metritis
dystocia
devitalized uterus
fetal/placental retention
clinical signs of metritis
foul smelling reddish brown discharge
fever
anorexia
lethargy
decreased milk production
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?
No - the bitch will still produce milk
what is uterine torsion
twisting of uterus along long axis
associated with: dystocia, pyometra, CEH
T/F ultrasound is the best modality to diagnose uterine torsion
False
ultrasound is non-diagnostic
when does uterine prolapse occur
complication of parturition/dystocia - < 48 hours
treatment for uterine proloapse
manual reduction
OHE
if cant reduce - may amputate uterine horns then remove ovaries by ventral celiotomy
what can cause a uterine rupture
dystocia
HBC
post c-section
pyometra
how is uterine rupture diagnosed
+/- ultrasound
often diagnosed on exploritory
T/F prognosis for dogs and cats with uterine cancer is good with OHE
False
- Dogs - benign tumors = good; malignant tumors with no metastasis = fair*
- cats - guarded; most have higher metastatic potential*
maternal causes of dystocia
primary or secondary uterine inertia
birth canal obstruction - small pelvic canal, malunion fracture
fetal causes of dystocia
malposition
malformation
oversize
secondary uterine inertia
clinical signs of primary uterine inertia
no signs of parturition
prolonged gestation (>68 days)
no puppies 36hr after temperature <100ºF
causes of primary uterine inertia
oversized litters - uterine stretching
undersized littlers - uterine stimulation
what is secondary uterine inertia
normal delivery of part of the litter
develop uterine fatigue
clinical signs of secondary uterine inertia
prolonged interval between neonates (>4 hours)
weak or absent uterine contractions
T/D primary and secondary uterine inertia can be treated medically
False
primary uterine inertia can be treated medically, secondary cannot
treatment of primary uterine inertia
oxytocin - repeat in 30 minutes if needed
positive result - continue to repeat oxytocin
perform c section if no results
indications for c section
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)
advantages of en bloc resection
OHE
dystocia treatment
decreased anesthesia time
decreased abdominal contamination
no increased fetal mortality
