Surgery of Ovaries and Uterus Flashcards by Kate Guiremand

common surgical diseases of the ovaries

ovarian cysts

ovarian neoplasia

ovarian remnant syndrome

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

True

still submit for histopathology

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functional folluicular ovarian cysts secrete _____

estrogen

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functional luteal ovarian cysts secrete ______

progesterone

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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

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diagnosis of functional ovarian cyst

vaginal cytology (dog)

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

abdominal ultrasound

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treatment of functional ovarian cysts

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

non breeding - OHE is curative

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clinical signs of ovarian neoplasia

often incidental finding

sometimes palpable

granulosa cell tumor - persistent proestrus, pyometra

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

True

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what is ovarian remnant syndrom

recurrence of estrus following OHE/OVE

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what is the cause of ovarian remnant synrome

inadequate visualization - keyhole incision

poor technique

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what is the treatment for ovarian remnant syndrome

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

usually done during estrus

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cystic endometrial hyperplasia is associated with

excess and prolonged progesterone

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what happens with cystic endometrial hyperplasia

glandular tissue becomes cystic

uterus fills with fluid - hydrometra, mucometra, hematometra

can lead to pyometra

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clinical signs of cystic endometrial hyperplasia

failure to conceive

vaginal discharge

PU/PD

most patients are alert (67%)

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how is cystic endometrial hyperplasia be diagnosed

ultrasound - most sensitive (fluid filled uterus)

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what happens when you combine bacteria with cystic uterine disease

PYOMETRA!

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when do pyometras occur

4-8 weeks after heat cycle

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bacteria associated with pyometra

E. coli - most common

pasteurella, Proteus, Pseudomonas

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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 ## Footnote *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