Surgery of the female reproductive tract Flashcards
What are the indication for an ovariohysterectomy?
Eliminates unwanted pregnancies
Eliminates inconvenience of oestrus
Decreased risk of mammary neoplasia
Ovariohysterectomy prevents the treatment of which diseases?
- Pyometra
- Metritis
- Ovarian / Uterine neoplasia
- Subinvolution of placental sites (sign: haemorrhagic vaginal discharge)
- Vaginal hyperplasia
- Vaginal prolapse
- Uterine torsion or prolapse (rare)
What are the advantages of spaying before the 1st season?
Reduced risk of mammary neoplasia
Uterine and ovarian vessels small > less haemorrhage
Reduced surgical / annaesthesia time?
Reduced inconvenience to owner
What are the disadvantages of spaying before the 1st season?
Anaesthesia ?
Juvenile behaviour?
Juvelin/hypoplastic vulva?
Obesity?
When is ovariohysterectomy before the 1st season contraindicated?
Juvenile vaginitis
Juvenile Urethral Sphincter Mechanism Incompetence (USMI)
When should ovariohysterectomy be performed?
In anoestrus - between seasons = 3 months after oestrus
How many weeks post partum should a bitch be spayed?
More than 6-8 weeks
Why should neutering be avoided whilst in season?
Increased size of uterine vessels
Uterine turgidity
Increased risk of haemorrhage
Cystic endometria hyperplasia is also known as?
Pyometra
When does Cystic endometria hyperplasia occur in the reproductive cycle?
Luteal phase
Which dogs are most affected by pyometra
Middle aged, intact females
What are the clinical signs of a pyometra?
Polyuria – polydipsia
Lethargy
Inappetence
Vomiting
Pyrexia
Dehydration
Abdominal pain
Vaginal discharge
Gait abnormalities
SIRS
How do the haematology results indicate a pyometra?
Inflammatory leukogram, leukocytosis in most cases, anaemia due to erythrocyte loss in uterine exudate
How is a pyometra diagnosed?
Abdominal radiography
Abdominal ultrasound
Describe pyometra treatment
- Prompt and aggressive : Stabilise first if needed
- IVFT to correct dehydration and acid-base status
- Broad spectrum antimicrobials: cefuroxime or amoxicillin/clavulanic acid
- Treatment of choice: ovariohysterectomy
- Continue with antimicrobials if systemically ill, uti, intraoperative contamination
When would medical management of a pyometra be acceptable?
Not recommended as a routine
Could consider if open pyometra, bitch of high breeding value
Risk of recurrence
‘Uterine emptying’ and antimicrobials for at least 14 days
How is a pyometra medically managed?
PGF2a ; side effects.. Pain, vomiting, hypersalivation, fever, dyspnoea, panting
If medical management successful can breed at next cycle
What is ovarian remnant sydrome?
- Signs of recurrent oestrus
- Diagnosis: history, vaginal cytology, hormone assays
- Exploratory coeliotomy; preferably if in oestrus
- Excise tissue from ovarian pedicles and submit for histopathology
What is the cause of a uterine stump granuloma?
Poor aspect technique
Use of non- absorbable suture material for ligatures
Excessive remaining uterine body
How does vaginal hyperplasia/prolapse present?
Oedematous enlargement of vagina during proestrus/oestrus under the influence of oestrogen
How is vaginal hyperplasia/prolapse treated?
- Mild cases can be treated conservatively
- Apply lubricant
- Prevent self-trauma (use of Elizabethan collar)
- Reduction of prolapse and purse string around vulva?
- Large masses/non-viable prolapsed tissue requires resection (episiotomy)
What is an episiotomy?
Incision of the vulva orifice to approach vaginal and vestibular lesions
When is an episiotomy indicated?
- Surgical exploration of the vagina
- Excision of vaginal masses
- Repair of vaginal lacerations post-mating
- Treatment of strictures/congenital defects
- Exposure of the urethral papilla
- Facilitation of manual foetal extraction
What is an episioplasty?
Reconstructive procedure to remove excess skin folds around the vulva
Excess skin folds > peri-vulvar dermatitis; rare consequence of early spay
Name some ovarian neoplasia
Teratomas, teratocarcinomas, dysgerminomas
Adenoma, adenocarcinoma
Granulosa cell tumours
How do dogs with ovarian neoplasia present?
Persistent proestrus/oestrus, cystic endometric hyperplasia, pyometra
Name the most common uterine neoplasia of dogs
Mesenchymal origin
Leiomyomas (90%)
Leiomyosarcoma
Name the most common uterine neoplasia of cats
Adenocarcinoma
What is the most common tumour of intact females?
Mammary neoplasia
Describe the main features of inflammatory carcinomas
- May affect multiple glands, both chains
- Signs similar to mastitis, dermatitis; poor demarcation, oedema, inflammation
- Short median survival times – poor prognosis
- Surgery not usually recommended
What % of mammary neoplasia are malignant in 1. dogs, 2. cats
Dogs - more than 50% are benign
Cats - 90% malignant
