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Small animal surgery I > Surgery of the ovaries and uterus > Flashcards

Surgery of the ovaries and uterus Flashcards

1
Q

T/F: Ovarian cysts may be functional or nonfunctional

A

TRUE

Nonfunctional = incidental

Functional = estrus-producing

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2
Q

What is the most common type of functional ovarian cyst? What are the clinical signs associated with it?

A
  • Follicular (estrogen) most common (esp. dogs)
  • Clinical signs
    • Prolonged stage of estrus cycle
    • Stage depends on hormones involved
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3
Q

What is the signalment associated with ovarian cysts?

A

Young adults (dogs < 3yrs; cats < 5yrs)

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4
Q

What is the treatment and prognosis for ovarian cysts?

A
  • Surgical excision is curative–good prognosis
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5
Q

Why can pyometra be associated with ovarian neoplasia?

A

Functional tumors can produce progesterone; pyometra is associated with excess/persistent progesterone

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6
Q

What is the general likelihood of metastatic disease with ovarian neoplasia?

A
  • Metastatic disease is uncommon overall
    • Risk varies with tumor type
    • Bilateral tumors reported (adenocarcinoma)
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7
Q

Which species is more at risk for metastatic disease with ovarian neoplasia: cats or dogs?

A

Cats

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8
Q

What is the significance of a functional, metastatic ovarian tumor?

A

Functional tumors can have secondary effects

If enough estrogen is secreted it can overwhelm and completely suppress the bone marrow

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9
Q

What is the prognosis for a solitary (non-metastatic) ovarian tumor?

A

Complete excision is curative

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10
Q

What is the etiology of ovarian remnant syndrome (ORS)?

A
  • Surgical error
    • Ovarian tissue left behind after OHE/OVE
    • Tissue dropped into abdomen revascularizes
    • No such thing as ectopic ovarian tissue
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11
Q

What are the clinical signs of ORS?

A
  • Recurrence of estrus cycle
    • Vulvar swelling
    • Behavioral estrus
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12
Q

T/F: You will typically see vaginal bleeding/discharge with ORS

A

FALSE

The uterus has been removed (during spay)–there is no endothelial lining available to shed and produce bloody fluid

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13
Q

How is ORS diagnosed in the dog?

A
  • Vaginal cytology
    • Mimics normal heat cycle
    • Must be done in standing heat
  • Hormone assays
    • Elevated estrogen and progesterone
    • Low LH
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14
Q

When correcting ORS, where should you look for the remnant tissue?

A

Caudal pole of the kidney

(ID easier during estrus/diestrus)

Follicles or CL present

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15
Q

What are the similarities between an OHE and OVE? What is the difference?

A
  • OVE = removal of ovary alone
    • Ligate ovarian vessels for OHE
    • Ligate uterine vessels at proper ligament
    • Excise ovary
  • No difference in implications between OVE and OHE
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16
Q

What is the etiology of pyometra?

A
  • Multifactorial etiology
    • Hormonal–progesterone–>uterine secretions
    • Bacterial–gram (-) most common (E. coli)
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17
Q

What is the hormone necessary for pyometra to occur?

A

Progesterone

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18
Q

What are the typical historical findings of a dog with pyometra?

A
  • Recent heat cycle
  • PU/PD (bac. toxins)
  • Systemic illness–variable
    • Anorexia
    • Lethargy
    • Vomiting
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19
Q

What is the difference between an open and closed pyometra? Which is worse?

A
  • Open–cervix open and purulent material trying to drain out
  • Closed–cervix is closed
    • Worse–purulent material cannot drain
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20
Q

How is pyometra diagnosed?

A
  • CBC/chem consistent with sepsis/SIRS
    • Neutrophilia with left shift
    • Mild-thrombocytopenia–inflammation
    • Hypoalbuminemia
    • Mild cholestasis (bilirubin, liver enzymes)
  • Imaging–large, fluid-filled uterus
    • Radiographs–good
    • U/S–ideal
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21
Q

What is the immediate treatment/steps for pyometra?

A
  • Stabilize first
    • ​IV fluids +/- colloids
    • IV antibiotics
      • Emperical therapy for gram -
      • Usually susceptible to ampicillin/enrofloxacin
    • Treat SIRS if necessary
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22
Q

What is the medical management for pyometra?

A
  • Prostaglandin F2a–smooth muscle, cervix
  • Systemic antibiotics
  • Close monitoring
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23
Q

What is the surgical treatment for pyometra?

A
  • Surgical treatment is preferred
  • OHE only after adequate resuscitation
  • Large incision–xiphoid to pubis
  • Usually no need to break suspensory
  • Milk purulent material away from cervix
    • Noncrushing clamps
    • Ligate prior to clamp placement–friable
  • Iatrogenic rupture possible
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24
Q

What are the indications for medical management of pyometra?

A
  • Not systemically ill
  • Open pyometra ONLY
  • Owner highly motivated and aware of risks
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25
Q

Why is medical treatment of a closed pyometra contraindicated?

A
  • Prostaglandin with a closed cervix can lead to rupture
  • Systemic deterioration is possible
  • Risk of recurrence
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26
Q

What is the likelihood of medical management of a pyometra preserving fertility?

A

> 50%

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27
Q

What procedure is used to surgically manage pyometra?

A

OHE (only after adequate resuscitation)

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28
Q

What is the difference between a standard OHE and an OHE for the treatment of pyometra?

A

Use non-crushing clamps and ligate prior to clamp placement (uterus very friable)

29
Q

What is the typical history of a dog with metritis?

A
  • Occurs postpartum (12h - 1wk)
  • Signs of systemic illness (fever, anorexia)
30
Q

What are the clinical signs of metritis (dog)?

A

Foul-smelling reddish-brown discharge

31
Q

What is the etiology of metritis in dogs?

A
  • Dystocia
  • Obstetric manipulation
  • Retained fetus or placenta
  • Devitalized uterine tissue
32
Q

How is metritis diagnosed?

A
  • Based on timing following parturition
  • CBC/chem chages similar to pyometra
  • Imaging
    • Similar to pyometra
    • Gas/air consistent with anaerobes
      *
33
Q

T/F: Vaginal cytology is not helpful in diagnosing metritis

A

TRUE

Will only show degenerative neutrophils and intracellular bacteria–normal postpartum finding

34
Q

How can you differentiate between metritis and pyometra?

A

Only done with timing following parturition

35
Q

What are the treatment options for dogs with metritis (broad categories)?

A

Medical or surgical management

36
Q

What are the indications for medical treatment of metritis?

A
  • Only if ALL are true
    • ​Valuable breeding animal
    • Good response to initial therapy
    • No devitalized tissue/retained placenta or fetus
37
Q

T/F: Depending on the severity, treatment for metritis might be an emergency

A

TRUE

38
Q

Which surgical procedure is generally used for a case of metritis? What is the prognosis?

A
  • OHE is default procedure
  • Hysterotomy if you need to preserve breeding
    • Healthy uterine wall
    • Remove debris
    • Levage/suction to flush uterus
  • Prognosis good with OHE
39
Q

T/F: An OHE following metritis will have an impact on milk production

A

FALSE

40
Q

What is the typical history compatible with cystic endometrial hyperplasia?

A

Failure to conceive

Muco/hydro/hematometra

41
Q

What are the clinical signs of cystic endometrial hyperplasia?

A
  • Most dogs (67%) BAR
  • May show signs similar to pyometra
    • Systemic illness usually less severe
    • May include vaginal discharge and PU/PD
  • Lab changes minimal
42
Q

How do you diagnose cystic endometrial hyperplasia?

A

ID cysts on ultrasound

43
Q

T/F: Cystic endometrial hyperplasia is typially an emergency situation that should be treated immediately

A

FALSE–not typically an emergency

44
Q

What are the (broad) categories of treating CEH?

A

OHE (default)

Medical therapy

45
Q

Which treatment of CEH is preferred?

A

OHE

46
Q

What is uterine torsion? Is it an emergency?

A

Rotation of uterine horn along its long axis

Surgical emergency

47
Q

What might uterine torsion result from?

A

Dystocia

48
Q

What treatment is typically used for uterine torsion?

A

OHE is treatment of choice

Remove viable pups via C-section

49
Q

T/F: Following uterine torsion, the uterine horn should NEVER be de-rotated

A

TRUE–that would be BAD

50
Q

What are the implications of uterine rupture with pyometra?

A

Can cause septic peritonitis

51
Q

What is the most common/preferred treatment choice for uterine rupture?

A

OHE

52
Q

What is uterine prolapse a complication of?

A

Parturition

  • Up to 48 hrs following final fetus
53
Q

In which species is uterine prolapse following parturition most common?

A

Cats

54
Q

What are the treatment options for uterine prolapse?

A

Manual reduction

OHE if manual reduction impossible

55
Q

What is the main (general) difference between uterine neoplasia in cats and dogs?

A
  • Dogs = benign leiomyoma–not serious
  • Cats = malignant, likely metastatic cancers–prognosis guarded
56
Q

Describe the 3 stages of labor

A
  • Stage 1 = restless, nesting behavior
  • Stage 2 = expulsion of fetus
  • Stage 3 = expulsion of placenta
57
Q

What is the criteria for diagnosing dystocia?

A
  • Prolonged gestation (>68 days)
  • Signs of toxemia during gestation
  • Stage 1 lasting > 24hrs
  • No puppies > 36hrs after temperature drop
  • Active stage 2 contractions > 30min
  • > 4hrs between puppies
58
Q

When is medical management of dystocia contraindicated?

A
  • Active contractions > 30min
  • Palpation consistent with uterine obstruction
  • Imaging showing fetal malposition or distress
59
Q

What are the 2 surgical treatments for dystocia?

A

C-section; En-bloc C-section with OVH

60
Q

What should be done at the beginning of a Cesarian section (before actually cutting into the uterus)?

A
  • Linea alba stretched thin
  • Distended uterus fills abdomen
    • Laceration risk!
  • Gently handle uterus
    • Friable, vascular
  • Pack uterus off w/ lap sponges
61
Q

What is the procedure for a hysterotomy?

A
  • Ventral midline incision into uterus
  • Do not make incision over fetus
  • “Milk” fetuses to incision
  • Gentle traction to remove fetuses
  • Clamp umbilical cord
  • Resuscitate fetuses
62
Q

How is an en-bloc C-section with OVH performed?

A
  • Breakdown broad ligament
  • Clamp pedicles, transect w/o ligating
  • Hand uterus off to sterile assistant
  • Remove puppies < 60min after clamping
  • Ligate pedicles, close abdomen routinely
63
Q

What procedure is performed as a simultaneous OHE and dystocia treatment? What does it decrease?

A
  • En bloc C-section with OVH
  • Decreased anesthesia time
64
Q

What is the holding layer for the closing incision in the uterus?

A

Submucosa

65
Q

What suture should be used when closing the uterus?

A

3-0 or 4-0 absorbable monofilament

66
Q

What is the prognosis for dogs undergoing surgery for dystocia?

A

Survival of bitch = 99%

67
Q

What is the prognosis for puppies undergoing surgery for dystocia?

A

Survival of puppies 87% 2hrs post-op

68
Q

T/F: An OHE does not affect milk production

A

TRUE

Small animal surgery I (25 decks)

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