Surgical Conditions of the Female Repro Tract

Question 1

Surgical diseases of the ovaries using DAMNIT-V.

Answer 1

• Developmental.
• Metabolic.
• Neoplastic.
• Inflammatory / Iatrogenic.
• Vascular.

Question 2

Ovarian congenital malformations.

Answer 2

Rare!
Ovarian hypoplasia.
Congenital ovarian cysts.

Question 3

Ovarian cysts…
1. Clinical signs of follicular cysts.
2. Clinical signs of luteal cysts.
3. Diagnosis.
4. Treatment.

Answer 3

1. Persistent pro-oestrus (oestrogen).
   Or none.
2. Persistent anoestrus (Progesterone).
   Or none.
3. Ultrasound.
4. Ovariohysterectomy or ovariectomy.

Question 4

1. Ovarian neoplasia.
2. Types of ovarian neoplasia.
3. Clinical signs of ovarian neoplasia.
4. Diagnosis pf ovarian neoplasia.
5. Treatment of ovarian neoplasia.

Answer 4

1. Uncommon.
   Age - middle-aged/younger.
   Most unilateral.
2. Benign e.g. haemangioma.
   Malignant e.g. haemangiosarcoma.
   Metastatic lymphosarcoma.
3. Dept. on whether functional or non-functional.
   Non-functional more common.
4. Ultrasound / radiography.
5. Ovariohysterectomy or ovariectomy.
   And adjunctive therapy.

Question 5

1. Signalment for ovarian remnant syndrome.
2. Aetiology of ovarian remnant syndrome.
3. Clinical signs of ovarian remnant syndrome?
4. Investigation of ovarian remnant syndrome?
5. Treatment of ovarian remnant syndrome.

Answer 5

1. ‘Recent’ OVE/OVH.
   +/- haemorrhage at time of surgery.
2. • Human error.
     - Ectopic ovarian tissue.
     - Auto-transplantation.
3. Persistent pro-oestrus/oestrus.
4. • Vaginal swab.
     - Imaging.
     - Bloods: progesterone, oestradiol or LH.
5. • Surgery to remove ovarian tissue.
     - Histopathology.

Question 6

Surgical diseases of the uterus using DAMNIT-V.

Answer 6

• Developmental.
• Metabolic.
• Neoplastic.
• Infectious / Inflammatory.
• Vascular.

Question 7

1. Signalment for pyometra.
2. Aetiology of pyometra.
3. Clinical signs of pyometra.

Answer 7

1. • Post-oestrus.
     - Middle aged and entire.
2. • Cystic endometrial hyperplasia.
     - Ascending bacterial infection.
3. • None.
     - PUPD, lethargy, abdominal distension.
     - Vulval discharge.
     - Collapse.

Question 8

1. Diagnosis of pyometra.
2. Treatment of pyometra.
3. Pyometra prognosis.

Answer 8

1. • Bloods.
     - Imaging.
2. • Stabilisation (Fluids – shock rate?, ABX).
     - Surgical – Ovariohysterectomy.
     - Medical management – high recurrence.
     - Euthanasia.
3. Good – 5% overall mortality.

Question 9

1. Signalment/history for uterine neoplasia.
2. Types of uterine neoplasia.
3. Clinical signs of uterine neoplasia.
4. Diagnosis of uterine neoplasia.
5. Treatment of uterine neoplasia.

Answer 9

1. Older, intact bitches/queens.
2. Leiomyoma / adenoma / fibroma.
   Adenocarcinoma / fibrosarcoma / lymphoma.
3. • Non-specific / asymptomatic.
     - Vaginal discharge.
     - Abdominal mass.
4. Imaging.
5. OVH – curative for benign tumours.

Question 10

1. Uterine prolapse in dogs and cats common?
2. Aetiology of uterine prolapse in dogs and cats.
3. Uterine rupture aetiology.
   – Result?
4. Uterine torsion common?

Answer 10

1. Uncommon.
2. Parturition.
3. Pyometra / parturition.
   – peritonitis.
4. Extremely rare.

Question 11

Surgical conditions of the vagina using DAMNIT-V.

Answer 11

• Developmental.
• Metabolic.
• Neoplastic.
• ## Inflammatory / Infectious.

Question 12

1. Vaginal prolapse common?
2. Vaginal prolapse associated w/?
3. Differentiate vaginal prolapse from?

Answer 12

1. Rare!
2. Parturition.
3. Type 3 vaginal hyperplasia.

Question 13

1. Signalment for vaginal hyperplasia.
2. Aetiology of vaginal hyperplasia.
3. Clinical signs of vaginal hyperplasia.
4. Diagnosis of vaginal hyperplasia.

Answer 13

1. • Brachycephalic / large breeds.
     - Oestrus / pro-oestrus.
     - Pregnancy.
2. Vaginal oedema and fibroplasia.
3. • Prolapsed tissue.
     - Dysuria.
     - Types 1,2,3.
4. Hx / exam / imaging.

Question 14

1. medical treatment of prolapsed vagina?
2. Surgical treatment of prolapsed vagina?

Answer 14

1. • Analgesia.
     - Protect tissue from trauma.
     - Topical ABX.
     - +/- U CATH.
     - Replace tissue.
2. • Temporary vulval sutures.
     - OVE/OVH.
     - Vaginal resection rarely required (type 3 only).

Question 15

1. Vaginal neoplasia signalment.
2. Vaginal neoplasia types.
3. Vaginal neoplasia clinical signs.
4. Diagnosis of vaginal neoplasia.

Answer 15

1. • Dogs.
     - Cats.
2. Leiomyoma.
   Leiomyosarcoma / adenocarcinoma / SCC / TVT.
3. Perineal bulging.
   Vulval discharge.
4. Imaging.
   Biopsy – through vulva.
   Staging if malignant.

Question 16

Treatment of vaginal neoplasia.

Answer 16

• Episiotomy to expose vagina.
• U CATH.
• Vaginectomy.
  – intraluminal –> w/in wall.
  – extraluminal. –> Into lumen.
• +/- OVE/OVH.

Question 17

Surgical procedures of the vulva using DAMNIT-V.

Answer 17

• Developmental.
• Inflammatory.
• Traumatic.

Question 18

1. Aetiology of juvenile vulva.
2. Clinical signs of juvenile vulva.
3. Treatment of juvenile vulva.

Answer 18

1. • Failure of development of external genitalia.
     - Associated w/ early spay and obesity.
2. • Local dermatitis.
     - UTI.
3. Episioplasty.

Question 19

Surgical diseases of the mammary glands using DAMNIT-V.

Answer 19

• Degenerative / Developmental.
• Metabolic.
• Neoplastic.
• Infectious / Inaflammatory / Iatrogenic.
• Traumatic.

Question 20

Mammary gland anatomy.

Answer 20

4 pairs of mammary glands in cats.
5 pairs of mammary glands in dogs.
Blood supply comes from cranial superficial epigastric artery and caudal superficial epigastric artery.
Cranially drain to axillary LNs.
Caudally drain to inguinal LNs.
Anastomoses between L and R.

Question 21

1. Signalment and aetiology of fibro-adenomatous hyperplasia.
2. Diagnosis of fibro-adenomatous hyperplasia.
3. Treatment of fibro-adenomatous hyperplasia.

Answer 21

1. After 1st oestrus.
   Any age/sex.
   One/more glands.
   Progesterone (endogenous/exogenous).
2. Biopsy.
3. • Stabilise medically.
     - OVE/OVH.
     - +/- mastectomy.

Question 22

Mammary neoplasia.

Answer 22

• Common but half as common in cats as in dogs – Siamese cats have 2x risk.
• Risk related to neutering – reduces risk w/ earlier neutering.
• 1 in 2 chance of malignancy in dogs.
• 80-90% chance of malignancy in cats.

Question 23

Mammary neoplasia red flags.

Answer 23

• Rapid growth.
• Reduce mobility or immobile.
• Excessive inflammation.
• Larger.
• LN involvement.
• Multiple gland involvement. o

Question 24

Mammary gland green flags.

Answer 24

• Small breed dogs tend to get benign types.

Question 25

Canine mammary neoplasia TNM staging system.

Answer 25

T - Primary tumour size.
– T1 = <3cm max diameter.
– T2 = 3-5cm max diameter.
– T3 = >5cm max diameter.
– T4 = inflammatory carcinoma.
N - Regional LN status.
– N0 = No metastasis.
– N1 = Metastasis to ipsilateral node.
– N2 - Metastasis to contralateral node.
M - Distant metastasis.
– M0 = No distant metastasis.
– M1 = Distant metastasis.

Question 26

Surgical options for mammary gland neoplasia.

Answer 26

• Mammectomy
• Simple mastectomy.
• Regional mastectomy.
  – +/- lymph nodectomy.
• Total / radical mastectomy.
  – Unilateral.
  – Bilateral.
  – Lymph nodectomy.
• need to opt straight for regional / total mastectomy for cats. *

Question 27

Regional mastectomy.

Answer 27

• Unilateral/bilateral.
• 1-2cm lateral margin.
• Deep margin to fascia and rectus sheath.
• Control bleeding based on blood supply of gland being removed.
• Local lymph nodectomy.

Question 28

Mammary neoplasia prognosis.

Answer 28

• Driven by WHO TNM staging system.
• Histopathology and surgical margins.
• Adjunctive therapies.
• OVE/OVH.
• Survival times.

Question 29

Take home message.

Answer 29

Canine remove when <2cm.
Feline remove ASAP.