Surgical diseases of the female reproductive system Flashcards
1
Q
What are benefits of ovarihysterectomies?
A
- Eliminates unwanted pregnancies
- Eliminates inconvenience of oestrus
- Decreases risk of mammary neoplasia
- Prevention + treatment of =
-Pyometra
-Metritis
-Ovarian/uterine neoplasia
-Subinvolution of placental sites
-Vaginal hyperplasia
-Vaginal prolapse - Control of certain diseases =
-Diabetes melitus
-Epilepsy
-Certain dermatoses (eg. generalised Demodex)
2
Q
What are benefits / disadvantages of OVH prior to 1st season?
A
- Benefits
-reduced incidence of mammary neoplasia
-uterine/ovarian vessels small (less haemorrhage)
-reduced anaesthetic /operating time
-reduced inconvenience to owner - Disadvantages
-anaesthetic considerations
-juvenile/hypoplastic vulva (failure of the vulva to develop because of no exposure to female sex hormones
3
Q
When would you not spay before 1st season?
A
- Juvenile vaginitis
- Congenital urethral sphincter mechanism incompetence
4
Q
When should you spay an animal?
A
- Between seasons, in anoestrus
- > 6-8wks postpartum
- Combined w caesarean
5
Q
What is cystic endometrial hyperplasia - pyometra?
A
- Potentially life threatening disorder
- Develops during luteal phase (progesterone production)
- Progesterone stimulates growth + activity of endometrial glands + reduces myometrial activity (+ immunosuppression)
- Colonisation of abnormal uterus w bacteria = pyometra
6
Q
What are clinical findings of Cystic endometrial hyperplasia
A
- Signs tend to be more severe with closed pyometra
- Purulent vulval discharge (open pyometra)
- Inappetence
- Lethargy
- Polyuria/polydipsia
- Vomiting
- Pyrexia
- Dehydration
- Enlarged uterus on abdominal palpation
7
Q
How is CEH-pyometra diagnosed?
A
- Hx - recent season
- Biochem, haematology, Urinalysis
- Vaginal cytology
- Radiography / Ultrasound
8
Q
What is treatment of CEH - pyometra?
A
- Prompt + aggressive IVFT
- Broad spec + bactericidal antibiotics
- Ovariohysterectomy
9
Q
What is ovarian remnant syndrome? What should be done?
A
- Suspect incomplete removal of ovarian tissue if recurrent oestrus post OVH
- Confirm w hormone assay / GnRH stim test
- Exploratory coeliotomy - when in season
- Excise scar tissue of ovarian pedicles + submit for histopath
10
Q
What is uterine stump pyometra?
A
- Must have progesterone source (endogenous/exogenous)
- CS, Dx + TX as for pyometra
- Inspect ovarian pedicle scars + remove obvious abnormal tissue
11
Q
What is Uterine stump granuloma?
A
- From poor aseptic technique
- Excessive remaining uterine body
- Ligatures of non-absorbable suture material
- Tx = resect remaining uterine body + cervix
12
Q
What are fistulae associated with inappropriate suture material? What should be done?
A
- Tracts discharging on flank, inguinal or medial thing region
- Refer for US +/or CT to aid diagnosis
- Exploratory coeliotomy + resection of ligatures + reactive tissue
- Consider REFERRAL
13
Q
What is seen with vaginal hyperplasia/ prolapse?
A
- Oedematous enlargement of vaginal tissue during pro/oestrus
- Mass may be seen protruding from vulval lips
- Prolapsed tissue promotes straining
- Mass may be traumatised by licking, abrasion or dessication
- Oedema spontaneously resolves after follicular phase but recurrence likely at next pro/oestrus
- Must differentiate from vaginal neoplasia
14
Q
How are vaginal hyperplasia / prolapse treated?
A
- Mild cases = conservative =
-prevent self trauma ( elizabethan collar), lubrication of mass, reduction of prolapse + purse string suture - Large masses = resection (episiotomy - vulva cut)
15
Q
What are indications for episiotomy? (incision of vulva)
A
- Surgical exploration of the vagina
- Excision of vaginal masses
- Repair of vaginal lacerations post-mating
- Treatment of strictures or congenital defects
- Exposure of the urethral papilla
- Facilitation of manual foetal extraction
