Written Exam - Complications of Ovariohysterectomy & Castration

Question 1

what is the #1 complication of OHE? what causes it?

Answer 1

hemorrhage - tearing the suspensory ligament, inappropriate tissue handling (pulling too hard on pedicle, rough handling), & inappropriate instrument handling

Question 2

what may be some signs seen post-op indicative of hemorrhage?

Answer 2

slow to recover, unable to stand/reluctant to move/collapse, hypothermic, pale MM, prolonged CRT, bleeding from incision

Question 3

how do you diagnose hemorrhage in a post-op patient?

Answer 3

ultrasound - hypoechoic fluid surrounding ‘floating’ organs

rads, abdominocentesis, PCV/TP

Question 4

what is the treatment for hemorrhage in a post-op patient?

Answer 4

stabilize the patient with fluids/blood products if needed

surgery

Question 5

what is ovarian remnant syndrome?

Answer 5

surgeon error where part of the ovary is left behind - results in the ovary becoming revascularized with signs of estrus/proestrus

Question 6

what is the treatment for ovarian remnant syndrome?

Answer 6

surgery to remove it

Question 7

how can ovarian remnant syndrome be prevented?

Answer 7

prevent by proper clamp placement & careful tissue handling

Question 8

what is required for a stump pyometra to occur?

Answer 8

CEH-P complex of residual uterine tissue - viable uterine body & progesterone (either endogenous or exogenous), diestrus

Question 9

how is a stump pyometra prevented?

Answer 9

removing all ovaries

Question 10

what causes fistulous draining tracts?

Answer 10

inappropriate choice of suture materials or accidental materials left in the abdomen

Question 11

how are fistulous draining tracts treated?

Answer 11

removing the offending materials

Question 12

what are adhesions?

Answer 12

fibrous tissue formation between abdominal structures - type of scar tissue, occurs during healing process

can also be trauma induced

Question 13

how can you reduce the incidence of adhesions?

Answer 13

gentle tissue handling

Question 14

what causes stump granulomas?

Answer 14

too much devitalized tissues (either ovarian or uterine pedicle), inappropriate suture materials or suture reaction, & potential contamination resulting in severe adhesions

Question 15

what is the treatment for a stump granuloma?

Answer 15

surgical removal

Question 16

what are the signs of an overt pseudopregnancy?

Answer 16

mammary development, lactation, behavior changes

Question 17

what is a mechanical cause of incontinence associated with OHE?

Answer 17

adhesions of the uterine body to the trigone - can occur immediately after surgery or 10 years later

Question 18

when can an overt pseudopregnancy occur in intact bitches?

Answer 18

45-60 days after estrus

Question 19

what causes the symptoms of pseudopregnancy?

Answer 19

prolactin

Question 20

how can spaying a dog cause an overt pseudopregnancy?

Answer 20

spaying at the end of estrus of during diestrus causes a very abrupt loss of progesterone (loss of corpus luteum)

Question 21

what is the treatment for false pregnancy?

Answer 21

natural regression

cabergoline

Question 22

what are some general causes of infection in post-op OHE dogs?

Answer 22

break in surgical asepsis

post-op infection (licking, dirty environment)

Question 23

what are some clinical signs associated with incisional infections in OHE dogs?

Answer 23

redness, heat, pain, swelling, +/- discharge

Question 24

how can patient induced trauma be prevented?

Answer 24

e-collar & owner compliance!!!! make sure sutures aren’t too tight

Question 25

how is patient induced trauma treated?

Answer 25

usually conservative - topical antibiotics +/- systemic antimicrobials & anti-inflammatories

Question 26

what are the clinical signs that support the presence of an abscess in an OHE dog post-op?

Answer 26

enclosed collection of pus that may or may not be painful, often soft/fluctuant but can be firm - patient may be febrile

Question 27

what do you do if your OHE patient develops an abscess at the incision site?

Answer 27

drain it, flush, antibiotics, & +/- surgical repair

Question 28

what is a suture reaction?

Answer 28

firm, hard, non-painful, non-reddened swelling that can be caused by patient reaction or the suture used was too large

Question 29

when does a seroma normally occur post op in OHE patients?

Answer 29

1 week

Question 30

why do seromas occur?

Answer 30

failure to obliterate dead space - soft, fluctuant, non-painful swelling

Question 31

how are seromas treated?

Answer 31

warm compress

Question 32

why does dehiscence occur?

Answer 32

failure to get a good closure of the linea alba/external rectus sheath

Question 33

when does dehiscence typically occur post-op?

Answer 33

3-5 days after - starts with swelling & serosanguinous discharge

Question 34

what are some examples of iatrogenic trauma?

Answer 34

lacerated spleen, lacerated bladder, accidental ligation, lost sponges/instruments

Question 35

what causes penile/urethral trauma?

Answer 35

not incising over the testicle - penis is directly under skin & SQ

Question 36

how do you prevent penile/urethral trauma in castration procedures?

Answer 36

always incise over the testicle

Question 37

hemorrhage in castration can lead to what complications?

Answer 37

profound blood loss/death, scrotal hematoma, & animal can bleed into the abdomen

Question 38

what are some causes of scrotal hematomas?

Answer 38

inappropriate ligation, subcutaneous bleeding, overactive post-op patients

Question 39

how are scrotal hematomas treated?

Answer 39

if mild - conservative severe - may require scrotal ablation

Question 40

how can you prevent infection in castrations?

Answer 40

make sure to keep aseptic technique - must use care to keep scrotum & scrotal hair from entering the surgical field

Question 41

what are the rates of anesthetic deaths in healthy small animal patients undergoing anesthesia?

Answer 41

1 in 1,000 - cats 1 in 2,000 - dogs

Question 42

what patients are you concerned about hypoglycemia for anesthetic procedures?

Answer 42

young, small breed animals with prolonged fasting pre-op

Question 43

what patients are you concerned about hypothermia for anesthesia?

Answer 43

smaller, pediatric patients

Question 44

how can you prevent hypothermia in surgical patients?

Answer 44

use warming agents during surgery - hot water blankets, bair huggers, hot water bottles