Written Exam - Complications of Ovariohysterectomy & Castration Flashcards
what is the #1 complication of OHE? what causes it?
hemorrhage - tearing the suspensory ligament, inappropriate tissue handling (pulling too hard on pedicle, rough handling), & inappropriate instrument handling
what may be some signs seen post-op indicative of hemorrhage?
slow to recover, unable to stand/reluctant to move/collapse, hypothermic, pale MM, prolonged CRT, bleeding from incision
how do you diagnose hemorrhage in a post-op patient?
ultrasound - hypoechoic fluid surrounding ‘floating’ organs
rads, abdominocentesis, PCV/TP
what is the treatment for hemorrhage in a post-op patient?
stabilize the patient with fluids/blood products if needed
surgery
what is ovarian remnant syndrome?
surgeon error where part of the ovary is left behind - results in the ovary becoming revascularized with signs of estrus/proestrus
what is the treatment for ovarian remnant syndrome?
surgery to remove it
how can ovarian remnant syndrome be prevented?
prevent by proper clamp placement & careful tissue handling
what is required for a stump pyometra to occur?
CEH-P complex of residual uterine tissue - viable uterine body & progesterone (either endogenous or exogenous), diestrus
how is a stump pyometra prevented?
removing all ovaries
what causes fistulous draining tracts?
inappropriate choice of suture materials or accidental materials left in the abdomen
how are fistulous draining tracts treated?
removing the offending materials
what are adhesions?
fibrous tissue formation between abdominal structures - type of scar tissue, occurs during healing process
can also be trauma induced
how can you reduce the incidence of adhesions?
gentle tissue handling
what causes stump granulomas?
too much devitalized tissues (either ovarian or uterine pedicle), inappropriate suture materials or suture reaction, & potential contamination resulting in severe adhesions
what is the treatment for a stump granuloma?
surgical removal
what are the signs of an overt pseudopregnancy?
mammary development, lactation, behavior changes
what is a mechanical cause of incontinence associated with OHE?
adhesions of the uterine body to the trigone - can occur immediately after surgery or 10 years later
when can an overt pseudopregnancy occur in intact bitches?
45-60 days after estrus
what causes the symptoms of pseudopregnancy?
prolactin
how can spaying a dog cause an overt pseudopregnancy?
spaying at the end of estrus of during diestrus causes a very abrupt loss of progesterone (loss of corpus luteum)
what is the treatment for false pregnancy?
natural regression
cabergoline
what are some general causes of infection in post-op OHE dogs?
break in surgical asepsis
post-op infection (licking, dirty environment)
what are some clinical signs associated with incisional infections in OHE dogs?
redness, heat, pain, swelling, +/- discharge
how can patient induced trauma be prevented?
e-collar & owner compliance!!!! make sure sutures aren’t too tight
how is patient induced trauma treated?
usually conservative - topical antibiotics +/- systemic antimicrobials & anti-inflammatories
what are the clinical signs that support the presence of an abscess in an OHE dog post-op?
enclosed collection of pus that may or may not be painful, often soft/fluctuant but can be firm - patient may be febrile
what do you do if your OHE patient develops an abscess at the incision site?
drain it, flush, antibiotics, & +/- surgical repair
what is a suture reaction?
firm, hard, non-painful, non-reddened swelling that can be caused by patient reaction or the suture used was too large
when does a seroma normally occur post op in OHE patients?
1 week
why do seromas occur?
failure to obliterate dead space - soft, fluctuant, non-painful swelling
how are seromas treated?
warm compress
why does dehiscence occur?
failure to get a good closure of the linea alba/external rectus sheath
when does dehiscence typically occur post-op?
3-5 days after - starts with swelling & serosanguinous discharge
what are some examples of iatrogenic trauma?
lacerated spleen, lacerated bladder, accidental ligation, lost sponges/instruments
what causes penile/urethral trauma?
not incising over the testicle - penis is directly under skin & SQ
how do you prevent penile/urethral trauma in castration procedures?
always incise over the testicle
hemorrhage in castration can lead to what complications?
profound blood loss/death, scrotal hematoma, & animal can bleed into the abdomen
what are some causes of scrotal hematomas?
inappropriate ligation, subcutaneous bleeding, overactive post-op patients
how are scrotal hematomas treated?
if mild - conservative
severe - may require scrotal ablation
how can you prevent infection in castrations?
make sure to keep aseptic technique - must use care to keep scrotum & scrotal hair from entering the surgical field
what are the rates of anesthetic deaths in healthy small animal patients undergoing anesthesia?
1 in 1,000 - cats
1 in 2,000 - dogs
what patients are you concerned about hypoglycemia for anesthetic procedures?
young, small breed animals with prolonged fasting pre-op
what patients are you concerned about hypothermia for anesthesia?
smaller, pediatric patients
how can you prevent hypothermia in surgical patients?
use warming agents during surgery - hot water blankets, bair huggers, hot water bottles
