Large Ani. Sx.- Equine Female Urogenital 1

wilsbach's version from 2015-11-09 05:01


Question Answer
what is a bimaunal exam?palpate with One hand in the rectum, one hand in the vagina
(pic) good vs bad comformation
what is pneumovagina? what is the etiology of it?Involuntary aspiration of air into the vagina. Etiology is due to Faulty seal of the vulva because of poor closure or abnormal position: Sometimes associated with poor general condition, Tilted vulva (Frequently seen in old multiparous mares), Inversion of the lips of the vulva, and Associated with perineal lacerations
Often penumovagina can be caused by poor general can you help the situation by correcting this?Too skinny--> need to get their body fat up. So, Feed, deworm, float teeth, etc
what is the sx procedure to correct penumovagina?caslicks technique
indications for caslicks procedure?Correct vaginal contamination associated with poor confirmation of the vulva, To make a performance mare or filly more aesthetically acceptable (Some mares suck air into the vagina when performing and make objectionable noises)
describe the technique for caslicks procedurenfiltrate the lips of the vulva at the mucocutaneous junction with local anesthetic (anesthesia AND distends tissue)--> With scissors, remove remove a small band of skin and mucosa at the mucocutaneous junction From the most dorsal aspect of the vulva and extending distally to the floor of the bony pelvis. Suture the skin edges with #00 suture ( It is common to use a simple continuous suture pattern, The first and last bites of the suture, should be deep enough to prevent the suture from pulling out. If non-absorbable suture is used, it should be removed after approximately 10 days)
what happens/what must you do if you want to breed a mare who has had a caslicks procedure done on her?Breeding by natural cover usually requires opening the sutured tissue and then resuturing following breeding. It is sometimes possible to breed (under the Caslicks) by inserting a breeding stitch (A breeding stitch is a heavy piece of suture placed at the ventral end of the Caslick closure to prevent the stallion from disrupting the closure). Is usually possible to examine the mare with a tube vaginal speculum and to breed artificially without cutting the sutured tissue
what must you do if there is a mare with a caslicks procedure and she is going to be foaling?It is necessary to open the suture line prior to foaling, then It is best to freshen the edges and close the vulva as soon as possible after after the placenta has passed.
what is a permanent result of the caslicks procedure?Once the Caslick procedure is performed the seal of the vulva has been compromised so it is common to "suture the mare" for the rest of her reproductive life
what are complications of caslicks procedure?(1) Incomplete seal (2) Urine pooling (3) Suture sinus
when does urine pooling become a complication with caslicks?Urine pooling can occur when the closure is extended too far ventrally--> When the mare urinates the urine can't escape adequately and accumulates in the anterior vagina
what is "suture sinus", and why is it a complication of caslicks procedure?This is basically a draining tract that is wicking along the suture from the procedure. This can be eliminated by not going through the vaginal mucosa with the suture--> Insert the suture through the skin, through the cut edge on the same side, then through the cut edge on the opposite side and out through the skin
what is a technique for a variation of the caslicks procedure?Removal of ONLY mucosa and insertion of sutures slightly anterior to the mucocutaneous junction: All steps are the same as for the Caslick's procedure except the removed tissue is only the mucosa just slightly anterior to the mucocutaneous Junction. This does not compromise the seal of the vulva and as a result it is not necessary to continue to do the procedure for the breeding life of the mare. This is a good modification to use if the procedure is being done to make the mare or filly more acceptable (as in the case of a racing filly that makes an objectionable noise). This modification takes a little more time so it is not commonly done (so basically, you are cutting the mucosa of the lips but not the lips themselves, then sewing them together)
what is the GADD technique aka?episioplasty or perineal body reconstruction
describe technique for GADD procedureInvolves the surgical removal of a right angle triangle shaped piece of mucosa from the dorsal aspect of the vestibule (one arm of the triangle is at the mucocutaneous junction, one arm at the dorsum of the vestibule and the hypotenuse anterior and ventral). Once the tissue is dissected free the raw edges of the vulva and caudal vagina are approximated with simple absorbable sutures. This surgery reconstructs or increases the size of the perineal body which improves the natural seal that occurs when the perineal body presses against the brim of the pelvis [basically: triangle pieces of mucosa are removed from either side of the dorsal vestibule.then the vulva is apposed to caudal vagina simple continuous sutures]
perineal body transection can be used to tx what conditions?Used for both pneumovagina and urovagina
how do you do a perineal body transection?(aka perineoplasty aka Pouret’s technique) Involves the division of the attachments between the rectum and caudal reproductive tract, which Returns the vulva to a more natural conformation. A six cm horizontal incision is made between the rectum and vulva--> A six cm horizontal incision is made between the rectum and vulva-->Sutures are placed to close the incision ( Usually there is considerable disparity and the skin (ventral to the anus) must be sutured to the musculature dorsal to the vagina)
What is the Schumacher and Brink technique?Laproscope technique- tack repro tract up against dorsal body wall- reduces amount of pull on vulva so its not on an angle

Perineal lacerations

Question Answer
what usually causes perineal lacerations?These Occur Secondary to Problems Associated with Delivery of a foal
Describe what a 1st degree, 2nd degree, and 3rd degree perineal laceration is likeFirst Degree Laceration: Involves Only the Skin and Mucous Membrane. Second Degree Laceration: Involves the Perineal Body but Not the Rectum. Third degree laceration: Involves the perineal body, the dorsum of the vagina and the rectum
how would you repair a first degree perineal laceration?(skin and mucous membrane only parts involved) These Heal without Complication and don't require special care
How should you repair a second degree perineal laceration? (WHEN? HOW?)You CAN repair immediately if you want, but often best to wait 5 to 10 days after inflammation and infection have subsided. Debride the area over the tear - if the mucosa has been allowed to heal completely this will be essentially the same as the Gadd technique (The debrided area will be in the form of a right angle triangle with the hypotenuse facing ventrodorsal). Insert multiple simple absorbable sutures to appose the debrided tissue. Suture placement should proceed from deep to superficial. Insert skin sutures as in the Caslick procedure (pic is of GADD procedure for reference)
3rd degree perineal lacerations usually occur when, and in who? HOW?cccurs at the time of delivery. Usually a foot of the foal is forced through the dorsal vagina and into the rectum, then The mare's delivery efforts force the foal out and produce the laceration. Most commonly occurs in maiden mares.
WHEN is the best time to repair a 3rd degree perineal laceration?Repair immediately after occurrence is supposedly possible but the normal routine is to wait six weeks or, if the foal is alive, until it is weaned. So you just do immediate wound care at time of injury (also remember tetanus prophy, give parenteral abx for 4-5d, carefully clean wound for 4-5d)
Evisceration is unlikely but possible in a 3rd degree perineal laceration. How might you determine if it's a possible prob and what would you do?If there is minimal tissue between the laceration and the peritoneum consider apposing tissues with large interrupted sutures
what are some important pre-op considerations for repair of 3rd degree perineal laceration?Dietary management to maintain a soft unformed stool is extremely important. Consider: Lush pasture, Bran and grain with no long stemmed hay, Completely pelleted feed, Frequent administration of laxatives (Mineral oil, linseed oil, saline laxatives)
what kinda instruments must you consider for repair of 3rd degree perineal hernia?Deep lacerations require instruments with long handles
describe sx technique to repair 3rd degree perineal hernia? (dissection techniques- different repair options discussed in other cards)Rectum and vagina flushed with a mild disinfectant--> Vulvar lips are retracted with stay sutures--> Sharp dissection to separate the rectal floor from vaginal roof at the cranial aspect of the laceration-> Dissection continued laterally and caudally at the Junction of the rectal and vaginal mucosa to the mucocutaneous junction at the vulva--> The incision is extended laterally far enough so that the edges of the rectum can be apposed with minimal tension--> (from here there are diff options, see other cards)
describe how to do a modified goetz technique(disection as described in other card) The initial suture is placed slightly cranial to the most cranial aspect of the incision. Then, The suture is passed through the vaginal mucous membrane on the right side. It is inserted approximately 3 cm to the right of the cut edge of the rectum passing through the musculature up to but not through the rectal mucosa and then out through the cut edge of the rectum. After exiting through the cut edge of the right rectum it is inserted just ventral to the mucosa of the rectum on the left side and passed laterally approximately 3 cm to exit through the ventral aspect of the dissected rectum. It is inserted through the left vaginal mucosa from dorsal to ventral. Then back up through the vagina from ventral to dorsal. The suture is crossed to the right side and is inserted through the dorsal aspect of the vaginal mucosa. The two ends of the suture are tied with the suture pulled tight enough so that the raw suture can not be palpated at the incision site. Perineal body is reconstructed with a number of simple approximating sutures (The anal sphincter is repaired with simple interrupted sutures, The lips of the vulva are repaired as described for the Caslick's technique)
describe how to do the annes technique for repair of 3rd degree perineal laceration(dissection same as described in other card) A continuous horizontal mattress suture pattern is used to close the vaginal mucosa. Simple interrupted sutures are used to close the muscular layer of the rectum and the perineal body. A continuous horizontal mattress suture pattern is used to close the rectal mucosa. The anal sphincter is closed at a second surgery 2 to 3 weeks following the initial closure
describe the pull-back technique for repair of 3rd degree perineal lacerationThis technique is been described for very shallow third degree lacerations (The dissection is as previously described)The perineal body is reconstructed with simple opposing sutures. The most caudal aspect of the rectum is pulled back to the area of the anus and sutured ((ppt says: Tissue between rectum & Vagina is divided Anterior for a distance equal to distance between the anal sphincter and anterior aspect of laceration. Tension applied to bring Tissue to Anus. sutured)
which 3rd degree laceration technique is used for if the laceration is very shallow (If Anterior Aspect Relatively Close to Rectum)pull back technique
what is the post-op management regimen for repair of 3rd degree perineal laceration?Maintenance of a non-formed stool for 10 days ( Lush pasture, Bran and grain with no long stemmed hay, Completely pelleted feed, Frequent administration of laxatives (Mineral oil, linseed oil, saline laxatives) ), Tetanus prophylaxis, Parenteral antibiotics for four or five days, Remove non-absorbable sutures in 10 days