Large Ani. Sx- Equine Female Urogenital 3

wilsbach's version from 2015-11-08 01:49

Uterine conditions

Question Answer
When does uterine torsion tend to occur...equine vs rumi?rumi: at term. equi: several mo prior to term
who will strain with uterine torsion- rumi or equi (why?)Rumi: Dam will not strain because the fetus is not in the pelvis. Mare shows abdominal pain (colic)
rumi vs equi: in uterine torsion, which will show asymmetry of the vulva?There is a definite asymmetry of the vulva in rumis. In equi, vulva looks symmetrical.
where does the twist tend to occur in uterine torsion for rumi vs equi?RUMI: The twist is usually caudal to the cervix (so cr vag) EQUI: Twist is usually anterior to the cervix (so ca uterus)
uterine torsion--> dx via palpation for rumi vs equiRUMI: The twist in the vagina can be felt on a vaginal and/or rectal examination. EQUI: Broad ligaments of the uterus can be felt as tense bands crossing above and below the body of the uterus (so in rumi you can feel vaginally too bc cr vagina twisted, whereas equi only feel on rectal palpation)
describe the non-sx management of uterine torsion in maresShort acting general anesthetic--> Cast the mare on her right side if the twist is clockwise and on her left if the twist is counterclockwise (therio says: Mare placed on the side TOWARDS which the uterus has rotated) Roll the mare in the same direction as the twist (assume that the uterus is going to stay in one place and that the mare is going to be rotated around the uterus). Best to roll the mare and then check rectally to determine the response
describe the sx management of uterine torsion in maresSurgical management Standing flank laparotomy is usually suggested (Controversy about the best side). The safest procedure is to raise the fetus and repel as compared to grasping an appendage and pulling. Right side for clockwise - left side for counterclockwise. The suggested routine is to correct the malposition, repair the abdominal wall and allow the fetus to be delivered in due time in the normal manner
at what point of uterine torsion will it be time to consider Csection?If the torsion is more than 270° it is difficult to correct by manipulation and it will probably be necessary to perform a cesarean to save the mare's life
Uterine rupture or laceration etiology?Almost always secondary to a difficult delivery
where is the most common place to have a uterine rupture/laceration?Most tears are in the uterine horns (much higher incidence in the right - no known reason)
which uterine horn tends to get more tears?R
how might a mare with a uterine tear present?Signs of peritonitis following foaling without evidence of GI complications
which is more effective management- medical or sx for a uterine tear?both equally effective
how effective is palpation for dx of uterine rupture?not very-- you can feel some of the body ruptures but most ruptures occur in the horns
best sx approach for repair of uterine rupture?ventral midline
What is the point of the Brown and McKinnon technique for urovagina?The result is an extended tunnel from the urethral orifice (under the transverse fold) to the caudal vaginal vault.

Equine Cesarean

Question Answer
what is the Window of opportunity for a live foal to be delivered via cesaran?In the mare once 2nd stage labor starts delivery must be accomplished in approximately 30 minutes or the foal will most likely be dead
5 factors which my predispose to a need for a c-section?(1) Bicornual pregnancy (rare) (2) Large fetus (seldom a problem in the mare-In the equine species the size of the dam is a major determining factor in fetal size) (3) Malposition which can't be easily corrected (Quite common because of of the long appendages of the foal) (4) Uterine torsion - that can not be corrected by other means (5) Deformities of the maternal pelvis
how do you do anesthesia for a C-section if the fetus is still alive?Use minimal amounts of barbiturates and maintain with gaseous anesthetics
what are the 4 approaches for a csection?ventral midline, Marcenac, Paracostal- flank, Paramedian
What approach for C-section is preferred?ventral midline
what is the Marcenac approach?Mare in right lateral recumbency with the legs extended slightly to the rear. A grid incision with the skin incision directed caudoventral from the middle of the costal arch to the fold of the flank (parallel to the fibers of the external abdominal oblique muscle
what is the paracostal approach?Low flank incision in which the skin incision is perpendicular to that of the Marcenac approach and is approximately 10 cm from the last rib
what is the paramedian approach?An incision made 4 to 6 inches lateral to the midline....The exposure is almost the same as in ventral midline approach, but there is a A greater problem with hemorrhage and a A greater problem with closure
is the incision into the uterus on the lesser cuvature, ventral, dorsal, or greater curvature?greater curvature
describe the technique of th C-section after you have gained access to the abd. cavityThe gravid uterine horn or, in the case of a bicornual pregnancy, the horn containing the hind limbs is exteriorized--> Incision is made on the greater curvature of the uterus--> The legs of the fetus are grasped and it is delivered (Care is taken to prevent tearing the uterus and contamination the peritoneal cavity with fetal fluids!) --> If the foal is alive, several minutes are allowed for blood the clear the placenta before clamping and cutting the umbilical cord--> The placenta is removed, if possible - if not possible, it is removed from the wound edges to prevent including it in the uterine closure---> The established procedure is to apply a simple continuous compressing suture to the cut edge of the uterus to control hemorrhage--> The uterus is closed with two layers of an absorbable suture using either a Cushing, Lembert or Utrecht suture pattern--> The peritoneum is not routinely sutured--> A variety of methods can be used to close the abdominal wall (Simple continuous suture, Simple interrupted suture, Cruciate suture) There is controversy concerning the necessity to close the subcutaneous tissue. The skin can be closed with suture or surgical staples
once you have pulled out the fetus from the uterus, what do you do about the umbilicus?If the foal is alive, several minutes are allowed for blood the clear the placenta before clamping and cutting the umbilical cord
how do you control hge of the cut uterus, and then how do you close it?apply a simple continuous compressing suture to the cut edge of the uterus to control hemorrhage then The uterus is closed with two layers of an absorbable suture using either a Cushing, Lembert or Utrecht suture pattern
what drug should you give post-op csection and why?Oxytocin - to encourage uterine contraction and expulsion of the placenta (Also abx if needed, and tetanus prophy)

Ovarian conditions + neoplasms + ovariectomy

Question Answer
how common are cystic ovaries?very rare~! Don't get trapped into this diagnosis on the basis of examination made during only one estrus cycle ( Usually if an abnormally sized ovary is reexamined at the next estrus cycle, it will be normal)
etiology of nymphomania?Not an ovarian abnormality but since it is commonly considered as one, it is discussed here
how do nymphomaniac mares present? Mares that are nymphomaniacs are usually very difficult to manage. Routinely show signs of psychic estrus yet will not stand to be bred. Many exhibit stallion like behavior and develop masculine conformation (thickened neck etc)
how do you manage a nymphomaniac mare?Most commonly the condition can not be associated with abnormal ovaries and an ovariectomy is usually of no value in managing the problem! If the abnormal behavior tends to be cyclical then an ovariectomy may be of value (unlikely). *Check for any reason for vaginal irritation (Improper closure of the vulva, Sutures not removed following third degree perineal laceration repair). Progesterone for extended periods has been effective in a few cases. Consider moving the mare to change her environment. Some mares have returned to normal following pregnancy
what is the most common ovarian neoplasm?Granulosa Cell Tumor
what are 6 types of neoplasms which have been reported in mare ovaries?Melanoma, Epithelioma, Cystademoma, Cystadenocarcinoma, Teratoma, Granulosa cell tumor (most common)
how do you dx ovarian neoplasm? (2)(1) Enlarged ovary on rectal examination that stays enlarged through several estrual cycles or for prolonged periods (2) Changes in the estrual cycle (Usually anestrus, occasionally showing nymphomania)
which part of the estrous cycle is a mare usually stuck in if she has ovarian neoplasia?anestrus
how do you manage ovarian neoplasia?ovariectomy
7 approaches to an ovariectomy?Flank, Inguinal, Ventral midline, Colpotomy, Paramedian, Parainguinal, Laparoscopic
when would you use flank approach for ovariectomy?Reasonable if the mare is of a temperament that will allow a standing procedure and if the ovary is relatively small (can be used in anesthatized mare)
what is the difficulty with the ventral midline approach for a ovariectomy?It is difficult to ligate the ovarian vessels
when is colpotomy a useful approach for a ovariectomy?Acceptable approach to remove a normal sized ovary - doesn't work well for an enlarged ovary
what is probably the best approach for ovariectomy?Parainguinal! Probably the best approach because it is easier to get to the ovary and the ovarian vessels (the external incision is closer to the ovarian attachment) and as a result less effort is required to ligate the ovarian vessels
surgical technique for ovariectomy (for all but the colpotomy and laparoscopic techniques)Approach as described--> Ovary identified and heavy stay sutures are inserted into the ovary--> Traction is applied to bring the ovary to the incision--> If the ovary is cystic, use a large bore needle to drain it--> Carefully dissect to identify the ovarian vessels--> Ligate vessels and cut the supporting ligament(Some surgeons use Staples (TA 90 applied twice) rather that ligatures)--> Abdomen closed in routine manner
Surgical technique for the colpotomy approach of ovariectomy?The mare should be kept off feed for 24 hours. Performed standing with the mare sedated and with epidural anesthesia. The tail is wrapped and the perineum is surgically prepared. The vagina is flushed with a warm non-irritating antiseptic solution--> Excess antiseptic solution is siphoned from the vagina--> A stab incision is made at the two or 10 o'clock position dorsal to the cervix with care taken to avoid the aorta--> The incision is enlarged with coned fingers and the hand--> A surgical sponge is firmly attached to a long segment of suture and soaked in local anesthetic--> The soaked surgical sponge is carried into the abdomen and wrapped around the ovarian pedicle--> After a short time the sponge is removed and a chain ecraseur is introduced--> The ovary is placed through the ecraseur and the chain tightened to cut the supporting structures--> The ovary and the ecraseur are removed--> The incision is allowed to heal as an open wound--> The mare should be placed in cross ties and prevented from straining until the incision heals (5 to 7 days)
will an ovariectomy prevent a mare from cycling?( Owners sometime inquire about the possibility of performing an ovariectomy to prevent a mare from coming in heat.) There might be some modification of the heat cycle or the intensity of the signs of estrus in the ovariectomized mare but an ovariectomy will not prevent a mare from cycling
wut dis? chain ecraseur (used in Colopotomy). tool used for colopotomy- loop goes around ovary and then handle tightens loop crushing it
If you see severe urine scalding like this, what might you suspect? has bladder calculi- every time bladder has small amount of urine- she urinates but bc she does this so frequently- she gets lazy and stops squatting. need to perineal uretrotomy to remove calculi.