Auer Ch 62 Uterus Ovaries

Front 1

Size and shape of ovary:

Back 1

The ovaries are bean or kidney shaped and approximately 7-8 cm by 3-4 cm.

Front 2

Where is the ovulation fossa located?

Back 2

ventral free border of the ovary

Front 3

What is the mesovarium?

Back 3

cranial aspect of the broad ligament

Front 4

Where does the mesovarium attach?

Back 4

dorsal border of the ovary

Front 5

What is the blood supply to the ovary?

Back 5

ovarian branch of the ovarian artery

Front 6

Where is the oviduct?

Back 6

extending from the cranial tip of the horn of the uterus to a loose attachment in the region of the ovulation fossa

Front 7

Structure of the oviduct:

Back 7

cranial or ovarian end of the oviduct is wider than the narrow, uterine end

Front 8

Entry of the oviduct to the uterus:

Back 8

tubal papilla

Front 9

What is the mesosalphinx?

Back 9

fold of the broad ligament containing oviduct

Front 10

What portions of the uterus are peritoneal/ retroperitoneal?

Back 10

The uterine horns and the majority of the uterine body are within the peritoneal cavity. The caudal aspect of the uterine body and the cervix are retroperitoneal.

Front 11

What is the broad ligament composed of and where attached?

Back 11

folds of the peritoneum and attached dorsally and laterally to the abdominal and pelvic cavity wall

Front 12

Broad ligament of the uterus AKA:

Back 12

mesometrium

Front 13

Major arterial supply to the uterus:

Back 13

uterine artery, the uterine branch of the vaginal artery, and the uterine branch of the ovarian artery

Front 14

Conditions of the ovary requiring surgery:

Back 14

neoplastic and non-neoplastic causing enlargement of the ovary with infertility

Front 15

Most common neoplastic condition:

Back 15

granulosa cell tumors, which is a sex-cord-stromal tissue tumor affecting granulosa and thecal cells

Front 16

Clinical signs of GCT:

Back 16

anestrus, intermittent or continuous estrous, or stallion like behavior.

Front 17

Diagnostic findings of GCT:

Back 17

ovarian enlargement on rectal palpation or ultrasound, a multicystic appearance on ultrasound, and elevated levels of testosterone and inhibin

Front 18

Non-neoplastic ovarian enlargement:

Back 18

hematomas, cysts, or abscesses.

Front 19

Removal of ovaries can be by:

Back 19

colpotomy, flank or ventral laparotomy, or flank laparoscopy

Front 20

Describe Colopotomy:

Back 20

standing position, sedation and analgesia, 4 to 5 cm incision into the vaginal wall at either the 2-4 o’clock position (right handed) or 8-10 o’clock position (left), ovary grasped with lidocaine soaked gauze, placement of the ecraseur, ecraseur is tightened until the ovary is freed, +/- losse apposition of vaginal incision

Front 21

Why are incision made at 2-4 or 8-10 position during colpotomy?

Back 21

avoid inadvertent laceration of bladder, rectum, or uterine branch of the urogenital artery

Front 22

Advantages of laparotomy ovariectomy:

Back 22

exteriorization of the ovary and direct control of hemorrhage

Front 23

Approaches to laparotomy ovariectomy:

Back 23

flank, ventral midline, ventral paramedian, or diagonal paramedian approach

Front 24

When is flank laparotomy chosen?

Back 24

recommended for an ovary less than 10 cm in diameter

Front 25

Flank approach generally chosen for ovariectomy:

Back 25

modified grid

Front 26

Describe modified grid:

Back 26

vertical incision midway between the last rib and the tuber coxae with the proximal aspect of the incision just dorsal to the dorsal margin of the internal AO muscle. Incision through the skin, SQ tissue and the external AO muscle. internal AO muscle and the transverse abdominal muscle bluntly separated

Front 27

Why ventral midline approach for ovariectomy chosen?

Back 27

very large tumors

Front 28

Describe diagonal paramedian approach:

Back 28

similar to parainguinal, bit closer to inguinal region than midline, over ovary

Front 29

How is ovary removed for all laparotomy approaches?

Back 29

Exteriorized, stay sutures placed in ovarian pedicle, TA-90 discharged, removed after incising between the 2 rows of staples

Front 30

Complications of laparotomy ovariectomy:

Back 30

hemorrhage, abdominal pain, incisional infections, and abdominal adhesions

Front 31

Advantages of laparoscopic ovariectomy:

Back 31

visualization of the surgical site, minimal tension on ovarian pedicle, direct hemostasis, avoidance of GA

Front 32

Methods of laparoscopic ovary removal:

Back 32

ligating loop sutures, stapling instruments, bipolar vessel sealing device

Front 33

Complications of laparoscopic ovariectomy:

Back 33

retroperitoneal insufflation, abdominal organ penetration, hemorrhage, loss of the ovary in the abdomen, post-operative colic or emphysema, incisional infection

Front 34

Conditions of the uterus potentially requiring surgical intervention:

Back 34

uterine cyts, pendulous uterus, neoplasia, pyometra, torsion, tears, or dystocia.

Front 35

Methods to remove uterine cysts:

Back 35

manual curettage or rupture, lavage with hypertonic solutions, electrocoagulation, laser ablation

Front 36

Most successful and accepted technique of uterine cyst management:

Back 36

Laser ablation

Front 37

Descibe surgical correction of pendulous uterus reported by Brink et al in 2010 EVJ:

Back 37

standing, laparoscopy, 3 incisions (midway between the last rib & tuber coxae at the level of the dorsal aspect of the IAO, 2 cm dorsal to this incision in the 17th ICS, and 6 cm distal and 2 cm caudal to the central incision) mesometrium infiltrated with lidocaine, polyglactin 910 number 6 continuous pattern to imbricate the uterus, starting caudally at the cranial body of the uterus and extending cranially to the horn, needle was passed through the seromuscular layer of the uterus then through the mesometrium 3-12 cm dorsal to its attachment to the uterus

Front 38

Describe total ovariohysterectomy:

Back 38

caudal ventral midline incision ovarian pedicles ligated and transected, broad ligament transection with vessel ligation, uterine body is transected as far caudal as possible, stump closed with a double inverting pattern

Front 39

Chaney et al 2007 direction of uterine torsion:

Back 39

59% of the torsion were clockwise

Front 40

Chaney et al 2007 foal survival:

Back 40

Overall 54%, 72% GE < 320 days, 32% GE > 320 days

Front 41

Direction to roll mare with uterine torsion:

Back 41

in the direction of the torsion, plank is placed on caudal abdomen to keep uterus in place

Front 42

Complication of rolling:

Back 42

uterine rupture

Front 43

Surgical management of uterine torsion:

Back 43

flank in a standing mare, grasp ventral gravid horn rock until returns to its normal position, or ventral midline celiotomy

Front 44

When is VM celiotomy chosen for uterine torsion:

Back 44

uterine rupture, tears or devitalization suspected, foal known to be dead, standing attempts unsuccessful

Front 45

How is uterine prolapse corrected?

Back 45

standing mare, replacement and eversion after lavage, if unsuccessful, mare anesthesized, hoisted to replace the uterus

Front 46

Association of uterine tears to pathogenesis:

Back 46

near tip of horn thought to be related to thrust of foals feet, in the body from force of limb or muzzle during dystocia

Front 47

Javsicas 2010 Vet Surg paper location of tears:

Back 47

horn > body, in horns, right > left

Front 48

Javsicas 2010 Vet Surg palpation of tears:

Back 48

All body tears palpable per rectum, 24% of horn tears

Front 49

Javsicas 2010 Vet Surg differences between medically and surgically managed uterine tears:

Back 49

none, other than medically managed mares had a higher RR at admission

Front 50

Javsicas 2010 Vet Surg overall survival:

Back 50

76%

Front 51

Javsicas 2010 Vet Surg parameters associated with survival:

Back 51

heart rate, total CO2 on admission

Front 52

Size and shape of ovary:

Back 52

The ovaries are bean or kidney shaped and approximately 7-8 cm by 3-4 cm.

Front 53

Ueno et al 2010 EVJ article most common site of periparturient hemorrhage:

Back 53

uterine artery in 24/31

Front 54

Ueno et al 2010 EVJ article other affected arteries involved in PPH:

Back 54

internal pudendal, caudal mesenteric, internal iliac

Front 55

Ueno et al 2010 EVJ article ruptures location:

Back 55

bifurcations, curves, or flexures within the vessels

Front 56

Ueno et al 2010 EVJ article histopathology affected vessels with PPH:

Back 56

smooth muscle atrophy with fibrosis of tunica media, disruption or calcification of tunica intima

Front 57

Arnold et al 2008 JAVMA PPH variables associated with outcome:

Back 57

tachycardia at presentation or during hospitalization, hemorrhage localized to vagina

Front 58

Treatment of PPH:

Back 58

avoiding excitement, restoring blood volume, controlling pain, facilitating hemostasis, preventing infection.

Front 59

Describe C section:

Back 59

caudal ventral midline incision, gravid horn exteriorized, stay sutures placed, uterotomy from hocks to feet, foal extracted, several cm of placenta peeled into lumen of uterus, closed in 2 layers, outer layer inverting

Front 60

Dystocia resolution:

Back 60

assisted delivery, controlled vaginal delivery, fetotomy, or cesarean section

Front 61

Assisted delivery:

Back 61

mare standing, assisted

Front 62

Controlled vaginal delivery:

Back 62

mare anesthetized, assisted delivery

Front 63

Where is the proper ligament of the ovary?

Back 63

connects the caudal end of the ovary to the uterus

Front 64

Complications of colpotomy:

Back 64

hemorrhage from the ovarian stump, eventration through the vaginal incision, abscessation or hematoma formation at the vaginal incision, and abdominal adhesions

Front 65

Chaney et al 2007 mare survival:

Back 65

84%, survival associated with gestational age and HR at admission, 97% with GE < 320 days, 65% > 320

Front 66

Options of ruminant c-section:

Back 66

standing paralumbar fossa celiotomy, ventral midline celiotomy, paramedian celiotomy, ventrolateral celiotomy, left oblique celiotomy

Front 67

Disadvantages of VMC approach ruminant c-section:

Back 67

dorsal recumbency is labor intensive and compromises CV status of cow, not good for daily cattle with abundant ventral vasculature

Front 68

Advantages of VMC approach ruminant c-section:

Back 68

better exteriorization of uterus for less risk of abdominal contamination, better for fractious beef cattle

Front 69

Disadvantages of paramedian ruminant c-section:

Back 69

dorsal recumbency is labor intensive & compromises CV status of cow, more hemorrhage because of multiple layers of tissue, poor holding power of closure

Front 70

Disadvantages of ventrolateral ruminant c-section:

Back 70

long incision in a vascularized region increases surgery time, surgeon is kneeling, increased post-operative incisional infections

Front 71

Advantage of ventrolateral ruminant c-section:

Back 71

good exteriorization of the uterus, especially with emphysematous fetus

Front 72

Back 72

chain ecraseur

Front 73

Back 73

kimberly rupp spay

Front 74

Back 74

willis-drop spay