Surgery - Mammary, C-Section, Pyometra

Front 1

Mammary Glands
-Dogs
-Cats

Back 1

Dogs (5 pairs)
-Cranial thoracic
-Caudal thoracic
-Cranial abdominal
-Caudal abdominal
-Inguinal

Cat (4 pairs)

Front 2

Mammary glands
-dog blood supply (cat)

Back 2

1-3 (1-2):
-lateral thoracic a. from axillary a.
-cranial superficial epigastric a. from internal thoracic

4-5 (3-4):
-caudal superficial epigastric a. from external pudendal

Front 3

Mammary glands
-lymphatic drainage in dog

Back 3

1-3:
-axillary lymph center

3-5:
-inguinofemoral Lymph center

*3 in the dog can go to either the axillary or inguinofemoral lymph center

Front 4

Mammary glands
-lymphatic drainage in cat

Back 4

1-2:
Axillary lymph center

3-4:
-inguinofemoral lymph center

*2 can drain to inguinofemoral
*3 can drain to axillary

Front 5

Mammary tumors
-most common origin

Back 5

-epithelial ---> carcinomas
-50% benign

Front 6

Mammary tumors
-typical signalment

Back 6

-intact female

Front 7

Mammary tumors
-risk factor

Back 7

Hormones
-risk of tumor increases with estrus

Front 8

When a female dog is spayed before the 2nd estrus, the risk of mammary tumor development is:

Back 8

8%

Front 9

Mammary tumor
-glands most commonly affected

Back 9

-caudal

Front 10

Mammary tumors
-things to be suspicious of for benign tumors

Back 10

-small
-well circumscribed
-firm on palpation

Front 11

Mammary tumors
-thing to be suspicious of for malignant tumors

Back 11

-rapidly growing
-poorly circumscribed
-invasive growth (fixation to skin or underlying tissue)
-ulcerated or inflamed

Front 12

Mammary tumor
-diagnostics and reasons

Back 12

Physical exam
-look for other affected glands and lymph node enlargement

CBC/Biochemistry/UA
-mature/geriatric animals

Cytology
-malignant tumors often lack signs of malignancy

Biopsy
-concern with how the tumor can be resected if margins may not be wide enough
-concurrent illness preventing treatment

Front 13

Mammary tumor
-how staging is determined

Back 13

-thoracic radiograph ---> distant metastasis

-abdominal US ---> iliac LN involvement from proximity to caudal glands

Front 14

Mammary tumor
-surgery indicated for

Back 14

All tumors except:
-inflammatory carcinoma
-distant metastasis

Front 15

Mammary tumor
-margins

Back 15

>0.5-1.0 cm or invasive: 2-3 cm margins

>3 cm, extensive fixation, LN involvement ---> body wall excision

Front 16

Mammary tumor
-effect of OHE

Back 16

-prevents formation of new benign tumors
-no influence on malignant tumors

Front 17

Lumpectomy
-describe

Back 17

-removal of benign nodules <0.5 cm
-includes the margin of rim of normal tissue

Front 18

Simple mastectomy
-describe

Back 18

-for tumors centrally located in gland but less fixed to deeper tissue
-2-3 cm margins with fascia and first muscle layer if attached to deeper tissue

Front 19

Regional mastectomy
-describe

Back 19

Enbloc removal of confluent glands

Thoracic gland tumor
-remove glands 1-3
-include axillary LN if enlarged or positive for metastasis

Caudal abdominal/inguinal gland tumor
-remove glands 3-5
-include superficial inguinal LN!!!

Front 20

Why include the Superficial Inguinal LN for a regional mastectomy of the Caudal abdominal or Inguinal mammary glands?

Back 20

-superficial and closely related

Front 21

Chain Mastectomy
-indications

Back 21

-multiple nodules
-tumors of 3rd gland (lymph drainage to axillary and inguinofemoral lymph centers; suspected malignancy)
-masses > 1cm with fixation
-new primaries

Front 22

Chain mastectomy
-describe

Back 22

unilateral

bilateral
-remove >95% mammary tissue
-stage 4-6 wks apart for decreased tension
-single episode

****perform OHE before tumor removal!!!

Front 23

Mastectomy
-post-op care/management considerations

Back 23

-dead space prevention
-analgesia
-monitor

Front 24

Mastectomy
-analgesics

Back 24

Opioids
-pure Mu agonists****

NSAIDs

Front 25

Mammary tumor
-prognosis dependent on

Back 25

-histologic tumor type and invasiveness
-presence of metastasis (LN vs. distant)
-tumor size/duration

Front 26

Inflammatory Carcinoma
-describe

Back 26

-rapidly progressive, highly metastatic tumor of the mammary glands

Front 27

Inflammatory carcinoma
-treatment

Back 27

-None ----> NO Surgery

Front 28

Inflammatory Carcinoma
-why shouldn't surgery be performed??

Back 28

-it is not beneficial due to the severity of the tumor and the high rate of metastasis

Front 29

Inflammatory carcinoma
-signs-

Back 29

-massive edema
-erythema
-firm
-painful
-multiple glands

Front 30

Feline Mammary tumors
-treatment

Back 30

Radical mastectomy
-wide margins
-inguinal LNs
-axillary LNs if there is metastasis
-fascia and a layer of abdominal muscle
-no need to stage bilateral mastectomy

Front 31

Feline Mammary tumors
-prognosis
-why

Back 31

Guarded
-tumor type
-metastasis
-surgical dose

Front 32

C-section
-indications

Back 32

-dystocia
-fetal distress (HR < 150-180)
-systemic disease signs
-high risk pregnancy (previous dystocia, at risk breed, old dog, large litter)

Front 33

C-section
-criteria

Back 33

-prolonged gestation (>68-72 days)
-lack of progression from Stage I to Stage II in 12-24 hrs
-failure to deliver within 36 hrs of rectal temp below 100F
->4 hrs between neonates
-fetal obstruction

Front 34

Dystocia
-diagnostics

Back 34

-physical/vaginal exam
-radiographs
-bloodwork

Front 35

Neonatal resuscitation

Back 35

-clear oral cavity/nose
-physical stimulation
-warmth
-oxygen delivery if bradycardic

DON'T:
-swing
-give doxaprim or atropine

Front 36

Neonate unresponsive due to opioid
-drug

Back 36

-sublingual naloxone

Front 37

Neonate has asystole
-drug

Back 37

-umbilical vein epinephrine

Front 38

Cystic Endometrial Hyperplasia-Pyometra Complex

Back 38

-Stage 1: cyctic endometrial hyperplasia (progesterone)

-Stage 2: diffuse plasma cell infiltration

-Stage 3: pyometra

-Stage 4: chronic endometritis, myometrial fibrosis (carring --> infertility)

Front 39

Pyometra
-signalment

Back 39

-intact ******* during diestrus

Front 40

Pyometra
-effects of progesterone

Back 40

-endometrial glandular stimulation
-suppression of uterine contractions
-reduced response of uterine mononuclear cells

Front 41

Pyometra
-bacteria

Back 41

E. coli
-adheres to endometrial receptors
-originates from perianal flora
-concurrent cystitis

Front 42

Pyometra
-clinical signs

Back 42

-PU
-vomiting
-lethargy
-inappetance
+/- vaginal discharge

Front 43

Pyometra
-physical exam findings

Back 43

-painful abdomen
-SIRS (pyrexia, tachycardia, tachypnea)