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Uterine Disorders, Non-neoplastic 1021

Uterine Disorders, Non-neoplastic Client Education
Sheet
VetBooks.ir Diseases and Disorders

• ± Collapse
BASIC INFORMATION
• ± Devitalized prolapsed tissue ishemic), cesarean section to deliver remain-
ing fetuses if still viable, or ovariohysterec-
Definition tomy (OHE) if tissue is devitalized
• Uterine torsion is an uncommon condition Etiology and Pathophysiology • Prolapsed tissue is cleaned and replaced
involving twisting of one or both uterine • Torsion: unknown cause; may be due to with combination of manual manipula-
horns or the uterine body on its own axis. fetal or bitch activity or abnormal uterine tion externally and abdominal surgical
• Uterine prolapse is a rare condition where the motility (inertia) with continued fetal activ- approach. OHE may be necessary if tissue is
uterus everts through the cervix and vagina ity; pyometra, mucometra, hydrometra, or devitalized.
(one or both horns may be involved). hematometra; neoplasia
• Prolapse: eversion of the tip of a uterine horn Acute General Treatment
Epidemiology followed by excessive straining (due to any Torsion:
SPECIES, AGE, SEX cause) during uterine involution or eversion • Broad-spectrum antibiotics (ampicillin
Either condition may occur at any age or of the tip of a horn due to uterine inertia 10-22 mg/kg IV q 6-8h with enrofloxacin
parity. Uterine torsion may occur unrelated followed by normal uterine contraction 10-15 mg/kg IM, SQ, or IV q 24h;
to pregnancy. Prolapse is more common in patterns maximum of 5 mg/kg q 24h IM in cats) as
queens. soon as diagnosis is confirmed and when
DIAGNOSIS devitalized tissue is present
RISK FACTORS • If the horn is severely ischemic or necrotic,
• Large litter size may predispose to torsion. Diagnostic Overview do not detorse the affected horn(s) because
• Any condition causing excessive straining • Torsion: based on cessation of labor or acute this may result in reperfusion injury and
(e.g., dystocia, necrotic vaginitis, severe cys- abdominal pain. Ultrasound may be sup- allow systemic circulation of bacteria
titis, diarrhea, constipation) may predispose portive, but diagnosis is conclusively based and toxin; perform OHE with torsion
to prolapse. on exploratory laparotomy. in situ.
• Prolapse: based on physical exam findings • If only one horn is affected, partial OHE
ASSOCIATED DISORDERS of prolapsed tissue from the vulvar lips may be performed, oversewing the uterine
Both may be associated with shock, sepsis, after parturition. Inability to locate the body at the level of the bifurcation.
disseminated intravascular coagulation, multiple uterus on ultrasound of the abdomen is Prolapse:
organ dysfunction syndrome, and systemic confirmatory. • Initially, digital pressure and inversion of the
inflammatory response syndrome. horn into itself starting distally and working
Differential Diagnosis toward the tip. Applying 50% dextrose solu-
Clinical Presentation Uterine torsion: tion topically and waiting a few minutes for
DISEASE FORMS/SUBTYPES • Pyometra osmotic detumescence may decrease size of
• Torsion may involve one or both horns and/ • Uterine rupture prolapsed tissue.
or the uterine body and may be from 90° • Uterine inertia (primary or secondary) • Care should be taken to invert the entire
to >2160° (six complete turns described in • Acute gastrointestinal disorders (bloat, gastric horn to its tip (this should be confirmed
one report). or mesenteric torsion), other causes of the visually).
• Prolapse occurs in the puerperal period and acute abdomen • Oxytocin after complete inversion for uterine
may involve one or both horns, be partial or Uterine prolapse: involution
complete, and occurs rarely before delivery • Bladder or vaginal prolapse • If manual reduction is impossible, uterine
of all fetuses. • Vaginal rupture and evisceration amputation is indicated.
• Vaginal, cervical, or uterine neoplasia
HISTORY, CHIEF COMPLAINT Behavior/Exercise
Torsion: Initial Database If the dam is stable, she may be allowed to
• History of no progression from stage 1 to • CBC: ± leukocytosis, ± toxic neutrophils, nurse any neonates.
stage 2 of labor or cessation of ongoing stage evidence of dehydration
2 labor • Serum biochemistry profile: normal to Recommended Monitoring
• Acute abdominal pain increased renal and hepatic values and CBC, serum biochemistry profile
• Shock electrolyte disturbance, depending on
Prolapse: duration PROGNOSIS & OUTCOME
• History of prolonged straining (labor, • Abdominal ultrasonography
other) ○ Hemorrhage into uterine lumen and • With early diagnosis, the prognosis is good
• Tissue protrudes from the vulvar lips. edema (hypoechogenicity) of the uterine for survival.
• Queens may present up to 48 hours after wall adjacent to the torsion • With systemic illness, the prognosis for
delivery of last kitten. ○ Fetuses may be viable or dead. survival is guarded to poor.
○ Intraluminal gas may be present. • Recurrence is unlikely.
PHYSICAL EXAM FINDINGS
• Acute abdominal pain and splinting TREATMENT PEARLS & CONSIDERATIONS
• Vocalization
• Hemorrhagic vulvar discharge Treatment Overview Comments
• Excessively vulvar licking Treatment goals: • Caution should be taken when handling
• Abdominal distention • Patient stabilization (IV fluid resuscitation, either condition because the uterine wall
• Tachycardia and tachypnea pain control) may be friable.
• Pale mucous membranes with increased • Exploratory laparotomy for correction of • Do not administer calcium or oxytocin to
capillary refill time torsion (if tissue is not necrotic or severely patients suspected of torsion or prolapse.
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