Approach to Examining the Female Tract Flashcards
Poppy started her first season in June 2018.
She had a routine ovariectomy in the first week in September 2018
In the second week of January 2019, she had vulval swelling but no discharge
Mammary gland enlargement was present last week
- What diagnostic tests might be useful in the case?
•Look at history, there is some vulvar swelling – normal time between oestrous cycles in dogs is 7 months
–Common to be interval of 3 months or so after the end of oestrous to neuter
–Interval makes us suspicious of ovarian remnant maybe?
–Hormonal environment if she had come back into oestrus – high oestrogen in January. Ask questions about her behaviour, would she lick discharge away before we could see
–Behavioural changes – prooestrous vs oestrus, did she seek males? Any swelling?
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–Mammary gland enlargement – at least 4 caudal glands are enlarged, so less likely. Hormonal environment that causes this – some aspect of prolactin that might cause behaviour changes but progesterone causes the enlargement of the glands.
–Almost certainly has an ovarian remnant as it has enlarged mammary glands, from progesterone! Which comes from ONLY the ovary – so we are suspicious on the history
–Could do a GnRH stimulation test or quite simply, measure progesterone! Will have high levels of progesterone for 2 months past oestrous. Could scan to look for it – can be difficult to see, but could try. If it was a cow/horse – might do rectal to see if we can feel it
What things should you try to get from the clinical history when examining a female reproductive tract
- History taking should be relevant and specific to the species, age and presentation of the clinical problem
- What you say will be heard by the owner and will influence their opinion of you as a veterinary surgeon
- Climate / nutrition / stress / teratogens may be implicated in reproductive disease in some species.The owner may not be aware of the impact/status of these parameters and this may require you to undertake further investigation
What is some important information you want to get from the owner before performing the physical exam?
- Has the animal previously been pregnant?
- Could the animal currently be pregnant?
–Is it possible that it is currently too early to detect?
–If this is possible you MUST remember this during your examination, especially if you consider breaching the cervix
If the female that has been recently mated, what stuff do yu want to do to find out about previous breeding records?
In the female that has been recently mated:
- When were exact dates of mating?
- Is the male of proven fertility (when was this performed)?
- Has pregnancy been confirmed: how and by whom?
- What clinical signs have been demonstrated?
- Has any vulval discharge been noted / when and what colour was it?
What do we want to know with regards to infectious disease risk in a female before any examination?
•Does this female pose or potentially pose a infectious disease risk?
–Could be infectious to us - zoonotic e.g.
- Leptospiral abortion/stillbirth in cows
- Brucella abortion in cows and sows
–Transmission of venereal / other pathogens as a result of clinical examination
•Could be transmissible to another female? By contaminating by examining this one and then going onto the next one etc.
–Could there be any requirement to report this condition or is it notifiable? e.g.
•Contagious equine metritis (CEM) [Taylorella] in mares
Name a notifiable reproductive disease in the mare
Contagious equine metritis (CEM) [Taylorella]
Name 2 zoonotic risks with a reproductive exam in cows and sows
–Could be infectious to us - zoonotic e.g.
- Leptospiral abortion/stillbirth in cows
- Brucella abortion in cows and sows
If this female poses or potentially pose a infectious disease risk to other horses or ourselves, as the vet - what should we consider doing?
Consider:
–Tail bandages, tail ties, rectal sleeves on tail
–Disposable gloves
–Parturition gowns (N.B. sleeves of underclothes)
–Footwear
–Disposable/sterilisable instruments
Before any physical examinations, what else should you consider that might be required?
•Is any bacteriological screening required?
–e.g. CEMO, Klebsiella, Pseudomonas in mares
•Is any virological screening required?
–e.g. FeLV in queens
•Are any genetic tests required?
–Cats: polycystic kidney disease
–Dogs: many eye disease (PLL, Cataract, PRA), von Willibrands, hip dysplasia etc.
–Arab horses: Severe Combined Immuno-Deficiency (SCID)
What do we vaccinate horses again whilst they are pregnant?
Horses – vaccinate for herpes virus during pregnancy
What do we vaccinate ewes again whilst they are pregnant?
Clostridial vaccination to pregnant ewes and pigs to prevent disease in neonates
What is a relevant pre-mating vaccine in egg laying birds?
•Relevant pre-mating vaccination?
–e.g. Salmonella in egg laying birds
When do we vaccinate for canine herpes virus with regards to pregnancy?
e.g. Canine herpes virus after mating (when required) to prevent abortion
Why do we perform a general clinical examination before a reproductive exam
•To ensure that there are no diseases or defects that preclude from getting pregnant / successfully taking pregnancy to term
–Body size, body condition
–Dentition, feet (predisposition to disease)
–Ventral hernia
•And to rule out hereditary defects
–Hip dysplasia in dogs etc
When we examine the mammary glands, what are we looking for?
- Correct number of teats
- Evidence of stage of the oestrous cycle
- Presence of current disease
- Evidence of previous disease
When examining the perineum of a horse, what are we looking for - what is a common conformation problem?
- The first line of defence
- Normal alignment of the vulval lips
- e.g. Mare – horses commonly have abnormal conformation of the vulvar and can be difficult to get pregnant and they often become infertile. In many horses, the anus (because of loss of fat) tends to sink inwards, and drags the vulvar with it – the angle of vulvar changes – no longer vertical, it becomes tilted. So when horse poos, get contamination of vulval lips – material can be aspirated into vestibule and can cause vaginitis and vestibulitis etc.
Describe what can be seen here on the ultrasound of the uterus
Is it normal or abnormal?
Ultrasound of normal oedema pattern of mares’ uterine horn during oestrus
Uterus in oestrous, oedema pattern. Looks like a wheel. Uterus is oedematous due to rise of oestrogen, causing accumulation of fluid within endometrial folds – dark patches are these fluid folds
Describe what can be seen here on the ultrasound of the uterus
Is it normal or abnormal?
Ultrasound of abnormal fluid in mares’ uterine horn
– free luminal fluid in uterus – can see anechoic presence – indicating free fluid, which is ALWAYS ABNORMAL. Likely to be a puss like material or blood like, most likely pus – endometritis. Might take a sample to see whats there
Holly had a routine ovariectomy in the November 2018 when she was 6 months old
In the last week of January 2019 she started what the owner thought was calling behaviour. The behaviour disappeared but returned yesterday and can be elicited by grasping her neck.
What diagnostic tests might be useful in the case?
–Do we need any test? This cat is showing oestrus behaviour – why else might a young female queen show these signs? Few reasons why:
- Oestrogen secreting tumour – so an ovary
- Adrenal tumour secreting oestrogen – but she young so this is unlikely
- Has someone given it oestrogen? Unlikely, why would someone do this?!
- Ovarian remnant likely. If unconvinced – measure oestrogen but an easier thing is to take vaginal smear to look for kornified cells. If uncertain or owner said she came calling last week, so cytology isn’t the best, could make her ovulate – give her short acting GnRH preparation or hCG, then progesterone will go up, and we can measure progesterone in 1-2 weeks time
–Could get false negative if just measuring oestrogen as she may be in the part of oestrous where the levels are decreasing, depending when owner brings her to you
