Ch.43 Male Reproductive Disorders Flashcards

1
Q

If a stallions penis is injured while erect, it may swell rapidly and massively from vascular rupture and hemorrhage. Hemorrhage usually originates from where?

A

superfiicial penile vessels in the plexus external to the tunic albuginea

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2
Q

testicular anatomy

A
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3
Q

stallion penis anatomy

A
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3
Q

stallion penis anatomy

A
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4
Q

stallion accessory sex glands

A
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5
Q

The penis of bulls is susceptible to injury during mating due to

A

vigorous thrust that accompanies copulation

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6
Q

Bulls: during copulatory thrusting in which the penis is bent, what occurs?

A

The tunica albuginea ruptures on the dorsal surfeace of the penis opposite teh attachment of the retractor penis mm

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7
Q

consequence of bulls with penile hematomas

A

larger hematomas restrict full retraction of the penis and result in prolapse of the prepuce from the sheath

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8
Q

Diagnosis of penile hematoma

A

presence of a swelling immediately cranial to the scrotum– initially soft, fluctuant and painful, then becomes firm as clot organization and fibrin formation progress

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9
Q

Main ddx for penile hematoma

A

extensive preputial laceration
others include:
rupture of urethra
abdominal hernia
chronic, fibrous adhesions

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10
Q

What signs are typically not seen with penile hematoma?

A

-dysuria
-other signs of urethral rupture or blockage, such as extensive preputial cellulitis and water belly, INC BUN/CREA, tissue necrosis

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11
Q

What are possible sequelae to penile hematomas:

A

abscess formation
fibrous adhesions
venous shunts that communicate between the CCP an other peripenile vasculature or corpus spongiosum penis (CSP)
-failure to find females vagina and/or ejaculate (dorsal nerve of the penis are damaged)
-not able to have full erection

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12
Q

Approximately what percentage of bulls with hematomas that are treated conservatively are reported to return successfully to breeding?

A

approx 50%

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13
Q

Advantages of surgical correction for penile hematoma:

A
  1. removing the blood clot before extensive fibrous adhesions develop
  2. permitting removal of a blood clot from w/in the body of the CCP itself, therefore reducing the chance of blockage of the cavernous filling
  3. suturing the tunica albuginea, which should reduce the chance of recurrence of the condition after return to service and likelihood fo developngi vascular shunts tha twill prevent complete filling of the CCP
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14
Q

When should surgical correction of a penile hematoma not the attempted?

A

-before coagulation of the extravasated blood
-once significant fibrin formation is present, px of successful correction is greatly reduce and should be attempted only in valuable bulls

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14
Q

When should surgical correction of a penile hematoma not the attempted?

A

-before coagulation of the extravasated blood
-once significant fibrin formation is present, px of successful correction is greatly reduce and should be attempted only in valuable bulls

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15
Q

Recommendations before electing surgical intervention for penile hematoma in bulls

A

-manually extending penis– extended 6 to 8 inc or more beyond heath orifice and penile sensation remains= good px
-if engorgement of the distal penis does not occur after careful stimulation w/ the electroejaculator, blockage of the CCP should be suspected and reduces the prognosis
-abscesses- poor risk b/c severe restrictive adhesions that usu develop

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16
Q

Conservative tx of penile hematomas

A
  • antimicrobials (prevention of abscess formation)- penicillin best d/t usu T. pyogenes infection
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17
Q

Reasons for phimosis in stallions

A

stenosis preputial orifice
-sequelae to injury leading to cicatrix formation (rarely congenital
-infectious: eq coital exanthema & dourine

Tumors: melanomas or SCC
Habronema granulomas

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18
Q

Define phimosis

A

inability to extend the penis into the prepuce

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19
Q

Treatment of phimosis in stallions

A

-diuretics and exercise (tx edema)
-cryotherapy
-emollient antibiotic preparations and hydrotherapy
-systemic antibiotics
NSAIDS
-sexual rest
-sx removal of cicatrix scars (sometimes successful)
-habronemiasis: systemic insecticides or ivermectin– kill larvae

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20
Q

What gene is linked to weak or failed development of the preputial mm, leading to habitual preputial eversion, which predisposes to injury in bulls?

A

Polled gene

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21
Q

Causes of phimosis in bulls

A

trauma to prepuce

congenital anomalies: such as short penis, short retractor mm

developmental anomalies: pseudohermaphrodites

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22
Q

Phimosis is rare in small ruminants, but may be due to:

A

-congenital -acquires- d/t adhesions or preputial scarring with trauma or balanoposthitis

–acquired phimosis in sm ruminants may be d/t: ulcerative prosthitis d/t Corynebacterium renale, C. pilorum or, C. cystitidis

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23
Q

define paraphimosis

A

inability to retract the penis into the prepuce

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24
Q

define priapism:

A

persistent erection

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25
Q

Penile paralysis in stallions likelyd evelops sceondary to:

A

insuffieicent tone of the trator penis mm

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26
Q

Motor innervation of the retractor penis mm is supplied by

A

alpha adrenergic fibers

**alpha adrenergic blocking drugs, such as phenothiazine derivative tranquilizers are admin– paralysis of mm can cause penile prolapse

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27
Q

Development of priapism:

A

-engorgement of CCP with blood and although the horse may not achieve full erection, penis is not flaccid
-penis fails to detumesce, CO2 tension in the CCP increases resulting in INC blood viscosity& subsequent venous occlusion where collecting veins joint the cavernous spaces
-edematous swelling fails of corporal trabeculae further dec venous outflow, thus INC the likelihood of irreversible venous occlusion, fibrosis and arterial occlusion

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28
Q

Causes of penile paralysis

A

-exhausted or debilitated horses
-myelitis
-spinal injury
-severe injury to penis

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29
Q

What is prognosis for stallion paraphimosis

A

px for recovery- guarded to grave as chronicity of the problem increases

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30
Q

Treatment of paraphimosis

A

-retaining the penis within the prepuce: purse string or pro-bang or bottle technique
-injecting bezotropine mesylate (drug induced)
phenylephrine into CCP
-flush CCP with heparinized LRS with 12 gauge needs to remove sludged blood (priapism of 12 to 24 hours duration)
-amputation if blood clot present, px is poor

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31
Q

Causes of paraphimosis in bulls

A

-same as phimosis
plus: penile tumors, parasitic invasion, traumatic or spinal dz, inadvertently severe retractor penis mm, physical trapping d/t constricted prepuce after injury
-spinal injury
-rabies

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32
Q

C/S of uroliths in stallions

A

-dribbling of urine with chronic cystitis
-dysuria and stranguria
-occasional hematuria
-recurrent colic
-stilted, painful gait in hind quarters

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33
Q

Define balanitis

A

inflammation of the glans penis

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34
Q

Define posthitis

A

inflammation of prepuce

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35
Q

define balanoposthitis

A

inflammation of prepuce and glans penis

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36
Q

Causes of balanoposhtitis

A

dourine
equine herpesvirus 3 (EHV-3)
miscellaneous bacteria
parasites

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37
Q

Causative organism of equine coital exanthema

A

EHV-3

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38
Q

How do stallions become infected with EHV-3

A

Inapparently infected mare transmits the virus to a stallion at time of breeding

**vice versa

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39
Q

Stallion C/S of Equine coital exanthema

A

systemic manifestations: dullness, anorexia and fever
-vesicles: up to 1.5 cm, penis then prepuce
-pustules, with raised borders– slough and ulcerate
-refuse to breed mares (when leasons are present)
–healed lesions– depigmented spots

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40
Q

Diagnosis of equine coital exanthema in stallions

A

-characteristic C/S
-PCR of of swabs or scrapings from edge of lesions, inclusions in lesion specimens or confirmed by using EM typical herpesvirus particles in fluid or tissue samples

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41
Q

Treatment of EHV-3 in stallions

A

infection is usu self-limiting

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42
Q

If concerned for bacterial infection affecting fertility of stallions, where should swabs be collected from?

A

-fossa glandis
-free portion of the penile body
-folds of external prepuce

**before washing the genitalia of stallion presented to a mare in behavioral estrus

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43
Q

Treatment of stallion infected with Pseudomonas aeruginosa and Klebsiella pneumoniae

A

-washing penis (including fossa glandis & diverticulum) daily with iodine based surgical scrub
- rinse with tape water with dilute disinfectants
-drying of penis followed by application of 1% SSD

**concern with reinfection from removing natural flora from the stallions genitals.
transfaunation with healthy stallion smegma may be indicated

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44
Q

Balanoposthitis in bulls is usually associated with traumatic injury and then infection. What infectious agents have been reported to cause Balanoposthitis without trauma?

A

-bovine rhinotracehitis-infectious pustular vulvovaginitis (IBR-IPV) caused by bovine herpesvirus 1 (BHV-1)
-tuberculosisi
-screwworm infestation

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45
Q

Bulls: acute lesions caused by BHV-1

A

-numerous small pustules that progress to ulcers and erosion
-purulent preputial discharge
-prepuce and penis inflamed and swollen

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46
Q

Bulls treatment with BHV-1 ccaused balanoposthitis?

A

spontaneously heal in 1 week and usu complete in 2 weeks

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47
Q

How long should bulls with balanoposthitis be sexually rested?

A

for 6 to 8 weeks to prevent spread and avoid abrasions

**can be spread venerally for 2 weeks or longer

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48
Q

Bulls infected with BHV-1 remained infected for life, as the virus remains latent in what location?

A

in the sacral ganglia

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49
Q

Viral shedding of BHV-1 in semen is intermittent, if valuable bulls need to be used, what should be performed?

A

detection of BHV-1 in semen by real-time PCR is more sensitive than virus culture isolation, two straw of extended processes ejaculate are necessary to detect the presence of the virus

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50
Q

In sheep, important to differentiate pizzle rot from

A

ulcerative dermatosis (caused by parapozivurs)

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51
Q

What is a cause of balanoposthitis in males and vulvovaginitis in female goats?

A

caprine herpesvirus

**can also cause abortion

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52
Q

Penile deviations can occur in stallions due to what pathogenesis?

A

D/t semen collection through most of their breeding carrier– most commonly (in US) to the right d/t repeat bending of the penis to the left to facilitate entry into the artificial vagina which causes damage tot eh CCP/tunic albuginea on right side, resulting in filling defects and fibrotic lesions that lead to penile deviation

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53
Q

define phallocampsis

A

deviation of the erect penis

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54
Q

phallocampsis is common in what spp

A

bulls

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55
Q

what is the most common cause of phallocampsis in bulls?

A

due to persistent penile frenulum

other causes: spiral, ventral and S -curved deviations
Less common; preputial or penile injury

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56
Q

Describe the appearance of a persistent penile frenulum in the bull during erection?

A

-remains connected to ventral surface of tip of penis & prepuce an causes the penis to bend ventrally during erection by prevention complete extension

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57
Q

Persistent frenulum interferes with copulatory ability with the exception of

A

Zebu-influenced breeds that are endowed wiht a plentiful prepuce

58
Q

Spiral deviations can occur without a penile deviation can be caused by what?

A

electrojaculator when the CCP is maximall distended with blood

59
Q

Bull: the ventral or rainbow deviation of the penis is less common than the spiral deviation and is a result of

A

the apical ligament being too thin to support the engorged, stretched distal end of the erect penis

60
Q

Persistent penile frenulum treatment

A

severing the persistent band– owners should be advised of the probable genetic basic and therefore undesirability of retaining these bulls for breeding

61
Q

What is the most common neoplasm of the stallion genitalia

A

squamous cell carcinoma (SCC)

62
Q

Squamous cell carcinomas in stallions may resemble what other lesion

A

-Habronema granulomas

63
Q

What are other possible tumors seen in the stallion besides SCC?

A

melanoma
papilloma
angioma
lymphosarcoma
sarcoid

64
Q

What is the only tumor that frequently invades the bovine penis or prepuce?

A

fibropapilloma

65
Q

fibropapillomas are common seen in what age bull?

A

young bulls

66
Q

appearance of fibropapillomas on bulls penis

A

-pedunculated and attached at a narrow base
-cauliflower like and friable
-hemorrhage is easily induced

**large ones may prevent retraction of penis

67
Q

Treatment of fibropapillomas in bulls

A

**usually regress spontaneously within a few months
-several vaccines– includign autogenous preparations
-surgical removal indicated– fibropapillomas may recur

68
Q

What is recommended to reduce the incidence of fibropapillomas in bulls?

A

housing of young replacement bulls in individual pens (if possible)- to reduce the incidence of penile fibropapillomas

69
Q

What parasite commonly invades the urethral process, glans penis and preputial ring of stallions?

A

Habronema muscae
Habronema microstoma
Drashia megastoma

70
Q

Summer sore appearance in stallions

A

-shallow irritations
-progress to irregular 1 to 3 cm granulomatous growth– involve the entire circumference of the urethral process
lesions are friable and bleed when manipulated
-intense pruritus
-freq micturition and dysuria

71
Q

Summer sore diagnosis

A

seeing yellowish granules (calcified larvae in teh lesion
**microscopially

72
Q

Hemospermia definition

A

blood in semen

73
Q

Does blood in sperm affect fertility in stallions?

A

Depends on the percentage of blood in extended semen

74
Q

What does a disproportionate number of luekocytes to erythrocytes suggest in semen

A

infection of the internal genital organs

75
Q

What are specific causes of hemospermia in stallions?

A

lacerations of penis
cutaneous habronemiasis
urethritis
urethral lacerations
infection or inflammation of the accessory genital glands

76
Q

Define urospermia

A

urination during ejaculation

77
Q

Urospermia is a condition in what spp?

A

stallions

78
Q

Underlying cause of urospermia?

A

Unknown– suspect neurologic dysfunction
can occur in bulls during electroejaculation

79
Q

adhesions develop in the scrotum between the visceral and parietal tunic when

A

inflammation, infection or hemorrhage occurs

80
Q

What is a hydrocele

A

accumulation of serous fluid w/in the vaingal tunic

81
Q

Causes of hydrocele

A

ascites
anasarca
local lymphadema b/c vaginal tunic communicates with the peritoneal cavity

82
Q

what is a hematocele

A

trauma to the scrotum results in accumulation of blood within the testicular tunics

83
Q

After hematocele or hydrocele recovery, how long does it take for the spermatozoa to gradually reappare in teh ejaculate?

A

around 1 to 2 months after injury

**4 to 5 months may be required for testis to return to normal size and sperm production

84
Q

What is the prognosis for hematocele?

A

px is poor for return to testicular function

85
Q

How to correct Hydrocele?

A

correct underlying pathology, such as the peritonitis or ascites

86
Q

Define testicular aplasia

A

absence (aplasia) of one or both testes (rare)

87
Q

Causes of testicular hypolasia

A

transplacental infections and intoxications
zinc deficiency
hormonal insufficiency
impaired testicular descent
abnormal karyotype
vascular disturbances

88
Q

testicular hypoplasia (unilateral or bilateral) is thought to be a result of:

A

failure of germ cells to multiply in the gonad

89
Q

Stallions 3 years of age should have a scrotal width greater than

A

8cm

90
Q

In bulls what ist he minimum recommended scrotal circumference

A

30 cm for 15 months old or younger
34 cm for 2 yr olds or older

91
Q

Scrotal circumference in bulls is associated with

A

positively correlated with number of normal functional seminiferous tubules

negatively correlated with pathologic seminiferous tubules in bulls

-higher scrotal circumference produce females that acquire puberty earlier than females produced by bulls with smaller scrotal circumference

92
Q

What is the inheritance pattern of cryptorchidism in horses?

A

dominant
**may be multifactorial

93
Q

The relative risk of cryptorchidism in horses is though to be influenced by what factor?

A

breed

94
Q

Embryonic development of testes

A

-testes originate near kidney
-migrate through the inguinal rings before descending into the scrotum
-epididymis precedes the testis in descent

**retained testes are usually located at some point along the path of migration

95
Q

Why is spermatogenesis inhibited in the abdominal testis?

A

because elevated temperature w/in abdomen

96
Q

Diagnosis of equine cryptorchids

A

-high basal testosterone (>100 pg/ml)
-respond to hCG admin with sig elevation of circulating testosterone w/in 30 to 60 min if testicular tissue is present
-high plasma estorgens (>400 ng/ml)
-Anti-mullerian hormone (AMH) serum concen useful in horses

97
Q

Testicular degeneration may be caused by:

A

-thermal factors after elevation of body temperature by systemic infections
-prolonged inc or dec in ambient temperature
-scrotal insulation from edema, dermatitis, scrotal hernias or hemorrhage
-abnormal conformation resulting in an incompetent heat exchange sys
-chemicals and ionizing radiation
-steroid hormone administration

98
Q

Hormonal criteria for confirming testicular degeneration in stallions typically include

A

-low concen of testosterone
-low LH concen (early)
-high FSH & low estradail (chronic (or irreversible))

99
Q

What is commonly isolated from infectious orchitis in stallions?

A

S. zooepidemicus

100
Q

In bulls, infectious orchitis can be caused by:

A

B. abortus
M. tuberculosis
T. pyogenes
Nocardia farcinica
bovine herpresvirus-1 (IBR-IPV)
other misc organisms

101
Q

C/S of acute orchitis

A

testes are hot, swollen and painful
–> swollen d/t restriction of tunica albuginea
–> INC tesicular temp, congestion and interference with circulation may lead to ischemia and infarction
+/- abscess formation
–> testicular atrophy and fibrosis follow as the condition becomes chronic

102
Q

Treatment of acute orchitis

A

cryotherapy
antiinflammatories
antibiotics (semen culture/sensitivity)– cont for 1 to 2 weeks after testicular swelling and pain

103
Q

Where do testicular tumors originate from?

A

interstitial (Leydig) cells
Sertoli cells
germinal epithelium

testicular surface: teratomas, lipomas, lymphosarcoma

104
Q

What is the most common testicular tumor in the descended testes of adult stallions?

A

seminomas

105
Q

What is the most common testicular tumor in the retained testes of adult stallions?

A

teratomas

106
Q

Seminomas diagnosed in stallions, do they require removal?

A

They are not hormonally active and usually benign

can be malignant and invade inguinal and abdominal tissues

107
Q

Which tumor cell type exerts an adverse effect on semen quality and fertility?

A

sertoli cell tumors

108
Q

Structures present in teratomas arise from all 3 embryonic layers and may include

A

hair, nervous tissue, salivary glands, adipose tissue, cartilage adn bone

109
Q

What are predisposing anatomy to a scrotal torsion?

A

-abnormal elongation of the caudal ligament of the epididymis (scrotal ligament)
-the proper ligament of the testis
-excessively long mesorchium

110
Q

Torsion of the spermatic cord can cause what C/S?

A

No pain or abnormality of semen to those involving vascular obstruction and acute colic

**often a transient condition

111
Q

Diagnosis of spermatic cord torsion is made via

A

displacement of the tail of the epididymis and scrotal ligament on palpation

Normal: head of epididymis normally located craniodorsal to the testis and the tail lies caudally, where it is attached to the testis by the proper ligament

112
Q

Severe C/S associated with torsion of the spermatic cord are due to

A

vascular impairment

–abdominal discomfort, tachycardia, tachypnea, unilat swelling and edema of the scrotum, INC testicular temp, tests painful, soft an dfriable

113
Q

Treatment of spermatic cord torsion

A

manual correction: sedated, horse sedated and testis is rotated in direction opposite the torsion

Surgical correction/removal of testis: if hemorrhage or necrosis of the testis is evident

NSAIDs and analgesics to control pain

114
Q

Define variocele

A

abnormally distended and tortuous veins fo the paminiform plexus

115
Q

Varioceles are most common in what spp? and identified by what C/S?

A

Rams– due to size– may decrease libido and discourage movement

116
Q

Infertilety due to a variocele is thought to be associated with

A

d/t disturbance of local thermoregulatory mechanism, causing increased testicular temperature and subsequent disturbance in spermatogenesis

**could affect level of oxygenation and normal interchange of hormones between arteries and veins

117
Q

Diagnosis of variocele

A

-palpating the dilated tortuous veins (“bag of worms”) within the spermatic cord
-confirmation via U/S: large echolucent areas in the venous plexus of the spermatic cord, with concurrent distention of ventral vein of testis

118
Q

Besides decreased libido and spermatogenesis, what is a potentially complication that can occur with a varicocele?

A

thrombosis

119
Q

Treatment of varicocele:

A

-surgical removal/ castation:
- improved semen quality in humans (not been done in large animals)
-indicated when thrombosis occurs
**castration also recommended for rams b/c potential heritability

120
Q

Define epididymitis

A

infection or trauma, commonly secondary to orchitis o infection fo the accessory sex glands

121
Q

Diagnosis of epididymitis

A

-C/S include:
pain when irregular swelling of the epididymis are palpated
-changes in shape & texture of organ
-adhesions between the epididymis and scrotal tunics
-enlargement of the tail of the epididymis

122
Q

Class presentation of rams that develop epididymo-orchitis syndrome caused by ACitnobacillus, histophilus and haemophilus

A

-younger than 1 year of age
-subclinical carriers or acutely ill: pyrexia, depression, pain as evidence by arched back, unilateral or bilat swelling & tenderness fo the scrotal contents

123
Q

If rams recover from acute epididymo-orchitis syndrome and develop chronicdisease, what clinical signs are seen

A

-enlarged and firm, irregular epididymis
-palpable adhesions of the epididymis to the testis and vaginal tunics
-atrophic testes
-abscess formation
-draining fistulas to the scrotal surface

124
Q

Epididymitis treatment

A

-systemic antibiotics (that reach the epididymis): oxytetracycline, dihydrostreptomycin
-castration- in unilateral cases– INc risk of infection

125
Q

Prognosis for epididymitis

A

mod to severe bilateral epididymitis: px for recover is poor

–obstructions and granulomas usu develop–> resulting in steirlity
– testiular atrophy

126
Q

Seminal vesiculitis (vesicular adenitis) is common in what spp?

A

bulls
– uncommon in stallions

127
Q

What organisms are incriminated in Seminal vesiculitis in stallions?

A

B abortus and P. querginosa

128
Q

What organisms are incriminated in Seminal vesiculitis in bulls?

A

Actinobacillus actinoides
Aeromonas hydrophila
T. pyogenes
B. abortus
C. psittaci
C. renale
C. pseudotuberculosis
E. coli
H. somni
M. tuberculosis
Mycobaterium paratubcerulosis
Mycoplasmas,
P. mirabilis
Strep
Stsaph Ureamplasmas and T. goetus

129
Q

In bulls what is the most frequently isolated in Seminal vesiculitis

A

T. pyogenes

130
Q

Seminal vesiculitis/ vesicular adenitis most common signalment (bulls)

A

-bulls of all ages
-most common: growing bulls fed high energy rations and housed together

131
Q

Seminal vesiculitis/ vesicular adenitis in bulls C/S

A

-asymptomatic
-non specific C/S other than detioration of semen quality

Severe cases: pelvic inflamm and peritonitis result in pain, reluctant to move, stiff gait, tense abdomen, difficult defecating and refusal to mate

132
Q

Can enlargement of the vesicular glands increased with seminal vesiculitis?

A

-acute phase: vesicular glands may not be significantly increased in size

-chronic phase: glands enlarge, eventually losing their lobularity and becoming fibrotic

133
Q

Abscessation of the seminal vesicles is often caused by what bacteria ( in bulls)?

A

T. pyogenes

134
Q

Consequence of abscessation of theseminal vesicles (in bulls)?

A

rupture into the urinary bladder or rectum

135
Q

What are characteristics of semen from bulls with vesicular adenitis?

A

-poor sperm motility
-increased morphologic defects
-elevated pH

136
Q

bacterial pathogens can be recovered from semen of affected stallions with vesicular adenitis, does this equate to infection?

A

No– bacteria could originate from another location

137
Q

What method shows low contamination of the semen samples collected from bulls?

A

-clipping of preputial hairs
-urination
-antisepsis of the preputial area
-flushing of the preputial cavity with antiseptic solution
-per rectum massage of accessory sexual glands
-semen collection by electroejaculation

138
Q

Treatment of seminal veisculitis (vesicular adenitis)

A

-antibiotics: based on CS, 2-4 wks duration, direct instillation into stallions seminal vesicles
-NSAIDs
-massage of seminal glands per rectum
-sx removal: seminal vesiculectomy

139
Q

What are properties of antimicrobials suitable for parenteral treatment of accessory sex gland infection include:

A

-high lipid solubility
-favorable pKa (higher than the pH (basic) of the target tissue or fluid)
-low or ltd protein binding

140
Q

Prognosis for seminal vesiculitis

A

-fair to poor

141
Q

Sperm granulomas are caused by:

A

accumulation of spermatozoa in blind efferent ducts
**common cause of infertility in buck and ram
**have been IDed in stallions

142
Q

Block of efferent ducts (sperm stasis), results in what

A

azospermia despite apparent ejaculation

–ampullae freq tense & enlargement may be demonstrated by U/S

143
Q

Treatment of blockage of efferent ducts (sperm stasis)

A

massage of ampullae per rectum followed by freq intervals for semen collection may result in ejaculation of a semen sample with high concen of spermatozoa (strings & plugs)

–collection of semen on a regular schedule may aid in preventing recurrence

–empiric tx of blockage of beta-receptors and stim of alpha receptors