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Theriogenology > Clinical Conditions of the Female > Flashcards

Clinical Conditions of the Female Flashcards

1
Q

what are the two way ovarian tumors can present?

A

-incidental finding on rectal exam
-clinical signs dependent upon hormones (this is more often)

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2
Q

what are the most common type of ovarian tumor?

A

granulosa theca cell tumor (GCT)

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3
Q

what are some types other types of of ovarian tumors

A

-teratoma
-angiosarcoma
-carcinoma
-fibroma
-fibrosarcoma
-dysgerminoma
-cystadenoma

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4
Q

what are some clinical signs of a GCT (3 scenarios)

A

-male like behaviour if its producing testosterone (aggressive, difficult to handle, mounting other mares)

-persistent estrus if producing estrogen (nymphomania in cows)

-inhibin production by granulosa ccells in tumor- inhibits FSH production by pituitary (contralateral ovary is very small/inactive)

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5
Q

what are some clinical exam findings to help diagnose GCT (4)

A

-rectal exam; one large ovary, usually unilateral

-in mares; the affected ovary has loss of a papable ovulation fossa (tumor destroys normal architecture)

-other ovary small and inactive

-ultrasound; multicystic classic appearance is the most common finding

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6
Q

what lab values do you submit to test for when you suspect a GCT?

A

GCT diagnostic panel; testosterone, inhibin and AMH

(elevated AMH can detect tumors earlier than inhibin)

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7
Q

what does a bovine GCT present as? what else do you see/find in addition

A

-presents as infertility
-aggressive behaviour, non retractable uterus, very large lumpy right ovary

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8
Q

what is a treatment for ovarian tumors

A

unilateral ovariectomy

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9
Q

-what is the result of a unilateral ovariectomy
-complications?

A

-eliminates unwanted behaviours, and still allows the animal to resume cycling eventually

-complications can be severe hemorrhage or incisional complications

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10
Q

how does a serous cystadenoma arise and what are its affects

A

-arises from lining epithelium of ovulation fossa
-usually dont produce hormones, so it doesnt affect cycling/behaviour
-rare!

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11
Q

what are other conditions that cause big ovaries? (5)

A

-paraovarian cysts; congenital
-Ovarian cysts in cows
-Ovarian Hematoma
-Transitional ovaries in mares (physiologically normal in mares)
-ovarian abscesses (rare)

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12
Q

paraovarian cysts; treatment, effect, findings, cause

A

-Remnants of mesonephric ducts
-Fluid filled, variable size
-Incidental finding on U/S
-Sporadic/ not uncommon in
mares
-No affect on fertility (can be
confused for a follicle)
-No treatment required

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13
Q

what happens to the paramesonephric (mullerian) ducts in males vs females

A

female = turns into oviduct, uterus, cranial vagina

male = regress

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14
Q

what happens to the mesonephric (wolffian) ducts in males vs females

A

female = regress
male = turns into vas deferens, epididymis

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15
Q

what happens to the urgenital sinus in males vs females

A

female = stays open, caudal vagina/vestibule

male = closes, urethra/prostate

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16
Q

how do you differentiate ovarian issues vs fall/spring transition in mares? (4)

A

-Time of the year
-Ovaries will be bilaterally large
-Ovulation fossas ARE palpable
-Hormone levels normal

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17
Q

ovarian hematoma; finding, cause, how common, treatment

A

-Bleed into a follicle instead of ovulating
-Incidental finding or history of pain
-treatment; Need time to regress – 4‐6 weeks. If large, rarely cause abdominal hemorrhage and death

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18
Q

what is the most common cause of big ovaries in cows

A

cystic ovarian disease

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19
Q

what is cystic ovarian disease

A

-Abnormal structures on the ovaries; usually follicular cysts, often multiple

-DEFN: persist for >10 days ‐ >2.5 cm in diameter; and absence of a CL

-May (or may not) interfere with normal cycling

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20
Q

what do most cows with endometritis/pyometra also have?

what can it lead to?

A

conditions of the oviduct
-Salpingitis, hydrosalpinx
-Bursitis/bursal cysts
-Ovaritis

-may result in oviductal blockage. cows with repeated infertility results in culling

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21
Q

what are bursal adhesions? what can they interfere with?

A

-Adhesions between ovary and fimbria
-Can interfere with oocyte pickup –leads to infertility

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22
Q

what is a bursal cyst

A

Fluid accumulation when adhesions become severe

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23
Q

oviductal blockage in mares; diagnosis, results, treatment

A

-Diagnosis is by exclusion
-When ALL other causes of infertility (especially endometritis) have been ruled out (consider including karyotyping if a young maiden mare)

-Application of PGE2 gel directly onto oviducts via laparoscopic surgery, or onto the oviductal opening via hysteroscopy or deep horn AI technique

-In selected cases, results have been excellent

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24
Q

what are some conditions of the cervix? (6)

A
  1. Cervicitis
  2. Cervical tears
  3. Tumours, polyps (rare)
  4. Double cervix/ other developmental problems (segmental aplasia)
  5. Fibrotic Cervix (old maiden mares)
  6. Varicose veins in mares
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25
Q

cervicitis; when it occurs, diagnosis, treatment

A

-Often occurs with chronic irritation (trauma, air feces, urine, endometritis)

-Diagnosis ‐ vaginoscopy (Look for endometritis, poor perineal conformation, urovagina, rectovaginal fistula)

-Treat the underlying cause (often endometritis)

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26
Q

when do cervical tears occur in mares vs cows

A

-May occur in mares following “normal” appearing foaling or dystocia
-Occurs in cows when a calf is pulled too early before cervix is fully dilated

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27
Q

cervical tears; diagnosis, sequelae

A

-Most easily palpated on vaginal exam; Cervix is palpated between thumb and first finger

-Visualize with vaginoscope

-Surgical Repair

-Severe vaginal and cervical trauma at foaling often leads to adhesions and vaginal/cervical stenosis

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28
Q

treatment of cervical tears in mares

A

-Minor tears often heal with time and medical management in the postpartum period
-Surgical repair is needed if >50% of the length of the cervix is affected
-Usually re‐tear at subsequent foaling and repair needs to be repeated
-Embryo Transfer

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29
Q

what is double cervix caused by? types? diagnosis?

A

-Caused by Incomplete fusion of
paramesonephric ducts

-May be complete (where each cervix
opens into a separate horn), or
partial (both sides open into a
common uterine body)

-May present as infertility, Or finding on vaginoscopy

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30
Q

where do you find varicose veins in mares

A

-in cervix or hymen of vagina

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31
Q

varicose veins in mares; outcomes

A

‐common cause of frank bloody discharge during pregnancy

‐if minor hemorrhage, topical application of Preparation H may shrink varicose veins

‐if significant, surgical laser or Ligasure cautery of vessels

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32
Q

conditions of the vagina, vestibule and vulva (7)

A
  1. Vaginitis, vestibulitis, vulvitis
  2. Pneumovagina (air in the uterus)
  3. Urovagina (urine pooling)
  4. Persistent hymen
  5. Vaginal cysts (cystic Gartner’s ducts)
  6. Tumours
  7. Perineal lacerations
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33
Q

vaginitis; what is it similar to, causes, species it affects

A

-similar to cervicitis

‐cows – IBR (herpes) or Ureaplasma are most common
‐bitches

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34
Q

what is an imperforate hymen

A

-Failure of canalization during
development of the paramesonephric duct system at the level of the urogenital sinus

-May be partial or complete

-If partial, may only be found during
first AI

-If complete may present as pink membrane protruding from vulva of maiden young filly

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35
Q

treatment of imperforate hymen

A

-If complete – leads to fluid accumulation anterior to it (ultrasound)

-Treatment – manual rupture (under
sedation !!) or electrocautery if thick

36
Q

causes of vaginal cysts/cystic gartners ducts

A

-Remnants of mesonephric ducts on vaginal floor
-Usually incidental unless large (drain)

37
Q

what are cystic bartholins glands? consequences/treatment

A

-Rare
-Obstruction of the duct of the vestibular glands in the lateral wall of the vulva

-Inconsequential unless large
-Rule out tumour
-Surgical excision

38
Q

three types of vaginal tumors

A

-Fibrosarcoma
-Leiomyoma
-Squamous Cell Carcinoma

39
Q

how do vaginal tumors present? diagnosis?

A

-May present with vaginal discharge, self‐mutilating behaviour (licking in bitches, rubbing area in large animals)

-Excision or biopsy for diagnosis and prognosis

40
Q

what is common in late gestation cows?

A

vaginal prolapse

41
Q

degrees of perineal lacerations

A

-First degree lacerations
-Second degree
-Third degree

42
Q

what defines a first degree perineal laceration? treatment?

A

-Minor tears of the dorsal commisure of the vulva
-Tear is limited to the skin, mucous membrane
-Treatment – Clean, debride and suture as soon as possible after parturition

43
Q

what defines a second degree perineal laceration? treatment?

A

-Tear extends into muscle layers of vulva
-Debride and Suture if fresh
-Allow to granulate if too old to suture

44
Q

what defines a third degree perineal laceration? treatment?

A

-Complete tearing of the shelf between rectum and vulva. leads to fecal contamination
-Usually the result of dystocia or improperly applied traction at foaling

-Surgical repair delayed 6‐8 weeks
-Wash daily and debride as required

45
Q

prognosis and dietary management for third degree perineal lacerations

A

-Dietary management – laxative diet
-Prognosis Good – for future fertility and uneventful foaling

46
Q

what causes a rectovaginal fistula and how can it present

A

-Fetal foot pushes up through the dorsal vaginal wall into the rectum
-The foot may recede and delivery appear normal!

47
Q

how do you diagnose a rectovaginal fistula? treatment?

A

-feces in vagina
‐manual palpation during PP exam

‐Treatment is to convert to 3rd Degree Tear and repair

48
Q

what are some conditions of the uterus that cause infertility (5)

A

-Segmental aplasia and intersex conditions
-Uterine infections (metritis, endometritis, pyometra etc.)
-Uterine (Endometrial) cysts (mare)
-Degenerative Endometrial Fibrosis in mares
-Uterine Tumours

49
Q

segmental aplasia; prevalence, cause, what can it cause

A

-Most often present for infertility
-Lack of development of a portion of the paramesonephric duct system
-High prevalence in some breeds of cattle

-Fluid accumulation in cranial parts of the tracts often occurs; May result in falsely diagnosing as pregnant

50
Q

freemartinism; how it presents

A

-Placental vascular anastomoses result in male fetus influencing development of female’s reproductive tract
-Ovaries and uterus are underdeveloped to varying degrees
-Vagina and vulva are hypoplastic
-Clitoris enlarged
-Seminal vesicles present, other male accessory structures vary

51
Q

two ways to diagnose freemartin

A

-Diagnosis on physical findings
-PCR test of blood for Y-specific sequence

52
Q

equine DSD/intersex; appearance, diagnosis, outcome

A

-Often inappropriate stallion‐like
behaviour in an apparent filly
-The external appearance varies widely; from normal appearing female with male‐like behaviour to clitoromegaly and very long ano‐genital distance

-Diagnosis on examination findings,
karyotype and cytogenetic tests

-These animals can be gonadectomised (and enlarged clitoris removed) and be useful pleasure horses

53
Q

what is pyometa

A

pus accumulation in uterus, with CL retained (exception = mare)

54
Q

what is mucometra

A

mucous accumulation in uterus

55
Q

what is endometritis

A

inflammation of endometrium, animal is not systemically ill

56
Q

what is metritis

A

inflammation of all layers of uterus, animal is systemically ill

57
Q

what is septic metritis

A

early postpartum, toxic infection, acute, severe illness

58
Q

why is the CL retained in pyometra ?

A

-Damage to endometrium = inability to produce PGF2a = no luteolysis
-Production of luteotropic PGE’s by wbc’s in exudate

59
Q

clinical signs of pyometra in cows (4)

A

-After first ovulation ie > 25 days
-Anestrus
- +/‐ vaginal discharge
-Large fluid‐filled uterus (Do not confuse with pregnancy)

60
Q

treatment of pyometra in cows

A

-PGF2a; two injections 14 days apart
‐lyse CL, estrus – opens cervix to allow drainage
‐uterine defense

61
Q

prognosis and prevention for cows with pyometra

A

-Prognosis ‐ Generally poor esp. if longstanding

-prevention = Examine all cows by 30 days postpartum to identify those with uterine disease

62
Q

cause, treatment and appearance of pyometra in the mare

A

-Present with periodic vaginal discharge
-Differentiated from endometritis by
extremely large volume of fluid in uterus
-Usually due to cervical trauma
-Difficult to treat
-Previously hysterectomy was often the best/only option
-Cervical wedge resection may help with drainage (Uterine lavage and antibiotics)

63
Q

clinical signs of pyometra in the bitch

A

-Open Pyometra – vaginal discharge usually 4‐6 weeks after a heat (when a CL is present)
-Closed Pyometra (Sick), no discharge

64
Q

pyometra treatment in the bitch

A

-Associated with cystic endometrial hyperplasia so spay often best option
-Medical treatment for breeding bitches

65
Q

cause of cystic endometrial hyperplasia in the bitch

A

-The result of prolonged exposure to progesterone (After estrogen priming)

66
Q

mucometra in cows; secondary to what? treatment?

A

-Secondary to cystic ovarian disease or associated with Segmental Aplasia

-Treatment= Ovsynch/ PGF2a/ treat COD OR Cull if segmental aplasia

67
Q

what is the most commone medical conditions reported in equine practice? what does it result in?

A

endometritis

-In mares is one of the most common medical conditions reported in equine practice
-Results in infertility

68
Q

types of endometritis in the mare

A
  1. Persistent Breeding Induced Endometritis (PBIE)
  2. Acute Endometritis
  3. Chronic Endometritis (diagnose by biopsy – presence of lymphocytes and plasma cells)
69
Q

causes of acute metritis in mares

A

-Venereal
-Infusion of Irritants into Uterus
-Contamination (feces, poor A.I. technique etc.)
-Can become chronic ie repeated breedings without pregnancy

70
Q

what is a normal physiologic reaction to semen

A

Breeding induced inflammation –
transient inflammatory response

71
Q

breeding induced inflammation; what does it normally do, when does it lead to a problem

A

-Natural system to eliminate sperm and debris
◦ Innate immune reaction
◦ Mechanical clearance

-Normal “resistant” mares resolve this inflammation within ~24 hours

-“Susceptible” mares can’t and develop PBIE

72
Q

Persistent breeding‐induced endometritis (PBIE) in mares; causes, what does it lead to

A

-Failure of physical clearance
◦ Decreased uterine contractility
◦ Failure of cervical relaxation
◦ Pendulous uterus (gravity)

-Accumulation of fluid/debris/bacteria
-Leads to infertility

73
Q

how many mares have a failure of the natural immune defense mechanisms

A

10-15%

74
Q

management of mares with PBIE (4)

A

-Breed only once per cycle to minimize contamination

-Ultrasound check for fluid within 24 hours after breeding

-Uterine lavage with sterile saline (as early as 6 hrs post breeding)
◦ ~ 1L at a time until returning fluid is clear

-Ecbolic (cause uterine contractions=clearance)
◦ Oxytocin
◦ PGF2a

75
Q

clinical signs of acute endometritis + diagnosis

A

+/‐ Vaginal discharge after breeding or at next estrus (may short cycle)

-Usually bacterial
-Can be venereal
-But can be iatrogenic due to irritants infused into uterus

-Diagnosis by ultrasound (fluid and/or excessive edema) and endometrial swab. Submit for Culture and cytology

76
Q

Treatment of endometritis in mares

A

-Uterine lavage
-Antibiotic infusion
-Ecbolic therapy
-Correct perineal conformation defects

77
Q

what do we hope to accomplish for treatment of entdometritis in mares

A

-Correct defects in uterine defense mechanisms
-Neutralize bacterial/fungal contaminants
-Control inflammation
-Promote uterine clearance

78
Q

qualities of a good antibiotic choice

A

-Effective against organism
-Effective in environment
-Reaches good uterine concentration
-Non‐irritating to uterus

79
Q

what antibiotic should you avoid in horses for endometritis and why

A

DO NOT use Baytril (enrofloxacin) intrauterine = causes adhesions!

80
Q

what are some antibiotics you can use to treat endometritis in mares

A

Combination of uterine lavage and antibiotic infusion into uterus
-Penicillin
-Gentamicin; Amikacin (very acidic and irritating = buffer with bicarb)
-Ceftiofur
-Ampicillin

81
Q

chronic endometritis; diagnosis

A

-Diagnosed by biopsy; Presence of lymphocytes and/or plasma cells
-Culture swab (often negative – bacteria has been cleared but inflammation remains)

82
Q

endometrial cysts in mares; appearance, associated issues

A

-Fluid filled structures in the uterus
-Usually are lymphatic in origin (dilated lymphatics)

-May interfere with fertility if they are large or in a large group
-Prevent the early embryo from migrating ‐‐‐ no maternal recognition of pregnancy OR may interfere with placental attachment
-Indicate uterine pathology – usually
fibrosis

83
Q

treatment of endometrial cysts in mares

A

-Do nothing if small and few in number
-Laser ablation if clusters or single
large cysts
-Uterine biopsy first to determine
prognosis

84
Q

degenerative endometrial fibrosis (DEF); what is it?

A

A chronic degenerative process with progressive changes over time
-Fibrosis
-Glandular dilatation
-Nesting of glands
-Vascular degeneration

-Can interfere with uterine clearance, and secretion of histotroph ‐‐‐‐ leads to EED

85
Q

is DEF reversible in mares?

A

no

86
Q

uterine tumors; how common, types, treatment?

A

-Uncommon

-Leiomyoma (most common)
-Fibrosarcoma
-Adenocarcinoma (nasty; metastasizes)

-Partial hysterectomy. May retain fertility depending on amount of uterus that is resected

Theriogenology (25 decks)

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