Clinical Conditions of the Female Flashcards
what are the two way ovarian tumors can present?
-incidental finding on rectal exam
-clinical signs dependent upon hormones (this is more often)
what are the most common type of ovarian tumor?
granulosa theca cell tumor (GCT)
what are some types other types of of ovarian tumors
-teratoma
-angiosarcoma
-carcinoma
-fibroma
-fibrosarcoma
-dysgerminoma
-cystadenoma
what are some clinical signs of a GCT (3 scenarios)
-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)
what are some clinical exam findings to help diagnose GCT (4)
-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
what lab values do you submit to test for when you suspect a GCT?
GCT diagnostic panel; testosterone, inhibin and AMH
(elevated AMH can detect tumors earlier than inhibin)
what does a bovine GCT present as? what else do you see/find in addition
-presents as infertility
-aggressive behaviour, non retractable uterus, very large lumpy right ovary
what is a treatment for ovarian tumors
unilateral ovariectomy
-what is the result of a unilateral ovariectomy
-complications?
-eliminates unwanted behaviours, and still allows the animal to resume cycling eventually
-complications can be severe hemorrhage or incisional complications
how does a serous cystadenoma arise and what are its affects
-arises from lining epithelium of ovulation fossa
-usually dont produce hormones, so it doesnt affect cycling/behaviour
-rare!
what are other conditions that cause big ovaries? (5)
-paraovarian cysts; congenital
-Ovarian cysts in cows
-Ovarian Hematoma
-Transitional ovaries in mares (physiologically normal in mares)
-ovarian abscesses (rare)
paraovarian cysts; treatment, effect, findings, cause
-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
what happens to the paramesonephric (mullerian) ducts in males vs females
female = turns into oviduct, uterus, cranial vagina
male = regress
what happens to the mesonephric (wolffian) ducts in males vs females
female = regress
male = turns into vas deferens, epididymis
what happens to the urgenital sinus in males vs females
female = stays open, caudal vagina/vestibule
male = closes, urethra/prostate
how do you differentiate ovarian issues vs fall/spring transition in mares? (4)
-Time of the year
-Ovaries will be bilaterally large
-Ovulation fossas ARE palpable
-Hormone levels normal
ovarian hematoma; finding, cause, how common, treatment
-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
what is the most common cause of big ovaries in cows
cystic ovarian disease
what is cystic ovarian disease
-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
what do most cows with endometritis/pyometra also have?
what can it lead to?
conditions of the oviduct
-Salpingitis, hydrosalpinx
-Bursitis/bursal cysts
-Ovaritis
-may result in oviductal blockage. cows with repeated infertility results in culling
what are bursal adhesions? what can they interfere with?
-Adhesions between ovary and fimbria
-Can interfere with oocyte pickup –leads to infertility
what is a bursal cyst
Fluid accumulation when adhesions become severe
oviductal blockage in mares; diagnosis, results, treatment
-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
what are some conditions of the cervix? (6)
- Cervicitis
- Cervical tears
- Tumours, polyps (rare)
- Double cervix/ other developmental problems (segmental aplasia)
- Fibrotic Cervix (old maiden mares)
- Varicose veins in mares
cervicitis; when it occurs, diagnosis, treatment
-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)
when do cervical tears occur in mares vs cows
-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
cervical tears; diagnosis, sequelae
-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
treatment of cervical tears in mares
-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
what is double cervix caused by? types? diagnosis?
-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
where do you find varicose veins in mares
-in cervix or hymen of vagina
varicose veins in mares; outcomes
‐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
conditions of the vagina, vestibule and vulva (7)
- Vaginitis, vestibulitis, vulvitis
- Pneumovagina (air in the uterus)
- Urovagina (urine pooling)
- Persistent hymen
- Vaginal cysts (cystic Gartner’s ducts)
- Tumours
- Perineal lacerations
vaginitis; what is it similar to, causes, species it affects
-similar to cervicitis
‐cows – IBR (herpes) or Ureaplasma are most common
‐bitches
what is an imperforate hymen
-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
treatment of imperforate hymen
-If complete – leads to fluid accumulation anterior to it (ultrasound)
-Treatment – manual rupture (under
sedation !!) or electrocautery if thick
causes of vaginal cysts/cystic gartners ducts
-Remnants of mesonephric ducts on vaginal floor
-Usually incidental unless large (drain)
what are cystic bartholins glands? consequences/treatment
-Rare
-Obstruction of the duct of the vestibular glands in the lateral wall of the vulva
-Inconsequential unless large
-Rule out tumour
-Surgical excision
three types of vaginal tumors
-Fibrosarcoma
-Leiomyoma
-Squamous Cell Carcinoma
how do vaginal tumors present? diagnosis?
-May present with vaginal discharge, self‐mutilating behaviour (licking in bitches, rubbing area in large animals)
-Excision or biopsy for diagnosis and prognosis
what is common in late gestation cows?
vaginal prolapse
degrees of perineal lacerations
-First degree lacerations
-Second degree
-Third degree
what defines a first degree perineal laceration? treatment?
-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
what defines a second degree perineal laceration? treatment?
-Tear extends into muscle layers of vulva
-Debride and Suture if fresh
-Allow to granulate if too old to suture
what defines a third degree perineal laceration? treatment?
-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
prognosis and dietary management for third degree perineal lacerations
-Dietary management – laxative diet
-Prognosis Good – for future fertility and uneventful foaling
what causes a rectovaginal fistula and how can it present
-Fetal foot pushes up through the dorsal vaginal wall into the rectum
-The foot may recede and delivery appear normal!
how do you diagnose a rectovaginal fistula? treatment?
-feces in vagina
‐manual palpation during PP exam
‐Treatment is to convert to 3rd Degree Tear and repair
what are some conditions of the uterus that cause infertility (5)
-Segmental aplasia and intersex conditions
-Uterine infections (metritis, endometritis, pyometra etc.)
-Uterine (Endometrial) cysts (mare)
-Degenerative Endometrial Fibrosis in mares
-Uterine Tumours
segmental aplasia; prevalence, cause, what can it cause
-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
freemartinism; how it presents
-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
two ways to diagnose freemartin
-Diagnosis on physical findings
-PCR test of blood for Y-specific sequence
equine DSD/intersex; appearance, diagnosis, outcome
-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
what is pyometa
pus accumulation in uterus, with CL retained (exception = mare)
what is mucometra
mucous accumulation in uterus
what is endometritis
inflammation of endometrium, animal is not systemically ill
what is metritis
inflammation of all layers of uterus, animal is systemically ill
what is septic metritis
early postpartum, toxic infection, acute, severe illness
why is the CL retained in pyometra ?
-Damage to endometrium = inability to produce PGF2a = no luteolysis
-Production of luteotropic PGE’s by wbc’s in exudate
clinical signs of pyometra in cows (4)
-After first ovulation ie > 25 days
-Anestrus
- +/‐ vaginal discharge
-Large fluid‐filled uterus (Do not confuse with pregnancy)
treatment of pyometra in cows
-PGF2a; two injections 14 days apart
‐lyse CL, estrus – opens cervix to allow drainage
‐uterine defense
prognosis and prevention for cows with pyometra
-Prognosis ‐ Generally poor esp. if longstanding
-prevention = Examine all cows by 30 days postpartum to identify those with uterine disease
cause, treatment and appearance of pyometra in the mare
-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)
clinical signs of pyometra in the bitch
-Open Pyometra – vaginal discharge usually 4‐6 weeks after a heat (when a CL is present)
-Closed Pyometra (Sick), no discharge
pyometra treatment in the bitch
-Associated with cystic endometrial hyperplasia so spay often best option
-Medical treatment for breeding bitches
cause of cystic endometrial hyperplasia in the bitch
-The result of prolonged exposure to progesterone (After estrogen priming)
mucometra in cows; secondary to what? treatment?
-Secondary to cystic ovarian disease or associated with Segmental Aplasia
-Treatment= Ovsynch/ PGF2a/ treat COD OR Cull if segmental aplasia
what is the most commone medical conditions reported in equine practice? what does it result in?
endometritis
-In mares is one of the most common medical conditions reported in equine practice
-Results in infertility
types of endometritis in the mare
- Persistent Breeding Induced Endometritis (PBIE)
- Acute Endometritis
- Chronic Endometritis (diagnose by biopsy – presence of lymphocytes and plasma cells)
causes of acute metritis in mares
-Venereal
-Infusion of Irritants into Uterus
-Contamination (feces, poor A.I. technique etc.)
-Can become chronic ie repeated breedings without pregnancy
what is a normal physiologic reaction to semen
Breeding induced inflammation –
transient inflammatory response
breeding induced inflammation; what does it normally do, when does it lead to a problem
-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
Persistent breeding‐induced endometritis (PBIE) in mares; causes, what does it lead to
-Failure of physical clearance
◦ Decreased uterine contractility
◦ Failure of cervical relaxation
◦ Pendulous uterus (gravity)
-Accumulation of fluid/debris/bacteria
-Leads to infertility
how many mares have a failure of the natural immune defense mechanisms
10-15%
management of mares with PBIE (4)
-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
clinical signs of acute endometritis + diagnosis
+/‐ 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
Treatment of endometritis in mares
-Uterine lavage
-Antibiotic infusion
-Ecbolic therapy
-Correct perineal conformation defects
what do we hope to accomplish for treatment of entdometritis in mares
-Correct defects in uterine defense mechanisms
-Neutralize bacterial/fungal contaminants
-Control inflammation
-Promote uterine clearance
qualities of a good antibiotic choice
-Effective against organism
-Effective in environment
-Reaches good uterine concentration
-Non‐irritating to uterus
what antibiotic should you avoid in horses for endometritis and why
DO NOT use Baytril (enrofloxacin) intrauterine = causes adhesions!
what are some antibiotics you can use to treat endometritis in mares
Combination of uterine lavage and antibiotic infusion into uterus
-Penicillin
-Gentamicin; Amikacin (very acidic and irritating = buffer with bicarb)
-Ceftiofur
-Ampicillin
chronic endometritis; diagnosis
-Diagnosed by biopsy; Presence of lymphocytes and/or plasma cells
-Culture swab (often negative – bacteria has been cleared but inflammation remains)
endometrial cysts in mares; appearance, associated issues
-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
treatment of endometrial cysts in mares
-Do nothing if small and few in number
-Laser ablation if clusters or single
large cysts
-Uterine biopsy first to determine
prognosis
degenerative endometrial fibrosis (DEF); what is it?
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
is DEF reversible in mares?
no
uterine tumors; how common, types, treatment?
-Uncommon
-Leiomyoma (most common)
-Fibrosarcoma
-Adenocarcinoma (nasty; metastasizes)
-Partial hysterectomy. May retain fertility depending on amount of uterus that is resected
