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Therio > Clinical Conditions of the Female Causing Infertility > Flashcards

Clinical Conditions of the Female Causing Infertility Flashcards

1
Q

what are the most common ways that ovarian tumours are detected?

A

Clinical signs dependent upon hormones produced (this is more often)
OR
incidental finding on rectal exam

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2
Q

most common ovarian tumour? a couple runners-up?

A

granulosa-theca cell tumour

also:
b. teratoma
c. angiosarcoma
d. carcinoma/adenocarinoma e. fibroma
f. fibrosarcoma
g. dysgerminoma
h. cystadenoma

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3
Q

equine Clinical signs of Granulosa (theca) cell tumour

A

Male behaviour if producing testosterone (most common scenario = stallion‐like behaviour)
◦ Aggressive, difficult to handle, mounting other mares

Persistent estrus if producing estrogen
◦ Nymphomania in cows

INHIBIN production by granulosa cells in tumour– Inhibits FSH production by pituitary
‐ Contralateral ovary is very small, inactive

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4
Q

what do theca cells make?

A

testosterone in the female

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5
Q

what cells produce estrogen in the female?

A

Granulosa cells of follicle, Placenta

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6
Q

equine granulosa cell tumour diagnosis?

A

◦ Rectal Exam – one large Ovary (usually unilateral)
◦ other ovary small and inactive
◦ Ultrasound – variable appearance – cystic or solid; any
combination
◦ Multicystic classic appearance is most common

Confirm with Laboratory testing and Histopathology

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7
Q

presentation of bovine granulosa cell tumour

A

Presents as Infertility
Aggressive/bullish behaviour
Non‐retractable uterus
Very large, “lumpy” right ovary

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8
Q

are GCT tumours hormonally active?

A

Usually hormonally active

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9
Q

what does a GCT diagnostic panel look at? what is diagnostic? what do we do if levels are low?

A

GCT Diagnostic Panel: Testosterone, Inhibin, AMH
- Elevated levels diagnostic (High Testosterone plus
Inhibin > 0.7ng/ml)
- Elevated Anti‐Mullerian Hormone (AMH) Levels
> Can detect tumours earlier than inhibin

What if levels low/borderline? – repeat 3‐6 mos. later

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10
Q

treatment for ovarian tumours - how is it done and what are the results? what are possible complications?

A

Unilateral Ovariectomy
◦ Usually by flank laparoscopy via paralumbar fossa
-Eliminates unwanted behaviour; rarely metastasize
-May require several months to resume cycling

Complications – difficult surgical exposure if large (requires ventral abdominal surgery)
◦ Severe hemorrhage
◦ Incisional complications

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11
Q

when are transitional ovaries in mares normal?

A

spring

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12
Q

what are parovarian cysts? what is their origin? how are they usually found and what do they look like? are they common? what is their effect on fertility and how do we usually treat them?

A

◦ Remnants of mesonephric ducts
◦ Fluid filled, variable size
◦ Incidental finding on U/S
◦ “follicle that is always there”
◦ 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 is a common finding on the mare ovary in transition?

A

multiple large ovaries and anovulatory follicles
-ovaries will be bilaterally large
-ovulation fossas will be palpable and hormone levels will be normal

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14
Q

ultrasound appearance of an anovulatory follicle can resemble what?

A

granulosa cell tumor

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15
Q

how does an ovarian hematoma arise? how do we usually find out about it?

A

bleed into a follicle instead of ovulating
-incidental finding or history of pain

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16
Q

do we often see ovarian hematoma with abdominal bleeding? what is a possible consequence?

A

no, rarely
-If large, rarely cause abdominal hemorrhage and death

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17
Q

how large is an ovarian hematoma, generally?

A

6-8cm

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18
Q

how long does an ovarian hematoma take to regress?

A

4-6 weeks

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19
Q

most common cause of big ovary in cows

A

cystic ovarian disease

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20
Q

what does bovine cystic ovarian disease look like? how long do they last? what may they interfere with?

A

Abnormal structures on the ovaries
‐usually follicular cysts – often multiple fluid filled structures
‐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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21
Q

at what point in a cows life are we more likely to see cystic ovarian disease?

A

Dynamic disease – cysts come and go
common is early post-partum cows

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22
Q

how are most cases of bovine cystic ovarian disease resolved?

A

most will recover spontaneously

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23
Q

what is the salpinx?

A

oviduct

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24
Q

Up to 70 % of cows with endometritis / pyometra also have:

A

*Salpingitis, hydrosalpinx
*Bursitis/bursal cysts
*Ovaritis
May result in oviductal blockage (infertinity > culling)

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25
Q

what is a bovine bursal adhesion? what can it result in?

A

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

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26
Q

what is a bursal cyst?

A

Fluid accumulation when bursal adhesions become severe

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27
Q

how does oviduct blockage occur in mares? what is the consequence and is it common?

A

Only live embryos pass thru the oviduct into the uterus in mares
‐embryo produces PGE‐2 to open the oviduct papilla
-Mare oviduct can become plugged with old oocytes and large amounts of follicular fluid
Uncommon cause of infertility in mares

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28
Q

how do we diagnose oviduct blockage in a mare? How do we treat it?

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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29
Q

what are common reasons for cervicitis?

A

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

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30
Q

how do we diagnose cervicitis?

A

vaginoscopy
◦ Look for endometritis, poor perineal conformation, urovagina, rectovaginal fistula

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31
Q

how do we treat cervicitis?

A

treat the underlying cause (often endometritis)

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32
Q

why do we get cervical tears in cows?

A

Occurs in cows when a calf is pulled too early before cervix is fully dilated

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33
Q

easiest way to palpate cervical tear

A

vaginal exam

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34
Q

how to visualize a cervical tear

A

visualize with vaginoscope

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35
Q

how to treat cervical tear

A

Minor tears often heal with time and medical management in the postpartum period

Re‐assess at 30 days after foaling

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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36
Q

Severe vaginal and cervical trauma at foaling often leads to:

A

adhesions and vaginal/cervical stenosis

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37
Q

partail or complete double cervix
(congenital abnormalities of cervix) are caused by:

A

Incomplete fusion of paramesonephric ducts

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38
Q

Varicose Veins in Mares are a common cause of what?

A

‐common cause of frank bloody discharge during pregnancy in mares
‐usually minor amount but can become severe in rare cases

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39
Q

how to treat varicose veins in mare cervix/hymen/vagina

A

‐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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40
Q

common causes of vaginitis in cows

A

IBR (herpes) or Ureaplasma are most common

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41
Q

what is the cause of Imperforate (Persistent) Hymen in the mare?

A

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

42
Q

how is Imperforate (Persistent) Hymen found? how does it present?

A

May be partial or complete

If partial, may only be found during first AI – as a band or tight sphincter

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

43
Q

complete Imperforate (Persistent) Hymen can lead to what? how do we treat?

A

If complete – leads to fluid accumulation anterior to it (ultrasound)
Treatment – manual rupture (under sedation !!) or electrocautery if thick

44
Q

3 common vaginal tumor types

A

Fibrosarcoma
Leiomyoma
Squamous Cell Carcinoma

45
Q

presentation of vaginal tumors

A

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

46
Q

diagnosis of vaginal tumors

A

Excision or biopsy for diagnosis and prognosis

47
Q

avoid confusing what with vaginal tumor

A

prolaspse, especially in pregnant cows in late gestation

48
Q

where anatomically will we usually see a vaginal squamous cell carcinoma?

A

Usually caudal tract – clitoris, vestibule, hymen area

49
Q

how to differentiate a vaginal squamous cell carcinoma in a mare vs intersex? how to treat?

A

History is different from an intersex/DSD
◦ Older animal; malodorous discharge often present ◦ May have offspring born previously
◦ Cycle normally, normal behaviour
◦ Self‐mutilation common
Locally invasive
Diagnosis by tissue biopsy
Treatment – excision + local chemotherapy (5‐FU)

50
Q

1st Degree Perineal Laceration - what is it and how do we treat?

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

51
Q

2nd Degree Perineal Laceration - what is it and how do we treat?

A

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

52
Q

3rd Degree Perineal Laceration - what is it, how does it arise, and how do we treat? prognosis?

A

Complete tearing of the shelf between rectum and vulva
Usually the result of dystocia or improperly applied traction at foaling

The tear is complete through the perineal body
Communication between rectum and vagina
Fecal contamination

Surgical repair delayed 6‐8 weeks
Wash daily and debride as required
It will look worse before it looks better!
Dietary management – laxative diet
Prognosis Good – for future fertility and uneventful foaling

53
Q

what is segmental aplasia of the uterus? how does it develop? what are the common presentations and what animals do we often see this in?

A

Most often present for infertility
Lack of development of a portion of the paramesonephric duct system
High prevalence in some breeds of cattle “white heifer disease” in white Shorthorns 0.2% prevalence in slaughterhouse studies

54
Q

what can occur with uterine segmental aplasia that can be confused with pregnancy?

A

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

55
Q

a cow is run through a chute for preg check with a small vulva and a big tuft of hair at the bottom of it. What are you thinking?

A

looks like a freemartin!

56
Q

what is a freemartin? how does this condition arise? what is the physical presentation?

A

-Heifers born co‐twin to a bull
-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

57
Q

in the case of freemartinism what is usually the case for the bull twin?

A

Fertility of the twin bull is also reduced

58
Q

how can we diagnose freemartinism?

A

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

59
Q

how can we diagnose equine intersex condition? what is a common fate for these animals?

A

Often inappropriate stallion‐like behaviour in an apparent filly
‐Or ambiguous external genitalia
The external appearance varies widely
‐from normal appearing female with male‐like behaviour to clitoromegaly and very long ano‐genital distance
Variety of syndromes
Diagnosis on examination findings, karyotype and cytogenetic tests

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

60
Q

Pyometra

A

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

61
Q

Mucometra

A

Mucometra – mucous accumulation in uterus

62
Q

Endometritis

A

Endometritis – inflammation of endometrium, animal is not systemically ill

63
Q

Metritis

A

Metritis – inflammation of all layers of uterus, animal is systemically ill

64
Q

Septic metritis

A

– early postpartum, toxic infection, acute, severe illness

65
Q

Pyometra – Why is the CL Retained?

A

Damage to endometrium – inability to produce PGF2a – no luteolysis

Production of luteotropic PGE’s by wbc’s in exudate

66
Q

why would we generally see pyometra in a cow? what are clinical signs?

A

After first ovulation post‐calving ie > 25 days PP
Anestrus
+/‐ vaginal discharge
Large fluid‐filled uterus
◦ Do not confuse with pregnancy
Cows are not sick
◦ Typically T. pyogenes

67
Q

Pyometra – Treatment for COWS? I

A

PGF2a

Two injections 14 days apart

‐lyse CL, estrus – opens cervix to allow drainage
‐uterine defenses

Prognosis ‐ ? Generally poor esp. if longstanding

68
Q

prevention for pyometra in cows

A

◦ Examine all cows by 30 days postpartum to identify those with uterine disease

69
Q

how does Pyometra in the Mare present? how is it differentiated from endometritis?

A

Present with periodic vaginal discharge
Differentiated from endometritis by extremely large volume of fluid in uterus

70
Q

what is the usual cause for pyometra in the mare?

A

Usually due to cervical trauma

71
Q

is Pyometra in the Mare easy to treat?

A

difficult to treat

72
Q

how to treat Pyometra in the Mare?

A

Difficult to treat
Previously hysterectomy was often the best/only option
Cervical wedge resection may help with drainage
◦ Uterine lavage and antibiotics

73
Q

Clinical Signs of Pyometra in the Bitch. What types are there?

A

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

74
Q

Pyometra Treatment ‐ Bitch. what condition is it associated with?

A

Associated with cystic endometrial hyperplasia
Spay often best option
Medical treatment for breeding bitches

75
Q

mucometra is secondary to what condition?

A

Secondary to cystic ovarian disease or associated with Segmental Aplasia

76
Q

mucometra may be confused with what? how do we differentiate?

A

Maybe be confused with a pregnancy
◦ No fetal membranes, placentomes or or fetus

77
Q

how do we treat mucometra in the cow?

A

Treatment – Ovsynch/ PGF2a/ treat COD
Cull if segmental aplasia

78
Q

endometritis usually affects cows at what time of their life?

A

postpartum period

79
Q

result of endometritis?

A

infertility

80
Q

Types of Endometritis in the Mare

A
  1. Persistent Breeding Induced Endometritis (PBIE)
  2. Acute Endometritis
    ◦ Venereal
    ◦ Infusion of Irritants into Uterus
    ◦ Contamination (feces, poor A.I. technique etc.)
    ◦ Can become chronic ie repeated breedings without pregnancy
  3. Chronic Endometritis (diagnose by biopsy – presence of lymphocytes and plasma cells)
81
Q

what is is purpose of breeding induced inflammation – transient inflammatory response in the uterus? when does it develop? what can go wrong in some mares?

A

A normal physiologic reaction to semen
Natural process 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 Persistent breeding-induced endometritis

82
Q

how common is Persistent breeding‐induced endometritis (PBIE) in mares? why does it occur? what does it lead to?

A

10‐15% of mares have a failure of the natural immune defense mechanisms
Failure of physical clearance
◦ Decreased uterine contractility
◦ Failure of cervical relaxation
◦ Pendulous uterus (gravity)
Accumulation of fluid/debris/bacteria Leads to infertility

83
Q

what is the pathological process whereby persistent breeding induced endometritis arises?

A

breeding > inflammation > NO/REDUCED CLEARANCE (as there would be in normal mares) > increased intraluminal fluid > increased inflammation > increased endometrial irritation > destruction of mucociliary barrier > bacterial colonization

=> in susceptible mares, we see an abnormal inflammatory resonse: influx of PMNs, IgG, proteins

84
Q

how do we diagnose persistent breeding induced endometritis

A

History: infertility
Previously retained fluid after breeding
Ultrasound mares at risk within 24 hours of breeding
◦ Presence of intrauterine fluid more than 24 hours after breeding is diagnostic

85
Q

Management of mares with PBIE

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

86
Q

things that can cause acute endometritis?

A

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

87
Q

clinical signs of acute endometritis?

A

+/‐ Vaginal discharge after breeding or at next estrus
◦ May “short cycle” (come back into estrus early – due to inflammation and endometrial PGF2a release

88
Q

diagnosis of acute endometritis?

A

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

89
Q

Treatment of endometritis in mares? What do we hope to accomplish?

A

◦ Treatment usually involves:
◦ Uterine lavage
◦ Antibiotic infusion
◦ Ecbolic therapy
◦ Correct perineal conformation defects

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

90
Q

Qualities of a Good Antibiotic Choice for endometritis

A

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

91
Q

treatment for Acute Bacterial Endometritis in Mares

A

Treatment is based on bacteria cultured

Combination of uterine lavage and antibiotic infusion into uterus

92
Q

what antibiotic should we not use in the uterus?

A

◦ Note: DO NOT use Baytril (enrofloxacin) intrauterine
>causes adhesions

93
Q

how do we diagnose chronic endometritis?

A

Diagnosed by biopsy
◦ Presence of lymphocytes and/or plasma cells

Culture swab (often negative – bacteria has been cleared but inflammation remains)

94
Q

where do we find Endometrial Cysts in Mares? what is usually their origin? what mares get them more commonly?

A

Fluid filled structures in the uterus
Usually within lumen
Usually are lymphatic in origin (dilated lymphatics)
Sometimes glandular Often seen in older mares

95
Q

effects of Endometrial Cysts in Mares

A

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

96
Q

what do endometrial cysts in mares indicate?

A

Indicate uterine pathology – usually fibrosis

97
Q

how do we treat Endometrial Cysts in Mares? what should we do first?

A

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

98
Q

Degenerative Endometrial Fibrosis (DEF) in Mares - how do we diagnose?

A

Diagnosed by endometrial biopsy

99
Q

what is Degenerative Endometrial Fibrosis (DEF) in Mares?

A

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

100
Q

effects of Degenerative Endometrial Fibrosis (DEF) in Mares? treatment?

A

Can interfere with uterine clearance, and secretion of
histotroph ‐‐‐‐ leads to EED
Non‐reversible -Biopsy helps give owners realistic expectations

Therio (13 decks)

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