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Theriogenology > Clinical Conditions of the Female Causing Infertility > Flashcards

Clinical Conditions of the Female Causing Infertility Flashcards

1
Q

What are the 6 diseases of the ovary

A

1) ovarian tumours
2) ovaritis/ ovarian abscess
3) paraovarian cysts
4) cystic ovarian disease (COD)/ ovarian cysts
5) ovarian hematoma
6) spring transitional ovaries

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2
Q

what species can get ovarian cysts

A

cows, mares, bitch

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3
Q

what determines the clinical signs produced by an ovarian tumor

A

the type of hormones produced -> can also be an incidental finding on a rectal exam

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4
Q

what is the most common type of ovarian tumor

A

granulosa-theca cell tumor aka G(T)CT or GCT

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5
Q

what are the clinical signs of G(T)CT based on:
- if producing testosterone
- if producing estrogen
- inhibin production

A
  • if producing testosterone: stallion-like behaviour (aggressive, hard to handle, mounting other mares)
  • if producing estrogen: persistent estrus, nymphomania in cows
  • inhibin production: inhibits FSH so the contralateral ovary is very small
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6
Q

what do you find on physical exam of a mare with a G(T)CT

A

1) one ovary is very small and one ovary is very large
2) loss of ovulation fossa on large ovary
3) variable appearance (cystic or solid) on ultrasound, but usually cystic

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7
Q

we suspect a granulosa theca cell tumor based on rectal exam and history of a mare; how can we confirm this?

A

histopathology and laboratory testing

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8
Q

what does the GCT panel test for (3)

A
  • testosterone
  • inhibin
  • AMH
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9
Q

T/F elevated inhibin and testosterone level can provide earlier detection of GCT than elevated AMH

A

F; other way around

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10
Q

how do bovine GCT’s present and how do we treat

A

Presentation:
- infertility
- unretractable uterus
- very large, lumpy ovary
- aggressive, bull-like behaviour

Treatment:
- unilateral ovariectomy

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11
Q

why do we perform unilateral ovariectomy for a cow with a GCT

A

to stop the unwanted behaviour (note, they rarely metastasize)

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12
Q

how long does it take a cow to resume cycling after removing a granulosa-theca cell tumor and why

A

several months, due to inhibin

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13
Q

what is the appearance of an ovarian teratoma

A
  • from embryonic origin so you will see teeth, hair, bone, cartilage, etc
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14
Q

serous cystadenoma:
- where do they arise from
- what is their impact on cycling and behaviour
- what hormones produced
- relative occurrence

A
  • lining epithelium of ovulation fossa
  • no impact
  • none
  • rare
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15
Q

what are paraovarian cysts formed from

A

remnants of the mesonephric ducts

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16
Q

how are paraovarian cysts diagnosed

A

incidental on ultrasound

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17
Q

what is the effect of paraovarian cysts on fertility and what is the treatment

A

no effect, no treatment

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18
Q

how do we differentiate transition follicles from tumors? what can be similar

A

Differentiate:
- both ovaries enlarged
- palpable ovulation fossa
- normal hormone levels

Similar:
- appearance on U/S can resemble a GCT

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19
Q

how are ovarian hematomas diagnosed

A
  • usually incidental
  • history of pain
  • rarely, abdominal bleeding
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20
Q

what is the treatment for an ovarian hematoma

A
  • give 4-6 weeks to let it regress
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21
Q

T/F ovarian hematomas often rupture into the abdomen, causing death

A

F; this happens rarely

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22
Q

what is the most common cause of a large tumor in cows

A

cystic ovarian disease

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23
Q

what is the DEFINITION of a cystic ovary

A
  • persist for longer than 10 days
  • absence of a CL
  • greater than 2.5cm diameter
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24
Q

up to 70% of cows with endometritis/pyometra also have: (3)(5)

A
  • salpingitis/ hydrosalpinx
  • bursal cysts/ bursitis
  • ovaritis
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25
Q

what are 2 common consequences of oviductal disease

A

oviductal blockage or bursal adhesions

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26
Q

what are bursal adhesions and what is a consequence

A
  • adhesions between ovary and fimbria
  • can result in infertility due to impaired oocyte pickup
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27
Q

what happens when a bursal adhesion becomes severe

A

fluid accumulation -> bursal cyst

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28
Q

how do we diagnose and how do we treat oviductal blockage in mares

A

1) diagnosed by exclusion, aka we rule out all other causes of infertility
2) treat with PGE2 gel application onto oviduct or oviductal opening -> contractions -> clears blockage

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29
Q

what are the 6 conditions of the cervix

A

1) cervicitis
2) fibrotic cervix
3) cervical tears
4) tumors, polyps
5) segmental aplasia and double cervix
6) varicose veins

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30
Q

what causes cervicitis and how is it diagnosed and treated

A
  • due to an underlying cause resulting in chronic irritation (trauma, air, feces, urine, endometritis)
  • diagnosed by vaginoscopy
  • treated by fixing the underlying cause
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31
Q

what is often the underlying cause of cervicitis

A

endometritis

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32
Q

what causes cervical tears in
- mares
- cows

A

mares: often when there is a “normal” appearing foaling or a dystocia
cows: often when a cow is pulled before the cervix is fully dilated

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33
Q

how do we diagnose cervical tears

A
  • palpate on vaginal exam
  • visualize with vaginoscope
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34
Q

how do we treat cervical tears

A

surgically

note: severe trauma often leads to adhesions and stenosis

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35
Q

when is surgical repair indicated to treat a cervical tear

A

greater than 50% of the length of the cervix is affected

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36
Q

what is the long term treatment for cervical tears:

A

often has to be retreated after subsequent foaling, so the best long-term prevention is embryo transfer

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37
Q

how is double cervix diagnosed and what is its common presentation

A
  • vaginoscopy or infertility
  • can be complete (each opens into their own horn) or partial (open into a common uterine body)
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38
Q

what causes double cervix

A

incomplete fusion of paramesonephric ducts

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39
Q

where can varicose veins be found

A
  • cervix
  • hymen of vagina
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40
Q

what is the most common cause of frank bloody discharge during pregnancy

A

varicose veins

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41
Q

how do we treat varicose veins

A
  • minor: apply preparation H
  • major: surgical laser or ligature cautery
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42
Q

what are the 7 conditions of the vagina, vestibule, vulva

A

1) itis (vaginitis, vestibulitis, vulvitis)
2) pneumovagina
3) urovagina
4) vaginal cysts (cystic Gartner’s ducts)
5) persistent hymen
6) tumors
7) perineal lacerations

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43
Q

how do we treat vaginitis

A

fixing the underlying cause (IBR or ureaplasma common in cows)

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44
Q

what causes a persistent hymen

A

failure to canalize the paramesonephric duct system at the level of the urogenital sinus during development

45
Q

how does a complete persistent hymen appear

A

protruding pink membrane from vulva of a maiden filly

46
Q

what is a consequence of a complete persistent hymen

A

fluid accumulates anterior to it (in vagina and uterine body)

47
Q

what causes vaginal cysts? how are they diagnosed? how are they treated?

A

remnants of the mesonephric ducts; incidental finding usually; large cysts are drained

48
Q

you see a cow with a large protruding mass in the lateral wall of the vulva… what is on your list of differentials

A

1) cystic Bartholin’s glands
2) tumor (need to rule out)

49
Q

what causes cystic Bartholin ducts to form

A

obstruction of the duct of the vestibular glands in the lateral wall of the vulva

50
Q

what are 3 common vaginal tumors

A

1) fibrosarcoma
2) leiomyoma
3) squamous cell carcinoma

51
Q

how do vaginal tumors present and what is an important differential in bitches and in pregnant, late gestation cows

A

Presentation
- vaginal discharge
- self-mutilation

Differential
- bitches: vaginal hyperplasia
- cows: vaginal prolapse

52
Q

what are the types of perineal lacerations (severity)? when do they usually occur

A
  • first degree
  • second degree
  • third degree

Usually occur at parturition

53
Q

what defines a first degree perineal laceration? how is it treated?

A
  • minor tear of the dorsal commisure of the vulva
  • limited to skin and mucous membrane
  • clean, debride and suture
54
Q

what defines a second degree perineal laceration and how do we treat

A
  • tear of skin, mucous membrane and extension into muscle layer
  • debride and suture if fresh OR allow to granulate if too old
55
Q

what defines a third degree perineal tear, what are the consequences and what is the treatment

A

complete tearing of the shelf between rectum and vulva; fecal contamination with resultant inflammation; must wash and debride daily for 6-8 weeks until healthier tissue forms, then surgically repair

56
Q

what is the prognosis for a third degree perineal tear

A

good for future breeding and fertility

57
Q

what is a rectovaginal fistula and how is it diagnosed and then treated

A

hole between vagina and rectum typically formed by the foal during parturition

diagnosed on post-partum exam, or by feces in vagina

treatment by conversion to a third degree perineal tear, then repair

58
Q

what are the 5 uterine conditions that can cause infertility

A

1) segmental aplasia and intersex conditions
2) uterine infections (metritis, endometritis, pyometra)
3) uterine cysts in mares
4) degenerative endometrial fibrosis in mares
5) uterine tumors

59
Q

what causes segmental aplasia

A

lack of development of a portion of the paramesonephric duct system

60
Q

why might an animal with segmental aplasia be falsely diagnosed as pregnant

A

fluid accumulation in the cranial parts of the tract often occurs

61
Q

animals with segmental aplasia most often present for what

A

infertility

62
Q

segmental aplasia causes _____________ disease in __________ (breed of ________)

A

white heifer disease; white shorthorns; cattle

63
Q

a heifer presents for pregnancy check; you notice a small vulva and a big tuft of fur at the bottom of it….

what is this condition?

A

freemartin (chimerism)

64
Q

what changes occur in a freemartin heifer?

A
  • hypoplastic vulva and vagina
  • underdeveloped ovaries and uterus
  • enlarged clitoris
  • seminal vesicles present
65
Q

what causes freemartins

A

placental vascular anastamoses results in the male fetus influencing the female reproductive tract

66
Q

how is chimerism diagnosed

A

physical exam findings; PCR for Y-specific sequence

67
Q

what is the range in appearance of equine DSD or intersex

A
  • normal appearing female with male behaviour to an clitoromegaly and a long ano-genital distance
68
Q

how does equine DSD commonly present

A

inappropriate stallion-like behaviour in an (apparent) filly

69
Q

T/F persistent mullerian duct syndrome and polled intersex syndrome are examples of intersex conditions in dogs and goats, respectively

A

T

70
Q

match the following:
1) endometritis
2) metritis
3) pyometra
4) mucometra
5) septic metritis

a) pus accumulation in uterus, with CL retained
b) mucous accumulation in uterus
c) inflammation of endometrium, animal is not systemtically ill
d) inflammation of all 3 uterine layers, animal is systemically ill
e) early postpartum, toxic infection, acute, severe illness

A

1) c
2) d
3) a
4) b
5) e

71
Q

why is the CL retained in the case of pyometra

A

1) damage to endometrium, so it is not able to produce PGE2 and cause luteolysis
2) production of luteotropic PGEs from WBCs present in the pus

72
Q

what are the clinical signs of pyometra in cows

A

1) greater than 25 days postpartum (after first ovulation has occurred)
2) large, fluid-filled uterus
3) anestrus
4) may see vaginal discharge
5) cows are not sick

73
Q

the prognosis for pyometra is ____________ depending on ___________

A

guarded to poor; chronicity

74
Q

how do you treat pyometra?
how do you prevent it?

A
  • 2 PGF2a injections, 2 weeks apart
  • prevent by examining all cows by 30 days postpartum
75
Q

how does pyometra present in the mare? how is it caused? how is it treated?

A
  • presents as periodic vaginal discharge
  • usually due to cervical trauma
  • previously treated by hysterectomy; now treated with cervical wedge resection, lavage and antibiotics
76
Q

T/F there is a way to treat pyometra in the mare without causing infertility

A

F

77
Q

how does pyometra present in the bitch

A
  • open: vaginal discharge 4-6 weeks after a heat
  • closed: sick, no discharge
78
Q

how is pyometra treated in the bitch

A
  • spay
  • medical treatment for breeding bitches
79
Q

what is associated with pyometra in the bitch

A

cystic endometrial hyperplasia, due to prolonged exposure to progesterone

80
Q

mucometra in cows is secondary to ______________ or associated with ______________

A

cystic ovarian disease; segmental aplasia

81
Q

how do you treat mucometra in cows

A

1) ovsynch/PGF2a/treat underlying COD
2) cull if segmental aplasia

82
Q

what is one of the most common medical conditions reported in equine practice and is generally a condition of the postpartum period in cows?

A

endometritis

83
Q

endometritis results in

A

infertility

84
Q

what are the 3 types of endometritis in the mare

A

1) persistent breeding induced
2) acute
3) chronic

85
Q

chronic endometritis is characterized by (2)

A

presence of lymphocytes and plasma cells

86
Q

describe breeding induced endometritis

A
  • inflammation is a normal physiologic reaction to semen
  • involves innate immune system and mechanical clearance
  • normal mares resolve inflammation within 24 hours
  • susceptible mares cannot clear the inflammation and develop PBIE
87
Q

what percentage of mares have failure of their natural immune defense mechanisms against semen

A

10-15%

88
Q

what are some reasons a mare may fail to physically clear semen, resulting in endometritis

A

1) decreased uterine contractility
2) failure of cervical relaxation
3) pendulous uterus

89
Q

how is PBIE diagnosed in mares

A

1) history of infertility
2) previously retained fluid after breeding
3) perform ultrasound within 24 of breeding -> if fluid is present this is diagnostic

90
Q

how do you manage mares with PBIE

A

1) breed only once per cycle
2) US within 24 of breeding to check for fluid
3) uterine lavage with sterile saline, 1L at a time until fluid is clear
4) ecbolic (PGF2a, oxytocin)

91
Q

what are the clinical signs of acute endometritis

A
  • vaginal discharge after breeding or at next estrus (note: may not see!)
  • short-cycling (due to inflammation and endometrial PGF2a release)
92
Q

acute endometritis in mares is usually ____________but can also be _____________or _______________ due to irritants infused into the uterus

A

bacterial; venereal; iatrogenic

93
Q

how is acute endometritis diagnosed

A

1) ultrasound
2) endometrial swab -> culture and cytology

94
Q

what is the best way to prevent endometritis in mares

A

aseptic technique when breeding or treating mares

95
Q

what are the goals of treating endometritis (4)

A

1) correct defects in uterine defense mechanisms
2) promote clearanve
3) control inflammation
4) neutralize bacterial/fungal contaminants

96
Q

endometritis treatment usually involves

A

1) uterine lavage
2) antibiotics
3) ecbolic therapy
4) correcting perineal conformation defects

97
Q

what are the qualities of a good antibiotic

A

1) effective against organism
2) effective in environment
3) reaches a good uterine concentration
4) non-irritating to the uterus

98
Q

what do you NOT want to use as a uterine lavage/antibiotic influsion combo to treat acute endometritis in mares

A

Baytril (enrofloxacin) -> causes uterine adhesions

99
Q

what do you want to correct to treat chronic endometritis

A

poor perineal conformation

100
Q

why might a culture swab be negative in a horse with chronic endometritis

A

bacteria has been cleared out but inflammation remains

101
Q

endometrial cysts:
- what type of structure?
- usually located where?
- usually are what origin?
- sometimes what origin?
- often seen in what age?

A
  • fluid-filled structure
  • lumen
  • lymphatic in origin
  • glandular
  • older mares
102
Q

T/F endometrial cysts can interfere with fertility if they are large or grouped

A

T -> they prevent the embryo from migrating -> no maternal recognition of pregnancy

note: can also interfere with placental attachment

103
Q

uterine cysts indicate what pathology

A

fibrosis usually

104
Q

how do you treat endometrial cysts in mares

A

1) nothing if small and few in number
2) laser ablation if large or clustered
3) uterine biopsy to determine prognosis

105
Q

degenerative endometrial fibrosis (DEF) is a ____________ degenerative process with ________ changes over time:
1)
2)
3)
4)

A

chronic; progressive
1) fibrosis
2) gland dilation
3) nesting of glands
4) vascular degeneration

106
Q

T/F DEF is non-reversible and results in infertility

A

T

107
Q

how is DEF diagnosed

A

biopsy

108
Q

uterine tumors:
- common/uncommon
- most common:
- what kind is the nastiest (metastasizes)
- treatment

A
  • uncommon
  • leiomyoma
  • adenocarcinoma
  • partial hysterectomy

Theriogenology (18 decks)

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