Endometritis and the Problem Breeding Mare

Question 1

layers of the equine endometrium

Answer 1

luminal epithelium
stratum compactum
stratum spongiosum
lymphatics

Question 2

Predisposing factors to endometritis

Answer 2

physical things like pelvic angles, vulvar conformation, VV sphincter, uterine position
age - gets worse with age and more fibrotic cervix, etc.
previous injuries
perineal conformation, windsucking
inflammatory and degenerative changes constantly
breed - clydes, shires, friesians, TW, TB

Question 3

Acute Physiological Endometritis

Answer 3

normal and good for health, caused by sperm, bacteria, saline, blood, saline, medications. Should clear in 12 hours

Question 4

HOw does the mare normally resolve acute physiological endometritis?

Answer 4

PMNs, Expulsion through cervix, and lymphatic drainage

Question 5

What is bad about the non-physiological endometritis

Answer 5

can be harmful to health, fertility
hostile environ for spermatozoa and conceptus
causes EED, failure to conceive
Leads to the secondary infections

Question 6

Non-physiological endometritis develops when?

Answer 6

after long natural mating, AI, along with pneumovagina, after any transcervical things

Question 7

From the diagram, what are the factors decreasing uterine clearance?

Answer 7

poor conformation
excessive fluid influx
poor lymph drainage
poor myometrial response

Question 8

Sequelae to non-physiological endometritis

Answer 8

weird cyclicity
failure to conceive
EED
mid-gest abortion
septic neonates
placentitis
post-partum metritis/RFM

Question 9

WHat are the mare factors that cause the endometritis?

Answer 9

1. age/parity - old maidens, cervical fibrosis (dystocia previous) –> less folds, less clearance
2. perineal conformation - longer vulva –> pneumo –> inflammation, also
3. uterine clearance - loss of support from stretched BLig –> pendulous non clearing uterus. ALso myometrial fibrosis
4. cervical competence
5. immune function - inflamm-aging
6. mucociliary dysfunction in the endometrial folds –> loss of cilia and accumulation

Question 10

HOw does myometrial fibrosis contribute to uterine clearance?

Answer 10

less activity or delayed onset contraction –> less clearance and lymphatic drainage. Is it calcium or NO?

Question 11

What is inflamm-aging related to?

Answer 11

age and obesity causing pro-inflamm cytokines, may decrease fertility

Question 12

What does strep zoo cause for endometritis?

Answer 12

hypersecretion of irritating, watery neutrophilic exudate, diffuse infection

Question 13

Whats the deal with biofilms and endometritis

Answer 13

adhere to endometrium, secrete matrix to coat, go dormant, then start up when activated

Question 14

What are the common pathogens of endometritis?

Answer 14

Gram positives mainly (strep zoo, staph, actinobacillus, bacteroides)
30% gram negs - e coli, klebs, pseudomonas, entercoccus, yeasts and fungi

Question 15

Which pathogens cause STD endometritis? how to tell?

Answer 15

culture in mare and stallion
klebs, pseudomonas
taylorella equigenitalis
trypanosoma equiperdum

Question 16

Susceptible mares are more likely to get - endometritis?

Answer 16

gram negative or mixed. the gram neg are harder to dx and treat.

Question 17

What is the immune response to endometritis?

Answer 17

Innate - PMNs, compliment, phagocytes

adaptive - APCs w/ Ag, T cells come along –> cytokines –> produce Ig –> destroy infected cells (CMI and Hum)

Question 18

What role does compliment play in endometritis in a normal mare? then in not normal?

Answer 18

Ig from seminal plasma and uterine secretions opsonizes the sperm –> release C5a, C5b, C3b –> attracts neutrophils –> come into the uterus.
Not normal mare - imparied opsonization –> not as good of PMNs

Question 19

Difference between fresh and frozen semen for endometritis?

Answer 19

frozen has no seminal plasma. Seminal plasma protects sperm, limits duration of inflammation and influences myo contractions. so Frozen is more irritating and will more likely cause PMIE

Question 20

Clinical presenation of endometritis and clinical signs

Answer 20

post mating inflammation
strep infections, some e coli
shortened inter-estrus intervals when going on.

Question 21

Clinical signs of PMIE

Answer 21

tail rubbing, discharge, estrous behaviour, but no stallion wanting to., shortened inter-estrus, EED, failure to concieve

Question 22

What is the likely cause of Chronic Inf Endometritis?

Answer 22

biofilm
in susceptible mares
insuff healthy glandular material

Question 23

What does CIE look like?

Answer 23

habitual abortions at 5-6 motnhs
failure to maintain preggo
lose by 40 days
ut infections in estrus and maintenance in diestrus (biofilm)
Usually gram negatives

Question 24

Which methods of Dx of endometritis are important in Gram negative infections?

Answer 24

Hysteroscopy

Endometrial biopsy

Question 25

What to Dx endometritis?

Answer 25

Hx, PE,
Palp - no tone after ov., dep uterus
US - lots of edema, air, some gram negs
Vag exam - relaxed, mucus, patent
Cerv exam -
hysteroscopy - cysts, tumor, adhesions, biofilm,
endometrial cytology***** - double guard, LVL or cytobrush
uterine culture - remember this from robinson lectures - pos when >5% N, 25% debris
endometrial biopsy - look at fibrosis, nesting, glands,

Question 26

Treatment goals for Endometritis

Answer 26

improve uterine clearance, reduce inflammation, eliminate pathogens, and prevent more