Lecture 24-26 - Diseases of the tubular tract Flashcards
What is salpingitis, what species is it most common in?
Salpingitis is an infection of the uterine tubes that is a continuatuion of an infection inside the uterus (endometritis).
Occurs more commonly in bovine
How can salpingitis lead to adhesions and hydrosalpinx?
Inflammation of hte uterine tubes can lead to trasnluminal adhesions, blocking the uterine tube. This results in accumulation of secretions from the epithelium, causing hydrosalxpinx.
Can you diagnose salpingitis via U/S? Can you diagnose hydrosalpinx via U/S?
You cannot see salpingitis via U/S in the cow, but you can see hydrosalpinx - uterine tubes are dstined with fluid
In horses, the utero-tubual junction remains shut, unless an embryo secretes ____ to dilate the utero-tubual jucntion so that it can enter the uterus.
PgE
What is hte most common reason for mares to have blocked uterine tubes? How do we treat?
When mares are used as atheletes for a long period of time, they will eventually stop when they get older and get bred for the first time, but fail to become pregnant. This is because their utero-tubual junction remains shut for long periods of time without being opened, and gets filled with old cells and debris, known as casts.
To treat this, we can dribble PgE directly onto the uterine tube on the side of the ovary that will ovulate laparascopically, which will open up the junction and release all the stuff that is in there. It takes a skilled specialist to do this procedure.
Endometritis vs Metritis vs Pyometra
- Endometritis = infection of the lining of the uterus
- Metritis = life-threatening infection of the entire uterus, including the myometrium, results in severe septiciemia. Occurs in the post partum period, and not seen in cycling animals.
- Pyometra = endometritis that results in the production of an exudate in the uterus and then that exudate does not pass through the cervix, but accumulates in the uterus.
Endometrosis, endometrial fibrosis, and cystic endometrial hyperplasia are all examples of conditions that cause ______ of the uterus.
Degeneration
What is endometrosis and endometiral fibrosis?
Endometrosis is the degeneration of the endometrium. Endometrial fibrosis is a form of endometrosis. Both are irreversible.
T/F: Endometrosis and endometiral fibrosis mean absolute infertility.
False - while the conditions are irreversable, they do not mean that the female is infertile, but are classic causes of subfertility, especailly in the hrose
Cystic endometrial hyperplasia is preculiar to which species?
The bitch
Endometrial cysts are most commonly encountered in what species?
Horses
Foreign bodies in the uterus are almost always the consequence of some _____ procedure.
Iatrogenic
Pathogenesis of uterine infections are usually due to ______ bacteria, and rarely due to _____ pathogens.
opportunistic; primary
Opportunisitc pathogens to cause uterine infections in the mare:
- Streptococcus equi spp. zooepidemicus*
- E. coli*
Opportunistic pathogens common to cause uterine infections in the bovine:
- Aracnobacterium pyogenes*
- Fusobacterium necrophorum*
Opportunistic pathogens common to cause uterine infection in the canine
E. coli
Proteus
Primary pathogens to cause uterine infections are almost always transmitted ______.
venereally
Is it common for equine coital exanthema (EHV 3) to affect the uterus?
No - hardly effects the uterus- herpes lesions are usually confined to the vulva an dmaybe the vestibule. Herpes viruses like lower than normal body temperatures, so they stay in the part of hte repro tract that is cooler than the rest.
What primary pathogen causes contagious equine metritis in the horse?
Taylorella equigenitalis
List three primary pathogens transmitted venereally in the horse to affect the uterus:
- CEM (contagious equine metritis) - Taylorella equigenitalis
- Equine coital exanthema (EHV 3)
- Some strains of Pseudomonas and Klebsiella
List three primary pathogens trasmitted venereally that cause uterine infections in the bovine:
- Trichomonas fetus
- Campylobacter fetus ssp. venerealis (uncommon due to vaccine)
- Bovine herpes virus (BHV-1) - generally remains int he caudal repro tract (likes cooler temps)
Most cases of endometritis are due to compromise of the uterine _____. Entry/contamination during ____ and _____ parturition are common times to lead to endometritis.
Defenses; estrus and parturition
2 types of compromised defenses in the uterus are:
Anatomical - barriers damaged
Functional - lack of expulsion
Compromised defenses of the uterus are potentiated by _______, why?
Progesterone - results in:
Low myometrial tone, closed cervix, suppressed leukocyte function (migration and phagocytosis), and no edema
T/F: hematology (CBC) is a good way to diagnose endometritis.
False - CBC remains NORMAL when only the endoemtrium is infected
T/F: A pyometra in the bitch results in changes in CBC.
True
Treatment for uterine infections
Cure compromised defenses
Flush (evacuate exudate)
Ecbolis - increase uterine contractions to evacuate the exudate
Anitbiotics
Luteolysis to decrease progesterone
During which part of the estrous cycle is it the most common for the uterus to become infected?
Estrus - cervix is relaxed - exacerbated by mating/breeding
Parturition -
T/F: There is no such thing as a non-endometritic post-partum female.
True - all females after giving birth hav some bacterial infection or infalmmatory response in the endometrium
While estrus is a common time for contamination of the uterus due to an open cervix, what defenses does the female have during estrus to prevent infection?
Under the influence of estrogen, the uterus secretes transudate - resulting in a net flow of transudate through the uterine lumen and out through the vagina (flushing mechanism)
Estrogen also enahnces leukocyte activity, so the uterus is well positioned to clean up any residual infection while the female is in heat.
Often in horses, endometritis is the consquence of an ______ deranged caudal reproductive tract.
Anatomically
How do horses with a sunken anus get predipsoed to uterine infections?
With a sunken anus, part of the vulva is drawn up and forward into the rectal recess. The vulvar lips are pulled open, and the direction of hte urethra changes. Normally the uretrha opens up caudally, and the vulva angles carnio-dorsal, allowing for the urine to exit the body. With a sunken anus, the urethra is now pointed at the ceiling of hte vestibule - resulting in splashing ans praying inside the vestibule which is more likely to overcome hte effective vestibulo-vaginal sphringer, and the slope of the vagina can become cranio-ventral and allows for urine to run cranially up the vagina.
A vulvometer is used to measure caslick’s index. What units is it measured in? How do you calculate caslicks index?
Measured in centimeters
Caslick’s index = length of vulva above ischeal artch in cm x angle of declination from vertical
What test on the mare can we do to determine if hte vestibulo-vaginal sphincter is working properly?
Windsucker test
tx for defective vestibulo-vaginal sphincter in the mare
Make the vulva opening smaller - just big enough to pass urine through
Healed cervical tears often lead to cervical _____.
Incompetency - cannot close properly
Which canine breed natrually has a cranioventral slope to the vagina?
English bulldog
Excessively deep perivulvar skin folds lead to ____ and ____ in the bitch.
Peri-vulvar dermatitis and ascending infections
what are the consequences of a large uterus as a result of older age and high number of parities in the bovine?
The uterus repeatedly stretches and will eventually hang over the pelvic brim. This does not allow for flow from the uterus into the vagina b/c the uterus os now lower than the vagina and the pelvis.
How does milking the cow only 2x a day and reduced exercise lead to impaired uterine emptying?
Everyime you milk a cow, we induce oxytoxin release. Naturally a nursing cow would nurse 6-12 times a day - so we dramatically decrease the oxytocin peaks in a cow when we milk her only 2x a day.
Exercise also increases abdominal pressure - putting pressure on the uterus and aiding in the evacuation from the uterus.
How does pushing dairy cows to produce a lot of milk lead to impaired uterine emptying?
We put them in a high ionized calcium state - leading to low/marginal calcium cocentrations, which compromises uterine contraction
How can intra-uterine AI impair uterine emptying in the cow?
A cow is not used to have things deposited in her uterine. The penis of the bull deposists semen into the vagina,and only motile sperm can enter the uterus. With AI - we introduce all the things included in semen extender into her uterus, which can start inflammation and can be further made worse by overgrowth of bacteria.
What are ventral sacculations in the mare?
In older mares - ventral sacculations develop at the base of hte uterine horn - they are pockets where fluid and exudate get stuck in.
How does lack of regular teasing lead to impaired uterine emptying in the mare?
Everytime a mare interacts with a stallion - she releases oxytoxin - leading to myometrial contractions which aid in uterine emptying.
Why is it important to stretch the mares cervix with AI?
Because it mimics the stallions large glans penis that opens the cervix wide up, so that it takes everal days for the cervix to contract down and close. These several days that the cervix is open is necessary to make sure whatever is in the uterus gets out befor eit closes.
Why does performing AI postovulation the mare with frozen semen lead to problems?
While frozen-thawed semen have a short lifespan and therefore should be inseminated right at the time of ovulation, once the mare has ovulated she is under the influence of progesterone, and she was not meant to be bred naturally under the influence of progesterone - so becuase of the influence of P - she is more suscepitble to endometritis
Four reasons that can lead to reduced leukocyte activity (migration and phagocytosis)
Long diestrus in bitches - due to prolonged exposure of P which supresses leukocyte activity
Meatbolic disarray and negative energy balance in dairy cows
Pituiatry adenoma in mare
Idiopathic in some mares
By design, the luteal function of hte bitch constitutes persistence of the ____.
CL
How does cystic endometrial hyperplasia develop in the bitch?
The bitch has long diestrus with a persistent CL htat keep ssecreting progesterone. This leads to an accumulation of uterine milk within the uterine glands, and the endometrium will eventaully become macroscopically cystic.
Cystic endometrial hyperplasia is potentiated by the induction of progesterone receptors by _____. What is the consequence of this?
estrogen
So the effect of progesterone on the endometrium is GREATLY magnified with simultaneous exposure to estradiol - so that the use of exogenous estrogens in dogs is not used anymore today.
Also the use of exogenous progesterone has become uncommon in dogs that are currently in proestrus (at a time with estradiol concentrations are high). The bitch wwas designed to FIRST be exposed to estradiol, the progesterone, NOT to be exposed to them simulatenously!
Being under the influence of both E and P simultaneously can lead to pyometra in the bitch.
T/F: In the horse, free fluid in the uterus at the time that there is a detectable CL on the ovary means she has endometritis until proven otherwise.
True!
When do we expect fluid in the uterus of a mare normally?
When she is in heat
In the bitch, when vaginal cytology shows 100% dead superficial cells, and you see the presence of leukocytes, where do these leukocytes come from?
Can not be from vaginal origin - leukocytes cannot get through the dead superfiical cell layer. Therefore, they must have come from the uterus - indicating endometritis.
What is the consequence of endometritis during estrus in the bitch?
Pyometra in the subsequent estrus - when her cervix is closed and the exudate accumulates in her utuers. This is easy to diagnose via U/S.
Do not culture the uterus unless you have cytological evidence that there is an infection in the uterus. How do you know there is an infection?
When we see neutrophils reacting to the bacteria. Bacteria alone does NOT indicate a uterine infection.
What are the hematological changes in metritis and canine pyometra?
Toxic left shift
Acute: leukopenia
Chronic: leukocytosis
When treating endometritis with antimicrobials, is it better to do local or systemic approach?
Systemic - because with local, you can introduce new bacteria and incite another infection
When lavaging the uterus (uterine flush) - to help make sure we do not leave any fluid behind, what can we administer to the female towards the end of hte procedure?
Oxytocin
A uterine flush can remove up to 99% of bacteria in the uterus. Why not 100%?
Small percentage will be insid ethe tissues of the endometrium
Occasionally we prefer to remove the fluid present in the mares the uterus, instead of flushing her uterus out. When would this be the case?
If it occured the day after AI - - do not want to disrupt the oocyte, so we can detect the pocket of fluid from U/S and aspirate it out. Since this fluid is undiluted - we can use this fluid for diagnostic purposes - cytological exam - if no neutrophils are present, we know the fluid is just residual transudate, and the mare doe snot have endometritis.
If you wish to use a local antimicrobial, and the agent we wish to use based on our sensitivity test does not appear on a published table of agents afte to use in the uterus of a hors, can we still use it?
NO - many antimicrobials can be so caustic that they can cause endoemtrial fibrosis
Pyometra in the mare is most often found in ______ and _____ mares.
Immunocompromised and older
Affected mares with pyometra show no systemic signs of _____!!
Toxemia
Which species is pyometra associated with systemic illeness? In which species is it NOT associated with systemic illness?
Pyometra is only associated with systemic illness in the dog! Pyometra in the horse and cow is NOT associated with systemic signs of disease.
The best time to diagnose whether or not a horse has endometritis with a cytology swab, is when her uterus should be free of both microorganisms and inflammatory cells. During which stage of the estrous cycle is this?
Diestrus
