Mare BSE and Infertility Flashcards
5 Broad main aspects to mare BSE:
1. 2. 3. 4. 5.
- History
- Visual inspection
- Visual inspection of perineal area
- General PE
- Repro examination
Order of procedures performed after perineal evaluation:
1.
2.
3.
4.
- Clean rectum of feces
- Palpation of repro tract
- Complete U/S of repro tract.
- Tail wrap / wash pernieum.
Order of procedures performed after repro palpation and u/s:
1.
2.
3.
4.
- Vaginoscopy
- Manual vaginal/cervical exam
- Uterine culture / cytology
- Uterine biopsy
Vulvar conformation
- Perform ___-test
- Ideal conformation?
- air
2. 1/3 above and 2/3 below pelvic bone
Caslick index is used to measure:
vulvar conformation
Purposes of Vaginoscopy:
1.
2.
3.
- Observe position of cervix in the vagina
- Detect presence and nature of discharge
- Detect vaginal lacerations
T/F The most reliable way to examine patency of cervix is by digital examination during anestrus
F, during diestrus
T/F: Both rectal examination and U/S evaluation are NOT reliable ways of determining cervical patency
T
Cervix:
Formed by:
1.
2.
3.
- Abundant collagenous tissue
- Smooth muscle fibers
- a few tubular glands
What animals will experience a natural loss of cervic functional integrity?
Maiden mares 8-10 years old that have never delivered a foal
Three most common cervix pathologies:
1.
2.
3.
- Fails to relax and open during estrus
- Fails to close during diestrus
- Adhesions
The best way to determine cervical pathology is by:
1.
2.
3.
4.
- U/S
- Vaginoscopy
- Digital exam in diestrus
- Endoscopic evaluation
Uterine Culture is a routine diagnostic technique used for:
1. 2. 3. 4. 5.
- Mares pre-breeding
- Screening mares pre-breeding
- Post-treatment
- Mares with poor repro histories
- Mares with signs of endometritis
Uterine swab:
- ______ or _____ guarded
- Technique?
- Single or double guarded
2. Move and roll in uterus for 30 seconds to maximize contact
Brush cytology:
- Used with ______
- benefit of the design of the brush?
- regular culture swabs
2. System allows outer sheath to remain in mare while swab is taken out and brush is then inserted
- You (do/do not) want to stain slides immediately?
2. Make how many slides?
- do
2. 2, one for diff-quik, one for special staining
The most endometritis causing bacteria in mares are:
1.
2.
- Strep zooepidemicus
2. E. Coli
Indications to perform uterine biopsy:
1. 2. 3. 4. 5.
- Repeated embryonic death
- Repeated abortions
- Fail to respond to treatment
- Unable to diagnose uterine pathology with routine endometrial swabs
- Prognosis of how difficult it will be to get her pregnant or to maintain the pregnancy
T/F: Uterine biopsy is a non-painful procedure
T
Two main things we are looking for in uterine biopsy?
Type of cells present, and glandular density
Grad I Uterine Biopsy is (normal/abnormal)?
normal
Grade I uterine biopsy: expected foaling rate?
80-90%
Grade IIA Uterine biopsy:
- Appearance?
- Expected foaling rate?
- mixed cellularity and fibrosis
2. 50-80%
Grade IIB Uterine Biopsy:
- Appearance?
- Expected foaling rate?
- isolate of glands in fibrous tissue. Moderate change
2. 10-50%
Grade III Uterine biopsy:
- Expected foaling rate?
- Severe change = < 10%
T/F: A mare with a Grade III uterine biopsy will never be able to give birth
F
Endoscopic examination is used to diagnose:
1. 2. 3. 4. 5. 6.
- Intraluminal adhesions
- Foreign bodies
- Status of endometrial folds
- Intraluminal cysts
- Tumors
- Purulent plaques
When to suspect oviductal blockage?
When everything appears normal but mare is unable to get pregnant or produce embryo
Ways to diagnose oviductal patency:
1.
2.
3.
4.
- Presence of embryo
- Starch granule test
- Fluorescent labeled beads
- Oviductal lavage with new methylene blue
Infertility: Categories of Problem Mares:
1.
2.
3.
4.
- Failure to cycle or ovulate normally
- Failure to conceive
- Early embryonic loss
- Pregnancy loss
Reasons a mare would fail to ovulate?
1. 2. 3. 4. 5.
- Winter anestrous
- Transitional mare having an irregular estrus period
- Pregnancy
- Endocrine (ovarian)
- Uterine pathology
Behavioral causes of non-cylic mare:
1.
2.
3.
4.
- Shy mares may be in novel environment
- Mare may be too familiar with or aversion to a particular stallion
- Maiden mares, mares with foal at foot or never bred by natural cover may not show estrus even though cycling normaly
- Iatrogenic - under anabolic or progesterone/progestins therapy
Ways to determine if mare is cycling:
1.
2.
3.
- Palpation U/S every 3-35 days
- Progesterone assay on weekly basis
- Treatment with Prostaglandin
Prolonged Diestrus/pseudopregnancy:
Potential etiologies: 1. 2. 3. 4.
- CL lifespan prolonged beyond 15 days
- Diestrul ovulations - mature CL at PGF2a release
- Early embryonic death after maternal recognition of pregnancy 15 or 35 days
- Failure of PGF2a release due to uterine abnormality - pyometra
Ovarian-related Etiologies for Failure to cycle:
1.
2.
3.
4.
- Reproductive senescence - old mares
- Nutrition induced (low BCS = negative energy balance
- Anterior pituitary dysfunction
- Adrenal problem
Gonadal Dysgenesis:
- Small ovaries and infantile tract is most commonly caused by what genotype?
- These animals will be phenotypically (male/female)?
- Describe this animals ovaries?
- Describe this animals uterus and cervix?
- 63XO genotype.
- female
- very small, firm, smooth
- thin and flaccid
(male/female) pseudohermaphrodites are more common?
Male
Tumors that could cause failure to cycle:
1.
2.
3.
4.
- Teratome
- Dysgerminoma
- Cystadenoma
- Granulosa (thecal) cell tumor
Differentials for large ovarian syndrome that are NOT tumors:
1.
2.
3.
4.
- Ovarian hematoma
- Ovaries with accessory CL’s - pregnancy
- Transitional ovaries
- Hemorrhagic Anovulatory Folllicles
Most common equine repro tumor?
Granulosa - Thecal Cell Tumor (GTCT)
GTC tumor:
Clinical presentation
- ___ abnormalities
- Ovary?
- Behavioral abnormalities (aggressive, nymphomania, stallion-like, anestrus)
- Enlarged ovary with loss of ovulation fossa, contralateral ovary may be small
GTCT:
- Tx?
- Prognosis?
- Remove ovary.
2. Return to cyclicity 6-8 months post sx
Endometritis accounts for about ___% of cases of infertility in mares?
60%
Barriers to infection that endometritis overcomes?
1.
2.
3.
- Vulva
- Vestibulo-vaginal fold
- Cervix
Types of Endometritis:
1. 2. 3. 4. 5.
- Breeding induced
- Persistent breeding induced
- Acute bacterial
- Chronic Bacterial
- Chronic Degenerative = ENDOMETROSIS
Persistent Breeding Induced Endometritis:
- Describe how it occurs?
- Mares unable to evacuate residual fluid via uterine contractions due to poor contractility or poorly relaxed cervix.
Persistent Breeding Induced Endometritis:
- Common in what animals?
- Root of the problem?
- old maiden mares > 8 years
2. Cervix
Ways to diganose endometritis:
1. 2. 3. 4. 5. 6.
- Palpation and U/S
- Uterine fluid
- Uterine inflam
- Culture/cytology
- Biopsy
- Endoscopy
Possible effects of uterine pathology on ovarian function:
1.
2.
3.
- Anestrus
- Short luteal phases
- Prolonged luteal phases
T/F: Not all uterine problems affect cyclicity
T
Presence of ___ in uterus is always a red flag
fluid
Uterus U/S Examination:
- Testing regimen?
- If fluid present, should be gone in how long?
- 12-24 hour intervals
2. 24 hr
Muco-Ciliary Defense:
Three aspects of the mechanism:
1.
2.
3.
- All three aspects are disrupted by _____
- Mucous continuum
- Adequate elasticity
- Adequate viscosity
- Mucus hydration
Alternative diagnostic methods for diagnosis of uterine infection:
1.
2.
3.
- Uterine biopsy
- Low volume lavage
- Endoscopic eval (hysteroscopy)
When should we culture a uterine biopsy sample?
1.
2.
3.
4.
- MARES WITH A PREVIOUS NEGATIVE CULTURE
- Mares that continue to accumulate fluid
- Mares that ovulate with hyper-edema
- Mares that show premature presence of uterine edema
Low volume uterine flush for diagnosis:
- Infuse _____ mLs of or ___ in the uterus
- 100-150 mls of saline
Broad therapy goals for Persistent mating induced endometritis:
1.
2.
- Reduce the degree of inflam
2. Reduce the time the fluid is accumulated
Ways to reduce the degree of inflam in PMIE:
1.
2.
- Reduce sperm numbers
2. Steroids (dexmethasone)
Ways to reduce the time the fluid is accumulated in PMIE:
1.
2.
3.
4.
- Uterine lavage via ECBOLIC AGENTS
- Oxytocin
- Prostaglandin analogues (cloprostenol)
- Carbetocin
How do you give antibiotics in the uterus?
intrauterine infusion in 20-60mLs of water, NaCl, or LRS for 3-5 days
Clinical Signs of Chronic bacterial or fungal endometritis:
1.
2.
3.
- Poor perineal conformation
- Cervical incompetence
- Poor uterine contractility
Therapy options to get rid of biofilms:
1. 2. 3. 4. 5 .
- Acetylcisteine
- DMSO
- Buffered chelating agents Tris EDTA/Tricide
- Gentocin
- Kerosene
2 Broad categories of causes for EED:
1.
2.
- Embryonic abnormality (chromosomal aberrations)
2. Deficient maternal environment
3 ways a deficient maternal environment can cause EED:
1.
2.
3.
- Insufficient maternal P4
- Inadequate endometrium
- Endometritis
Signs of EED:
1. 2. 3. 4 .
- Small size for gestational age
- Irregular vesicle prior to day 20
- Absence of a heart beat at day 28-30
- Free fluid or disseminated edema in a pregnant mare
Causes for insufficient progesterone (P4) in a mare:
1.
2.
- Failed MRP d/t cysts impeding migration.
2. PGF2a via severe stress or disease
Abortion in a mare defined as loss of fetus after what age?
45 days before birth (?)
Non-infectious causes of abortions:
1.
2.
3.
4.
- Placental insufficiency
- Twisted umbilical cord
- Trauma
- Poor nutrition
Causes of Placental Insufficiency:
1.
2.
3.
- Twinning
- Uterine body pregnancy
- Endometrial atrophy / fibrosis
Three routes of bacterial infection in mare repro tract:
1.
2.
3.
- Transcervical
- Hematogenous
- Previous intrauterine infection?
Bacterial Causes of abortion:
1.
2.
3.
4.
- E. Coli
- Strep
- Actinomycetes
- Lepto
Lesions in EHV infection?
Fetal lesions including hydrothorax, pulmonary edema, hepatic necrotic foci
Characteristic cytology of EHV?
Intranuclear eosinophilic inclusion body and chromatin margination
Coital Exanthema
- caused by what virus
- Transmitted by?
- EHV-III
2. Stallion
Clinical Signs of Equine Viral Arteritis:
1.
2.
3.
- Fever/depression
- Rhinitis/conjunctivitis
- Ventral edema
What is the only true venereal sexually transmissible disease in horses?
Contagious Equine Metritis