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Equine Therio > Common Complaints in the Non-Pregnant Mare > Flashcards

Common Complaints in the Non-Pregnant Mare Flashcards

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1
Q

Contraception and undesirable behavior

A

• Unwanted horse issue
• Undesirable reproductive behavior in performance
mares

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2
Q

• Undesirable reproductive behavior in performance

mares

A 
 Estrus poor performance
 Cyclicity related tying up
 Nymphomania
 Aggressive behavior
 Male-like behavior
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3
Q

Causes of poor performance during estrus

A

 Pain at ovulation (ovarian hematoma or large follicles)
 May be very colicky

• Other differentials
 Vaginitis
 Cystitis

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4
Q

• Methods for elimination of estrus behavior

A 
Progestogens
Glass marbles (poor efficacy)
Oxytocin injections (efficacy 70%, 45 to 50 days)
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5
Q

Progestins used to eliminate estrus behavior

A

–Altrenogest (0.044 mg/kg)

–Progesterone (0.2 mg/kg)

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6
Q

• Most common ovarian

tumor in the mare

A

Granulosa-theca Cell Tumor (GTCT)

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7
Q

Granulosa-theca Cell Tumor (GTCT) characteristics

A 
• Typically benign, slow
growing, non-metastatic
• Affected ovary is large (8
to 30 cm in diameter)
• Non-affected ovary is
very small, inactive
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8
Q

Common complaints associated with GTCT

A

• Stallion-like, aggressive,
(most common)
• Anestrus
• Nymphomania

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9
Q

Granulosa-theca Cell Tumor (GTCT) Dx

A

– Transrectal palpation
– Transrectal ultrasonography
• Endocrinology

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10
Q

Endocrinology Dx of GTCT

A 
• Endocrinology
–Progesterone
–Testosterone
• >100 pg/mL
– Inhibin
• >0.8 ng/mL
–Anti-Mullerian Hormone (AMH
• > 8.0 ng/mL, diagnostic
• 3.8-8 ng/mL suggestive
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11
Q

• Treatment of GTCT

A

– Ovariectomy- confirmation by
histopathology
– Normal cyclicity expected in 3 to 12
months after unilateral ovariectomy

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12
Q

4 classes of ovarian neoplasms

A
  • Gonadostromal tumors
  • Mesenchymal tumors
  • Epithelial tumors
  • Germ cell tumors
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13
Q

• Gonadostromal tumors

A
  • Granulosa theca cell tumor

* Interstitial cell tumor

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14
Q

• Mesenchymal tumors

A
  • Hemangioma, leiomyoma

* Germ cell tumors

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15
Q

• Epithelial tumors

A

• Cystadenoma, adenocarcinoma

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16
Q

• Germ cell tumors

A

• Dysgerminoma, teratoma

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17
Q

Metastases to the ovary

A

• Lymphosarcoma, melanoma,

adenocarcinoma

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18
Q

Ovarian Hematoma features

A 
• Does not affect the estrous
cycle
• Regresses over a few weeks
• Occasionally take several
months (calcified ovary)
• May cause discomfort
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19
Q

Common complaints in

the non-pregnant broodmare

A
  • Anestrus
  • Abnormal estrous cycles
  • Repeat breeding (infertility)
  • Abnormal vaginal discharge
  • Abnormal external genitalia
  • Mammary gland disorders
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20
Q

Routine examination of the reproductive organs

A 
• Perineal conformation and
examination of the vulva
• Mammary gland
• Palpation per rectum
• Transrectal
ultrasonography
• Vaginal examination
• Endometrial cytology and
culture
• Endometrial biopsy
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21
Q

Adavanced examination of the reproductive organs

A
  • Endocrinology
  • Hysteroscopy
  • Cytogenetics
  • Laparoscopy
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22
Q

Anestrus- causes

A

• Physiological: Season, puberty, PREGNANCY
• Acquired vs. Congenital
 History
– Mare has shown regular cycle or has foaled before
– Mare never showed any reproductive activity

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23
Q

Anoestrus – Persistent CL

A 
• Diestrus can last 60 to 90 days
• Normal ovarian size, CL
present (ultrasound or
progesterone)
• Uterus: tone (no pregnancy)
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24
Q

Treatment of persistent CL

A 
 PGF2α (Dinoprost
thrometamine)
 Analogue (cloprostenol, less
side effects) ****
 Spontaneous recovery
possible
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25
Anestrus – Persistent endometrial cups - cause
* Embryonic Death (>35 days) * Endometrial cups already formed * Normal genital tract on palpation
26
Dx of persistent endometrial cups
• eCG (commercial kits) • Biopsy or hysteroscopy • Check for reasons of embryonic loss: Fibrosis, metritis, iatrogenic
27
Anoestrus – Ovarian tumors
``` Not very common • Ovarian tumors that may cause anestrus  Granulosa-Theca cell tumor (GTCT)  Luteoma (rare) • Need to differentiate from other causes of ovarian enlargements ```
28
Anoestrus - Pyometra
```  Pyometra is usually not a cause but a consequence of acyclicity  CL not always present  Cervical or vaginal adhesions  Variable cycle history  Very old mares  Poor prognosis ```
29
Anoestrus – other causes
• Cytogenetic abnormalities: Ovarian dysgenesis (63 XO Turner syndrome) • Hormonal Treatments: Progesterone, Anabolic steroids: negative feed back on the hypothalamus • Nutrition: Weight loss after foaling, poor body condition • Old mare syndrome • Ovariectomized mares • GnRH implants (ovuplant®) (no longer approved in the USA) • Immunization against GnRH (Not approved in the USA)
30
• Abnormal interval between ovulations causes
 Aging  Anovulatory hemorrhagic follicles  Unilaterally functional ovary?
31
abnormal duration of estrus
 Short or Split-heat (common in transitional mares)  Long estrus (NO OVARIAN FOLLICULAR CYSTS IN THE MARE!!!) • Abnormal duration of the luteal
32
Abnormal luteal function
* Failure of ovulation * Short luteal phase * Lengthened luteal phase
33
• Failure of ovulation
 Anovulatory hemorrhagic follicle |  Equine metabolic disease
34
• Short luteal phase
 Early release of PGF2α from the endometrium (endometritis, intrauterine treatment)  Abnormal corpus luteum function
35
• Lengthened luteal phase
 Persistent CL with spontaneous recovery |  Early embryonic death
36
Luteal insufficiency
``` • Not well documented • Most often suspected because of  Small CL size  Poor uterine tone • Treatment  Progesterone supplementation – Altrenogest (0.044 mg/kg PO) – Progesterone injections (compounded) ```
37
Repeat breeding (infertility) - Hx
* Mare with regular cycles * Review breeding management practices * Health and reproductive history * Previous breeding soundness examinations * Endometrial biopsy * Common causes of infertility
38
• Common causes of infertility with regular cyclicity
 Fertilization failure |  Early embryonic death (before day 14)
39
Fertilization failure
• Stallion / semen factor • Breeding management Gamete transport
40
• Breeding management resulting in fertilization failure
 Technique  Gamete survival – Timing in relationship to ovulation – Uterine environment (endometritis)
41
• Gamete transport resulting in fertilization failure
```  Oviduct patency – Oviductal mass – Salpingitis • Cervical lesions (trauma, adhesions) ```
42
Fertilization failure - Oviductal masses
```  Type I collagen  At the ampulla-isthmus junction  Diagnosis be exclusion of all other cause  Treatment- laparoscopic application of PGE2 onto the oviduct ```
43
• Other bilateral disorders of the | oviduct (uterine tube)
* Hydrosalpinx * Salpingitis * Ovario-bursal adhesions
44
Early embryonic loss (before day 14)
 If the embryo dies before maternal recognition of pregnancy. The mare will return to estrus within a normal interval
45
 Embryo quality
– Aged gametes | – Chromosomal abnormalities (stallion and mare)
46
early embryonic loss is often caused by what
decreased embryo quality, poor uterine environment (cysts, fibrosis, infection), or abnormal hormonal development (luteal insufficiency
47
Uterine cysts - how they affect fertility
* Reduced embryo mobility * Abnormal placentation * Compromised cervical tone
48
predisposing conditions of uterine cysts
* Factors * Aged mares * Origin * Vascular changes * Lymphatic cysts
49
treatment of uterine cysts
* Aspiration | * Cauterization, laser ablation
50
major cause of infertility in the mare
endometritis
51
Etiology/pathogenesis of endometritis
 Contamination and establishment of infection  Failure of anatomical barriers to infection  Failure of uterine defense mechanisms
52
 Failure of uterine defense mechanisms
– Uterine contraction (uterine clearance) – Local immune response – PMN function
53
Endometritis: Risk factors
``` • Age • Breed • Anatomy  Perineal conformation  Large pendulant uterus  Endocrine disorders (Metabolic syndrome) • Endocrine disorders  PPID  Equine metabolic syndrome  Reduced immune functio ```
54
Endometritis - Diagnosis
``` • Transrectal palpation and ultrasonography  Large uterus  Thick edematous uterus  Overt uterine edema  Intrauterine fluid accumulation • Vaginal examimation  Cervicitis  Fluid in the vagina / vaginal discharge • Endometrial cytology and culture • Biopsy (GOLD STANDARD) ```
55
Endometritis – Common isolates; bacteria
 Streptococcus equi spp. zooepidemicus  E. coli  Pseudomonas aeruginosa  Klebsiella pneumoniae
56
Endometritis – Common isolates; fungal
``` (<5% of all cases)  Candida spp.  Aspergillus spp.  Mucor spp.  Others… ```
57
Endometritis – Diagnostics
Cytology, culture, bx
58
Endometritis - cytology
 Considered positive if >2 P
59
endometritis - culture
 Poor sensitivity in chronic endometritis  May culture one, two or even 3 bacteria  Best results is to culture from the biopsy
60
Endometritis - Treatment
``` • Intrauterine therapy • Uterine lavage (Elimination of biofilm Immunostumulation Intrauterine antimicrobials) • Systemic therapy (Antimicrobials, Anti-inflammatories) • Breeding management ```
61
Endometritis – surgical treatment
Correction of predisposing factors to ascendant infections (eg caslicks, Repair of vestibulo-vaginal sphincter) Correction of urovagina (urethral extension) repair of cervical tear elecation of uterine body (uteropexy)
62
Repair of vestibulo-vaginal sphincter
– Episioplasty | – Perineoplasty
63
Uterine lavage
* Removal of intrauterine fluid and inflammatory debris * Sterile fluids (Equine uterine flush®, LRS, 0.9% NaCl) * 2 to 5 liters total volume
64
Intrauterine antibiotic infusion
Intrauterine antibiotic infusion
65
Endometritis – Other intrauterine treatments
``` • Infusion of mucolytics or chelators • Dissolve thick mucus and pus • Help to remove biofilm and improves antibiotics penetration • Infused 4 to 12 hours prior to lavage • Use of Tris-EDTA (Tricide®) • 0.6% N-acetycysteine •30% DMSO ```
66
Endometritis - Antiseptics
``` • 0.05% povidone-iodine in LRS • 0.5 to 2% chlorhexidine, Some mares do not tolerate antiseptic infusion ```
67
Treatment of fungal endometritis
``` • Correction of anatomical defects • Uterine lavage • Uterine infusion Systemic +/- topical antifungals • Candida and Aspergillus form biofilms ----Mucolytics – Tris EDTA, N-Acetylcysteine infusions ```
68
uterine infusion for fungal endometritis
• 250 ml 2% acetic acid for 3 to 4 minutes
69
• 2 major classes of antifungals
* Azoles (inhibit ergosterol synthesis, fungistatic) | * Polyenes (bind ergosterol, fungicidal)
70
Persistent Mating-induced endometritis (PMIE)
Inability of the uterus to clear inflammatory products and semen by 12 hours post-mating or artificial insemination
71
• Risk factors (Susceptible mares) - PMIE
• Uterine clearance mechanism defects • Poor conformation • Cervical fibrosis (Old maiden mare syndrome)
72
• Treatment options
* Ecbolics (Oxytcin, PGF2α) * Uterine lavage * Topical therapies to relax the cervrx * Antibiotics * Anti-inflammatories * Acupuncture
73
Treatment for PMIE: Ecbolics
``` • Oxytocin • 10-20 IU, IM (3 to 4 times /day starting 4 hours post AI) • Carbectocin -Long acting oxytocin analogue (not available in the USA) • Cloprostenol ```
74
Cloprostenol
``` • More sustained uterine contractions compared to oxytocin • Premature luteolysis if given frequently or used more than 2 days post-ovulation ```
75
Cervical relaxation
``` • Treatment of PMIE in “Old maiden mare syndrome” • Tight cervix • Fluid accumulation pre and post insemination ```
76
cervical relaxation - drugs
``` • Topical PGE1 (Misoprostol) • Crushed tablest or compounded cream • Topical Nbutylscopolammonium bromide (Buscopan®) • Compounded cream ```
77
Uterine masses/neoplasms - most common
leiomyoma
78
leiomyoma
``` • Usually solitary • Well-circumscribed • Involves myometrium • Large masses require partial hysterectomy (mares can still carry a pregnancy ```
79
Abnormalities of the external genitalia
persistent hymen | XX sex reversal
80
• Persistent hymen
``` • Perforate hymen - Incidental finding in maiden mares - Easily ruptured manually - Perforate hymen • Imperforate hymen - Accumulation of mucus in the vagina and uterus - Can bubble out of the vulva - May require surgical excision ```
81
Mastitis usually occurs when?
•Usually occurs after weaning
82
clinical signs of mastitis
* Clinical signs * Swollen, warm udder * Ventral edema * Fever * Hind limb lameness
83
Dx of mastitis
``` •Cytology and culture of milk •Serous, serosanguinous or purulent •S. zooepidemicus most common isolate •Ultrasonography ```
84
Tx of mastitis
* Systemic antibiotics, NSAIDs * Frequent milking * Hot-packing or hydrotherapy
85
Mammary gland neoplasia - Primary Tumors
Adenocarcinoma (MOST COMMON), adenoma
86
Skin origin mammary tumors
• Squamous cell carcinoma, melanoma, | sarcoids
87
metastatic tumors of the mammary gland
• Melanoma, mastocytoma, | lymphosarcoma
88
clinical signs of mammary tumors
* Mammary gland enlargement * Pain, discharge * Skin lesions * Weight loss
89
• Diagnosis of mammary tumors
* Ultrasonography * Cytology (FNA) * Biopsy
90
metastatic pattern of mammary adenocarcinoma
• Metastasize to the inguinal lymph | nodes, liver, lungs, other organs
91
treatment (if no mets) of mammary adenocarcinoma
``` • Mastectomy • Chemotherapy • Radiation therapy • Survival < 18 months even with treatment ```
92
Inappropriate lactation in neonates
• Elevated lactogenic hormones of maternal origin in fetal circulation
93
• Galactorrhea
* Milk production in non-pregnant /foaling mares * Elevated prolactin * Pituitary Pars Intermedia Dysfunction * Rule of mastitis * Treatment * Treat PPID with pergolide or cyproheptadine * Treat others with pergolide or bromocryptine, decreased feed (protein and energy) * Do not milk out as it will stimulate more lactation

Equine Therio (6 decks)

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