Test 1: lecture 4: fertility problems

Question 1

differentials

Answer 1

small ovaries/ streak ovaries

• hypoplasia- 63 XO karyotype
• anestrus?
• atrophied ovaries

Question 2

how to diagnose 63 XO karyotype?

Answer 2

small ovaries

• Repeated palpations reveal no ovarian activity since estimated time of puberty.
• Ovaries are very small, smooth and firm. “streak ovaries”
• Extensive follicular atresia at birth
• Uterus and cervix are usually small and flaccid due to a lack of ovarian hormones.
• The mare is smaller in stature than expected.
• Definitive diagnosis by karyotype reveals only one X chromosome

Question 3

ca a 63 XO mare have a foal

Answer 3

yes, if you transfer an embryo and give progestogen throughout gestation.
* they don’t have their own eggs and their repro tract is small

Question 4

— most common ovarian tumor in mare.

Answer 4

Granulosa Cell Tumor (GCT)

• enlarged ovaries
• hard
• no ovulation fossa palpation
• abnormal hormones- ↑ testosterone, inhibin, AMH
• othere ovary will be small from ↑ inhibin
• behavior changes: anestrus, nymphomania, heterotypic/stallion like behavior

Question 5

how to treat Granulosa Cell Tumor (GCT)

Answer 5

ovariectomy of GCT; may take up to 1.5 years for opposite ovary to regain function

• hard tumor, can’t feel ovulation fossa, behavior changes: anestrus, nymphomania, stallion-like behavior

Question 6

Answer 6

Granulosa Cell Tumor (GCT) are multicystic

• no obvious ovulation fossa

Question 7

behavior changes from GCT

Answer 7

Anestrus- These mares do not have an estrus cycle because the follicles will not mature and ovulate due to the high concentrations of inhibin. lack steroids
Nyphomania- These mares do NOT have elevated concentrations of estrogens. But if they are housed in proximity to stallions or amorous geldings they will not resist/reject the stallions advances because they have no progesterone. So they may appear to be in heat every day but in fact they really are not cycling.- lack steroids
Heterotypic behavior is behavior of the opposite sex. So male/stallion type behavior in a mare. ↑ androgens

Question 8

what happens to other ovary with GCT

Answer 8

one big
one little from ↑ inhibin

Question 9

test for GCT

Answer 9

blood test measuring hormone concentrations
* 48% have elevated testosterone
* 80% have elevated inhibin
* 98% have elevated anti Mullerian hormone
* Progesterone concentrations are usually < 1 ng/ml as most mares do not cycle and ovulate. Therefore the mare has no CL. We have seen a few pregnant mares with a GCT.

Question 10

Answer 10

Histological section of a cystic space of a GCT. The diagnosis is made by the presence of piles of layers of granulosa cells lining irregularly shaped cystic spaces.

Question 11

mare ovary, other ovary normal

Answer 11

Cystadenoma or Cystadenocarcinoma

Question 12

— are rare but are often confused with a GCT. One should always have histology performed on any mass that is removed from the ovary.

Answer 12

Cystadenomas

Question 13

— are germ cell tumors.

Answer 13

Teratoma
Neoplastic cells are pluripotent and can form many different cell types.

Question 14

Answer 14

hematoma- will eventually regress on its own, does not effect cycling
* can still feel ovulation fossa

Question 15

Answer 15

Epoophoron cyst will always be present on the ovary. Cystic remnant of the mesonephric tubules. Is not thought to cause problems. Just don’t confuse with a breed-able follicle.

Question 16

— will always be present on the ovary. Cystic remnant of the mesonephric tubules.

Answer 16

Epoophoron cyst

• Is not thought to cause problems. Just don’t confuse with a breed-able follicle.

Question 17

differentials for large ovaries

Answer 17

• GCT- other ovary small, behavior changes
• Cystadenoma
• teratoma
• hematoma- resolves on its own
• Epoophoron cyst- always there but its fine- old mesonephric tubules
• transitional ovaries- normal for the season

Question 18

Patency of the oviducts is evaluated by

Answer 18

direct flushing of the oviduct or by placing starch grains, fluorescent beads, radioactive spheres on the surface of the ovary and examining for evidence of marker particles in uterine lavage effluent.

Question 19

an accumulation of fluid in the oviduct due to an occlusion of the ends of the oviduct (may be congenital or acquired).

Answer 19

hydrosalpinx

Question 20

how to treat hydrosalpinx if unilateral

Answer 20

if unilateral, surgical removal of
oviduct and ipsilateral/same side ovary.

Question 21

Answer 21

Sonogram of the convoluted, anechoic fluid distended oviduct.

• hydrosalpinx

Question 22

Answer 22

Parovarian cyst - cystic remnants of the mesonephric ducts; not pathologic. May be mistaken for a follicle during ultrasound examination.
* no treatment required

Question 23

Answer 23

Germinal inclusion cysts or “fossa-cysts” are formed by peritoneal fragments that become imbedded in the ovary following ovulation. These “serosal” cysts may be large enough or numerous enough to be of clinical significance by possibly interfering with ovum transport in older mares.“

Question 24

infundibulum

Answer 24

Fimbria cysts (Hydatid of Morgagni)

• only remove if too big, hemorrhage, adhesions

Question 25

blocked oviduct- how to treat?

Answer 25

blocked oviduct- accumulation of type 1 collagen fibers * PGE2 (endoscopic, directyly on duct) will cause isthmus to expel the globular mass- $$$ * misopostol (PGE1) intrauterine application

Question 26

Dr ied exudate on the hindquarters of this mare that has chronic ---

Answer 26

endometritis

Question 27

three main defense machanisms to prevent bacterial infections in the uterus

Answer 27

1. **Anatomical barriers**: Vulva and its underlying musculature, Vestibulovaginal ring, Cervix 2. **Immune system**-The presence of bacteria on the endometrium causes a rapid infiltration of neutrophils, immunoglobulins and serum proteins. Complement and opsonins bind to bacteria and enhance the neutrophils’ ability to phagocytize bacteria. The inflammation results in fluid production in the uterus. Note: Neutrophils from mares susceptible to endometritis have aa reduced ability to phagocytize bacteria as compared to mares resistant to endometritis. 3. **Mechanical uterine clearance**-Myometrial contractions normally expel uterine debris and exudate through a relaxed cervix. Although most mares will have good uterine contraction initially after contamination mares susceptible to endometritis tend to have reduced myometrial contractions after 6-8 hours. This results in an accumulation of bacteria and inflammatory products in the uterus that will continue to activate the immune system and produce more uterine fluid.

Question 28

three anatomical barriers to prevent endometritis

Answer 28

1. Vulva and its underlying musculature 2. Vestibulovaginal ring 3. Cervix

Question 29

how does immune system prevent endometritis

Answer 29

The presence of bacteria on the endometrium causes a rapid infiltration of neutrophils, immunoglobulins and serum proteins. Complement and opsonins bind to bacteria and enhance the neutrophils’ ability to phagocytize bacteria. The inflammation results in fluid production in the uterus. Note: Neutrophils from mares susceptible to endometritis have aa reduced ability to phagocytize bacteria as compared to mares resistant to endometritis.

Question 30

how does mechanical uterine clearance prevent endometritis

Answer 30

Myometrial contractions normally expel uterine debris and exudate through a relaxed cervix. Although most mares will have good uterine contraction initially after contamination mares susceptible to endometritis tend to have reduced myometrial contractions after 6-8 hours. This results in an accumulation of bacteria and inflammatory products in the uterus that will continue to activate the immune system and produce more uterine fluid.

Question 31

mare uterus

Answer 31

endometritis - filled with hyperechoic fluid - uterine horn distended

Question 32

4 causes of endometritis

Answer 32

* Chronic contamination caused by pneumovagina or urovagina due to abnormal conformation or injury to the vulva and perineal region. * Normal or abnormal parturition. * Introduction of pathogenic bacteria at the time of copulation or uterine manipulation, particularly in mares with a low resistance to infection. * Abnormal uterine motility, or obstruction of genital tract.

Question 33

clinical signs of endometritis

Answer 33

* May be none. Mare does not show systemic signs of illness. * Discharge from uterus. * Fluid in uterus, seen on ultrasound examination. * Uterine edema during diestrus. * Infertility.

Question 34

common causative organisms of endometritis

Answer 34

* Beta hemolytic streptococci ( Strep. zooepidemicus - 90%; Strep. equisimilis - 10%). * E coli. * Pseudomonas aeruginosa * Klebsiella pneumoniae. * Yeast – Candida sp. * Fungi - Aspergillus and Mucor sp.

Question 35

endometrium

Answer 35

**endometritis**: Severe granuloma evidenced by the large foci of **lymphocytes and plasma cells** in this endometrium.

Question 36

how to treat endometritis

Answer 36

* flush uterus- with saline * correct any physical abnormalities * give meds to evacuate uterus (oxytocin) * intrauterine antibiotics ∓ systemic antibiotics * give prostaglandin to hasten estrus- better defenses * good hygiene during exams and breeding

Question 37

how to stimulate uterine evacuation for treating endometritis

Answer 37

* oxytocin- 20 min contractions * prostaglandin- 4 hrs contractions * exercise * **Ecbolics** are drugs that stimulate contraction of the uterus.

Question 38

can you give chlorhexidine into uterus

Answer 38

no, will slough and fuse uterus

Question 39

how to treat steptococcal endometritis

Answer 39

β-hemolytic Streptococcus sp * ceftiofur (excede) * IM given q 4 days

Question 40

how to treat E. coli endometritis

Answer 40

need to breakdown biofilm * N-acetylcysteine- mucomyst * then go back next day and give antibiotic infusions * can also use 1% hydrogen peroxide to break down biofilm

Question 41

wall of uterus

Answer 41

**Periglandular fibrosis** is severe and there is severe nesting of glands and severe cystic glandular distension associated with the fibrosis. This would be Category III-5 endometrium that would have **difficulty carrying a foal to term**.

Question 42

why would horse not get pregnant

Answer 42

endometrial cyst - embryo needs to touch all the walls of uterus, this would get in the way and cause lutinization and loss of pregnancy

Question 43

what can cause endometrial transluminal adhesions

Answer 43

trauma; parturition; fetotomy; iatrogenic from infusion of caustic agents (chlorhexidine, Nolvasan®, iodine). * Treatment - break down manually; may reoccur. Mare may benefit from progesterone during early pregnancy to override luteolysis.

Question 44

Answer 44

Pyometra - accumulation of pus in the uterus

Question 45

what type of tumor

Answer 45

Leiomyoma- uterine tumors are not common

Question 46

Contagious Equine Metritis (CEM) is caused by

Answer 46

Taylorella equigenitalis * Venereal transmission and contaminated equipment and handling.

Question 47

Contagious Equine Metritis (CEM) in mares vs stallions

Answer 47

mares- can usually clear infection on its own stallion- asymptomatic and spread the disease ## Footnote reportable disease- Taylorella equigenitalis, need to screen all imported horses, need special culture

Question 48

how to repair poor perineal conformation

Answer 48

**Caslick's operation** - episioplasty - suture dorsal portion of vulvar lips together. If it is true that poor vulvar/perineal conformation is inherited, this procedure may allow perpetuation of the condition within a breed by allowing mares to reproduce that would otherwise have been naturally eliminated from the "gene pool". Severe cases may benefit from a Gadd’s procedure.

Question 49

how to treat urovagina

Answer 49

* Surgical urethral extension. * Improve body condition * Episioplasty to prevent pneumovagina may alleviate urovagina * In some mares, may be able to swab the urine out of the vagina

Question 50

horse " laying an egg"

Answer 50

persistent hymen * manual rupture of dorsal portion of hymen (vestibulovaginal fold).

Question 51

how to treat bleeding from varicose blood vessels in vagina

Answer 51

preparation H (hemorrhoid cream)

Question 52

why might you do clitoral sinusectomy

Answer 52

to prevent Contagious equine metritis