Abnormalities Involving Uterus

8/12/2019 Abnormalities Involving Uterus

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ABNORMALITIES INVOLVING UTERUS

Palpation for Uterine Disorders

During routine post partum examinations in cases in which pregnancy diagnosis isnegative or in examination of problem cows, the reproductive tract should beexamined for palpable abnormalities. The essential questions for the examiner toanswer are the following:

o Is the uterus symmetrical and approximately the size and tone of the nongravid tract?

o Is there a corpus luteum or an ovarian follicle associated with corpus luteumor an ovarian follicle associated with increased uterine tone that is indicativeof cyclicity?

o Are there any palpable lesions of the reproductive tract?

Uterine Inflammation

It is generally possible to diagnose moderate to severe endometritis, acute metritis orpyometra by rectal examination.

Adhesions

On rectal examination it would be possible to detect the presence of uterine or utero-ovarian adhesions that would interfere with normal retraction of some part of thetract.

Commonly, the uterus will adhere to the rumen, the omentum or the ovarian bursae. Prognosis depends on the severity of adhesions and the degree of involvement of the

oviducts and fimbriae.

Perimetrial Adhesion

Parametrial Adhesion


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Abscesses

Uterine abscesses can occuro following dystociao as a sequel to the improper use of an intrauterine pipette.

Location and size of the abscess varies depending on the degree of mechanical insultin the former and the degree of endometrial/ myometrial insult in the latter.

Abscess is most often located in the area of the uterine body and is approximately thesize of a golf ball and in either case the abscess is firm and raised and may causediscomfort when palpated.

Adhesions of the abscessed portion of the uterus to other abdominal or pelvic organsare common.

Pipette Abscess

Tumors

Tumors of the bovine uterus are not common but when seen occur predominantly inolder cows. Uterine lymphosarcoma, leiomyoma and rarely carcinoma have beendiagnosed.

Lymphosarcoma may be detectable as multiple smooth nodular enlargements of theuterine wall, often with concurrent enlargement of the deep inguinal and iliac lymphnodes.


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Leiomyoma Lymphosarcoma

Fetal Remnants

Occasionally, a fragment of an autolyzed term fetus may remain in the uterine lumenfollowing parturition

Can be detected as a moveable firm mass in the lumen of an involuting uterus. A foulvaginal discharge will often be noted.

Cows or heifers that do not calve at the expected time following a positive pregnancydiagnosis may have either a mummified or macerated fetus.

In cases of fetal maceration, a distended uterus with palpably crepitant fetal bones

can be felt. An ipsilateral CL may be present, as well as a fetid vaginal discharge.

The prognosis for future fertility of such cows is grave due to severe damage to theendometrium .

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Fetal Mummification Fetal Maceration

Freemartinism

In Freemartinism the cervix is rudimentary while the uterus is underdeveloped andcharacterized by the presence of two thin walled, very narrow tubes occupying thesites of the normal horns, suspended in ligamentous sheets resembling the broadligaments

Lateral exploration along the edge of the broad ligaments leads to location of barelyperceptible thickening indicating the rudimentary ovary

Failure to locate the normal cervix during the course of rectal examination shouldalways be followed by a thorough exploration for signs of freemartinism.

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White Heifer Disease
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Also known as segmental aplasia of the Mullerian duct The extent of aplasia and the number of the missing segments is variable Secretion of the normal segments becomes entrapped between the missing segments

or anterior to the missing part, resulting in marked distension of the normal segmentassociated with thinning of the wall. Persistence of the hymen, one of the forms of

white heifer disease, results in accumulation of secretion in the anterior part of thevagina, with consequent dilation which elicits tenesmus.

Uterus Unicornis

This relatively rare abnormality has been found in practically all breeds. The horn that is present is functionally normal and conception is possible only

during an estrus when the follicle develops and ovulates occurs in the ovary on theside of the normal horn

Reduced fertility can be anticipated.

Uterus Unicornis

Cervix Duplex or Double Cervix

This also is a rare abnormality. The presence of two cervices, resulting in two singletube genital tracts anterior to the vagina, might cause temporary confusion in theexaminers mind. Diagnosis, however, is easy .

Fertility of the affected animal does not have to be impaired if natural breeding isemployed. Artificial insemination might result in failure to conceive unless the ovarycarrying the follicle ready to ovulate is detected and the semen is deposited in thecervix of the same side.

Bilateral insemination in the double cervices might also be recommended.


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True Double Cervix

Pyometra

Characerised by accumulation of pus in the uterus and may occur due to lack ofsufficient relaxation of the cervix or to the presence of cervicitis combined with atonyof the uterus and consequent lack of expulsive force.

The amount of exudates varies from 25cc., which is barely felt upon examination, toseveral liters.

The uterine walls are thinner than in the non-pregnant uterus, but thicker than thepregnant uterus

The condition has to be differentially diagnosed from pregnancy

Post coital pyometra Pyometra

Mucometra or Hydrometra


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Both mucometra and hydrometra are similar except for the degree of hydration ofmucin present in the uterus which may vary from a watery fluid to a semisolid mass.

Condition is observed in heifers or cows followingo arrest in the development of mullerian duct system.o persistence of hymeno prolonged hormonal stimulation with estrogens or progestogens

Cows with mucometra or hydrometra due to defects of genital tract are sterile.

Cows with pyometra do not cycle, while cows with a hydrometra do.

HydrometraHydrometra is generally the result of an

obstruction. In this instance the blockage is atthe level of the cervix. The right horn and thebody of the uterus are distended with watery

fluid.

Hydrometra/ Clear FluidClear watery fluid was aspirated from the lumen

of the uterus with hydrometra.

Chronic Nonproductive Metritis

This condition is often referred to as chronic endometritis On rectal palpation

o the uterus lacks tone,o has a thin wall, especially in the intercaruncular spaces,o caruncles, therefore, appear more prominent, and the endometrial surface

feels wavy and uneven. Diagnosis is by vaginal examination and histological examination of biopsies.


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Chronic Metritis

ABNORMALITIES INVOLVING THE OVARIES

Smooth Ovaries

Ovaries are smooth Repeated palpation confirms the presence of smooth ovaries. Systemic or local

causes should be investigated.

The detection of smooth ovaries at a single examination in cycling cows, especially during

the first few days following ovulation when the developing CL is not palpable is perfectly

normal.

ABNORMALITIESOF THE

OVIDUCT

Only thoseassociated withenlargement ofthe oviduct aredetectableclinically.

Hydrosalpinx


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Smooth Ovaries

Ovarian Cysts

Ovarian cysts are fluid-filled structures greater than 2.5 cm in diameter.

Should be differentiated from parovarian cysts, which do not involve the ovary but rather

involve remnants of the mesonephric or paramesonephric duct systems.

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Follicular Cyst

Ovarian Hypoplasia
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Ovarian hypoplasia is found in all breeds and may be bilateral or unilateral. Bilateral hypoplasia is found in heifers only and is always associated with sterility . Cows and heifers which are affected unilaterally might reproduce relatively normally. The degree of hypoplasia varies and the affected ovary might be recognized as a

barely distinguishable thickening of the mesovarium. In other cases, the ovary mightbe slightly larger.

Whenever the dimensions of the ovary are found to be less than 2 cm x 0.5 cm x 0.5cm this disease should be suspected. The affected gonads are are hard and static.

Functional structures such as follicles or corpus luteum are not present. In cases of doubt, re-examination should be recommended, especially for

differentiation from ovarian atrophy. Hypoplasia of ovaries has been found to be hereditary in nature, and it is very

important to detect the unilateral cases which might reproduce and transmit thedisease to offspring.

Ovarian Hypoplasia

Streak Gonad

Underdevelopment of Ovaries in Heifers

Usually bilateral and is found primarily in poorly fed and managed heifers Most commonly heifers of the same age are affected The ovaries are small and static, consistency varies from flaccid to fibrotic while

there is atrophy of the uterine wall

It is difficult to differentiate this condition from ovarian hypoplasia based on singleexamination. Re-examination, preferably after correction of feeding practices, might

be necessary

Ovaritis or Oophoritis

Inflamation or infection of the ovary also known as ovaritis or oophoritis occurso secondary to traumao to infection from the uterus that passes through the oviductso by extension of infection through the uterine walls

Associated with marked enlargement of the ovary.


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In acute ovaritis, enlargement is due to edema. Diagnosis of chronic ovaritis is based on enlarged fibrotic ovaries and presence of

organized adhesions to the surrounding structures, primarily to the mesosalpinx.

Oophoritis

Miscellaneous Ovarian Conditions

Include abscesses and tumors. Both of these conditions result in a greatly enlarged,usually firm ovary and may be associated with bursal and uterine adhesions

Abscessed ovaries may have a softened area within the firm mass and may cause painwhen palpated

Unaffected ovary may function normally so that cyclic structures may be palpated

Ovarian Abscess Granulosa Cell Tumour

ABNORMALITIES OF THE OVIDUCT

Only those associated with enlargement of the oviduct are detectable clinically.

Hydrosalpinx


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Hydrosalphinx is the local or general enlargement of the oviduct Manifests itself in the form of enlarged segments of varying length Local enlargements may resemble ovaries in size. When the entire oviduct is

involved, it appears as a conglomerate of a fluctuating tube The width of the enlarged oviduct varies from case to case and may reach 2 cm. in

diameter

Impossible to pathologicaly differentiate serosalpinx, pyosalpinx and hemosalpinx byclinical examination

Adhesions may be present between the loops of the enlarged oviducts

Hydrosalphinx

Pyosalphinx

Follows severe uterine infection and is less commonly reported than hydrosalphinx Associated with severe adhesions of the mesosalphinx and mesovarium.

May also follow

o removal of retained corpus luteumo injection of large doses of estrogen

ABNORMALITIES INVOLVING THE MESOSALPHINX ANDOVARIAN BURSA

Clinical differentiation between parasalpingitis, perisalpingitis and ovarian bursitis ispractically impossible.

For clinical purposes, perisalpingitis appears to be the most correct term to describethe inflammation and the consequent thickening and adhesion formation involvingmesosalpinx, mesovarium and salpinx. Other structures in the area, such as theovaries, the horns of the uterus and others, might also be embedded in theadhesions.

Very fine adhesions between the ovary and fimbria-the fringes of the edge of theinfundibulum-are present in numerous animals, especially immediately afterovulation. These do not appear to interfere with the normal function of the oviduct.


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Cystic Ovarian Bursa Ovaro Bursal Adhesions

ABNORMALITIES INVOLVING UTERUS

Uterine abnormalities can be subdivided intoo Abnormalities associated with auniformaly enlarged uteruso Abnormalities associated withdiscrete abnormalitieswithin the uteruso Parauterine abnormalities

Uniformaly Enlarged Uterus

Must be differentiated from pregnancy and a postpartum uterus. Involution of themares uterus occurs very rapidly after foaling in comparison to the cows. By thebeginning of foal heat, it should be no more than two to three times its normal size.Other causes of a uniformly enlarged uterus are pyometra and pneumo uterus.

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Pyometra

Pyometra in a mare with an occluded cervix due toadhesions. Both horns are distended with pus

TOP

Discrete Uterine Enlargements

Must be differentiated from early pregnancy by identifying the embryo as adiscrete bulge in the uterine horn.

Other enlargements includeo endometrial cysts (result from blocked and dilated endometrial glands),o lymphatic lacunae (which result from blocked lymph channels),o abscesses in the uterine wall and corneal dilatation (following atrophy of

the uterine mucosa in older mares)
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Dilated Lymphatic on the Perimetrium ofthe Left Horn

No clinical significance in terms of fertility. It maybe confusing to the palpater or on ultrasound

examination

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Parauterine Abnormalities

Parauterine abnormalities include hematomas in the broad ligament of the

uterus that are usually associated with parturition.

A fresh hematoma should not be disturbed, and the mare should be treated withsystemic antibiotics to prevent abscessation.

A chronic hematoma rarely causes a fertility problem and usually regresses overtime.
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Hematoma in the broad ligament caused by rupture of the uterine artery

ABNORMALITIES INVOLVING OVARIES

Ovarian abnormalities identified on physical examination can be divided into smallovaries and large ovaries

Small Ovaries

These may be either normal or abnormal. Prepubertal or juvenile ovaries are small;therefore, the age and previous cyclic history of the mare is important

In anestrus the ovaries are inactive and one half the size they will attain during thebreeding season. In some small, docile, chronically anestrus mares a chromosomalanomaly called XO Gonadal dysgenesis may be the cause of small ovaries. Anendometrial biopsy from these mares often demonstrates glandular insufficiency

True nymphomaniac mares also contain smal ovaries. These mares act as if theyare in persistent estrus, yet often they will not allow mounting; some of these mares

will demonstrate male like behavior. Other than small, firm ovaries, no otherabnormalities of the genital tract are noted in the nymphomaniac mare

Enlarged Ovaries

May be a seasonal phenomenone. During the transitional periods, follicles may growto abnormally large sizes and persist for various lengths of time before ovulating orregressing


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Large Ovulatory Follicle of a Mare inEstrus

They usually do not suppress activity in the other ovary and resolve themselves andcause no permanent problem

In the early transition period they can be treated with 1000 to 5000 IU of HumanChorionic Gonadotrophin but results are variable. These persistent follicles are oftendiagnosed as cystic ovaries by practitioners unaccustomed to palpating the maresovaries

Cystic ovaries, such as those that occur in cows, do not occur in mares. The biggestproblem in dealing with persistent follicles in mares is differentiating them fromcertain types of ovarian tumors

Ovarian tumors

In the mare ovarian tumors are usually classified according to the main type of cellmaking up the tumor. Most of these tumors are unilateral and rarely malignant

The cystadenoma must be differentiated from persistent follicles. These usuallyenlarge over a period of time unlike the persistent follicle that remains the same orregresses. They probably arise from the surface epithelium of the ovary or the reteovarii and have one or several large fluid-filled cavities within them. Diagnosis is byultrasound treatment is only ovariectomy


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CystadenomaRare ovarian tumor that is not accompanied

by aberrant reproductive behavior

Serous CystadenomaThis is a rare polycystic tumor. These tumors appear to

be endocrinologically inactive

Granulose-theca cell tumors

Most common ovarian tumor in the mare Grow to very large sizes and are usually unilateral and benign Produce a variety of hormones and usually suppress activity of the opposite ovary In addition to secreting inhibin, these tumors frequently secrete testosterone causing

the mare to exhibit stallion-like behavior. Hormonal analysis and endometrial biopsy may also be helpful in diagnosing this

tumor.

Clinical signs vary from anestrus to nymphomania and even to virility depending onthe predominant hormone produced by these tumors.

Treatment is removal of the affected ovary, and the prognosis for fertility is fair togood, depending on the length of time that the tumor has existed and the degree ofsuppression of the opposite ovary. Resumption of cycle occurs 1 to 4 month after thetumor is removed.

Much less common ovarian tumors are teratoma and the dysgerminoma.

Teratoma


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o The teratoma is a multiple tissue type tumor that usually has epithelialstructures including cartilage, bone, hair and glandular epithelium.

o Are usually benign and produce no hormones, so the contralateral ovaryusually remains functional, and the mare may continue to cycle. As in theother ovarian tumors, ovariectomy is indicated.

Dysgerminoma

o Unlike the previously discussed ovarian tumors, the dysgerminoma can bemalignant.

o It arises from the germinal epithelium of the ovary and can become very large.The tumors may be solid or contain fluid-filled multiple cysts. Ovariectomy isthe treatment of choice.

GCT Surgically RemovedThis granulosa cell tumor was surgically removedvia a flank laparotomy. The ovary was large and

firm on palpation

GCT Cross SectionCross section of a granulosa cell tumor following

surgical removal, showing the multilocular, cystic

structures typical of this type of tumor

Non-Neoplastic Ovarian Enlargements

Other causes of ovarian enlargement such as non-neoplastic ovarian abscesses andhematoma are common and are difficult to differentiate.


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The mares temperature and white blood cell count may help identify the ovarianabscess, yet these abscesses are often encapsulated within the ovary and do notproduce a systemic reaction after they become chronic.

Ovarian hematomas often feel similar to ovarian abscesses. In both cases theopposite ovary usually remains functional and the mare continues to cycle. Ovarianhematomas usually regress over a period of time and cause no fertility problems.

Hormone stimulation tests may differentiate these from ovarian tumors. Anultrasound examination may be of some help in differentiating them.

The last cause of ovarian enlargement that should not be overlooked is the unusuallylarge, normal cyclic follicle. Most cyclic follicles range in size from 2.5 to 6 cm indiameter prior to ovulation.

Occasionally, one or several large follicles grow to 10 cm or more before ovulation. Inthis and all cases of ovarian enlargement, several examinations over a 15 to 30 dayperiod are a valuable means of differentiating these ovarian abnormalities.

Abnormalities Involving Uterus

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