Reproductive Disease Pathology, Diagnostics, Surgery

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Reproductive Disease Pathology, Diagnostics, Surgery by Mind Map: Reproductive Disease Pathology, Diagnostics, Surgery

1. Pathology of Male Genital Tract

1.1. Diseases of Scrotum

1.1.1. Dermatitis

1.1.1.1. Chrioptic mange, frost bite, trauma

1.1.2. Thermoregulatory failure

1.1.3. Testicular degeneration

1.1.4. Neoplasia

1.1.4.1. Mast cell tumour, Haemangiosarcoma, Papilloma (boar)

1.1.5. Tunica vaginalis - Hydrocoele (in ascites), Periorchitis (FIP, Glasser's), Tumours, Adhesions (epididymitis/orchitis/penetrating wounds)

1.2. Testis and Epididymis

1.2.1. Developmental

1.2.1.1. Male pseudohermaphroditism (external female), with testes True hermaphroditism - one testis and ovary, or ovotestis

1.2.1.2. Cryptorchidism - small testis - hypoplastic, fibrotic - inc. risk of tumour formation

1.2.1.3. Testicular hypoplasia - Nutrition, Zn def., genetic, endocrine/cytogenic abnormalities

1.2.2. Degeneration

1.2.2.1. Testicular atrophy - after puberty, infertility (most common) - inc. temp, dec blood supply, vitamin A/Zn, drug reaction, radiation, obstruction, hyperoestrogenism

1.2.3. Inflammation

1.2.3.1. Granulomatous inflammation to spermatozoa = spermatic granuloma

1.2.3.2. Orchitis - rare - haematogenous (Brucella abortus - purulent), trauma, reflux orchitis (from epididymidis, prostate, bladder, urethra, mixed infections) Sterility

1.2.3.3. Epididymitis - more common than orchitis (ram, dog) - ascending infection - abscess, granuloma formation

1.2.3.3.1. Can lead to testicular atrophy, degeneration (pressure, heat etc.) From mixed infections mostly (coliforms, staphylococci, streptococci)

1.2.3.3.2. Infectious (Ram) - Brucella ovis (NOTIFIABLE) - haematogenous Actinobacillus seminis, Histphilus somni, E.coli - ascending swelling, spermatic granuloma formation

1.2.4. Neoplasia

1.2.4.1. Interstitial cell tumour/Leydig cell tumour

1.2.4.1.1. Old dogs, tan-orange, greasy, haemorrhagic masses, polyhedral cells packed by fibrous stroma Predominately benign, may secrete hormones

1.2.4.2. Sertoli cell tumour

1.2.4.2.1. Old dogs (3rd most common) Higher risk in cryptorchids Testicular enlargement, fibrous, cystic, white/brown, multilayered sertoli cells with abundant fibrous tissue

1.2.4.3. Germ cell tumour (seminoma, teratoma)

1.2.4.3.1. Seminoma - from spermatogonia, old dogs - swelling, pain, soft cream masses Polyhedral cells, large nucleus thin, looks like lymphoid tissue cytoplasm, mitoses

1.2.4.3.2. Teratoma - horses, 25% in cryptorchids Young animals, from totipotential primordial germ cells (Ectoderm, mesoderm, endoderm)

1.3. Accessory sex glands/prostate

1.3.1. Hyperplasia of prostate (old, entire) - enlarged, constipation, urinary stasis Hyperplastic, papillary proliferation - hormone dependent

1.3.2. Metaplasia - Glandular epithelium to squamous epithelium - predispose to inflammation e.g. in Sertoli cell tumours Cattle/sheep - oestrogenic implants, phytoestrogen ingestion

1.3.3. Prostitis - uncommon, together with hyperplasia, ascending infections (coli, strept, staph) - may develop peritonitis, septicaemia, toxaemia, may be subclinical

1.3.4. Neoplasia

1.3.4.1. Carcinoma, unaffected by castration glandualar cells invading intestritium, marked fibrosis

1.3.4.1.1. High rate of local recurrence, or metastasis (LN, lung, bone) - guarded prognosis Hyperplasia, cachexia, locomotor abnormalities

1.4. Penis and prepuce

1.4.1. Venereal transmitted disease

1.4.1.1. Tritrichomonas foetus - infertitlity, early embroynic death, abortion, metritis/pyometra

1.4.1.1.1. sheath wash, culture

1.4.1.2. Campylobacter foetus spp./ venerealis - infertility, early embryonic death, abortion

1.4.1.3. Herpesvirus, papillomavirus

1.4.2. Non-inflammatory disease - hypoplasia, directional deviations, hypospadia/epispadia (abnormal opening) Haematomas, Paraphimosis (can't retract into prepuce - trauma, inflammation, neoplasia etc.)

1.4.3. Inflammation

1.4.3.1. Glans penis - balanitis Prepuce - Prosthitis Balanoposthitis

1.4.3.1.1. Bovine HV-1 EHV-3 Canine herpesvirus

1.4.4. Bacteria

1.4.4.1. Sheep - Ulcerative posthitis (Pizzle rot) - castrated males - Crynebacterium renale

1.4.4.1.1. Necrosis, ulceration, slough, secondary infection Hypoplatic penis/prepuec, urinary soiling, high planes of nutrition

1.4.5. Parasites

1.4.5.1. Cutaneous habronemiasis (summer sores) in horses - granulation following larvae Dourine (trypanosomiasis) - NOTIFIABLE

1.4.6. Neoplasia

1.4.6.1. Sqaumous cell carcinoma - horses - novel papillomavirus (EPV-2)- malignant squamous epithelium, keratin pearls

1.4.6.1.1. Low grade malignancy, minority to local LNs, will recur even after removal Can lead to secondary infection, ulceration

1.4.6.2. Firbopapilloma - bulls benign, large BPV-1

1.4.6.2.1. Regress with age Secondary infections, penile obstructions

1.4.6.3. Transmissible venereal tumour - rare in UK dogs Histiocytic origin (sheets of lymphoblasts), variable cauliflower like

1.4.6.3.1. Ulceration, secondary infection Metastases rare, regression common unless poor health Vincristine responsive

2. SA Surgical procedures

2.1. Ovariohysterectomy - ovaries, uterus, ventral midline or left flank (cat)

2.1.1. Sterilisation, pyometra, ovarian cysts, hydrometra/mucometra, uterine torsion, uterine prolapse, uterine rupture, ovarian/uterine neoplasia, metritis, control diabetes mellitus/epilepsy

2.1.1.1. Uterine horn - ovary - suspensory ligament (near kidney) - ligate at cervix

2.1.1.2. Mesovarium - contains ovarian artery and vein - haemostasis, crush mark in mesovarium window OA from aorta Ligate broad ligament (maybe not in immature/small dogs/cats)

2.1.2. Haemorrhage, wound breakdown, infection, swab, uterteral injury, retained ovarian remnant

2.1.2.1. Urinary incontinence, weight gain, anaesthetic complication

2.1.3. Laparoscopic

2.1.3.1. Ovariectomy - vessel sealing device, minimally invasive, quicker recovery, high capital cost

2.2. Caesarean section

2.2.1. 64% dystocia dogs; 80% cats

2.2.1.1. Foetal distress, dystocia (see repro diseases)

2.2.1.1.1. Stabilise - electrolytes, metabolic Do ASAP for viable foetus

2.2.1.1.2. Anaesthesia

2.2.1.1.3. Midline - exteriorise uterus Foetus down uterine horn, clamp umbilical cord Only remove placentas freely

2.2.2. Surgical complications, remove ALL foetuses

2.2.2.1. Uterine haemorrhage, retained placenta, foetuses, acute metritis, subinvolution of placental sites, uterine rupture, uterine prolapse, toxic milk syndrome, agalactia, galactostasis, acute mastitis, puerperal tetany, disturbed maternal behaviour

2.2.3. En Bloc OVariohysterectomy - prior to hysterotomy

2.2.3.1. All neonates need resuscitating at once

2.2.3.2. Minimise anaesthesia time for dam, minimal peritoneal contamination, population control, all in one surgery

2.3. Castration

2.3.1. Pre-scrotal incision single in dog, or paired in cat

2.3.1.1. Population control, behavioural mod., testicular neoplasia, cryptorchidism, testicular torsion, orchitis/epididymitis, testicular trauma, anal adenoma, perineal rupture, prostatic disease, repair inguinal/scrotal hernia

2.3.1.1.1. Open - Vicryl, ligatures Vaginal tunic opened

2.3.1.1.2. Closed - vaginal tunic intact

2.3.1.2. Cat - clean, open Ligatures rare - knot spermatic vessels and vas deferens, or overhand knot in spermatic cord

2.3.2. Cryptorchids - may require US locating (hard if hypoplastic, inguinal fat pads)

2.3.2.1. Inguinal approach, or Caudal midline laparotomy

2.3.2.1.1. Look between caudal pole of kidney and inguinal ring Follow vas deferens from inguinal ring?

2.3.3. Wound b/d, infection, haemorrhage Scrotal swelling, urethral damage, failure to locate testicle

2.3.3.1. Weight gain, urinary incontinence, anaesthetic complications

2.4. Scrotal Ablation

2.4.1. Remove scrotum AND testes

2.4.1.1. Scrotal disease (MCT, trauma) Improved cosmesis, lower complications in mature dogs (bruising, swelling) Scrotal/perineal urethrostomy Skin donor from scrotum

2.5. Neutering age - can spay and castrate pre-pubertally

3. Pathology of Genital tract in Pregnant Animal

3.1. Parturition - initiated by foetus Abortion - foetal stress (illness, hyperthermia) inc foetal glucocorticoid - fresh non-autolysed foetus Rapid foetal death (e.g. septicaemias) = loss of pregnancy by other mechanisms, leading to autolysed foetus

3.2. Embryonic/foetal loss

3.2.1. Failure for zygote attachment to endometrium

3.2.2. Early embryonic loss: chromosomal, inherited disorder, uterine environment Late embryonic loss: after recognition, similar causes

3.2.2.1. Embryo death - zygote loss, 15-30% loss normal, expulsion, reabsorption Normal return to oestrous, or delayed (esp. cow) Chromosomal abnormalities important

3.2.2.1.1. Infections rarer: Tritrichomonas foetus, Campylobacter spp., BVD

3.2.3. Foetal losses: placentitis to foetal ischaemia, foetal death Stillbirth - death in viable gestation stage

3.2.3.1. Foetal death: abortion, stillborn, retained (mummification, maceration, emphysema)

3.2.3.1.1. Uniparous: early gestation (leading to mummification, resorption, or abortion) Multiparous: most foetus dies then abortion, if only a few then retention - SMEDI

3.2.3.1.2. Mummification - in multiparous animals, no putrefying bacteria, foetal skin developed, absorption of foetal and placental fluid, no odour, closed cervix, expulsion varies

3.2.3.1.3. Maceration: liquified, bacterial uterine infection, reabsorption or expulsion of purulent exudate, complete or incomplete, foetid odour

3.2.3.1.4. Foetal emphysema: putrefactive organisms, from vagina (gas producing, clostridial), patent cervix, associated with dystocia and incomplete absorption, distension with foul gas, crepitation, advanced uterine lesions

3.2.3.2. Protozoa

3.2.3.2.1. Neospora caninum: cattle persistent infection, repeat abortions rare but ocur, dog = horizontal transmission, vertical most common, calves of infected dam are +ve,

3.2.3.2.2. Parasites

3.2.4. Abortions

3.2.4.1. Infectious

3.2.4.1.1. Mostly haematogenous e.g. Brucella spp, Chlamydophila spp., Coxiella spp. Bacteiral and fungal abortion in mares mostly ascending

3.2.4.1.2. Venereal: Tritrichomonas foetus, Camylobacter foetus venerealis

3.2.4.1.3. Bacterial and fungal disease

3.2.4.1.4. Viral causes of foetal loss

3.2.4.2. Non-infectious

3.2.4.2.1. 50% cattle 40% sheep 60-70% pigs 60-70% horses Fairly low diagnostic success

3.2.4.2.2. Conditions in dam - pyrexia, anaemia, endotoxaemia

3.2.4.2.3. Beware of zoonotic potential of abortion pathogens - report to APHA

4. Examination of Male repro tract

4.1. Male fertility

4.1.1. Pre/post purchase/sale pre-mating Vet certs for insurance Repro problem

4.1.1.1. Temporary/permanently unsound Physically 3.8% incidence below scrotal circum. threshold 6.2% Poor semen quality 14% Low serving capacity 15.8%

4.1.1.2. Pre-mating - 6-8 weeks before (spermatogenesis) Repro problem - ASAP, dont want to miss season

4.1.1.3. Clinical history, PE, genital exam Semen eval., Mating ability/libido, other tests

4.1.1.3.1. Past performance, general, future use

4.1.1.3.2. PE - abnormalities, potential problems e.g. weight, joint problems, feet, BCS, teeth (rams dont eat much when breeding)

4.1.1.3.3. Genitals - scrotal palpation - size, tone, lesions, symmetry, scrotal circumference (seasonality? juvenile?) Tone = sperm output, breeding soundness (flexed bicep) Scrotal mange, external wounds, internal lesions

4.1.1.3.4. Semen - colour, volume First rusty load as not been active - cloudy

4.1.1.3.5. Mating ability/libido (desire)

4.1.1.3.6. Other tests