2 Congenital and Acquired Defects of Uterus

Transcript

Dear Veterinarian,

Good day and in the last class we have discussed the sum of congenital anomalies. Today we are going to discuss Congenital and acquired lesions of the uterus.

Uterus Unicornis: What do you mean by Uterus unicornis? Segmental aplasia involving the uterine horns is not uncommon and if only one horn is involved, the condition is called a uterus unicornis. (showing picture) The left horn is fully developed and the right horn is not developed, so congenital absence of right horn and if you see the ovaries almost normal and both ovaries are present and functional. However, when ovulation occurs in the ovary, unaccompanied by the horn until coming to the estrum. So because the ovaries are normal, the ovaries will produce a sufficient amount of estradiol as well as progesterone, so because of the estradiol, the animal exhibit the estrous behaviour, and subsequently the animal remain as an anestrous animal, because the corpus luteum will be formed up, so it may not be luteinized, or it may not be regressed away, because the uterus is involved in the synthesis of luteinizing, so which is the hormone responsible for the lysis of the corpus luteum. But in this case absence of one uterine are the reason for the poor secretion or poor synthesis of luteinizing, which is essential for the lysis of the corpus luteum. So, the animal that remains here is an anestrous animal. So even after a manual rupture or manual inoculation of corpus luteum resulted in the animal will come into the estrum and subsequently, the animal remains is an anestrous animal, due to the persistent presence of corpus luteum.

So, in this image also you can see the left one is absent, the left uterine horn is absent and the right one is fully developed, both the ovaries are normal and functional, so this is about Uterine unicornis. And the next one Uterus Didelphys: This is double Uterus, so the complete failure of fusion which resulted in the double cervix and each uterine horn connecting with the vagina by a separate cervical canal. There is often also a division of the cranial portion of the vagina, as this is also derived from the paramesonephric ducts. So, in this image, you can see a double cervix, so both the external horns are leading to a separate cervical canal which enters directly into the uterine horn. So, this is a typical case of uterus didelphys. So, these animals may conceive and if at all provided with insemination in the horn, which is ipsilateral to the ovulation, and it will carry the calves to term and it also gives the birth normally. Suppose if you do the artificial insemination in the contra uterine horn that means the ovulation is another side and you are doing insemination on another side, so resulted in the conception failure because the ovulation resulted in the transport of the gametes in other horn, but someone deposited in another horn. So definitely the animal will not get conceived.

Another anomaly is Congenital lack of endometrial glands: So congenital lack of endometrial gland in the bovine uterus has been absorbed in few heifers. These heifers exhibited a failure of the estrum and a retained or persistent corpus luteum apparently due to failure of the endometrium to produce the luteolytic factor or prostaglandin necessary for the involution of corpus luteum. So, you all know that the endometrial glands are very important for the synthesis of luteinizing especially PGf2 Alpha, which is responsible for the lysis of the corpus luteum.

Manual removal of the corpus luteum also will result in the lysis of the corpus luteum. So, the animal will return into the estrum within 3-4 days of manual inoculation, however, in the next cycle, again corpus luteum will persist. So definitely the animal will be either infertile one or sterile one, this is due to genetic or congenital is still unknown. So, this is about a congenital lack of endometrial glands.

So next Inflammation of Uterus: Endometritis, Metritis, Perimetritis, Parametritis. Sclerotic metritis, and Chronic endometritis, there are some of the Inflammation of the uterus and you know what does mean by inflammation of endometritis? this is basically the lumen, layers, inner layer of the uterus is endometrium. Inflammation of the endometrial layer of the uterus is called Endometritis, Inflammation of the myometrium of the uterus that is the middle layer is called Metritis, Inflammation of serosal layer, the especially outer layer of the uterus is called perimetritis, Inflammation of adjacent structures to the uterus is called parametritis, Inflammation of all three layers of uterus and fibrosis is called sclerotic metritis, and chronic inflammation of endometrium is called chronic endometritis. So, these all are some of the Inflammation of the uterus.

So in the next slides, you can see some of the images; endometritis,perimetritis, and parametritis, you always will get confused about how would you diagnose clinically, so you have to do the rectal examination obviously and you have to palpate the uterus. All of you know how you can suspect endometritis, for example, if you do the rectal palpation, you can be able to see the thickening of the endometrium, especially in the bifurcation region. So along with the clinical signs, you can easily diagnose the endometritis because affected cows will show purulent discharge, so easily you can diagnose the endometritis. As far as perimetritis is concerned, it is somewhat difficult, but the entire uterus is inflamed and a little bit you can able to see the tonicity, adhesion may be absorbed in the adjoining region also, and the clinical signs, the animal may not be conceived, so it may be repeated one and infertile one.

Parametritis: so definitely this is chronic inflammation, so adhesion may happen so the other adjoining structure, like ovarian bursal and peritoneum and other structures, will get inflamed, and probably adhesion may happen. So, this is about inflammation of uterine layers. So as far as Chronic endometritis is concerned and so you can see this image, because of chronic inflammation of the endometrium, there is an accumulation of secretions, so that will be continuously accumulated and that will be inspissated and it looks like hard mosses and sometimes very thick moss. So definitely such kinds of cases will not get conceived because the entire layer is get affected and probably the uterine function is getting lost due to the chronic inflammation and sometimes the chronic inflammation leads to the fibrosis of the entire uterus, so once the fibrosis happened and then definitely the animal will get not get conceived, so probably it may be sterile ones only treatment is slaughter, so you cannot save the animal.

So, the next condition is bilateral cystic endometrial hypoplasia: So, some animals may continuously be exposed to estrogen, especially pyro estrogen or estrogen implants, or some estrogen-like substances. So, you know the estrogen is normally a secreting natural hormone, so it continuously stimulates the endometrium so that the endometrium will become secrete in nature, sometimes the endometrial glands will get enlarged, and there will be some cystic[1]like structure formed. So, in this image, you can easily identify the presence of cystic endometrial hypoplasia, so definitely these kinds of animals also will not get conceived probably sterile in nature, so there is no treatment for such kind of cases.

The next thing is Hydrometra, Mucometra, and Pyometra.

So, in Hydrometra, you know the water-like fluid is accumulated in the uterus and it will look like a pregnant uterine horn, so how will you diagnose or how will you differentiate between the pregnancy and the hydrometra, mucometra, and pyometra. So, you know Hydrometra means accumulation of water-like fluid inside the uterus, Mucometra means accumulation of mucus inside the uterus, and Pyometra means the accumulation of pus inside the uterus. Suppose if you cannot be able to identify these positive signs of pregnancy and you may assume that these may be the reasons and sometimes, we clinically also these conditions are evident. For example, In the case of Hydrometra, continuous water-like discharge maybe happen so this is one, In Mucometra continuous mucus-like discharge may be present, and In Pyometra also continues pus-like discharge may be there. So based on the clinical conditions you can correlate, and repeated examination also is necessary and re-examine the animal in 10 days intervals or 15 days intervals and you can identify these conditions. And if the animal is pregnant, definitely the foetus may enlarge, may grow, and further enlargement is that we will visualize and easily identify. So based on the ultrasonography findings, you can easily differentiate. So, this is about Hydrometra, Mucometra, and Pyometra.

The next condition is Uterine Tumours, so the sum of tumours is rare, but Leiomyomas, Fibromyomas, Fibromas, Lymphosarcomas, and Adenocarcinoma of the uterus, these tumours accounted for almost 77% of the total tumours. These are often the incidental findings at the time of slaughter, definitely sometimes you cannot be able to confirm through the rectal examination unless you don’t have an ultrasound machine. suppose if you have ultrasound easily you can identify but in olden days it was very difficult to identify, so only at the time of slaughter you can encounter these kinds of tumours. So often large and they can potentially be mistaken for the presence of mummified foetus on palpation per rectum, so most of the veterinarians mistakenly think that it may be a mummified foetus, because the tumour looks like a hard and firm mass, the mummified foetus also looks like a hard doughy mass, because all the fluid gets reserves inside the uterus, so leaving only a hard mass or doughy mass. So occasionally these tumours are massive in size. Most of the time it is smaller in size, only occasionally it may be a massive one. The Adenocarcinoma present as a moderately enlarged, firm and constricted lesion of the uterine wall and have a high rate of metastases, so only adenocarcinoma metastases one, Affected animals often present clinically as having a chronic wasting disease, so the animal may be wasting in nature, probably sterile, very weak in nature right. So, you can easily diagnose and quickly you can dispose of the animal because of wasting natural unproductive animals. This is about the uterine tumour, and

Uterine Adhesions: so, this is a common sequel of some of the obstacle’s procedure as well this is the instruction. Uterine adhesions are the common sequel of perimetritis also the adhesion may be present as fibrinous state tags over the surface of the uterus, adhesion that involve the ovarian bursa, or adhesion to other pelvic/abdominal viscera. A similar lesion may follow uterine rupture or retention of the foetus after dystocia also. So, as I told you that after Caesarean most of the time, some cases will develop uterine adhesion also because of leaking of any discharge or uterine discharge may enter into the peritoneal cavity, so that will cause inflammation and subsequently it will end up the adhesion with adjacent structures like peritoneum and intestines and abdominal wall and other ovarian bursal structures. So, such lesions definitely are more frequently associated with sterility because adhesion will affect entire reproductive performance like the gamete transport, ovulation and the secretion of hormones and all, so it completely blocks the normal reproductive functions, definitely, the animal may remain as a sterile animal, so the treatment you know already.

So, the summary of the second-day lecture we have discussed, Uterus Unicornis, Uterus, Didelphys, Congenital lack of endometrial glands, Endometritis, Metritis, Perimetritis, Parametritis, and Sclerotic metritis, Chronic endometritis and Endometritis Hyperplasia, Hydrometra, Mucometra, and Pyometra, Uterine Tumours and some Uterine adhesions.

So, thank you!