3 Diagnosis of Endometritis

Transcript

Happy to invite you all to this session. In the previous sessions, we have seen various aspects from Types, Incidents, Clinical signs, as well as the Etiology and Pathogenesis of Endometritis and Sub-clinical Endometritis. In this session we are going to see about the Diagnosis of Endometriosis, this is one of the important application parts in the case of Endometritis. Clinical endometritis, as we have already dealt with, there are very clear signs in the case of clinical endometritis. We can see the observation of vaginal discharge with pus, it’s a very clear indication, this is one of the first methods to Diagnose. Observation of the vaginal discharge, if it is going to have a purulent discharge, pus, then we can say that animal is having a uterine infection.

The next thing we have seen about the observation when the animal is going to be in natural condition, then in case of Clinical Examination, the contents of the vagina can be examined by passing a gloved hand, clean sterile gloves into the vagina, then you can get the secretions of the or the mucus from the vaginal passage. It’s very clear if there is any pass, the animal is going to have an infection. We have seen about the manual vaginal examination, and this is here another method with the manual technique using a vaginal speculum, the Vaginoscopy. Using this Vaginoscopy, vaginal speculum, we can inspect the mucus flowing out of the cervical loss, bypassing the vaginal speculum into the vaginal canal, you can just see the cervical loss and if there is any discharge coming out of that cervix, we can notice that one. And this is one more instrument or equipment Metricheck, this is going to be a stainless-steel rod. it has a hemisphere made of rubber in the tip of the stainless-steel rod, this can be passed into the vagina, and you can go and back rake it, while taking back it will be coming along with the discharge and based on the nature of discharge you can grade it as we already discussed we can grade it.

(showing score on pictures 1,2,3, and 4) This is very clear that is score 0, this is with some sort of flex of pus that is going to be score 1, this is with less than 50% of pus(<50%) it is going to be can be scored as 2 and more than 50% pus(>50%) it is going to be scored as 3 and this is one of the important latest equipment that is being used for identifying the degree of infection. Sub-Clinical Endometriosis: all the time we have seen about clinical endometritis, but it’s very easy because it’s all known the discharge is there and you can see the nature of discharge, you can also get that pus material and everything, you can very easily say that animal is having an endometritis condition.

But Sub-clinical endometritis, as we already told there are no clinical signs at all, the discharge is very much clear, so the problem here we have to Diagnose, and it also leads to the repeat breeding conditions. so, it is very important to Diagnose the Subclinical endometritis first, especially in case of repeat breeders. There is a massive infiltration of the endometrium we have already seen that and uterine lumen with the neutrophils/the Polymorphonuclear leucocytes (PMN) cells.

The detection of neutrophils/the PMN cells, is one of the important things, in the case of diagnosis of Sub-clinical endometritis. The first thing the White side test: it is going to be a very simple, field-level, rapid ‘Cow-side’ test. It can be performed very easily, you have to collect the cervical mucus aseptically, mix 1ml of cervical mucus with 1ml of 5-10% sodium hydroxide solution, mix it well and allow it to boil in a spirit lamp or any lamp. once it gets boiled, cool it under running tap water, that is a very important thing, there will be some color changes. If it is going to be clear, without any color change, then it is normal, no infection indicates that there is no infection at all. But the degree of color will change from yellow color, light yellow to dark yellow, light yellow color indicates mild infection and yellow color indicates moderate infection, the dark yellow color has a severe infection. The positive reaction for the White side test is due to the presence of neutrophils/leukocytes. These neutrophils or leukocytes will react with the sodium hydroxide and the color change occurs. In the case of normal cervical mucus, there will be very few numbers of neutrophils so the color change is not evident, but in the case of sub-clinical endometritis, the cervical mucus contains a higher number of leukocytes or neutrophils, that will evince or change the color of the reaction.

And the next method is Endometrial cytology: this is one of the reliable methods for diagnosing sub-clinical endometritis. Endometrial cell samples can be subjected for cytological examination, the methods used for collecting the endometrial samples are –the Uterine lavage technique as well as the Cytobrush technique.

First, we will see about the Uterine lavage technique– a small volume of 10-20 ml of 0.9% sodium chloride solution, that is normal saline, is infused into the uterine body with a syringe attached to a sterile AI sheath. The uterus was massaged. The fluid was recovered by negative pressure aspiration, and it is being transferred to the collection tube and can be centrifuged. The sedimented cells can be taken and they can be streaked onto a sterile slide and can be dried and stained with a normal Giemsa stain.

Next is the Cytobrush technique: It’s one of the recent techniques, adapted from human technologies. The Cytobrush will be having a sanitary plastic sleeve, it will be having a brush-like appearance in the tip, and it can be covered with a sanitary plastic sleeve. It can be passed into the uterus transposing the cervix and it can be rotated along the uterine wall. The endometrial cytology or the cell samples can be taken from this brush by rolling over the slide, The slide can be dried, and it can be stained as described previously.

How to Interpret? here is a slide after staining, you can see the different types of cells– the endometrial cells, the pathogen, and the inflammatory cells. So, by counting 100 to 200 cells in each field, you can now know the percentage of polymorphonuclear (PMN) cells. Different thresholds of PMN cells during di. rent periods of postpartum will indicate the degree of sub-clinical endometritis. During the postpartum 20 to 30 days postpartum period, when you are going to collect the endometrial samples, if the PMN cells are going to be more than 18% (>18%)then it is considered as sub-clinical endometritis, if it is 30 to 40 days postpartum more than 8% (>8%)PMN cells will indicate sub-clinical endometritis, and if it is 40 to 60 days postpartum more than 5%(>5%) PMN cells itself will indicate the animal is having sub-clinical endometritis and thus this is one of the reliable methods to diagnose the sub-clinical endometritis.

This is another method the Ultrasonography: it has been used as a method to diagnose sub[1]clinically based on the presence of intrauterine fluid and the evaluation of uterine wall thickness. Usually, you’ll be having, you could see this is a normal one (showing 3 different ultrasonography pictures), where there is no fluid and here the uterine lumen with a little bit of fluid and here the uterine lumen with more fluid and this indicates the degree of infection. What’s the biggest thing here is even in estrous, you will be having some sort of nutrient fluid accumulation. So, some of the reports are saying that ultrasonography is not the most reliable method for diagnosing sub-clinical endometritis, but anyway, the cytological study is one of the important ones for diagnosing sub-clinical endometritis.

To put it in nutshell, as well as a different Diagnosis of endometritis, as well as the sub-clinical endometritis, Clinical endometritis can be based on clinical signs, that will be very good we could see the purulent or mucopurulent discharge and vaginal contents should be inspected for the presence of pus, then we can diagnose it as Clinical endometritis, but in case of sub-clinical endometritis, there are no clinical signs, the clear discharge is one of the biggest problems, some animals will show a copious discharge that is one of the indications thin consistency, so in such animals, we can suspect for subclinical endometritis and usually the animals with subclinical endometriosis will be having a repeat breeding condition and the most reliable method for diagnosis of clinical endometriosis is the White side Test as well as the Cytology Test, it can be a field test or a laboratory test. So, this is one way of diagnosing sub-clinical endometritis.

So, we have seen in this session the various methods of diagnosing endometritis as well as sub-clinical endometritis. This is one of the important steps before deciding on the treatment, so we have to see about the clinical status, the nature of vaginal discharge, as well as based on the laboratory test you diagnose the condition, then we can go for the treatment. So, the Treatment we are going to see in the next session.

See you all.

Thank you!