Changes

=Introduction=

=Introduction=

Endometritis is the '''infection of the uterine endometrium''' [[Image:Endometritis.jpg|thumb|right|200px|Endometritis,Copyright RVC 2008]]

Endometritis is an '''infection of the uterine endometrium''' [[Image:Endometritis.jpg|thumb|right|200px|Endometritis,Copyright RVC 2008]]

=Equine Endometritis=

=Equine Endometritis=

==Diagnosis==

==Diagnosis==

* '''Clinical'''''' examination''' may reveal '''vulval discharge''' or '''matted tail hairs'''.

* '''Clinical examination''' may reveal '''vulval discharge''' or '''matted tail hairs'''.

* '''Vaginal''' '''examination''' should identify any '''discharge''' and '''increased vascularity''' of the tissue. Conformational abnormalities such as pneumovagina and urovagina may be evident.

* '''Vaginal''' '''examination''' should identify any '''discharge''' and '''increased vascularity''' of the tissue. Conformational abnormalities such as pneumovagina and urovagina may be evident.

* '''Ultrasound''' examination of the uterus - '''more than 2 cm of fluid with abnormal character''' suggests endometritis.

* '''Ultrasound''' examination of the uterus - '''more than 2 cm of fluid with abnormal character''' suggests endometritis.

* '''Clitoral''' and '''endometrial swabs''' should be taken for '''culture and sensitivity'''. Clitoral swabs should be taken if a chronic venereal infection is suspected. Guarded endometrial swabs should be taken during oestrus to identify either acute venereal infection or the causative organism of other endometrial infections and evidence of inflammation. A high level of neutrophils is indicative of endometritis. The mare should be confirmed as not pregnant prior to passing an endometrial swab.

* '''Clitoral''' and '''endometrial swabs''' should be taken for '''culture and sensitivity'''. Clitoral swabs should be taken if a chronic venereal infection is suspected. Guarded endometrial swabs should be taken during oestrus to identify either acute venereal infections or the causative organism of other endometrial infections and evidence of inflammation. A high level of neutrophils is indicative of endometritis. The mare should be confirmed as not pregnant before taking an endometrial swab.

* '''Uterine flush''' - the uterus should be flushed with 100mls of fluid which can then be examined '''cytologically'''.

* '''Uterine flush''' - the uterus should be flushed with 100mls of fluid which can then be examined '''cytologically''' for evidence of inflammatory cells and bacteria.

* '''Endometrial endoscopy''' can be performed to visualise and assess the endometrium.

* '''Endometrial endoscopy''' can be performed to visualise and assess the endometrium.

*''' Uterine biopsy''' - this should be performed after all other tests have failed to reach a diagnosis or to '''definitively diagnose''' endometriosis or chronic infectious endometritis. A single sample should be representative if the uterus feels normal on palpation. If an abnormality is detected on examination per rectum then samples should be taken from both normal and abnormal sites.

*''' Uterine biopsy''' - this should be performed after all other tests have failed to reach a diagnosis or to '''definitively diagnose''' endometriosis or chronic infectious endometritis. A single sample should be representative if the uterus feels normal on palpation. If an abnormality is detected on examination per rectum then samples should be taken from both normal and abnormal sites.

==Treatment==

==Treatment==

Treatment involves a combination of treatments which collectively aim to resolve the inflammation within the uterus and treat existing infections:

A combination of multiple therapies should be used to collectively resolve the inflammation within the uterus and treat existing infections:

'''(1) Uterine lavage''' with copious amounts of fluid. This is beneficial because it:

'''(1) Uterine lavage''' with copious amounts of fluid. This is beneficial because it:

- removes contaminants such as bacteria and purulent material

- removes contaminants such as bacteria and purulent material

'''(2) Antibiotics (intrauterine or systemic)''' - antibiotic type should be guided by culture and sensitivity and activity of the drug in the uterus where possible. The length of the treatment should be proportional to the severity of infection.

'''(2) Antibiotics (intrauterine or systemic)'''. Antibiotic type should be guided by culture and sensitivity and activity of the drug in the uterus where possible. The length of the treatment should be proportional to the severity of infection.

'''(4) Hormonal therapy''' - Oestradiol Benzoate and PG can be used to aid the clearance of infection. They are more effective during oestrus.

'''(4) Hormonal therapy'''. Oestradiol Benzoate and PG can be used to aid the clearance of infection. They are more effective during oestrus.

=Cattle Endometritis=

=Cattle Endometritis=

Cattle endometritis  is a '''common''' condition that is known by the layman as ''''whites''''. It occurs '''three weeks or more''' '''after calving''' and should not be confused with the more severe condition of metritis which occurs immediately post-partum. The main consequence of endometritis is '''poor fertility''' and it therefore has a '''major economic impact''' by '''increasing calving interval''', '''services per conception''' and '''cull rates''' and by '''decreasing milk yield'''. It is reported to have an incidence of between '''ten and fifteen percent''' in dairy herds (however it is very variable from herd to herd), with the total cost of '''£160 per case'''.

Cattle endometritis  is a '''common''' condition that is known by the layman as ''''whites''''. It occurs '''three weeks or more''' '''after calving''' and should not be confused with the more severe condition of metritis which occurs immediately post-partum. The main consequence of endometritis is '''poor fertility'''. Therefore it has a '''major economic impact''' by '''increasing calving interval''', '''services per conception''' and '''cull rates''' and by '''decreasing milk yield'''. It is reported to have an incidence of between '''ten and fifteen percent''' in dairy herds (however it is very variable from herd to herd), with the total cost of '''£160 per case'''.

==Aetiology==

==Aetiology==

The normally '''sterile''' uterus is '''contaminated by environmental microorganisms during parturition''' or '''immediately postpartum'''. The main bacteria involved in endometritis is '''''Actinobaccillus pyogenes''''' however numerous '''gram-negative anaerobes''' may also be involved. The presence of this opportunist bacteria can '''delay return to service''' and '''cyclical activity''', '''prevent fertilisation''' and cause '''early embryonic death''' be producing a hostile uterine environment. It is also reported that it increases incidence of '''ovarian cysts'''.

The normally '''sterile''' uterus is '''contaminated by environmental microorganisms during parturition''' or '''immediately postpartum'''. The main bacteria involved in endometritis is '''''Actinobaccillus pyogenes''''' however numerous '''gram-negative anaerobes''' may also be involved. The presence of this opportunist bacteria can '''delay return to service''' and '''cyclical activity''', '''prevent fertilisation''' and cause '''early embryonic death''' by producing a hostile uterine environment. It is also reported that it increases incidence of '''ovarian cysts'''.

==Signalment==

==Signalment==

* Concurrent disease and nutrition - [[Fatty Liver Syndrome|fatty liver disease]] and [[Hypocalcaemia|hypocalcaemia]] are reported to increase endometritis rates

* Concurrent disease and nutrition - [[Fatty Liver Syndrome|fatty liver disease]] and [[Hypocalcaemia|hypocalcaemia]] are reported to increase endometritis rates

Multiple defense mechanisms exist to prevent opportunistic infection of the uterus. The '''vulva''' and '''cervix''' provide a '''physical barrier''' to opportunist bacteria; '''resident bacteria''' in the vagina '''prevents''' the '''colonisation''' of harmful bacteria; '''involution''' and '''caruncle sloughing''' expel contaminants and tissue debris; a '''higher pH''' during oestrus prevent bacterial growth and various '''immunological mechanisms''' also act to prevent infection of the uterus. Following parturition endometritis may still occur, especially is one or more of the mentioned predisposing factors is present.

Multiple defense mechanisms exist to prevent opportunistic infection of the uterus. The '''vulva''' and '''cervix''' provide a '''physical barrier''' to opportunist bacteria; '''resident bacteria''' in the vagina '''prevents''' the '''colonisation''' of harmful bacteria; '''involution''' and '''caruncle sloughing''' expel contaminants and tissue debris; a '''higher pH''' during '''oestrus''' prevent bacterial growth and various '''immunological mechanisms''' also act to prevent infection of the uterus. Following parturition endometritis may still occur, especially is one or more of the mentioned predisposing factors is present.

==Clinical Signs==

==Clinical Signs==

Generally a '''broad spectrum antibiotic''', active against '''''Actinobaccillus pyogenes''''' and '''gram-negative anaerobes''' should be used. Ideal antibiotics are [[Cephalosporins|cephalosporins]] and [[Tetracyclines|oxytetracycline]] as they match the majority of criteria listed above. Some resistance to oxytetracyclines is reported and additonally some formulations cause irritation to the endometrium, therefore '''intrauterine cephalosporin''' should be considered the '''most effective antibiotic treatment'''.  

Generally a '''broad spectrum antibiotic''', active against '''''Actinobaccillus pyogenes''''' and '''gram-negative anaerobes''' should be used. Ideal antibiotics are [[Cephalosporins|cephalosporins]] and [[Tetracyclines|oxytetracycline]] as they match the majority of criteria listed above. Some resistance to oxytetracyclines is reported and additonally some formulations cause irritation to the endometrium, therefore '''intrauterine cephalosporin''' should be considered the '''most effective antibiotic treatment'''.  

Sulphonamides, aminoglycosides, nitrofurazones and penecillins have decreased activity as a result of the uterine environment and bacteria present. Metranidazole and chloramphenicol should not be used as they are banned from use in food-producing animals.

[[Sulphonamides|Sulphonamides]], [[Aminoglycosides|aminoglycosides]], nitrofurazones and [[Penicillins|penecillins]] have decreased activity as a result of the uterine environment and bacteria present. [[Nitroimidazoles|Metranidazole]] and [[Chloramphenicol|chloramphenicol]] should not be used as they are banned from use in food-producing animals.

Some antibiotics are rapidly absorbed and distributed throughout the body, and in these cases it may be of more use to administer them parenterally.  

Some antibiotics are rapidly absorbed and distributed throughout the body, and in these cases it may be of more use to administer them parenterally.  

Prognosis is '''dependant on the severity of infection and the effectiveness of treatment'''. Greater success is seen with mild cases of endometritis

Prognosis is '''dependant on the severity of infection and the effectiveness of treatment'''. Greater success is seen with mild cases of endometritis

==References==

=References=

 

 

Pycock, JF (1997) '''Self-Assessment Colour Review Equine Reproduction and Stud Medicine''' ''Manson''

Pycock, JF (1997) '''Self-Assessment Colour Review Equine Reproduction and Stud Medicine''' ''Manson''

Pycock, JF (2004) '''Pre-breeding checks for mares''' ''In Practice 2004 26: 78-85''

Pycock, JF (2004) '''Pre-breeding checks for mares''' ''In Practice 2004 26: 78-85''

Ricketts, S (1987) '''Vaginal discharge in the mare''' ''In Practice 1987 9: 117-123''

Ricketts, S (1987) '''Vaginal discharge in the mare''' ''In Practice 1987 9: 117-123''

[[Category:Reproductive Diseases - Cattle]]

[[Category:Reproductive Diseases - Cattle]]

[[Category: To Do - Siobhan Brade]]

[[Category: To Do - Siobhan Brade]]