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Locomotor > DS - Swollen joint > Flashcards

DS - Swollen joint Flashcards

1
Q

Arthrocentesis - septic arthritis

A
  • fluid yellow and opaque, reduced viscosity
  • typically leukocyte count ? 30,000 cells/microL (>90% neutrophils)
  • elevated TP (>2.5g/dl) ** mainstay of dx
  • culture may be negative (blood culture medium and synovial biopsy can increase sensitivity)
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2
Q

Rads - septic arthritis

A
  • often normal initially
  • lysis within few days
  • osteomyelitis presence may affect px (or dictate prolonged AB)
  • repeat weekly until resolution of CS
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3
Q

Tx - septic arthritis

A
  • BS AM (cephalosporins or penicllin/aminoglycoside combinations)
  • foals should have joing lavage (needle through and through OR arthroscopic lavage, especially more established cases where debridement of fibrin may be required. Can be done in field - foals sedated/anaesthetised)
  • resample joint fluid q48 h
  • Oral AB duration based on sensitvity
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4
Q

Management - septic arthritis

A
  • minimise joint mvt, reduces damage to AC
  • passive mvt may reduce fibrin adhesion
  • box rest and supportive bandages initially
  • physio after to reduce adhesions and prevent periarticular fibrosis
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5
Q

Px - septic arthritis

A
  • improved with prompt recognition + aggressive tx + local AB
  • multiple site involvement: detrimental impact on survival and future athleticism
  • Consider: intended use, structures involved, concurrent bone involvement
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6
Q

What do replacement gilts weighing 110kg suggest?

A

underweight - likely DJD

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7
Q

Ddx - acute onset lameness in pigs (gilts), one recumbent

A
  • Mycoplasma hyosynoviae
  • DJD
  • Erysipelas infection
  • Glassers disease (Haemophilus parasuis)
  • trauma
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8
Q

Post- mortem - Mycoplasma hyosynoviae

A
  • if early, joint fluid may be blood tinged
  • synovial membrane red and thick
  • joint surface cartilage normal
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9
Q

PM - DJD

A
  • radiolucency and sclerosis

- joint cartilage has craters, exposed bone and synovial fluid, OPs

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10
Q

Erysipelas - PM

A
  • skin lesions (diamond shape)
  • inflammatory exudates
  • thickening of joint capsule
  • splenomegaly
  • hepatomegaly
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11
Q

PM - Glasser’s dz

A
  • septicaemia
  • congestion of internal organs
  • excessive fluid and fibrin tags within abdomen and chest
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12
Q

Tx - Mycoplasma hyosynoviae

A

Lincomycin or tiamulin

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13
Q

Prevention - Mycoplasma hyosynoviae

A
  • in feed medication
  • lower stress
  • respiratory spread control
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14
Q

How shold you justify an investigation?

A
  • clinically
  • financially
  • ethically
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15
Q

What equipment can you use to remove a chip from joint space of horse?

A

Ferris-Smith fragment rongeurs (rotate to tear fragment free of soft tissue attachments)

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16
Q

What is a common racehorse fx?

A

Intermediate carpal bone (2nd most common site in intercarpal joints)

  • excellent px
  • return to performance decreases with chronicity and consequent loss of AC and subchondral bone
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17
Q

What is periosteal proliferativ arthritis?

A

= an idiopathic inflammatory arthritis

- linked to FeLV, FIV, FeSFV

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18
Q

Tx - periosteal proliferative arthritis

A
  • prednisolone (immunosuppressive dose then taper down)
  • poor reaction (add cyclophosphamide or azathioprine - never in cats, for canine IMPA)
  • monitor response: SF cytology, WBC, secondary infections
  • Physio (improve ROM)
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19
Q

Px - periosteal proliferative arthritis

A
  • guarded to poor

- if joint deformity severe, euthanise on humane grounds

20
Q

If NSAIDs have been given to manage joint pain, what should you question>

A
  • dose?
  • is this high enough to have an effect on pain?
  • has dz progressed such that more pain now being experienced?
21
Q

What biochemical analysis is done of joint tap?

A
  • WBC, TP and differential count
  • WBC >3000/microL (inflammatory)
  • WBC
22
Q

What to note on appearance of joint fluid:

A
  • viscosity
  • colour
  • elasticity
  • clarity
23
Q

Describe joint fluid in DJD and IMPA (non-erosive)

A
  • DJD: increase in macrophages, often WBC 3000 WBC/microL, negative culture
24
Q

Tx - IMPA

A

steroids 3-6w, after this time about 56% are ‘cured’

25
Q

What hx to take with iguanas that are lame:

A
  • balanced diet?
  • what exactly are they fed?
  • adequate water access?
  • if nutritional deficit suspected, iguana may also have cracked skin/scales
26
Q

Differentiate primary and secondary gout

A
  • accumulation of urate crystals in organs and joints d/t chronic hyperuricaemia, generally d/t excess protein in diet
  • secondary gout: d/t chronic hyperuricacemia d/t causes such as renal insufficiency or dehydration
27
Q

Aetiology - secondary nutritional hyperparathyroid

A
  • poor diet (low Ca:P ratio, vit D3 deficiency)

- poor husbandry (lack of UVB light/ inadequate thermal provision)

28
Q

Aetiology - secondary renal hyperparathyroidism

A

renal dz

29
Q

Ddx - lame iguana

A
  • gout (primary/secondary)
  • MBD (secondary nutritional hyperparathyroidism or secondary renal hyperparathyroidism)
  • immune-mediated
  • inflammatory/ infectious
30
Q

Radiographs - lame iguana

A
  • GOUT: mineralisation in affected organs/joints. Ca can be deposited along with uric acid crystals (needle shaped crystals)
  • MBD: generalised skeletal demineralisation
  • RENAL DZ: kidneys enlarged/smaller
31
Q

Bloods - lame iguana

A
  • determine hydration
  • secondary nutritional hyperparathyroidism: low plasma 25-DHC, late stage = hyperphosphataemia, low total and ionised Ca
  • Secondary renal hyperparathyroidism: hyperphsphataemia, hypocalcaemia, signs reduced renal function
  • GOUT: increased uric acid
32
Q

How useful is USG in reptiles?

A

limited value for assessing kidney function in reptiles because filtrate is isosthenuric (changes in kidney are not reflected in USG)

33
Q

Tx - gout

A
  • Pain relief - lack of evidence! (NSAIDs - ketoprofen monitor for GIT side effects, butorphanol, morphine)
  • Diet (primary gout); reduce/eliminate high-protein food
  • Re-hydrate (secondary gout): water baths, fluid therapy, drinking water, moisture laden foods
  • Allopurinol to reduce blood uric acid levels, drugs must usually be long term because signs typically recur if tx discontinued (not during acute outbreak!)
  • euthanasia (painful mvt, suppressed appetite)
34
Q

Differentiate gout and pseudogout

A
  • GOUT: deposition of monosodium urate crystals in joints d/t hyperuricaemia, needle shaped crystals in synovial fluid
  • PSEUDOGOUT: deposition of crystals not formed from sodium urates in the joins (e.g. calcium crystals), rhomboid shaped crystals in synvoial fluid
35
Q

T/F: Lots of infectious agents causing lameness in pigs can be tested by Ab titre in sera to investigate systemic problem.

A

True

36
Q

T/F: Osteochondral doesn’t mean OCD.

A

It just means bone and cartilage involvement.

37
Q

What type of sling is used to stop a hip dislocating?

A

Ehmer sling – to stop a hip dislocating

38
Q

Pin and cerclage wire opposes all 3 forces

A

False

39
Q

How do you tell if physes are abnormally wide?

A

Physes abnormally wide – hard question, if physis width is very similar to joint width, then no they aren’t abnormally wide

40
Q

T/F: Femoral neck osteophytes don’t directly relate to degree of hip subluxation.

A

True

41
Q

How do you look for collateral ligament damage on a radiograph?

A

– look at a cr-cd radiogrpah, not a lateral one.

42
Q

What do you expect to see radiographically with calcaneal bursitis?

A

soft tissue swelling on tip of the calcaneus.

43
Q

Name 3 acceptable tendon sutures

A

locking loop, 3-pulley loop, bunnel suture

44
Q

Which animals get true Vit C deficiency?

A

guinea pigs and humans (v rarely others)

45
Q

Outline polydioxanone

A

only 10% strength loss, lasts 90 d,

46
Q

Outline polyglycolic acid

A

loses 90% strength and lasts less time vs polydioxanone which lasts 90d

47
Q

Origin lateral collateral ligament

A

lateral malleolus

Locomotor (31 decks)

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