DS - Swollen joint Flashcards
Arthrocentesis - septic arthritis
- 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)
Rads - septic arthritis
- often normal initially
- lysis within few days
- osteomyelitis presence may affect px (or dictate prolonged AB)
- repeat weekly until resolution of CS
Tx - septic arthritis
- 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
Management - septic arthritis
- 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
Px - septic arthritis
- 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
What do replacement gilts weighing 110kg suggest?
underweight - likely DJD
Ddx - acute onset lameness in pigs (gilts), one recumbent
- Mycoplasma hyosynoviae
- DJD
- Erysipelas infection
- Glassers disease (Haemophilus parasuis)
- trauma
Post- mortem - Mycoplasma hyosynoviae
- if early, joint fluid may be blood tinged
- synovial membrane red and thick
- joint surface cartilage normal
PM - DJD
- radiolucency and sclerosis
- joint cartilage has craters, exposed bone and synovial fluid, OPs
Erysipelas - PM
- skin lesions (diamond shape)
- inflammatory exudates
- thickening of joint capsule
- splenomegaly
- hepatomegaly
PM - Glasser’s dz
- septicaemia
- congestion of internal organs
- excessive fluid and fibrin tags within abdomen and chest
Tx - Mycoplasma hyosynoviae
Lincomycin or tiamulin
Prevention - Mycoplasma hyosynoviae
- in feed medication
- lower stress
- respiratory spread control
How shold you justify an investigation?
- clinically
- financially
- ethically
What equipment can you use to remove a chip from joint space of horse?
Ferris-Smith fragment rongeurs (rotate to tear fragment free of soft tissue attachments)
What is a common racehorse fx?
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
What is periosteal proliferativ arthritis?
= an idiopathic inflammatory arthritis
- linked to FeLV, FIV, FeSFV
Tx - periosteal proliferative arthritis
- 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)
Px - periosteal proliferative arthritis
- guarded to poor
- if joint deformity severe, euthanise on humane grounds
If NSAIDs have been given to manage joint pain, what should you question>
- dose?
- is this high enough to have an effect on pain?
- has dz progressed such that more pain now being experienced?
What biochemical analysis is done of joint tap?
- WBC, TP and differential count
- WBC >3000/microL (inflammatory)
- WBC
What to note on appearance of joint fluid:
- viscosity
- colour
- elasticity
- clarity
Describe joint fluid in DJD and IMPA (non-erosive)
- DJD: increase in macrophages, often WBC 3000 WBC/microL, negative culture
Tx - IMPA
steroids 3-6w, after this time about 56% are ‘cured’
What hx to take with iguanas that are lame:
- balanced diet?
- what exactly are they fed?
- adequate water access?
- if nutritional deficit suspected, iguana may also have cracked skin/scales
Differentiate primary and secondary gout
- 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
Aetiology - secondary nutritional hyperparathyroid
- poor diet (low Ca:P ratio, vit D3 deficiency)
- poor husbandry (lack of UVB light/ inadequate thermal provision)
Aetiology - secondary renal hyperparathyroidism
renal dz
Ddx - lame iguana
- gout (primary/secondary)
- MBD (secondary nutritional hyperparathyroidism or secondary renal hyperparathyroidism)
- immune-mediated
- inflammatory/ infectious
Radiographs - lame iguana
- 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
Bloods - lame iguana
- 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
How useful is USG in reptiles?
limited value for assessing kidney function in reptiles because filtrate is isosthenuric (changes in kidney are not reflected in USG)
Tx - gout
- 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)
Differentiate gout and pseudogout
- 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
T/F: Lots of infectious agents causing lameness in pigs can be tested by Ab titre in sera to investigate systemic problem.
True
T/F: Osteochondral doesn’t mean OCD.
It just means bone and cartilage involvement.
What type of sling is used to stop a hip dislocating?
Ehmer sling – to stop a hip dislocating
Pin and cerclage wire opposes all 3 forces
False
How do you tell if physes are abnormally wide?
Physes abnormally wide – hard question, if physis width is very similar to joint width, then no they aren’t abnormally wide
T/F: Femoral neck osteophytes don’t directly relate to degree of hip subluxation.
True
How do you look for collateral ligament damage on a radiograph?
– look at a cr-cd radiogrpah, not a lateral one.
What do you expect to see radiographically with calcaneal bursitis?
soft tissue swelling on tip of the calcaneus.
Name 3 acceptable tendon sutures
locking loop, 3-pulley loop, bunnel suture
Which animals get true Vit C deficiency?
guinea pigs and humans (v rarely others)
Outline polydioxanone
only 10% strength loss, lasts 90 d,
Outline polyglycolic acid
loses 90% strength and lasts less time vs polydioxanone which lasts 90d
Origin lateral collateral ligament
lateral malleolus
