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Equine > Eq1 - mid1 - Septic arthritis, laminitis > Flashcards

Eq1 - mid1 - Septic arthritis, laminitis Flashcards

1
Q

Septic arthritis in foals

  • causes
A
  • can be due to intrauterine infection or umbilical infection after birth.
  • The Ig level after birth is critical in the new born and will indicate if there is an infection
  • Partial IgG 400-800 mg/dl are normal, or complete under 400 mg/dl can result in bacteremia - septicaemia
  • can be Haematogen - joint/bone
  • most common joints are hock, stifle, carpal, shoukder
  • Gram negative are most common 62,5%
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2
Q

Septic arthritis

  • Types of infection in foals
A

S-type:

  • Only synovial fluid and synovial membran
    • Little swelling around the joint is the most typica sign, a little bit lame but no fever
  • Mostly in young foal less than 2 weeks old
  • Joints involved: tarsocrural, stifle, MCP/MTP
  • joint effusion
  • Lameness +/-

E-type:

  • Articular epiphysial complex
    • Longitudinal growing of the bone. Rich in blood supply. Easier for the bacteria to get to the bone.
  • Mostly in older foals (older than 2 weeks), with multiple joints

P-type:

  • Majority of cases
  • older foals (weeks to months)
  • long bones physis (epiphysis) and joints
  • Enterobacteriace (E.coli, salmonella), Streptococcus, Rhodococcus (osteomyelitis in long bone)
  • Poor prognosis
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3
Q

Septic arthritis

  • clinical signs in foals
A
  • Lameness, joint swelling
  • Periarticular edema, pain
  • neutrophilic leukocytosis
  • hyperfibrinogenemia
  • radiographic findings –> lysis
  • synovial fluid analysis (20 G needle)
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4
Q

Septic arthritis

  • Adults septic infection, causes and risk factors
A

Causes:

  • penetrating traumatic injury
  • iatrogenic following surgery or intrasynovial infections

Surgical risk factors:

  • draft breeds
  • tibiotarsal joint arthroscopy
  • Digital flexor tendon sheath arthroscopy
  • removal of large OCD fragments
  • intraarticular injections
  • veterinarian experience level
  • injection site preparation method
  • use of sterile gloves
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5
Q

Septic arthritis

  • clinical signs in adults
A
  • hematogenous spread rare and can be associated with septic bursitis - subchondral bone lysis
  • presence of bone or tendon involment - decreased survival
  • early recognition and aggressive treatment - better prognosis
  • treated within 24 hr of synovial contamination
  • before 6 hours better prognosis
  • Because bacteria have a very strong connection to the synovial membrane after 6 hr. So flushing before 6hr have good prognosis.
  • Fushing after 6hr has worse prognosis due to the bacterial attachement and the fibrin.
  • staphylococcus aureus (34,3%): multiresistance. bad prognosis.
  • penetrating wounds - mixed bacterial population
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6
Q

Septic joint

  • diagnosis
A

– synovial fluid analysis (most important)

  • gluid colour range rom normal yellow to dark orange/red.
  • WBC over 20 G/L
  • less than 20G/L: aseptic
  • Normal: 0.1-0.2 G/L
  • Total Protein (TP) greater than 3,5 g/dl
  • Normal: 0.1-0.2 g/gl
  • Cytology-presence of 90% degenerative neutrophils
  • Serum amyloid (SAA) 1000-2000 mg/L
  • Microbiology
  • Positive culture from synovial fluid 64-89%
  • Radiographic images
  • increased soft tissue swelling
  • lytic subchondral defect
  • CT/MRI
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7
Q

Septic joint treatment

A
  • Synovial sepsis is serious potentially life threatening and performance limiting condition
  • will lead to laminitis in the contrallateral limb.
  • Synocial lavage:
  • high volume lavage –> 20L
  • removal of foreign material
  • debridement of contaminated and devitalized tissue
  • removal of inflammatory cells and mediators
  • not 100% success because of the dorsal and palmar recesses norally found in a joint
  • Athroscopy is much better
  • Bc you can se the foreign material, fibrin and you can use higher amount of fluid.
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8
Q

Septic arthritis - fibrin clot treatment

A
  • Lavage
  • Drains (used if 1st surgery is not successfull)
  • Open drainage (last option)
  • Endoscopic surgery with drains
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9
Q

Open joint injuries

A
  • joint surface is visible
  • Foamy discharge during motion
  • waterlike yellow discharge
  • suspect from location
  • needs diagnostic intraarticular puncture
  • using probe is not advised! (can make a hole)
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10
Q

Open joint injuries

  • septic joint
A
  • joint effusion, swelling
  • palpation: warm, painfull
  • lameness 4/5
  • Synovia:
  • WBC: more han 40G/L
  • TP: more than 2 G/L
  • Cytology: Neutrophil granulocytes
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11
Q

Opened joint injuries

  • treatment
A
  • emergency intervention is needed within 6hr
  • pre and peripoerative AB
  • Most important, if possible: Joint lavage
  • via an arthroscopic approach for debridement of fibrin clot etc.
  • joint puncture away from injured field
  • great amount of sterile fluid is needed
  • intraarticular AB therapy + systemic
  • local debridemtn, wound closure! (dont leave it open!)

Septic joint therapy:

  • IV ab: gentamycin (gmg/kg, 4-5 days, 1xdaily)
  • IM ab: penicillin, amoxicillin + clavulanic acid
  • joint lavage: IA ab (amikacin)
  • joint drain
  • regional limb perfusion with AB is another option!
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12
Q

how to perform Regional limb perfusion

A
  • tourniquet should be placed above and below the area to be treated
  • the largst veins (cephalic/sephanous) are used
  • use a wide-elastic Esmarch
  • butterfly catheter
  • optimal volume: 60ml (gemtamicin, amikacin)
  • wait 20-30 min
  • done e.g. after arthroscopic surgery
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13
Q

Intraarticular treatment

A
  • done every 24-48 hours
  • mostly used: Amikacin, ceftiofur, gentamycin
  • Almost never used (last possibility): imipenem, vancomycin
  • antibiotic impregnated biomaterials
  • more commonly used in bone and implant infections
  • collagen sponges
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14
Q

Septic joint

  • analgesia
A
  • septic synovial structure - non weight bearing lameness, very painfull!
  • high risk of supporting limb laminits
  • recumbent for prolonged period
  • decubital ulceration
  • weight loss

Pain management:

  • NSAIDs (toxic side effects: ulcers. always use omeprazole etc. foals very sensitive to NSAIDs)
  • Phenylbutazone (mostly used)
  • Flunixin-meglumine
  • Ketoprofen
  • Omeprazole /sucralfate
  • Epidural anaesthesia (in case of hindlimbs)
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15
Q

Septic podotrochlear bursitis

A
  • street nail
  • puncture of solar surface of the hoof
  • mostly hind limb
  • moderate to severe supporting lameness
  • the hoof is warmer than the normal, and prominent digital pulsation
  • foreign body or puncture wound
  • based on location, direction, depth of injury - radiological examination
  • navicular bursa, DIP joint, digital flexor tendon sheath - burscopy
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16
Q

Treatment of street nail

A
  • the entire hoof is trimmed
  • puncture tract carefully cleaned and disinfected
  • sterile metal probe inserted
  • contrast material in bursa - integrety of synovial membrane

Surgical treatment:

  • Surgical debridement of puncture wounds
  • initial debridement of sole (standing)
  • aseptic treatment/bursoscopy (in general anaesthesia)
  • lateral recumbency - torniquet
  • systemic ab for 2 weeks + local Ab
  • regional intravenous perfusion repeated several times
  • guarded prognosis (mostly bad prognosis)
17
Q

Laminits

  • pathophysiology and theories
A

pathophysiology:

    • pathological deformation of the lamellar attachment appartus
    • injury of basement membrane - lysis
    • hyperinsulinaemia - lamellar deformation

Theories:

  • enzymatic theory - MMP activity
  • ischaemia/reperfusion injury
  • gram negative endotoxins
  • TNF, IL-6 –> inflammation
  • decreases digital blood flos, lamellar perfusion
  • Equine metabolic syndrome:
    • insulin resistanve, cresty neck, increased adipose tissue, insulin concentration elevated.
  • Cushing disease
  • pituitary enlargement
  • corticosteroids
  • supporting limb laminitis
18
Q

Diagnosis of laminits

A
  • most often both front limbs are affected, with or wothut hind limbs
  • lameness is worse on hard ground
  • digital pulse amplitude occurs
  • radiographic examination (use block to elevate)
  • LM - baseline position of the DP within the hoof capsule
19
Q

Medical therapy of laminits

A
  • Imprtant to treat the primary disease!!
  • toxaemia due to: enteritis, colitis, pleuropneumonia, retained placenta, metritis
    • treatment: antiendotoxin hyperimmune serum (expensive)
    • Flunixin meglumine 1,1mg(kg 2xdaily IV, mostly used
    • Phenylbutazone 4,4mg/kg IV/POS
  • reduce foot pain
  • cryotherapy
  • cool the feet reduce lamellar tissue metabolism
20
Q

Laminits

  • digital blood flow therapy
A
  • Acepromazine
  • Isoxsuprine hydrochloride
  • IM, 2-3 x day, decreases BP
  • Dimethyl sulfoxide (DSMO) –> free radical scavenging and antiinflammatory effect
  • good against toxins, IV
  • the concentration must remai 20% - risk of hemolysis. can injure the endothel of jugular vein
21
Q

Chronic laminits

A
  • displacement of distal phalanx within the foot
  • the damage of lamellar interface is extensice - relationship between hoof capsule, dermis and distal phalanx
  • x-ray examination is essential
  • rotation
  • distal displacement
  • normal foot hoof DP distance is 18mm
  • dislocation results shear within the solar dermis
  • progressive lamellar separation and inspiration of seroma results radiolucent airline in LM radiographic image
22
Q

Hoof care of laminitc horse

A
  • the goal is to reduce stress and minimizing the displacement of distal phalanx
  • elevating the heel reduces the stress on DDFT
  • frog support: high density foam
  • hoof cast
  • in chronic phase the goal is to minimize further rotation
  • the palmar aspect of the hoof should be supported
  • traditional therapeutic horse shoes:
  • heart bar shoe
  • reverse shoe with a wedge
  • reverse show with frog support
  • eggbar shoe
23
Q

Deep digital flexor tenotomy

A
  • the procedure reduce the forces pulling the DDFT
  • decrease the shearing stresses on lamaellae
24
Q

Management of laminits

A
  • removal of shoes - so attraumaticallu what is possible
  • or leave the shoes in place
  • monitoring: reexamination with x-ray
  • with acute laminitis: box rest
  • reduction of body weight
  • in chronic laminits the heel tends to grow more quickly than the toe

Equine (8 decks)

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