Exam 3: Lecture 27 - Developmental Done Diseases Flashcards
What are the primarily inflammatory bone diseases
- panosteitis
- hypertrophic osteodystrophy (HOD)
when do the primarily inflammatory bone diseases appear?
characteristically during growth period of large and giant breed dogs
what is the definition of canine panosteitis
disease of young dogs causing lameness, bone pain (in long bones), endosteal bone production, and occasional periosteal bone production
what are some synonyms of canine panosteitis
enostosis, eosinophilic panosteitis, juvenile osteomyelitis and osteomyelitis of young GSDs
what is the etiology of canine panosteitis
unknown (maybe genetic, viral, or autoimmune??)
what is the pathophysiology of canine panosteitis
osseous compartment syndrome from protein rich high calorie diets
excessive protein leads to intraosseous edema and secondary increase medullary pressure and ischemia
T/F: Canine panosteitis is a disease of adipose bone marrow
true!
what is the usual signalment of canine panosteitis
male large breed dogs (~80%), young dogs under 2 years old, and SOMETIMES seen in older dogs
what is the usual history of canine panosteitis
shifting leg lameness, pain on deep bone palpation, may be acute lameness on one leg or chronic leg shifting
what do we usually see on gait analysis with canine panosteitis
single or multiple leg involvement, a varying severity of lameness (usually grade 1 or 2)
what do we usually see on PE with canine panosteitis
pain on direct palpation of affected bone(s) and generally weight bearing
T/F: you can diagnose canine panosteitis just by palpation of the long bones
FALSE!! Also need radiographs
T/F: With canine panosteitis clinical signs may preceed radiographic changes by up to 10 days and the radiograph sings are usually progressive
true!
What are the radiographic findings of canine panosteitis
- widening of the nutrient foramen
- intramedullary radiopacity (clouds)
- endosteal thickening
- perosteal new bone
What developmental bone disease are these rads showing
canine panosteitis
what is the medial treatment for canine panosteitis
self limiting disease, NSAIDs, exercise restriction when lame
T/F: You should surgically correct canine panosteitis
false!! Not indicated
is prognosis good or poor for canine panosteitis
good!
What is the definition of hypertrophic osteodystrophy (HOD)
disease causing disruption of metaphyseal trabeculae
what are some synonyms of HOD
skeletal scurvy, canine scurvy, Moeller-Barlow disease, osteodystrophy types 1 and 2, metaphyseal osteopathy and metaphyseal dysplasia
What is the etiology of HOD
unknown, maybe caused by diminished levels of vit C, and viral causes are suspected
why are viral causes suspected for HOD
usually have accompanying history of recent GI/respiratory problems
what is the pathophysiology of HOD
disturbance of metaphyseal blood supply, no bone formed on calcified cartilarge, and osteoclastic resorption
what do we see with disturbance of metaphyseal blood supply in HOD
- changes in physis and adjacent metaphyseal bone
- delayed ossification of physeal hypertrophic zone
- widening of physis (increased width of hypertrophied chondrocyte zone)
T/F: There is no bone formed in calcified cartilage with HOD and instead we see inflammatory infiltration of neutrophils and mononuclear cells
true!!
What is the usual signalment seen with HOD
- young rapidly growing large breed dogs
- males more commonly than females
- clinical signs around 3-4 months old but can be seen as early as 2 months old
- Weimaraners are at increased risk
what is the usual history we see with HOD
- acute onset of lameness
- may be severely affected (puppies may not walk)
- inappetence and lethargy
- history of recent diarrhea may precede lameness
what do we usually see on PE with HOD
- mild to severe lameness of all 4 limbs (may be unable to stand or walk)
- long bone metastases swollen warm and painful on palpation
- swelling often present of all 4 limbs
- swelling in forelimbs may be more obvious
what are some potential differential DDx’s when we see a patient with suspected HOD?
septic arthritis, septic physitis, and panosteitis
what are the radiographic findings of HOD
- irregular radiolucent line metaphyseal side of physis (a “double physis”)
- widening of physis
- usually evidence in multiple limbs
What is this radiograph showing
osteolysis on metaphyseal side of active physis…. AKA the “second growth plate”
what is A
active physis
what is B
osteolysis
What disease are these progressive rads showing
HOD
what is the treatment for HOD in animals that are NOT severely affected
HOD is self limiting so we focus on supportive care like analgesics to control pain
how do we treat severely affected animals with HOD
- corticosteroids
- antibiotics
- vit c
- IV fluids
What must we rule out prior to using corticosteroids for HOD treatment
MUST RULE OUT bacteremia!!!
what is the prognosis for HOD
most recovery fully in 7-10 days but relapses may occur
when should we consider euth for HOD
if there is severe debilitation or multiple severe relapses
What are retained ulnar cartilaginous cores
cones of growth plate cartilage that project from distal ulnar growth plate into distal metaphysis
what is retained ulnar cartilaginous cores also known as
Retained endochondral cartilage core
what is the usual clinical presentation of retained ulnar cartilaginous core
- large to giant immature canines
- growth plate manifestation of osteochrondrosis
- +/- carpal valgus
- forelimb deformities may be identical to premature closure of distal ulnar and radial growth plates
How do we definitively diagnose retained ulnar cartilaginous core
radiographs
What is this rad showing
retained ulnar cartilaginous core
What is the treatment for retained ulnar cartilaginous core with no forelimb deformities
no treatment needed
What is the treatment for retained ulnar cartilaginous core with forelimb deformities
- surgical correction of deformity may be required
- all patients should be prescribed well balanced diet
- cores may disappear spontaneously
What is legg-calve-perthes disease
non-inflammatory aseptic necrosis of femoral head in young patient prior to capital femoral physis closure
what is the pathophysiology of Legg-calve-perthes disease
collapse of femoral epiphysis caused by interruption of blood flow (a hypoxic event leads to necrosis and collapse of femoral epiphysis)
what is the etiology of legg-calve-perthes disease
unknown but proposed theories of hereditary factors, hormonal influence, anatomic conformation, intracapsular pressure, and infarction of femoral head
T/F: Synovitis or sustained abnormal limb position may increase intra-articular pressure and collapse fragile veins which inhibits blood flow
true!!!
T/F: vascular supply to the femoral head in young animals comes from the epiphyseal vessels
true!!
T/F: metaphyseal vessels cross the physis to help contribute to femoral head vascularity
false, they do NOT cross physis
T/F: epiphyseal vessels course along femoral neck surface, cross growth plate, penetrate bone, and supplies nourishment to the femoral epiphysis
true!!
What is the usual signalment of legg-calve-perthes disease
- young small breed dogs
- peak incidence 6-7 months old but ranges from 3-13 months
- males and females affected equally
- occurs bilaterally 10-17% of affected animals
what is the usual history for legg-calve-perthes disease
- slow onset with weight bearing lameness that worsens over 6 to 8 weeks
- lameness may progress to NWB
- may present as acute onset due to sudden collapse of epiphysis
- other clinical signs such as irritability, reduced appetite, and chewing at skin over hip
what is the PE we usually see with legg-calve-perthes disease
hip joint pain and with advanced disease can have limited range of motion, muscle atrophy, and cepitus
What disease is the radiograph showing
legg-calve-perthes disease
how do we medically manage legg-calve-perthes disease
can in early stages of disease and if it is not painful
can use NSAIDs, limited leash walking or NWB exercises like swimming
How do we surgically treat legg-calve-perthes disease
Excision of femoral head and neck (FHO)
what is the post op care for legg-calve-perthes disease
- limb should be used immediately after sx
- NSAIDs to reduce pain and encourage early fcn
- passive flexion-extension exercises
- physical therapy
when is the prognosis good for legg-calve-perthes disease
after FHO and when there is slight intermittently lameness
when is prognosis poor for legg-calve-perthes disease
NWB prior to surgery, severe preoperative muscle atrophy, incorrect surgical techniques
