Foundational Laminitis

Question 1

what is the stratum externum?

Answer 1

thin, outermost layer

Question 2

cell of stratum spinosum differentiate into cells of _____________________

Answer 2

stratum corneum

Question 3

what does the dermis of the hoof provide?

Answer 3

blood supply and nutrients to epidermis

Question 4

what is the blood supply of the hoof?

Answer 4

palmar digital arteries and veins

Question 5

what innervates the hoof?

Answer 5

palmar digital nerve

Question 6

what is the most common type of laminitis?

Answer 6

endocrinopathic laminitis

Question 7

what conditions are associated with endocrinopathic laminitis?

Answer 7

equine metabolic syndrome
pituitary pars intermedia dysfunction
exogenous corticosteroid administration
pasture-associated

Question 8

how does hyperinsulinemia cause microvascular damage?

Answer 8

activation of complement and platelets

Question 9

what are some common disorders associated with sepsis/SIRS?

Answer 9

gastrointestinal disease
pneumonia
metritis
grain overload

Question 10

what is the least common type of laminitis?

Answer 10

supporting limb laminitis

Question 11

who does supporting limb laminitis occur in?

Answer 11

patients with painful musculoskeletal conditions

Question 12

are radiographic or structural changes evident during the acute phase (first 72 hours) of laminitis?

Answer 12

no

Question 13

what are some hoof-associated changes in laminitis (on exam)?

Answer 13

elevated digital pulses
hoof warmth
sensitivity to hoof testers
altered hoof appearance

Question 14

what might be necessary to take radiographs in a painful patient?

Answer 14

local anesthesia

Question 15

where is contrast injected for a digital venogram?

Answer 15

palmar digital vein

Question 16

what are the three prongs to treating laminitis?

Answer 16

biochemical support
analgesia
treat underlying cause

Question 17

what can you do during the acute phase to promote load-sharing by recruiting the solar surface?

Answer 17

soft bedding
deformable/impression material
removable boots with an insert

Question 18

what is a surgical treatment for biochemical support?

Answer 18

deep digital flexor tenotomy

Question 19

what side effects are we worried about with horses on NSAIDs?

Answer 19

nephrotoxic
damaging to GI tract

Question 20

what can opioids do that may predispose horses to colic?

Answer 20

decrease gastrointestinal motility

Question 21

how is oral bioavailability of gabapentin in horses?

Answer 21

poor: 16%

Question 22

what effects does lidocaine have?

Answer 22

analgesic
anti-inflammatory

Question 23

what temperature should the hoof be below to achieve effective hypothermia in digital cryotherapy?

Answer 23

10 degrees C

Question 24

where does growth begin of the epidermis?

Answer 24

coronary segment

Question 25

what makes up the two-layered stratum germinativum?

Answer 25

cells of stratum basale migrate into stratum spinosum

Question 26

what are the layers of hard keratins in the stratum corneum?

Answer 26

stratum externum stratum medium stratum internum

Question 27

what does the stratum internum feature?

Answer 27

featured epidermal lamellae: primary and secondary

Question 28

what provides the critical connection between the hoof wall and the distal phalanx?

Answer 28

dermal papilla interdigitate with epidermis: primary and secondary dermal lamellae

Question 29

what is the terminal arch?

Answer 29

anastomosis in solear canal of palmar digital arteries and veins

Question 30

where does the dorsal branch of the palmar digital nerve innervate?

Answer 30

dorsal 1/3 of hoof

Question 31

what forces act upon the digit?

Answer 31

weightbearing support of frog and sole pull of deep digital flexor tendon lamellar attachments pull of extensor tendon

Question 32

is endocrinopathic laminitis inflammatory?

Answer 32

no

Question 33

what does insulin do in endocrinopathic laminitis?

Answer 33

activates insulin-like growth factor-1 receptor mitosis lamellar cells dysregulation cellular adhesions

Question 34

how does sepsis/SIRS cause laminitis?

Answer 34

injury to basement membrane: separation of dermal and epidermal lamellae

Question 35

what causes loss of lamellar cellular adhesions in supporting limb laminitis?

Answer 35

protracted alteration in weightbearing leads to decreased perfusion of food and decreased oxygen/nutrients ischemia and negative energy balance

Question 36

where is sensitivity to hoof testers most common with laminitis?

Answer 36

toe region

Question 37

which radiographic views are taken for laminitis?

Answer 37

lateral-medial dorsal-palmar/plantar +/- dorsoproximal-45 degree palmaro/plantarodistal oblique

Question 38

why is heel elevation useful in treatment?

Answer 38

decreases tension from deep digital flexor tendon on dorsal laminae decreases compression of solar corium and circumflex artery

Question 39

why is a rocker component of a shoe useful?

Answer 39

allows patient to adjust breakover

Question 40

what are the indications for deep digital flexor tenotomy?

Answer 40

continued rotation of distal phalanx progressive/persistent vascular deficits in venogram no hoof growth despite mechanical intervention

Question 41

what are the non-selective COX inhibitors?

Answer 41

phenylbutazone flunixin meglumine

Question 42

how does gabapentin work?

Answer 42

mimics neurotransmitter GABA

Question 43

what can ketamine be combined with?

Answer 43

alpha-2 agonist opioids lidocaine

Question 44

what can lidocaine be combined with?

Answer 44

alpha-2 agonist opioids ketamine

Question 45

what is the duration of bupivacaine (abaxial sesamoid perineural block)?

Answer 45

120-240 minutes

Question 46

what can be used in an epidural?

Answer 46

local anesthetic opioid alpha-2 agonist

Question 47

what effects does digital cryotherapy have?

Answer 47

vascular effects analgesic effects anti-inflammatory effects metabolic effects