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Surgery > joint fluid > Flashcards

joint fluid Flashcards

1
Q

role of synovial fluid

A
  1. Lubricate joints
  2. Shock absorption
  3. Nutrient absorption + waste removal
  4. Barrier against cell entry/fluid exit
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2
Q

ddx for increased soft tissue opacity in the joint space

A

degen, inflam, infectious, traumatic, neoplasia

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3
Q

necessary equipment for arthrocentesis

A
  • 21G needle, 40mm
  • 5ml syringe (dogs)/2ml (cats)
  • EDTA blood tube
  • Blood culture tube
  • Slides
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4
Q

technique of carpus arthrocentesis

A
  1. Flexed 90degrees
  2. Depression at radiocarpal jt
  3. Needle medial to cephalic vein, btwn CDE (lateral) + ECR (medial)
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5
Q

technique of talocrural joint arthrocentesis

A
  1. No flexion
  2. Needle medial to lateral malleolus at dorsomedial aspect of joint
  3. Direct needle plantar + medial
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6
Q

technique of stifle jt arthrocentesis

A
  1. Slight flexion + external rotation
  2. Needle lateral to patella lig, midway btwn patella + tibial tuberosity
  3. Direct needle 45degrees to skin + parallel to patella tendon + lateral to patella
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7
Q

normal gross appearance of joint fluid

A
  1. Volume: <0.5ml (distal joints)
  2. Viscosity: strand test - 2.5cm stretch
  3. Colour: colourless
  4. Turbidity: clear
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8
Q

gross appearance of infectious OR inflammatory joint fluid

A
  1. Volume: increased/normal
  2. Viscosity: reduces
  3. Colour: yellow, serosanguinous
  4. Turbidity: increased
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9
Q

preparation of joint fluid samples

A
  1. Slides for cytology - air dry + diff quik
  2. EDTA tube 0.1ml
  3. Blood culture tube 0.5ml
    • aerobic media = blood
  • *anaerobic media = transport
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10
Q

info gained from cytology

A

bacteria in 50% of septic arthritis cases
RBCs
neuts

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11
Q

normal TP of synovial fluid

A

<2.5g/dL

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12
Q

cell count characteristics of infectious/inflammatory synovial fluid

A

neut heavy

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13
Q

percentage of false negatives w/ joint culture

A

20-50% of cases thus neg. culture is not definitive

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14
Q

pathogens assoc. w/ septic arthritis in a dog

A

Strep. intermedius, beta-haemolytic strep

Staph. aureus

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15
Q

pathogens assoc. w/ septic arthritis in a cat

A

Bacteroides (fights)

Pasteurella multocida

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16
Q

Tx of septic arthritis

A

initial IV ABs, + ongoing PO 1month

ie. amoxiclav

17
Q

when is sx intervention indicated in septic arthritis

A
  1. Gross contamination (FB/implant)

2. No response to medical management

18
Q

resolution of septic arthritis is confirmed by….

A

repeat synovial analysis consistent w/ OA fluid

<3% neuts

19
Q

prognosis of septic arthritis

A

resolves in 95% of cases

note: ongoing OA management indicated

20
Q

synovial structures in the distal forelimb of a horse

A
  1. Coffin jt + navicular bursa
  2. Pastern jt
  3. Fetlock jt

+ assoc. DFT sheath

21
Q

synovial structures in the carpus of a horse

A
  1. Carpometacarpal jt + carpal sheath
  2. Middle carpal jt + CDE + LDE tendon sheath
  3. Radiocarpal + ECR tendon sheath
22
Q

synovial structures in the shoulder of a horse

A

bicipital bursa + glenohumeral jt

23
Q

signalment of neonatal synovial sepsis in foals

A

<30d, failure of passive transfer –> haematogenous spread from other source
ie. pneumonia, umbilical infection, gastroenteritis

24
Q

organisms commonly involved in foal synovial sepsis

A

Enterobacteriaceae
Salmonella
Satphylococcus

25
Q

pathogen assoc. w/ iatrogenic synovial sepsis in adult horse

A

Staph. aureus

26
Q

pathogens assoc. w/ synovial sepsis in adult horse

A

enterobacteriaeceae, clostridium, staph.aureus

27
Q

ddx for adult horse synovial sepsis

A

subsolar abscess, fractures, severe cellulitis

28
Q

method of synoviocentesis for horses

A

US guided is best

- if diff. to collect inject 5-10ml saline + aspirate –> cytology is still relevant

29
Q

what test can you use to test communication of joints/wounds?

A

pressure testing (injecting saline at pressure - watching exit wounds for fluid)

30
Q

what neut and protein parameters indicate synovial sepsis of a horse?

A

> 90%
40g/L protein

*must interpret in light of case

31
Q

aims of treatment of equine synovial sepsis

A
  1. Eliminate causative organisms
  2. Remove inflammatory mediators
  3. Maintain normal joint function
32
Q

components of treatment of equine synovial sepsis

A
  1. ABs: systemic and local
  2. Lavage of synovial cavity: arthroscopic or needle
  3. Analgesia and anti-inflams
  4. Chondroprotective therapy
  5. Physiotherapy
33
Q

routes of local antibiotics to tx equine synovial sepsis

A
  • intra-synovial

- regional perfusion: IV or intraosseous

34
Q

examples of intra-synovial ABs to tx equine synovial sepsis

A
  • 250mg ceftiofur
  • 250-500mg amikacin
  • 150mg gentamicin
35
Q

describe admin of intra-synovial ABs in tx of equine synovial sepsis

A

direct injection of ABs into synovial cavity q24h 3-5days

36
Q

describe admin of intravenous regional perfusion ABs in tx of equine synovial sepsis

A
  1. Sedate
  2. Tourniquet proximal to affected synovial structure
  3. 20G butterfly cath into SF vein; saphenous, cephalic, palmar digital
  4. Inject 10ml lignocaine or mepivacaine first
  5. Infuse over 5 min
  6. Remove tourniquet after 20-30minutes
  7. Rpt q24-36h after 3-5tx
37
Q

describe frequency of lavage to tx equine synovial sepsis

A
  1. Initial arthroscopic lavage preferred

2. 3-5 subsequent lavages may be required –> rps if lameness increases, synovial fluid cytology deteriorates

38
Q

appropriate NSAIDs to tx equine synovial sepsis

A

Bute 2.2mg/kg BID

OR flunixin, meloxicam, firocoxib

39
Q

prognosis of equine synovial sepsis

A
  1. Success can be up to 80% if early aggressive therapy and arthroscopy
  2. Prognosis reduced if:
    - bone involvement
    - failure to remove fibrin at lavage that can harbor bacteria
    - recrudescence of infection following discontinuation of tx
    - resistant organisms
    - chronic change in the jt causing persistent lameness
  3. Tx can be expensive and protracted –> unresponsive infection/tx failure can necessitate euthanasia on humane grounds

Surgery (22 decks)

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