Laminitis

Question 1

What is the most common cause of most laminitis cases?

Answer 1

Endocrinopathy

PPID, EMS

Question 2

How can retained foetal membranes or other systemic infections lead to laminitis?

Answer 2

Laminitis is a consequence of SIRS/endotoxaemia

Question 3

Hospitalised horses are at risk of developing supporting limb laminitis. What is this?

Answer 3

If non-weight bearing on one leg, develop laminitis on contra-lateral limb

Question 4

What is glucocorticoid induced laminitis?

Answer 4

Laminitis due to high doses of glucocorticoid administration
(Esp in animals prone to laminitis)

Question 5

How does carbohydrate overload cause laminitis?

Answer 5

Excess carbohydrates overwhelm intestines and cause bacterial proliferations
Release endotoxins which enter laminae

Question 6

What is pastern associated laminitis?

Answer 6

Laminitis due to fructans intake (lush pasture)

Question 7

What are the 3 components to EMS?

Answer 7

Obesity - predisposing factor
Insulin dysregulation/hyperinsulinaemia - pathogen
Laminitis - consequence

Question 8

A consequence of laminar failure is that the hoof is free to move within the foot. What is capsular rotation? What is bony rotation?

Answer 8

Casular rotation - hoof diverges from dorsal surface of P3, but remains aligned with P2
Bony rotation - hoof capsule diverges from dorsal surface of P3 and P3 rotated palmarly around DIPJ (more severe - implies damage to DDFT)

Question 9

What is a sinker?

Answer 9

Vertical displacement of P3 downwards

With or without rotation

Question 10

Sinker horses are usually very painful and have a serious pathology. How does sinking affect the sole depth?

Answer 10

Thin soled

Prognosis may be hopeless if distance from extensor process on P3 to coronary band is >14mm

Question 11

In the acute phase of pedal bone movement, what happens to the gap in the hoof?

Answer 11

Forms haematoma, seroma or necrotic tissue

can become foot abscess if infected!

Question 12

What are some chronic consequences of pedal bone movement?

Answer 12

Haematoma forms lamellar wedge (dysplastic horn)
Pedal bone can become ‘Turkish slipper’
Abnormal hoof growth and shape
Compromised blood supply to coronary band

Question 13

What age horses should you suspect PPID causing laminitis?

Answer 13

<10 = unlikely
10-15 = consider it
>15 = definitely consider!

Question 14

How are HR, RR and temperature affected by laminitis?

Answer 14

HR and RR may be higher due to pain

Temperature normal

Question 15

How does cresty neck link t laminitis?

Answer 15

Horses with a cresty neck score above 3 likely to be hyperinsulinaemic

Question 16

What feet are usually affected by laminitis if a horse has a high stepping gait, like a ‘cat on a hot tin roof’?

Answer 16

Hindlimbs

Question 17

What are the 4 Obel grades of laminitis?

Answer 17

Grade 1 - lifting feet, shortened gait at trot
Grade 2 - horse has lameness at walk but moves willingly, can lift foot off ground without difficulty
Grade 3 - horse moves reluctantly and resists to have foot lifted
Grade 4 - horse refuses to move

Question 18

How can you differ from laminitis or a bruised foot/abscess without radiographs?

Answer 18

Time will tell
Bruises improve
Abscesses get worse
Laminitis stays the same

Question 19

What are the phases of laminitis?

Answer 19

Prodromal therapy
Acute phase
Stabilisation phase
Chronic phase
(most return to soundness )

Question 20

What actions can be taken in the prodromal phase to reduce laminitis?

Answer 20

Cryotherapy

But often unnoticed

Question 21

The first thing to do when treating laminitis is remove or treat the underlying cause. How can this be done to try limit endocrinopathies?

Answer 21

Take off pasture to monitor feed intake
restrict diet
Start on pergolide if PPID

Question 22

A horse is laminitic and you suspect EMS. How can you confirm this? What are the disadvantages to this test?

Answer 22

Measure insulin after oral glucose

Requires starved patient, affected by stress

Question 23

A horse is laminitic and you suspect PPID. How do you test for this?

Answer 23

Basal ACTH and LDDST

Tier 2 - TRH stimulation

Question 24

If PPID is confirmed, what can be done with a horses diet to try prevent laminitis?

Answer 24

Soak hay overnight
Use balancer
Monitor weight with tape/scales

Question 25

What pain relief can be given for 1st opinion laminitis cases?

Answer 25

Phenylbutazone

Paracetamol

Question 26

Why should care be taken when giving PBZ daily for laminitis?

Answer 26

Can cause R dorsal colitis at high doses

esp ponies

Question 27

Nerve blocks are contra-indicated as treatment for laminitis, however in some situations they may be used. Give an example. What nerve block should you use?

Answer 27

For euthanasia
For radiography
Abaxial sesamoid NB

Question 28

What circulatory changing drugs can be used for laminitis management?

Answer 28

ACP - only in acute stages

Aspirin (no analgesia, not licensed)

Question 29

How does ACP work to treat laminitis?

Answer 29

Causes vasodilation

Reduces blood pressure to laminae

Question 30

Apart from diet changes, cryotherapy, circulatory medications and analgesia, what should be done to the foot to help with laminitis?

Answer 30

Trimming
Shoeing? Some cases
Lily pads for frog support

Question 31

For a horse to return to work following laminitis, can they be on analgesia?

Answer 31

No - must be fully sound and off analgesia

Question 32

What is a salvage procedure for laminitis when the DDFT pull is causing rotation or pain?

Answer 32

DDFT tenotomy