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Neurology > Laminitis > Flashcards

Laminitis Flashcards

1
Q

Laminae

A

Many 1° lamellae each with many 2° lamellae
Art-ven shunts in laminae
Constant glucose needed for basement structures (not insulin mediated)
-each hoof> brain glucose
None on sole
Weightbearing wall
Endocrinopathic causes
-EMS
-PPID
Hyperinsulinaemia (cytoskeletal damage)

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2
Q

Laminar failure

A

Pedal bone free moving
Capsular rotation (common)
-hoof capsule diverges from P3 dorsal surface, P3 and P2 aligned
Bony rotations - P3 rotated palmarly around DIP
Sinker - P3 downwards
Ac- haematoma -> abscess/ dysplastic horn
-white line Jct. stretch - bacteria ingress
Compromised coronary band blood supply
-Abnormal hoof growth

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3
Q

Laminitis Hx

A

<10 no PPID
>15 definitely consider PPID
Recurrence common

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4
Q

Laminitis Dx

A

BCS, cushings
Rock back to take weight off fronts
Reluctance to move
Obel grade 1-4
Increased digital pulse
Hoof testers - worst over edge of pedal bone

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5
Q

Laminitis phases

A

Prodromol
-<72hr pre 1st signs
Ac
-pain apparent, P3 may move, analgesia, rest
Stabilisation
-P3 stabilised, analgesia, support P3
Chr
-less pain, new hoof growth

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6
Q

Laminitis Tx aims

A

Remove cause
-remove from pasture, PPID Tx (if indicated)
Analgesia
-Phenylbutazone, paracetamol
Provide circulatory changing drugs
-Acepromazine, aspirin
Support foot
-take weight of tip of pedal bone
-deep bedding, shoes depend in Individual
-EMS/ PPID tests (ACTH)
Investigate cause
Rehabilitate foot
-trim to return foot to normal conformation
DDFT tenotomy - if it is causing rotation
Radiographs prognostic

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7
Q

Foot balance

A

Assess conformation
-front, lateral, long axis
3D balance:
;anterior/front- M/L sym, coronary band relation to bearing surface
;lateral/ side- hoof pastern axis, coronary band dorsal to palmer
;solar- bisect midline

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8
Q

Dynamic assessment

A

Soundness
Stride length
Symmetry
Footfall
Tracking up

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9
Q

Corrective shoeing/ trimming

A

Broken back HPA
-long toe, underrun heel
Mediolateral
-medial heel shunting
Broken forward HPA
-concavity dorsal hoof wall

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10
Q

Tx of foot balance issues

A
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11
Q

Dx lameness approach

A

Hs
CE
Dynamic lameness exam
LA
Imaging - radiography

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12
Q

Lateromedial radiographs

A

Phalangeal/ solar angle
Joints and extensor process
navicular

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13
Q

Dorsopalmer projection

A

P3 margins - sidebone
DIPJ and PIP joint space
Navicular bone margins

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14
Q

Dorsoproximal-palmarodistal
oblique – P3

A

Upright pedal
-vascular channels or F#, crena vs lysis
High coronary

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15
Q

Foot structure important in lameness

A

DIP
Distal phalanx
Podotrochlear apparatus (navicular)
DDFT
Navicular bone

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16
Q

Management DIP conditions

A

Rest
Systemic NSAIDs
Joint medication

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17
Q

Pedal bone F#

A

Aetiology blunt trauma
CS- Ac foot pain
Dx- LA, radiography
Tx- immobilisation, Sx also possible

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18
Q

Navicular Dz

A

Chr bilateral FL lameness
Worse on hard surfaces and circles
Low heel/ long toe conformation
Pth- thinning of fibrocartilage and roughening DDFT
Dx- foot conformation
Tx- NSAIDs, farriery, intra articular meds, neurectomy

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19
Q

Radiographic

A

Medullary cyst
Flexor cortex erosion
Loss of corticomedullary definition
Distal border fragmentation
Entheseophytes

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20
Q

DDFT

A

Mild-severe Ac onset unilateral lameness
CE unrewarding
Dx- blocking, MRI

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21
Q

Hoof crack tx

A

Determine (in)sensitive parts
Farriery
-debride, filler to stabilise, trim
ID underlying cause
AB

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22
Q

White line disease

A

Progressive crumbling poor quality hoof wall with white line separation
Env. nutritional and mechanical
CS- separation of hoof wall
Tx-remove abnormal horn
-support remaining horn
-prevent progression

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23
Q

Coronary band and hoof wall injuries

A

Aet - laceration, trapping, overreach
CS- avulsion, lameness, haemorrhage
Tx- preserve coronary band, AB, NSAID, bandaging, cast, flush

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24
Q

Foot puncture wound farriery

A

Common lameness cause
Nail bind- mild lameness, pain around nail
Shoe prick- nail in sensitive structures, subsolar abscess can form

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25
Investigation of pastern/ fetlock
Dx ana - Perineural ASNB, Intra synovial PIPJ Imaging/ fetlock
26
OA pastern
High load, low motion joint Progressive destruction of articular cartilage with subchonral bone thickening CS- bone thickening, lameness Block - perineural Dorsal radiography changes Rest, NSAID, arthrodesis
27
Soft tissue injuries (pastern/ fetlock)
SDFT/ distal sesamoidean ligaments injury Ac lameness after trauma US NSAIDs
28
P1 and P2 F#
P1 Sagittal, frontal, comminuted Start at sagittal groove at articular surface Dx- radiography Internal fixation P2 Comminuted Acute over load injury
29
Osteochondrosis
Osseous cysts/ osteochondral fragmentation Palliative management
30
Pastern subluxation
Trauma CS- acute lameness, soft tissue swelling Dx- radiography Tx- pastern arthrodesis
31
Lameness work up
Head nod (up bad) -good for FL, less reliable HL (ipsilateral FL pain) Hip hike Foot contact Symmetry Length of stride
32
Carpus investigations
CE- swelling, ROM, crepitus, joint effusion Blocking (carpal joint anaesthesia) Radiography US - carpal and digital extensors and carpal sheath Advanced imaging
33
SDFT tendonitis
Ac lameness - more often jumpers CS - swelling, fetlock sinking US- core lesion Ac- limit inflammation, protect limb Proliferative phase- d-wks, promote angiogenesis -minimise scarring Chr modelling- controlled exercise programme
34
DDFT tendonitis
Less common c.f. SDFT Seen in sheath
35
ALDDFT desmitis
Swelling in proximal palmar metacarpus deeper to SDFT Tx- rest clod therapy NSAID Heals poorly
36
Suspensory ligament desmitis
Ac- swelling Chr - lameness Dx- palpation, blocking, US Tx- cold hose, NSAIDs, >3m rehab Sx for Chr desmitis HL
37
Metacarp/ tarsal investigation
CE- swelling, pain, crepitus, effusion Dx Ana - H6NB, deep branch lateral plantar NB Radiography US Advanced imaging -nuclear scintigraphy (bone scan), MRI, CT
38
Metacarp/ tarsal conditions
Bone -F# -Dorsal metacarpal bone DZ -exostosis 2nd/ 4th meta bones (splint) Soft tissue -SDFT, DDFT tendonitis -ALDDFT desmitis -SL desmitis -DFTS tenosynovitis -wounds
39
Metacarpus F#
Condylar, diaphyseal, transverse, proximal articular External trauma (kick) Condylar F# fail due to repetitive strain Present- lame, swelling, displacement Dx- Xray (don't over collimate) Tx- Zone 2 external co-aptation -cons., Sx
40
Dorsal metacarpal Dz
Shore shins Stress F# excessive loading Focal pain and poor performance Dx- imaging Tx- alterations in training
41
Splint F#
Lateral more common (trauma) Dx- radiography Tx- cons., Sx
42
Exostosis of splint
Trauma -> periosteal bleed -> new bone Normally incidental Lameness caused by interference with SL CS- Ac- swelling, Chr - bony swelling Dx- radiography Tx- cons. - rest, cold therapy, NSAID
43
PAL (palmer/plantar annular ligament) syndrome
DFTS effusion Notching limb, lameness and pain on flexion +ve response to DFTS analgesia Dx- US, contrast tenogram (fetlock canal constriction) Tx- cons. -Sx- tenoscopy, PAL desmotomy
44
Carpal osteoarthritis
DJD -2° to trauma, poor conformation, arab predisposition CS- lameness, joint effusion, fibrosis, poor ROM, +ve carpal flexion Dx- intra articular anaesthesia Tx- intra articular meds
45
Osteochondral fragmentation
Carpal chip fracture Dx- blocking and xray Tx- arthroscopic removal
46
Carpal bone F#
Slab, frontal, comminuted -Ac/ stress maladaptation Dx- Ac lame, joint effusion, Radiography (skyline view) Tx- cons. (incomplete F#), Sx- internal fixation
47
Carpal canal syndrome
Idiopathic/ septic tenosynovitis Tendinitis SD/DDFT Radial physeal exostosis (impinge DDF) Osteochondroma of distal radius- separate centres of cartilage ossification CS- carpal sheath effusion, lameness, septic puncture Dx- block, synoviocentesis, US, radiography Tx- underlying cause -tenoscopic lavage -tenoscopy - remove exostosis, osteochondroma -local antiinflammatories
48
Carpal subluxation
Trauma Very lame, swelling, carpal instability, overt anatomical derangement Radiography Tx- full limb bandage plus splints (zone 3 external coaption) Often PTS
49
Radial F#
External trauma -open/ complete -> PTS -can weightbear if incomplete Cons. management -full limb bandage and splints Sx- internal fixation (foal)
50
Ulna F#
Trauma -> olecranon F# normally Ac lame and wounded Dropped elbow stance Radiography Splint carpus Cons.- delayed/ non union in adults Sx-tension band principal (convert distractive forces of triceps to compress) -plate fixation adults do well
51
Osteochondrosis
Elbow- osseous cyst like lesion prox. radius -intra articular meds/ Sx (extra articular drilling) Shoulder- osseous cyst like lesion in distal scapula -OCD glenoid cavity Poor prognosis as 2° joint Dz oftten present
52
Shoulder dysplasia/ subluxation
Shetland/ small breeds Subluxation also possible 2° to trauma Xray- abnormal alignment, 2° OA also present Reduction under GA possible 2° OA managed conservatively SHoulder arthrodesis
53
Calcaneal bursae
Gastrocnemius bursa - gastrocnemius tdn and tuber calcis Intertendinous bursa - garstrocnemius and SDFT Conditions -OCD -Osteoarthritis -F#/ subluxation -Soft tissue - collateral lig, tarsal sheath swelling
54
Osteochondritis dissecans
Distal intermediate ridge of tibia CS- young w/ tarsocrural joint effusion Arthroscopy 75% success
55
Tarsal bone collapse
Incomplete ossification Supportive therapy Poor prognosis
56
OA small tarsal joints
Common DIT and TMT Compression and rotation of the bones Lameness, poor performance Dx- block and radiograph Tx- NSAIDs, intra articular corticosteroids
57
Tarsal F#
Malleolar - arthroscopic removal Calcaneal - PTS if unstable Small bones - cons./ internal fixation
58
Tarsal luxation
TMT/ PIT Severe lame and swollen Stress radiograph Cast, internal fixation, PTS
59
Collateral ligament injuries
Swelling and effusion Rest, NSAID, cold hose Physio
60
Tarsal sheath synoviocoele
Mild lame Unilateral caudodistal crus US- effusion, fibrinous deposits Cons./ Sx tx
61
Calcaneal bursa/ lateral luxation of SDFT
Medial tear -> lateral luxation Swollen Bursal effusion US Rest, NSAIDs Sx (debride tear)
62
Stifle compartments
Femero patellar Medial/ lateral femorotibial (septal division) Soft tissue -menisci, cruciate, patellar lig., collateral lig.
63
Osteochonrosis desicans (stifle)
Young warmbloods Lateral trochlear ridge Stifle effusion presenting signs Dx- radiography/ US Tx- cons. <1yr dietary advice, exercise restriction >1yr -SX- remove osteochondral fragments, curettage to healthy subchondral bone
64
Osseous cyst like lesions
Young, medial femoral condyle CS- lame, MFT effusion Dx- radiography Tx- intra articular corticosteroids
65
OA stifle
Cause- trauma, sequelae Dx- mod lameness,block, radiography Tx- palliative
66
Upper HL F#
Tibial tuberosity - cons. Patella- Sx Complete F# - femur/ tibia >250kg - PTS
67
Upward fixation of patella
Aet- medial trochlear ridge CS- poor msc. conformation, extension locked Tx- build msc, splitting medial patellar lig.
68
Coxofemoral joint
OA- 2° to other, mod lameness, Intra meds poor results Subluxation- minibreeds, Sx repair
69
Pelvic F#
Aet- trauma, end stage bone fatigue (ileal wing young TB) CS- asymmetry, lame, atrophy, shock (iliac arteries severed) Tx- pain relief, rest Poor prog - acetabular/ ilial shaft
70
SI Dz
Large framed horses Lameness, poor performance, asymmetric pelvis Dx- exclusions, blocking, scintigraphy Ac- 2m box rest, NSAIDS, physio Chr- work + NSAID, physio, shockwave, perilesional injection (corticosteroids)
71
Cervical spine basics
7C, 3-5 no ID feature C1 (atlas) - no body or articular process -develops in 2 lateral halves which ossify -longitudinal lucent line in foals C2 (axis) - separate ossification centres, lateral vertebral foramina C6,7- shorter, C6- extra ventral lamina -C7- small dorsal spinous process
72
Cervical spine presentation
Stiffness, pain, ataxia, poor performance CE- visual, palpation -ROM, neuro, dynamic -imaging Problems -dev - cervical vertebral malformation -degenerative - OA -trauma
73
Cervical vertebral malformation (wobblers
Developmental Dz Multifactorial Aet WB and TB predisposed
74
Rare cervical problems
Spina bifida Butterfly vertebrae
75
Thoracolumbar spine
Trauma/ degenerative Dz Presentation -poor performance, behavioural, back spasms CE- conformation, swellings, white hair (saddle poor) -palpation and flexion -lunging Imaging- radiography, US, scintigraphy
76
Thoracolumbar spine problems
Wither F# (falling backward) - rest, NSAID, fibrous union Saddle induced -recognise early -Tx- rest, US therapy, correct saddle Supraspinous lig. -rigid gait, Ac- swelling, Chr - thickening Dx- US Tx- cold compress, NSAID, rest Chr- physio
77
Dorsal spinous process impingement
Aet- conformational and degenerative Dx- xray, confirm significance , blocking Tx - med/ Sx- excision
78
Developmental Orthopaedic Diseases
Angular limb deformities Flexural limb deformities Physitis (non septic) Osteochondrosis
79
Angular limb deformity
Frontal plane deformity Congenital/ acquired Dx- CE, xray, determine which joint Valgus - lateral deviation (knee towards inside, hoof goes laterally) Varus - medial deviation Origin - bone/ soft tissue laxity Straightens manually - laxity Can't do manually - bone (incomplete ossification cuboidal bones) Tx- restrict Ex, bandage +splint
80
ALD - Acq, Tx
Acquired - poor nutrition (excess energy/ Zn) -rapid growth, trauma (growth cartilage) -overload of opposite limb causing contralateral lameness Tx- Cons.- limit exercise, corrective hoof trimming, limit nutrition Sx- growth acceleration/ retardation (oste otomy/ ectomy) -grow (elevate periosteum (concave)), less (bridge physis convex) (remove implant) Hoof balance (Valgus lower lateral/ medial extension, Vr lower medial) -Ev 2wks, lightly rasp concave side -Hoof + Sx in severe cases
81
ALD prognosis
Good - early Tx, (epi) physis Fair to poor -diaphyseal -crushed cuboidal bones -severe angulation
82
Flexural limb deformity
Sagittal plane deformity Anatomy - SDFT, flexion MCP/ MTP, DDFT, DIP flexion Congenital/ acquired Dx- radiographs, CE, rapid growth -DIPJ, MCJ, carpus -Grade I/ II Tx- cons. - farriery, physio, analgesia, cast/ splint (force extension), -oxytetracycline (hydrate as nephrotoxic) -Sx -DIP- lower heel, less nutrition, analgesia, desmotomy (distal check lig.) -FLD- palmar/plant splint, oxy tet, analgesia, AL-SDFT desmotomy
83
Digital hyperextension (FLD)
Tendon laxity, fairly common in neonates Flexor tendon laxity Mild/mod - w/ exercise corrects in 2wks Severe - protect heel bulbs (palmar fetlocks) Avoid bandages and splints
84
Septic synovitis and physitis
Aet - haematogenous, trauma, iatrogenic Foals -sys Dz, impaired defence, FPT CS- joint effusion, peri articular swelling, lameness, reluctant to stand Tx- underlysing cause, lavage synovial structure, NSAID Prognosis depends on systemic involvement
85
Physitis and synovitis Dx
Dx- Hx, CE, xray, US (umbilicus), synoviosentesis Xray - wide physis, radiolucency, soft tissue swelling Blood culture - septic Synoviocentesis - many cells esp. neutrophils, turbid low viscosity
86
ALD
Classification - Congenital or acquired * Mild, moderate or severe * Bone versus soft tissue * Valgus versus varus – Bone centered – disparity in growth rates across physis – Joint centered – dysmature or periarticular laxity – Importance of radiographing – Slow the fast side (convex); speed up the slow side (concave) – Carpal valgus foot straight ahead- leads to fetlock varus – Fetlock ALD * Must act fast
87
FLD
– Laxity – no bandage – Flexed joint * Splints and bandages * Farriery * Analgesia and oxytetracycline – Can foal do its own physiotherapy? * If so, some exercise is good
88
Acute renal failure
Abrupt and sustained low GFR Reversible in early stages Pre (haemodynamic) /renal/ post (foal bladder rupture)
89
Acute renal
Aetiology -haemodynamic-hypoVol, effusion, low CO, sepsis(perfusion) -renal-tubular necrosis, nephrotoxins, glomerulonephritis -ischaemia- prolonged haemodynamic changes -toxins- aminoglycosides, NSAID CS-anoxia, depressed, uraemia
90
Ac renal Dx/ Tx
Dx-Hx, CS, urinalysis, bloods -normal to have a little protein -hyponatraemia, hypocholoraemia, acidosis Tx- IVFT, 60ml/kg/day(30L/d) (poor prognosis if poor response) Monitor Oliguric- furosemide, dopamine
91
Chronic renal failure
Rare Glomerular Dz Ac tubular necro -> Chr interstitial nephritis CS- weight loss, mouth ulcer, poor coat, mild anaemia Dx- azotaemia, hyper Ca, hypo PO4 -hyposthenuria, US Tx- palliative -provide plenty water and salt, low Ca in diet >800 creatinine is grave
92
PU/PD
PU> 50ml/kg/d (25L), PD >100ml/kg/d Varies with age and env., maintain plasma osmolality -foal 250ml/kg/d Dysuria- abnormal urination (polla/ strang) Ddx-renal failure, PPID, psychogenic, DI, DM PD may be compensatory for PU Pth Rule out physiological PD/ Pth PU
93
PU/PD Dx
Complpete blood count Serum biochem Urinalysis Azo+Iso -> Chr renal failure Azo+Hypo (<1.007) -> Ac renal failure Just hypo- psycho/ DI PPID- ACTH tests
94
Pigmenturia
Red to brown -haem, Hgb, myoglobin Hgb- haemolysed serum -haemolytic anaemia -Coombs test, high bilirubin Blondheim test Myoglobin- high CK and AST
95
Haematuria
Red cells in urine Ddx- UTI, lithiasis, neo Throughout- kid, ureter, bladder Start- distal urethra End- proximal urethra/ bladder nech Pyelonephritis- culture, prolong AM Cystitis- urinalysis, 1° cause, AM
96
97
Renal test
Water deprivation test - DI vs psycho -not if azo/ dehydrated -empty bladder, baseline Kg -deprive from water, periodic USG/ urea/ Kg -USG> 1.025 (24hr) psycho PD -5% BW loss/ azo stop test Medullary washout Neuro DI > 1.02 w/ ADH admin (clofibrate) -nephro DI no change (thiazide)
98
Urolithiasis
Urolithiasis-male >10, LUT -Ca crystals (alk) -US, scopy, laparocystotomy -low Ca in diet, acidify urine Sabulous cystitis -crystal sediment in ventral bladder -2° to bladder para (EHV1) -Tx regular emptying and lavage -poor prog

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