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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
Q

Investigation of pastern/ fetlock

A

Dx ana - Perineural ASNB, Intra synovial PIPJ
Imaging/ fetlock

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26
Q

OA pastern

A

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

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27
Q

Soft tissue injuries (pastern/ fetlock)

A

SDFT/ distal sesamoidean ligaments injury
Ac lameness after trauma
US
NSAIDs

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28
Q

P1 and P2 F#

A

P1
Sagittal, frontal, comminuted
Start at sagittal groove at articular surface
Dx- radiography
Internal fixation
P2
Comminuted
Acute over load injury

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29
Q

Osteochondrosis

A

Osseous cysts/ osteochondral fragmentation
Palliative management

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30
Q

Pastern subluxation

A

Trauma
CS- acute lameness, soft tissue swelling
Dx- radiography
Tx- pastern arthrodesis

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31
Q

Lameness work up

A

Head nod (up bad)
-good for FL, less reliable HL (ipsilateral FL pain)
Hip hike
Foot contact
Symmetry
Length of stride

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32
Q

Carpus investigations

A

CE- swelling, ROM, crepitus, joint effusion
Blocking (carpal joint anaesthesia)
Radiography
US - carpal and digital extensors and carpal sheath
Advanced imaging

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33
Q

SDFT tendonitis

A

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

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34
Q

DDFT tendonitis

A

Less common c.f. SDFT
Seen in sheath

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35
Q

ALDDFT desmitis

A

Swelling in proximal palmar metacarpus deeper to SDFT
Tx- rest clod therapy NSAID
Heals poorly

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36
Q

Suspensory ligament desmitis

A

Ac- swelling
Chr - lameness
Dx- palpation, blocking, US
Tx- cold hose, NSAIDs, >3m rehab
Sx for Chr desmitis HL

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37
Q

Metacarp/ tarsal investigation

A

CE- swelling, pain, crepitus, effusion
Dx Ana - H6NB, deep branch lateral plantar NB
Radiography
US
Advanced imaging
-nuclear scintigraphy (bone scan), MRI, CT

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38
Q

Metacarp/ tarsal conditions

A

Bone
-F#
-Dorsal metacarpal bone DZ
-exostosis 2nd/ 4th meta bones (splint)
Soft tissue
-SDFT, DDFT tendonitis
-ALDDFT desmitis
-SL desmitis
-DFTS tenosynovitis
-wounds

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39
Q

Metacarpus F#

A

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
Q

Dorsal metacarpal Dz

A

Shore shins
Stress F# excessive loading
Focal pain and poor performance
Dx- imaging
Tx- alterations in training

41
Q

Splint F#

A

Lateral more common (trauma)
Dx- radiography
Tx- cons., Sx

42
Q

Exostosis of splint

A

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
Q

PAL (palmer/plantar annular ligament) syndrome

A

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
Q

Carpal osteoarthritis

A

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
Q

Osteochondral fragmentation

A

Carpal chip fracture
Dx- blocking and xray
Tx- arthroscopic removal

46
Q

Carpal bone F#

A

Slab, frontal, comminuted
-Ac/ stress maladaptation
Dx- Ac lame, joint effusion, Radiography (skyline view)
Tx- cons. (incomplete F#), Sx- internal fixation

47
Q

Carpal canal syndrome

A

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
Q

Carpal subluxation

A

Trauma
Very lame, swelling, carpal instability, overt anatomical derangement
Radiography
Tx- full limb bandage plus splints (zone 3 external coaption)
Often PTS

49
Q

Radial F#

A

External trauma
-open/ complete -> PTS
-can weightbear if incomplete
Cons. management
-full limb bandage and splints
Sx- internal fixation (foal)

50
Q

Ulna F#

A

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
Q

Osteochondrosis

A

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
Q

Shoulder dysplasia/ subluxation

A

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
Q

Calcaneal bursae

A

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
Q

Osteochondritis dissecans

A

Distal intermediate ridge of tibia
CS- young w/ tarsocrural joint effusion
Arthroscopy 75% success

55
Q

Tarsal bone collapse

A

Incomplete ossification
Supportive therapy
Poor prognosis

56
Q

OA small tarsal joints

A

Common
DIT and TMT
Compression and rotation of the bones
Lameness, poor performance
Dx- block and radiograph
Tx- NSAIDs, intra articular corticosteroids

57
Q

Tarsal F#

A

Malleolar - arthroscopic removal
Calcaneal - PTS if unstable
Small bones - cons./ internal fixation

58
Q

Tarsal luxation

A

TMT/ PIT
Severe lame and swollen
Stress radiograph
Cast, internal fixation, PTS

59
Q

Collateral ligament injuries

A

Swelling and effusion
Rest, NSAID, cold hose
Physio

60
Q

Tarsal sheath synoviocoele

A

Mild lame
Unilateral caudodistal crus
US- effusion, fibrinous deposits
Cons./ Sx tx

61
Q

Calcaneal bursa/ lateral luxation of SDFT

A

Medial tear -> lateral luxation
Swollen
Bursal effusion
US
Rest, NSAIDs
Sx (debride tear)

62
Q

Stifle compartments

A

Femero patellar
Medial/ lateral femorotibial (septal division)
Soft tissue
-menisci, cruciate, patellar lig., collateral lig.

63
Q

Osteochonrosis desicans (stifle)

A

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
Q

Osseous cyst like lesions

A

Young, medial femoral condyle
CS- lame, MFT effusion
Dx- radiography
Tx- intra articular corticosteroids

65
Q

OA stifle

A

Cause- trauma, sequelae
Dx- mod lameness,block, radiography
Tx- palliative

66
Q

Upper HL F#

A

Tibial tuberosity - cons.
Patella- Sx
Complete F# - femur/ tibia >250kg - PTS

67
Q

Upward fixation of patella

A

Aet- medial trochlear ridge
CS- poor msc. conformation, extension locked
Tx- build msc, splitting medial patellar lig.

68
Q

Coxofemoral joint

A

OA- 2° to other, mod lameness, Intra meds poor results
Subluxation- minibreeds, Sx repair

69
Q

Pelvic F#

A

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
Q

SI Dz

A

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
Q

Cervical spine basics

A

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
Q

Cervical spine presentation

A

Stiffness, pain, ataxia, poor performance
CE- visual, palpation
-ROM, neuro, dynamic
-imaging
Problems
-dev - cervical vertebral malformation
-degenerative - OA
-trauma

73
Q

Cervical vertebral malformation (wobblers

A

Developmental Dz
Multifactorial Aet
WB and TB predisposed

74
Q

Rare cervical problems

A

Spina bifida
Butterfly vertebrae

75
Q

Thoracolumbar spine

A

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
Q

Thoracolumbar spine problems

A

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
Q

Dorsal spinous process impingement

A

Aet- conformational and degenerative
Dx- xray, confirm significance , blocking
Tx - med/ Sx- excision

78
Q

Developmental Orthopaedic Diseases

A

Angular limb deformities
Flexural limb deformities
Physitis (non septic)
Osteochondrosis

79
Q

Angular limb deformity

A

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
Q

ALD - Acq, Tx

A

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
Q

ALD prognosis

A

Good
- early Tx, (epi) physis
Fair to poor
-diaphyseal
-crushed cuboidal bones
-severe angulation

82
Q

Flexural limb deformity

A

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
Q

Digital hyperextension (FLD)

A

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
Q

Septic synovitis and physitis

A

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
Q

Physitis and synovitis Dx

A

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
Q

ALD

A

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
Q

FLD

A

– 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
Q

Acute renal failure

A

Abrupt and sustained low GFR
Reversible in early stages
Pre (haemodynamic) /renal/ post (foal bladder rupture)

89
Q

Acute renal

A

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
Q

Ac renal Dx/ Tx

A

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
Q

Chronic renal failure

A

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
Q

PU/PD

A

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
Q

PU/PD Dx

A

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
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

94
Q

Pigmenturia

A

Red to brown
-haem, Hgb, myoglobin
Hgb- haemolysed serum
-haemolytic anaemia
-Coombs test, high bilirubin
Blondheim test
Myoglobin- high CK and AST

95
Q

Haematuria

A

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
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

96
Q
A

Neurology (25 decks)

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