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LAM 1 > Laminitis > Flashcards

Laminitis Flashcards

1
Q

What is laminitis?

A

Inflammation of the soft tissue of the hoof

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2
Q

What is the laymens term for laminitis?

A

Founder- typically refers to the chronic process

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3
Q

What is the classic experimental model for laminitis?

A

CHO overload

Gave rise to the Obel lameness grading system

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4
Q

T/F: Laminitis has specific sex and breed predilections.

A

No- some correspondence to weight to foot size though

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5
Q

T/F: Laminitis is typically not seen in young animals.

A

True

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6
Q

What are some classical signs of laminitis?

A

Heat in feet, palpable digital pulses, splayed stance

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7
Q

Do younger or older animals typically respond better to symptomatic laminitis therapy?

A

Younger- in older animals it’s typically a secondary condition and symptomatic treatment will not be as effective

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8
Q

What are some primary causes of laminitis?

A

Sepsis, endocrinopathies, trauma (road founder)

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9
Q

What plant toxicity discussed is known to cause laminitis?

A

Black walnut extract

Reasons why dark wood bedding is avoided in stables

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10
Q

What poundage of grain at one time may result in CHO overload syndrome?

A

> 4lb

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11
Q

Grazing what kind of pastures can result in development of laminitis?

A

Lush green pastures, higher non-structural CHO content

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12
Q

What are some sepsis related causes of laminitis?

A

Endotoxemia, SIRS, GI disease, black walnut toxicity, CHO overload

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13
Q

What kind of endocrinopathies can result in laminitis?

A

Anything in results in an increase in circulating glucocorticoids

PPID, equine metabolic syndrome, exogenous administration

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14
Q

What is road founder syndrome?

A

Non-weight bearing lameness in one foot causing excessive concussive force on the contralateral foot

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15
Q

What is the pathophysiology of laminitis?

A

Structural failure of the attachment between the epidermal laminae and the dermal laminae resulting in the loss of suspension of the foot within the hoof

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16
Q

T/F: Laminitis may be associated with systemic illness or with local factors.

A

True- stress, concussive forces, endotoxin, steroid use, trauma, etc

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17
Q

T/F: Regardless of the cause, the process and end result of laminitis is the same.

A

True

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18
Q

Why does SIRS cause laminitis?

A
  • Leukocyte infiltration/migration to laminae
  • Uncontrolled activation of metalloproteinases
  • Vasculitis
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19
Q

What enzymes are directly involved in controlled detachment of laminae as required for normal hoof growth?

A

Matrix metalloproteinases

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20
Q

What is the vascular hypothesis towards the development of laminitis?

A

Initial development of reduced perfusion and digital ischemia followed by constriction of digital circulation culminating in the development of lameness

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21
Q

T/F: According to the vascular theory, any vascular issues are secondary to inflammatory mediators.

A

True

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22
Q

What clinical signs of laminitis support the vascular theory?

A

Reflex hyperemia and development of increased hoof temperature

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23
Q

What manifestations of compartment syndrome are found in laminitis?

A

Development of edema, swelling, and cell death which can be self-perpetuating

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24
Q

Is there experimental support for reperfusion injury implicated in laminitis?

A

Yes- production of oxygen free radicals that contribute to cell death and inflammation upon reperfusion of a hypoxic environment

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25
Q

What denotes the development of a chronic laminits?

A

Structural failure- earliest signs are microscopic and can develop into a gross lesion and clinical disruption

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26
Q

Why is hyperinsulinemia theorized to contribute to development of laminitis?

A

Results in the sensitization of the structures of the hoof so that they are at increased risk for laminitis

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27
Q

Could hyperinsulinemia be a contributer to the pathophysiology of sepsis and endotoxemia?

A

Yes

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28
Q

What is though to be central to the mechanism of endocrinopathies in causing laminitis?

A

Glucose metabolism dysfunction

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29
Q

T/F: Hyperinsulinemia also results in vascular dysfunction which can contribute to inflammatory mechanisms of laminitis.

A

True

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30
Q

What are some proposed causes of traumatic laminitis?

A
  • Traumatic tearing of tissues
  • Traumatic induced vasospasm
  • Tissue fatigue and vasocompression (in unilateral weight bearing)
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31
Q

What are the major forces involved in disruption of the laminae?

A

Vertical load, shear forces, tensile forces, and solar fulcrum

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32
Q

What is the dominant factor for displacement?

A

Vertical load

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33
Q

What is the vertical load dependent on?

A

Weight of the horse and the size of the foot

Heavier horses with smaller feet have an increased vertical load which may predispose them to laminitis

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34
Q

What is rotational displacement mostly attributed to?

A

Tensile forces from the pull of the deep digital flexor on P3

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35
Q

What contributes additionally to rotational displacement of the hoof?

A

Lack of sufficient dorsal hoof dermal-epidermal interface

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36
Q

T/F: The heel growing faster than the toe has a tendency to make heel lengthen and causes flexion of distal interphalangeal joint

A

True

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37
Q

What type of displacement has a poorer prognosis: vertical or rotational?

A

Vertical

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38
Q

T/F: Vertical displacement is often associated with damage/disruption throughout the entire foot.

A

True

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39
Q

Is P3 typically in a fairly normal position in vertical displacement?

A

Yes

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40
Q

In what kind of displacement is it possible for a horse to entirely lose a hoof?

A

Vertical displacement

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41
Q

What is typically the presenting complaint in laminitis?

A

Lameness and reluctance to move/walk

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42
Q

What is the typical stance in acute laminitis cases?

A

Standing in one place continually shifting weight with the front feet forward and more weight loading on the heel

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43
Q

T/F: Variation of stance does occur depending on severity and number of feet involved.

A

True

44
Q

What is the stance of a horse with all four feet affected with laminits?

A

All four feet are under belly

45
Q

Is single foot involvement very rare?

A

Yes

46
Q

What is the most common situation where only one foot is involved?

A

Non-weight bearing injury to the contralateral limb

47
Q

What situation will present with the most normal stance?

A

In very severe cases, especially if it’s sinking or mechanical collapse

48
Q

What is the typical gait of a laminitis horse?

A

“Walking on eggshells”

Accentuated when on uneven or hard surfaces, esp. gravel

49
Q

T/F: Laminits horses are very reluctant to turn or rotate.

A

True, may be the only sign in very subtly effected horses

50
Q

What is a useful exercise to assess improvement and therapy in a recovering horse?

A

Turning/circling

51
Q

What is the typical pattern of involvement for laminitis?

A

Both forelimbs

52
Q

Clinical signs may not be as dramatic in what presentation of laminitis?

A

Hindlimb

53
Q

Hindlimb laminitis is typically associated with severe or mild systemic illness?

A

Severe systemic illness- CS may not be as severe though

54
Q

What are some strategies to diagnose laminitis?

A
  1. General physical exam
  2. Lameness exam
  3. Limb/foot exam
  4. Radiography
55
Q

Digital pulses can only be palpated in what kind of horses?

A

Abnormal horses

56
Q

What is the typical pulses you’re able to palpate in a laminitis case?

A

Strong bounding digital pulses

57
Q

Why is checking for pulse symmetry important?

A

To ensure that the condition is affecting multiple feet and to assess severity

58
Q

T/F: Laminitis is the only condition that creates palpable digital pulses.

A

False- solar abscesses, penetration wounds, etc

59
Q

What happens to the temperature of the hoof in a laminitis case?

A

Increases

60
Q

What pathology occurs at the coronary band?

A

Swelling and edema in severe cases

61
Q

What is an indication of sinking at the coronary band?

A

Depression when palpated with the thumb

62
Q

Where is pain typically detected in laminitis cases?

A

At the toe

May have positive test on the sole area if coffin bone is penetrating

63
Q

T/F: Hoof testers are very specific for laminitis.

A

False- many horses will respond diffusely

64
Q

What is the most important thing to assess radiographically to determine severity/prognosis of a laminitis case?

A

Coffin bone position relative to the hoof

65
Q

Should radiographic changes be evaluated regularly on active cases?

A

Yes

66
Q

Are radiographic changes closely linked to prognosis?

A

Yes

67
Q

Where is the most typical place to put a marker to assess laminitis radiographically?

A

On the dorsal wall of the hoof on lateral view

68
Q

How do you evaluate rotation on a radiograph?

A

Compare the angle of the coffin bone to the angle of the dorsal wall of the hoof

Can also measure the distance for the hoof wall to the dorsal surface of the coffin bone at repeated sites and comparing

69
Q

What does marking the tip of the frog assess?

A

Gives you the relationship between the coffin bone and the tip of the frog in order to properly fit corrective shoes

70
Q

What are the four phases of a laminitis case?

A
  1. Developmental
  2. Acute
  3. Subacute
  4. Chronic
71
Q

What is the developmental phase?

A

Time spanning from the occurence of the causative event/illness and development of identifiable lameness

aka PRIOR to clinical sign development

72
Q

What is the goal of intervention during the developmental stage?

A

Prevent development rather than treat affected patient

73
Q

What is the acute phase?

A

Begins with the first identifiable typical CS and ends after the development of either

  1. 72 hours without physical/radiographic evidence of progression
    or
  2. development of mechanical digital collapse which can occur in less than 24 hours
74
Q

What is the goal of intervention during the acute phase of laminitis?

A

Limit the severity to optimize progression into subacute as opposed to chronic

75
Q

What is the duration of the subacute phase of laminitis?

A

Can be variable ranging from days to months/years

76
Q

What is the minimum duration of the subacute phase?

A

8-12 weeks typically

77
Q

What is happening with the foot of the horse during the subacute phase?

A

The hoof is healing but still weakened and prone to structual failure

78
Q

T/F: Most horses in the subacute phase of laminits make a full recovery.

A

True

79
Q

What is the goal of intervention during the subacute phase of laminitis?

A

Limit progression into the chronic phase of the disease

Ie prevent mechanical disruption in a compromised hoof

80
Q

What is the determinant of the chronic phase of laminits?

A

Mechanical disruption and collapse

81
Q

T/F: The chronic phase of laminits can occur during any stage of the disease.

A

True, in serious cases it can occur during the first 24 hours

82
Q

What are the two types of mechanical disruption that can occur in the hoof?

A

Rotational and vertical dispacement

83
Q

Do horses in the chronic phase ever fully recover?

A

No

84
Q

What is recovery and treatment based on during the chronic phase of laminitis?

A

Severity of collapse and clinical signs

85
Q

What is the chronic phase most often associated with?

A

Vascular insufficiency, localized sepsis, metabolic and growth dysfunction

86
Q

What is the goal of intervention during the chronic phase?

A

Rehabilitation- full recovery is usually never attained once horses are in the chronic phase

87
Q

What is an important to consider with treatment no matter what phase of laminitis the horse is in?

A

The inciting cause of the laminitis

88
Q

T/F: Replacing or removing the shoe on a horse with laminitis will help with treatment and recovery.

A

FALSE- any manipulation of the hoof can severely worsen the condition and as such shoes should be left alone during treatment

89
Q

What is an important aspect of treatment of laminitis no matter what the cause?

A

Pain management and reduction of inflammation

90
Q

What does the promotion of digital vascular perfusion do to aid in treatment and recovery?

A
  1. Limit edema
  2. Promote vasodilation in developmental phase
  3. Normalize digital perfusion in later stages
91
Q

What drug is used at the coronary band to help reduce inflammation?

A

DMSO- helps with reduction of local edema

92
Q

What is nitroglycerine used for in laminitis treatment

A

Over saved PD arteries in oder to promote vasodilation

93
Q

What other vasodilatory agents are used during the developmental stages?

A

Acepromazine, isoxuprine, l-arginine

94
Q

Isoxuprine is typically used in what modle of laminits?

A

Navicular model

Effectiveness is questionable

95
Q

T/F: Pentoxyfiline is used to help promote digital perfusion/

A

True

96
Q

What is the benefit of ice baths in the treatment of laminitis?

A

Promote local vasoconstriction and prevents infiltration of pro-inflammatory mediators

97
Q

Is digital support always beneficial in laminitis cases?

A

No- depends on severity and stage

98
Q

What are some non-invasive support techniques?

A
  • Deep soft bedding
  • Styrofoam insulation
  • Rolled gauze taped to foot over frog area
  • Cast padding booties
99
Q

What are some shoeing/invasive support techniques?

A
  • Egg bar shoe
  • Heart bar shoe
  • Elevated heel shoe
  • Equine digital support system
  • Redden shoe
100
Q

What is the ultimate goal of the treatment of laminitis?

A

Limit progression of collapse

101
Q

What are some choices for treatment if collapse does occur?

A
  • Dorsal hoof wall resection
  • Heart bar shoe
  • EDSS
  • Redden shoe
102
Q

What are some determinants of prognosis?

A
  1. Cause
  2. Finding on physical and diagnostic evaluation
  3. Response the therapy
103
Q

What is an indicator for grave prognosis?

A

Sinking (vertical displacement)

104
Q

Does the long-term outcome correlate well with degree of rotation?

A

No

105
Q

Is clinical assessment or radiographic findings more reliable means to determine final outcome?

A

Clinical assessment

LAM 1 (10 decks)

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