laminitis - diagnosis + treatment Flashcards
What feet is laminitis seen in?
- Both front feet
- Then all four feet
- Then one foot only
- Then both back feet
How can you diagnose laminitis?
- Radiographs
- History - how old (>15 = PPID?), had it before?, duration?, any Tx?
- Physical exam - BCS, cushings?, BAR?, HR,RR, stance + gait
What is seen on physical exam of laminitis?
- Increased HR + RR from pain
- Hypertrichosis = cushings
- BCS = fat = EMS
- Stance + gait = rocking back if forelimb laminitis, subtle constant weight shifting
- Reduced stride, reluctant to move, worse on hard surface + when turning, heel-toe foot impact
What is seen with hind limb laminitis?
High stepping = cat on a hot tin roof
When examining the foot what should be done?
- Assess all feet + compare
- Check digital pulses - inflammation
- Palpate coronary band for sinking
- Assess foot conformation - had it before?
- Hoof testers
What are DDX for laminitis?
- Tetanus - stiff not painful + facial muscles affected
- Colic vs hindlimb laminitis - will eat if laminitis
- Peritonitis / pleuropneumonia - reluctant to move, ill, pyrexic, feet not painful
- Grass sickness - abnormal stance, willing to move
What are different phases pf laminitis?
- Prodromal phase = up to 72hrs before first signs = cryotherapy
- Acute phase = pain apparent, P3 may move = limit damage, analgesia, rest, support P3
- Stabilisation phase = P3 stabilised - still painful = analgesia, rest, support P3, radiographs
- Chronic phase = pain lessening, new hoof growing = exercise, analgesia, trimming
- Soundness = some cases never reach full soundness
What are aims with treatment of laminitis?
- Remove the cause
- Provide analgesia
- Provide circulatory changing drugs
- Support the foot
- Investigate the cause
- Rehabilitate the foot (trimming/shoeing)
How can you remove the cause of laminitis?
- Treat endotoxaemia / colitis / RFM …
- Usually endocrinopathic = remove from pasture (control diet), PPID tx if convinced, box rest
What can be used for analgesia? What can go wrong?
- NSAIDs = phenylbutazone - NSAID toxicity (right dorsal colitis)
- Paracetamol = Safe but not licenced
- Nerve blocks = contraindicated as horse will move too much + displace P3 further
What circulation changing drugs can be used?
- Acepromazine = vasodilation = hypotension = reduce blood pressure to digit (only useful in ACUTE stage)
- Aspirin = stabilizes platelets
- Cryotherapy = vasoactive, analgesic, anti-inflammatory, hypometabolic effect
What is the most practical way of supporting the foot?
- Deep bedding
How would you investigate the cause of laminitis?
- EMS = measure insulin after oral glucose - requires starved patient + affected by stress = not on first visit
- PPID = blood sample for ACTH
What is specific Tx of EMS / PPID?
- PPID = pergolide - may take 2-4weeks to work
- EMS = insulin reducing drugs = ertugliflozin
-soaked hay, no treats, manage weight
How could you rehabilitate the foot?
- Trimming once stable - shortening toe + removing excess heel (horse may be painful after trim)
- Radiographs to investigate before trimming
What are radical trimming methods to treat laminitis?
- Coronary band grooving - relieve pressure on coronary band
- Dorsal wall resection - relive pressure under dorsal wall
- Vertical hoof grooving - allows rigid deformed hoof to expand and flex
When would you start walking / turnout / exercise?
- NOT in ACUTE stage
- no hard + fast rules
- consider pain, analgesia, weight management, facilities
- Introduce some gentle exercise moving for chronic / stable cases
- MUST be completely sound and off analgesia to return to work
When would you perform deep digital flexor tendonotomy?
*Acute / chronic cases where pull of DDFT is causing active rotation / chronic pain
* Aim for pasture soundness
What is prognosis of laminitis?
- Common reason for euthanasia
- Lighter, lower BCS + lower obel grade = more likely to survive
- Radiograph = >14mm sink in P3 = poor prognosis
