laminitis - diagnosis + treatment Flashcards
1
Q
What feet is laminitis seen in?
A
- Both front feet
- Then all four feet
- Then one foot only
- Then both back feet
2
Q
How can you diagnose laminitis?
A
- Radiographs
- History - how old (>15 = PPID?), had it before?, duration?, any Tx?
- Physical exam - BCS, cushings?, BAR?, HR,RR, stance + gait
3
Q
What is seen on physical exam of laminitis?
A
- 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
4
Q
What is seen with hind limb laminitis?
A
High stepping = cat on a hot tin roof
5
Q
When examining the foot what should be done?
A
- Assess all feet + compare
- Check digital pulses - inflammation
- Palpate coronary band for sinking
- Assess foot conformation - had it before?
- Hoof testers
6
Q
What are DDX for laminitis?
A
- 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
7
Q
What are different phases pf laminitis?
A
- 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
8
Q
What are aims with treatment of laminitis?
A
- Remove the cause
- Provide analgesia
- Provide circulatory changing drugs
- Support the foot
- Investigate the cause
- Rehabilitate the foot (trimming/shoeing)
9
Q
How can you remove the cause of laminitis?
A
- Treat endotoxaemia / colitis / RFM …
- Usually endocrinopathic = remove from pasture (control diet), PPID tx if convinced, box rest
10
Q
What can be used for analgesia? What can go wrong?
A
- NSAIDs = phenylbutazone - NSAID toxicity (right dorsal colitis)
- Paracetamol = Safe but not licenced
- Nerve blocks = contraindicated as horse will move too much + displace P3 further
11
Q
What circulation changing drugs can be used?
A
- Acepromazine = vasodilation = hypotension = reduce blood pressure to digit (only useful in ACUTE stage)
- Aspirin = stabilizes platelets
- Cryotherapy = vasoactive, analgesic, anti-inflammatory, hypometabolic effect
12
Q
What is the most practical way of supporting the foot?
A
- Deep bedding
13
Q
How would you investigate the cause of laminitis?
A
- EMS = measure insulin after oral glucose - requires starved patient + affected by stress = not on first visit
- PPID = blood sample for ACTH
14
Q
What is specific Tx of EMS / PPID?
A
- PPID = pergolide - may take 2-4weeks to work
- EMS = insulin reducing drugs = ertugliflozin
-soaked hay, no treats, manage weight
15
Q
How could you rehabilitate the foot?
A
- Trimming once stable - shortening toe + removing excess heel (horse may be painful after trim)
- Radiographs to investigate before trimming
