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LAM1 > Muscle Disease > Flashcards

Muscle Disease Flashcards

1
Q

How do we diagnose muscle dz?

A
  • CS
  • enzymes
  • EMG
  • muscle biopsy
  • exercise challenge test
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2
Q

Describe AST enzyme and it’s use:

  • is it muscle specific?
  • how long does it take to see/leave?
A
  • NOT muscle specific
  • increases slowly (12-24h)
  • stays elevated longer (2+ weeks)
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3
Q

Describe CK enzyme:

  • is it muscle specific?
  • how long does it take to see/leave?
A
  • YES, muscle specific
  • very sensitive
  • reflects muscle damage
  • peak around 6-8h
  • decreases within 3 days
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4
Q

What will the CK value look like with:

  1. Recumbency with colic
  2. Venipuncture
  3. Rhabdomyolysis
A
  1. 500-1,000
  2. 300-1,000
  3. Tens/hundreds of thousands!
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5
Q

Describe the method of obtaining muscle biopsy:

A

Include unaffected + affected muscle

6mm biopsy

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6
Q

Exercise challenge test:

  • method
  • normal values
  • increases
A
  • 15-30min of light exercise
  • normally won’t see any CK elevations
  • 5x increase or more = rhabdomyolysis
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7
Q

What is the signalment for Hyperkalemic Periodic Paralysis

A

Quarter horses

Impressive-line horses

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8
Q

CS for HyPP:

A
  • variable!

- intermittent signs by 2-3yo and normal btwn episodes

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9
Q

HyPP episode triggers:

A 
Stress
Sudden cold
Transportation
Sudden diet changes
Surgery/anesthetic recovery
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10
Q

What are the CS associated with HyPP?

A

Prolapse of 3rd eyelid
Sweating
Muscle fasiculations
Cramping

  • episodes can last min-hrs*
  • some young horses that are HOMOZYGOUS can get upper resp muscle paralysis and resp stridor*
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11
Q

T/F: HyPP is autosomal recessive inheritance

A

False!

Autosomal DOMINANT

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12
Q

What [in terms of electrolytes] is abnormal in HyPP?

A

Abnormal Na channels

Hyperkalemia

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13
Q

Why are the Na channels abnormal? What is wrong with them?

A

Resting potential is closer to firing

Na channels remain open

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14
Q

T/F: Hyperkalemia in HyPP is only seen during an attack

A

True!

During attacks, high efflux of K occurs

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15
Q

Risk factors for HyPP

A
  • fasting
  • general anesthesia
  • concurrent illness
  • exercise restriction
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16
Q

How do we diagnose HyPP?

A

Gene testing
CS
HyperK in an episode

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17
Q

How do you tell patients in renal failure apart from HyPP patients?

A

Horses in renal failure don’t demonstrate any muscular dysfunctions

otherwise, they both have very high HyperK

18
Q

T/F: As horses age, episode #s increase

A

False, the episode #s decrease with age

19
Q

DDx for HyPP:

A

Colic

Seizures

20
Q

How do we treat acute, mild episodes of HyPP?

A
  • light exercise [walking]
  • feed some carbs
  • feed often
21
Q

How do we treat acute episodes of HyPP with severe hyperkalemia?

A
  1. IV Ca Gluconate [cardioprotection]

2. IV dextrose/insulin to help drive K intracellularly

22
Q

What are some management changes we can try in treating HyPP?

A
  1. Diet: avoid high K feed, feed several times a day
  2. Minimize stress
  3. Regular exercise
23
Q

T/F: we can feed HyPP horses with alfalfa hay, brome hay, canola oil, soybean oil, sugar, beet molasses

A

False!! These are all foods high in K.

Instead, we should be feeding them foods low in K: grass hay, grains, sugar beet pulp

24
Q

What is acetazolmide and what does it do for the HyPP horse?

A

K wasting diuretic BUT since we give lower dose it doesn’t have that diuretic effect.

It stabilizes blood glucose and stimulates insulin secretion

25
Q

What are some possible etiologies for rhabdo?

A
  • inadequate training [pushing them too hard]
  • alteration of blood supply [post-anesthetic hypotensive episodes]
  • genetics
  • underlying muscle abnormalities
26
Q

What does a Type I rhabdo horse look like?

A 
Associated with limited exercise 
2-4yo nervous filly
Weekend rider
RER
PSSM
High grain intake, not exercised regularly
27
Q

What does a Type II rhabdomyolysis horse look like?

A

Endurance horses
Overexertion
Electrolyte/perfusion disturbances

28
Q

T/F: Mild cases of rhabdo occur AFTER race, poor performance, normal urine color, no muscle pathology, painful/firm hindquarters

A

True

29
Q

What are some CS of a severely affected rhabdo horse?

A
  • happens DURING exercise
  • don’t want to move; colic; recumbent
  • pigmenturia
  • acute renal failure
30
Q

How do we diagnose rhabdo?

A
  • elevated enzymes [CK over 10k]
  • muscle biopsy
    Standard exercise test [shows increase in CK with minimal exertion]
31
Q

How can we treat rhabdo?

A
  • limit exercise [and further muscle damage]
  • NSAIDs [phenylbutazone]
  • Muscle relaxant [dantrolene]
  • fluids [LRS]
  • vasodilators if normal hydration and not hypotensive [ace]
  • supportive care
32
Q

T/F: To reduce rhabdo recurrence we can feed them a high carb, low fat, low protein diet

A

False!

  • we feed them LOW carb, MOD fat, HIGH protein diet
  • increase exercise and avoid inactivity periods
  • dantrolene as prophylactic
  • acepromazine 30min before exercise
33
Q

What is the signalment for RER horses?

A

RER = recurrent exertional rhabdomyolysis

  • young, nervous fillies
  • autosomal dominant
34
Q

Pathophysiology of RER:

A

Autosomal dominant, heritable stress-related defect in intracellular Ca regulation

35
Q

T/F: The most reliable diagnostic measure for RER is muscle biopsy.

A

True.

Look for centralized nuclei [vs normal peripheral fiber location]

36
Q

What are some management changes we can make in RER horses? [pretty much same as rhabdo question from before]

A
  • maintain stress-free
  • dantrolene
  • exercise them [avoid stall rest]
  • low carb diet
37
Q

What is PSSM? What is the signalment here?

A

PSSM = polysaccharide storage myopathy

Seen in calm draft horses

38
Q

T/F: Definitive diagnosis of PSSM = glycogen accumulation in cardiac muscle.

A

False!

The glycogen accumulation is in skeletal muscle

39
Q

What can we increase in the diets of PSSM horses to help them?

A

Increase the fat

40
Q

What is the signalment for anesthetic-related rhabdo?

A

Muscle mass and hypotension!!!

41
Q

How do we treat anesthetic rhabdo?

A

Just like exertional rhabdo!

  • NSAIDs
  • fluids
  • dantrolene
  • low carbs, mod fat, high protein
  • exercise but only once CK is normal
42
Q

T/F: one major CS of anesthetic rhabdo is prolonged/difficult anesthetic recovery

A

True!

LAM1 (7 decks)

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