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Large Animal Surgery > Septic Arthritis > Flashcards

Septic Arthritis Flashcards

1
Q

What are 3 types of causes of septic arthritis?

A
  • Naturally occurring
  • Iatrogenic
  • Usually bacterial (sometimes viral, mycobacterial, fungal)
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2
Q

What can cellular infiltrates such as degradative enzymes and cytokines create?

A

Create a cycle of cartilaginous matrix destruction.

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3
Q

What are 5 general aspects of the pathogenesis of septic arthritis?

A
  • Decreased HA synthesis
  • Loss of PG
  • Joint effusion
  • Painful
  • Compromise synovial blood flow
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4
Q

What are 4 overall consequences involved with septic arthritis?

A
  • Acute synovitis with suppurative effusion
  • Cartilage destruction via cellular and bacterial enzymes and cytokines
  • Capsular fibrosis/ankylosis
  • DJD
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5
Q

What are 2 examples of complications that can be seen with septic arthritis?

A
  • Contralateral limb laminitis

- Euthanasia

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6
Q

How can septic arthritis be caused in foals?

A

Failure of passive transfer

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7
Q

In checking for FPT, normal IgG levels should be over what?

What can be used to get this value?

A
  • Over 800

- SNAP test

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8
Q

What are 3 types of septic arthritis seen in foals?

A
  • S-Type
  • E-Type
  • P-Type
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9
Q

What is affected in the S-Type of septic foal arthritis?

A

Joint space - synovial membrane, synovial fluid

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10
Q

What age of foal is more commonly affected by the S-Type of septic arthritis in foals?

A

Less than 1 week

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11
Q

What type of joints are more commonly affected with S-Type septic arthritis in foals?
What are 2 examples of these?

A
  • Larger joints

- Stifle, tibiotarsal

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12
Q

What is the most common joint affected by S-Type septic arthritis in foals?

A

Tibiotarsal

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13
Q

Is it more common the see one joint or multiple joints affected with S-Type septic arthritis in foals?

A

Multiple joint involvement more common.

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14
Q

What are 3 clinical signs seen with S-Type septic arthritis in foals?

A
  • Acute onset
  • Severe lameness
  • Effusion
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15
Q

What are is affected by E-Type septic arthritis in foals?

A

Bone adjacent to articular cartilage.

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16
Q

What are 2 changes seen with E-Type septic arthritis in foals?

A
  • Expanding epiphysis

- Subchondral lysis

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17
Q

What age range is most commonly affected by E-Type septic arthritis in foals?

A

Weeks old

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18
Q

History of what 2 conditions can indicate E-Type septic arthritis in foals?

A
  • Failure of passive transfer (FPT)

- Other disease (pneumonia, diarrhea)

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19
Q

Is it more common to see one or multiple joints affected by E-Type septic arthritis in foals?

A

Multiple joints

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20
Q

What are 4 examples of areas that can be affected by E-Type septic arthritis in foals?

A
  • Distal femur
  • Talus
  • Tibia
  • Radius
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21
Q

What is a pattern of clinical signs commonly seen with E-Type septic arthritis in foals?

A

Mild intermittent lameness with or without fever followed by acute exacerbation lameness/effusion.

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22
Q

What area is affected by P-Type septic arthritis in foals?

A

Physis of long bones

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23
Q

What should be checked when physitis is present?

A

Check the joint space.

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24
Q

What age range is most commonly affected by P-Type septic arthritis?

A

Weeks to months

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25
Q

How can foals with P-Type septic foal arthritis often present?

A

Seemingly healthy with no history of prior disease.

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26
Q

What are 3 common locations of P-Type septic arthritis in foals?

A
  • Distal physis of MC3/MT3
  • Radius
  • Tibia
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27
Q

Does P-Type septic arthritis in foals more commonly affect one or multiple joints?

A

One

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28
Q

What clinical signs can be seen with P-Type septic foal arthritis?

A

Premonitory lameness THEN acute severe lameness/swelling.

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29
Q

Periarticular swelling usually without effusion can be seen with what type of septic arthritis in foals?

A

P-Type

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30
Q

What are 3 types of diagnostics that can be used to detect P-Type septic foal arthritis?

A
  • Radiographs
  • US guided aspirate of physis (submit for culture)
  • Possible bone biopsy
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31
Q

What should not be done due to the risk of damaging the physis and causing premature closure?

A

Do NOT debride!

Generally speaking

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32
Q

With which 2 types of septic arthritis in foals can you see lameness, effusion and sometimes fever?

A
  • S-Type

- E-Type

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33
Q

If performing synovial fluid analysis, a cell count over what level and a neutrophil count over what level are indicative of suppurative inflammation?

A
  • Greater than 50,000 cells

- Greater than 90% neutrophils

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34
Q

What are 2 possible findings on blood work for a foal with septic arthritis?

A
  • Increased fibrinogen

- +/- leukocytosis

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35
Q

If there is septic arthritis, fibrinogen levels in the blood work can get over what?

A

Greater than 900 mg/dL

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36
Q

What can be seen on US with foal septic arthritis?

A

Hypercellular fluid

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37
Q

It is important to identify what when dealing with septic arthritis in foals?

A

Must ID all joints involved.

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38
Q

What part of the foal should be examined with US due to it being a source of infection?

A

Umbilicus

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39
Q

What part of the patient should be evaluated when a foal is suspected of having septic arthritis?

A

Evaluate the entire patient!

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40
Q

What is the prognosis for foals with septic arthritis?

A

77% survival rate

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41
Q

What are 3 potential risk factors for septic arthritis in adult horses?

A
  • Iatrogenic
  • Trauma
  • Bacteremia
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42
Q

What are 3 types of procedures where septic arthritis can be caused iatrogenically?

A
  • Synovial surgery
  • Fracture repair
  • Arthrocentesis
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43
Q

Is hematogenous spread a rare or common cause of septic arthritis in adult horses?

44
Q

What is a common bacterial source of septic arthritis with arthrocentesis in adult horses?

A

Staphylococcus

45
Q

An open joint is a what?

A

An open joint is an INFECTED JOINT.

46
Q

Septic arthritis in adult horses is similar to what?

A

Similar to foals without bone involvement.

47
Q

The is an acute onset of what clinical sign with septic arthritis in adult horses?

A

Severe lameness

48
Q

What are 2 clinical signs that can be seen per-articular with septic arthritis in adult horses?

A
  • Heat

- Swelling

49
Q

What is a clinical sign that may or may not be seen with septic arthritis in adult horses?

50
Q

What is the gold standard for diagnosis sepsis in adult horses?

A

Microbiology using a joint tap.

51
Q

What are 3 factors of synovial fluid to grossly examine?

A
  • Color
  • Clarity
  • Viscosity
52
Q

What are 3 aspects of clinicopathological fluid joint evaluation with septic arthritis in adult horses?

A
  • Total protein
  • Cell count differential
  • Staining of smears
53
Q

A joint should be tapped for evolution distant to what?

A

Distant to the wound.

54
Q

What are 2 types of media that can be used for culturing and sensitivity of a joint tap for septic arthritis in adult horses that can give a much better yield?

A
  • Enrichment media

- Blood culture media

55
Q

If the initial sample from a joint tap looking for septic arthritis in adult horses comes back negative, what should be done?

A

Repeat culture

56
Q

When evaluating joint fluid, what color is considered normal?
What is considered abnormal?

A
  • Pale yellow

- Serosanguinous, orange

57
Q

When evaluating joint fluid, what clarity is considered normal?
What is considered abnormal?

A
  • Clear

- Turbid

58
Q

When evaluating joint fluid, what WBC count is considered normal?
What is considered abnormal?

A
  • Less than 500 cells/dL

- Thousands +

59
Q

When evaluating joint fluid, what neutrophil differential is considered normal?
What is considered abnormal?

A
  • Less than 10% neutrophils

- Greater than 90%, usually degenerated

60
Q

When evaluating joint fluid, what total protein level is considered normal?
What is considered abnormal?

A
  • Less than 2 g/dL

- Greater than 3.5 g/dL

61
Q

Cultures should be taken before what happens?

A

Before antibiotics are given.

62
Q

Can you still culture if antibiotics have been initiated?

63
Q

Why is it important to do the joint tap away from the wound?

A

Don’t want to introduce anything into joint.

64
Q

What are 3 radiographic signs that can be seen with septic arthritis in adult horses?

A
  • Marked effusion
  • Soft tissue swelling
  • Osseous involvement
65
Q

For treatment of septic arthritis to be successful, what 2 things need to take place?

A
  • Rapid recognition of disease

- Immediate aggressive treatment

66
Q

Treatment goals for returning cartilage to a normal environment include what 3 aspects?

A
  • Eradicate infection
  • Eliminate inflammation
  • Minimize matrix loss and cartilage damage
67
Q

If treatment goals for septic arthritis are not accomplished what can happen?

A

Irreversible structural damage and decreased prognosis for return to function.

68
Q

While waiting for results of septic arthritis samples, what can be done?

A

Begin broad spectrum antibiotics such as penicillin or gentamicin.

69
Q

What is the mainstay of treatment for septic arthritis?

How often should it be done?

A
  • Lavage with large volumes (5-10 L)

- Early and often

70
Q

What type of lavage is ideal?

What is another type that could be used?

A
  • Arthroscopic lavage

- Needle (Through and through) lavage

71
Q

What are 3 reasons that arthroscopic lavage is ideal?

A
  • Rapid accurate delivery
  • Removal of fibrin clots
  • Targeted debridement
72
Q

What size needles are used for needle lavage?

Where are they placed?

A
  • 18-16 gauge needle

- Needles placed in all compartments

73
Q

What are 2 necessary parts of treatment for septic arthritis if the horse is to remain standing?

A
  • Sedation

- Local anesthesia

74
Q

What is an example of a local anesthetic used for septic arthritis?

A

2% mepivacaine

75
Q

What are 2 types of balanced electrolyte solutions that can be used to lavage joints for septic arthritis?

A
  • LRS

- Normosol

76
Q

What are 2 things not to add in a lavage used for septic arthritis?
Why?

A
  • Chlorhexidine, Povidone-iodine

- Shown to be inflammatory, effective concentrations would cause damage to tissue

77
Q

How often should a septic joint be lavaged?

A

Daily initially if not fully responsive.

78
Q

When should lavage treatment for a septic joint be stopped?

A

Timing is specific to the individual.

79
Q

What are 3 signs that indicate it might be time to stop lavage with septic arthritis?

A
  • Resolution of lameness
  • Resolution of effusion/swelling
  • Able to discontinue use of NSAIDs/analgesics
80
Q

Which type of antibiotic is more important in the treatment or septic arthritis: local or systemic?

81
Q

When is it ok to stop antibiotics?

A

Minimum 30 days and 2 weeks beyond resolution of clinical signs.

82
Q

What are 4 routes of administration for local antibiotics with septic arthritis?

A
  • Intra-osseous
  • Intra-articular
  • Regional limb perfusion
  • Impregnated biomaterials
83
Q

When can antibiotics be administered intra-articularly?

A

After completion of lavage

84
Q

Intra-articular administration of antibiotics can lead to a very high concentration of the drug where?

A

At site of sepsis (joint)

85
Q

500 mg of Amikacin provides a concentration greater than MIC for most common pathogens for how long when given intra-articularly?

86
Q

What do you have to be careful about when dealing with septic arthritis in multiple joints?

A

Not to exceed the daily total systemic dose.

87
Q

How often is regional limb perfusion performed?

A

4 times a day

88
Q

Proper tourniquet placement is essential for what type of dosing?

A

Regional limb perfusion

89
Q

What size catheters are used for regional limb perfusion?

Why?

A
  • 25-27 gauge

- Use smaller size to try and make the vein last.

90
Q

How should a regional limb perfusion be injected?

A

Slowly over 5-10 minutes

91
Q

How long should the tourniquet be left of for with regional limb perfusion?

A

30 minutes

92
Q

What is an example of an anti-inflammatory that can be given topically with regional limb perfusion that has less perivascular swelling and edema?

93
Q

What is the general rule of thumb when dosing for regional limb perfusion?

A

1/3 of systemic dose

94
Q

What drug is used for regional limb perfusion in cattle?

What are 2 bacteria that is acts against?

A
  • Florfenicol

- F. necrophorum and A. pyogenes

95
Q

When using regional limb perfusion, it is important to not do what?

A

Not to exceed the total daily systemic dose.

96
Q

What size hole is drilled for intra-osseous antibiotic administration?
What can fit into this size hole?

A
  • 4 mm

- Male end of lure tip extension

97
Q

What should be used and then left on for at least 30 minutes after IO antibiotic administration?

A

Tourniquet

98
Q

What can be excruciatingly painful?

A

Septic arthritis

99
Q

What is a reason for using analgesia in conjunction with septic arthritis?

A

Contralateral limb laminitis

100
Q

What are 4 possible consequences as a result of excessive time in recumbency?

A
  • Decubital ulcers
  • Respiratory disease
  • GI disease
  • Weight loss
101
Q

What are 2 examples of GI protectants that can be used in horses?

A
  • Omeprazole

- Sucralfate

102
Q

What are the 2 most reliable and important measures to assess response to treatment for septic arthritis?

A
  • Clinical lameness

- Pain

103
Q

What is something to be careful of when evaluating effectiveness of a treatment for septic arthritis?

A

NSAIDs and other analgesics can mask pain and give a false impression of success.

104
Q

Never discharge any antibiotics or lavage until what occurs?

A

Until horse is evaluated AFTER analgesics have been reduced or discontinued.

105
Q

What are 3 goals of adjunct treatment for septic arthritis?

A
  • Eradicate infection
  • Eliminate inflammation
  • Return cartilage to it’s normal environment
106
Q

What is an example of an adjunct treatment that can be used with septic arthritis?

Large Animal Surgery (30 decks)

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