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EBCM Lecture > Septic Arthritis and Tenosynovitis > Flashcards

Septic Arthritis and Tenosynovitis Flashcards

1
Q

What causes septic arthritis or tenosynovitis?

A

Iatrogenic, hematogenous, lacerations and punctures, local infection and idiopathic

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2
Q

What should you consider if you are suspicious of an iatrogenic cause of septic arthritis?

A

If you used a steroid you should be concerned of the immunosuppression and watch carefully for signs since they may not show for 2 weeks and be more mild than expected.

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3
Q

Treat all post-injeciton and post op lameness as an…

A

EMERGENCY

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4
Q

Who commonly suffers from a hematogenous origin of septic arthritis?

A

Foals
- umbilicus, lungs, GIT

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5
Q

How often should you check foal’s joints? How often should you check for lameness?

A

2x day for joint check
1x day for lameness

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6
Q

What are the clinical signs of septic arthritis?

A

Lameness, effusion, soft tissue edema/swelling, heat, pain on palpation and fever (not always in adults)

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7
Q

How do you diagnose septic arthritis?

A

HX, PE, Clin path (CBC, fibrinogen, serum amyloid A), Ultrasound, rads, CT, MRI, arthtocentesis

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8
Q

What should you be highly suspicious of when examining a foal?

A

Full exam
Effusion
Pain
Decreased Range of Motion
Listen to Lungs
Palpate umbilicus and abdomen

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9
Q

What are some clinical pathology findings that may suggest septic arthritis?

A

Increase WBC
Increase Fibrinogen (>1000mg/dl)
Increased Serum Amyloid A (>50mg/L)

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10
Q

What may you see on the ultrasound of a septic joint?

A

Increased synovial fluid, increased echogenicity, gas, thickened synovium, fibrin, soft tissue disruption and foreign body

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11
Q

What may you see on rads of Septic Arthritis?

A

Gas in synovial structure, tracking wound, foreign body, fracture, nail, osteomyelitis, physitis

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12
Q

Always visualize the nail on x-ray before you…

A

Pull it out

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13
Q

What would the synovial fluid look like in a normal joint?

A

TP <2.0 g/dl, WBC <450-5000/ul, Cell <10% neutrophils

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14
Q

What would an infected joints fluid cytology look like?

A

TP >4.0 g/dl, WBC >30,000ul, Cells >80% neutrophils

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15
Q

What are some common pathogens you may find on microbial culture of joint fluid?

A

Salmonella, strep zoo, e.coli, staph aureus, borrelia, clostridium, mycoplasma, fungal

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16
Q

What is a clean wound?

A

No sepsis, no inflammation (Surgical)

17
Q

What is a clean contaminated wound?

A

Minor sepsis (break in sterility)

18
Q

What is a contaminated

A

acute non-purulent inflammaiton (dumb GIT)

19
Q

What is a dirty-infected wound?

A

Traumatic, devitalized, fecal contaminate, FB, puss (old wound)

20
Q

What factors determine the prognosis of a septic arthritis?

A

Synovial structures involved, tendon and ligament, blood vessels, nerves, virulent bacteria, drug resistance of bacteria

21
Q

Why can a puncture wound be worse than a laceration?

A

Bacteria and FB driven in deep, may not know in synovium, hard to assess depth and location, tract seals quickly

22
Q

Is a synovial structure more painful when it is open or closed?

A

Closed (effusion swells and is painful)

23
Q

How should you evaluate and clean a septic joint?

A

PE, sedated, sterile lube and clip, debride and lavage, no soap (iodine or chlorohex), palpate with gloves, ultrasound, rads, arthrocentesis, through and through lavage

24
Q

What should your first line of defense be?

A

Broad spectrum antibiotics and lavage (penicillin and gentamicin systemic), intraarticular amikacin, regional limb perfusion with amikacin

25
Q

What is a reason it is important to lavage synovial structures?

A

To help prevent adhesions

26
Q

What factors help decide if closure is needed?

A

Duration, devitalized tissue, communication, sepsis, high motion or not

27
Q

When should primary closure be completed?

A

<4hrs
Minimal trauma, sepsis and good blood supply are necessary

28
Q

What is delayed primary cloure?

A

> 8hr
Need debridement and topical antibiotics

29
Q

When is delayed Secondary Closure used?

A

Severe contamination or tissue devitalization
>4 days, managed as 2nd intension

30
Q

What is second intention healing?

A

Avulsion injury with contamination, skin loss and soft tissue damage
-Debride and lavage, may skin graft

31
Q

How should a regional limb perfusion be performed?

A

Sedate
use saphenous, cephalic or digital vein
clip and prep aseptic
gause to protect tendon
tourniquet
20g butterfly cathert
amikacin 2g in 30ml LRD
inject slow
topical diclofenac
pressure bandage

32
Q

What is vetrigel?

A

Release antibiotic over time (7 day)

33
Q

What is the prognosis for a septic joint?

A

12-24 hrs with minamal truama = good
>24-48 fair to good

EBCM Lecture (24 decks)

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