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LA Sx Exam 1 > Septic Arthritis/Physitis > Flashcards

Septic Arthritis/Physitis Flashcards

1
Q

What are naturally occurring causes of septic arthritis/physitis?

A

Hematogenous, traumatic

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2
Q

What age is hematogenous septic arthritis/physitis more common?

A

Foals

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3
Q

What are iatrogenic causes of septic arthritis/physitis?

A

Arthoscopy/centesis, fracture repair

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4
Q

What infectious cause is most commonly the cause of septic arthritis/physitis?

A

Bacterial

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5
Q

What is joint effusion a response to?

A

Pain

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6
Q

What are components of septic arthritis/physitis pathogenesis?

A

Decreased HA synthesis, loss of PG, compromised synovial blood flow, irregular cartilage

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7
Q

How often should you evaluate a septic foal to make sure its joints are ok?

A

At least 4x/day

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8
Q

What are types of septic arthritis in foals?

A

Synovial, epiphyseal, physeal

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9
Q

Foals <1wk exhibit acute severe lameness and effusion of the stifle and tibiotarsal (multiple joints common)

A

Synovial arthritis

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10
Q

Involves the synovial membrane and synovial fluid and requires a synovial sample for dx

A

Synovial arthritis

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11
Q

Bone adjacent to articular cartilage

A

Epiphysis

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12
Q

What will you see on rads of an epiphyseal arthritis?

A

Subchondral lysis

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13
Q

Foals a few weeks old exhibit mild lameness and fever prior to an acute exacerbation of lameness and effusion in multiple joints

A

Epiphyseal arthritis

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14
Q

What joints are most commonly affected by synovial arthritis?

A

Stifle and tibiotarsal

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15
Q

What joints are most commonly affected by epiphyseal arthritis?

A

Distal femur, talus, tibia, radius

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16
Q

What must you ddx epiphyseal arthritis from?

A

FPT, pneumonia, diarrhea

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17
Q

Affects the physis of long bones with or without joint involvement

A

Physeal arthritis

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18
Q

Seemingly healthy foal weeks-months old with premonitory lameness prior to acute severe lameness and swelling at only one site

A

Physeal arthritis

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19
Q

Periarticular swelling usually occurs w/o effusion

A

Physeal athritis

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20
Q

What joints are most commonly affected by physeal arthritis?

A

Distal MC3/MT3, radius, tibia

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21
Q

How do you dx physeal arthrtisis?

A

Rads, aspirate of physis, bone biopsy

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22
Q

What happens if you try to debride a joint affected by phyesal arthritis?

A

Damage physis = premature closure

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23
Q

Which types of foal arthritis are similar?

A

Synovial and epiphyseal

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24
Q

What synovial fluid analysis parameters will indicate septic arthritis?

A

> 50k cell count, >90% PMNs

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25
Q

What bloodwork parameters will indicate septic arthritis?

A

> 900 fibrinogen +/- leukocytosis

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26
Q

How will synovial fluid appear on US w/septic arthritis?

A

Hypercellular

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27
Q

What is the px for survival in a foal with septic arthrits?

A

77%

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28
Q

What area other than the joints should you US on a foal w/septic arthritis?

A

Umbilicus

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29
Q

What are iatrogenic risk factors for septic arthritis in an adult horse?

A

Synovial sx, fx repair, arthrocentesis

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30
Q

What bacteria usually causes septic arthritis after an arthrocentesis in an adult horse?

A

Staph spp.

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31
Q

How common is arthrocentesis post-op septic arthritis?

A

1/1279 injections

32
Q

What bacteria is the most common cause of septic arthritis in an adult horse that has suffered trauma?

A

Enterobacteriaceae

33
Q

How common is bacteremia in adult horses?

A

Rare - no hematogenous spread

34
Q

An open joint is an _____ joint

A

Infected

35
Q

What are clinical signs of septic arthritis in an adult horse?

A

Acute onset of severe lameness, synovial effusion, peri-articular heat and swelling

36
Q

What is the gold standard for septic arthritis diagnosis?

A

Microbiology

37
Q

What media should you use to culture a septic arthritis sample?

A

Enrichment/blood culture media

38
Q

What is the normal TP for a horse joint fluid?

A

<2 g/dL

39
Q

What is normal WBC for a horse joint fluid?

A

<500 cells/dL

40
Q

What is normal differentiation of WBCs in horse joint fluid?

A

<10% neutrophils

41
Q

What is the most common isolate from septic arthritis?

A

Staphylococcus

42
Q

Where do you joint tap a wounded joint?

A

Away from the wound

43
Q

How do you treat septic arthritis?

A

Lavage, local abx, effective draining

44
Q

What are consequences of septic arthritis?

A

Cartilage destruction, DJD, contralateral limb laminitis

45
Q

How do we return cartilage to its normal environment??

A

Get rid of infection and inflammation and minimize matrix loss and damage

46
Q

What broad spec abx should be administered after getting a synovial fluid sample?

A

Penicillin/gentamycin

47
Q

What is the mainstay of septic arthritis treatment?

A

Lavage (5-10L early and often)

48
Q

What is the best way to lavage a septic joint?

A

Arthoscopic

49
Q

How can you lavage an acutely infected joint?

A

Needle/through and through lavage

50
Q

Rapid, accurate lavage delivery, removes fibrin clots, targeted debridement

A

Arthroscopic lavage

51
Q

This is the only time to use a needle over 20G

A

Needle/through and through lavage

52
Q

How do you sedate a horse for joint lavage?

A

2% mepivicane into the joint

53
Q

How do you sedate a hores for athroscopy or arthrotomy?

A

General anesthesia

54
Q

What lavage solution should you use to flush a joint?

A

LRS, nomosol (sterile isotonic solutions)

55
Q

Why would you NOT add clorhexidine or povidone-iodine to your lavage solution?

A

Cytotoxic and damages cartilage, low efficacy

56
Q

How does DMSO help if added to your lavage solution?

A

Reduces inflammation and edema via free radical scavenging

57
Q

How much DMSO can you add to your lavage solution and why should you not exceed this amount?

A

10% - any more can cause hemolysis

58
Q

How often should you lavage and when should you stop?

A

EOD until lameness and effusion has resolved or use of NSAIDs has started

59
Q

_____ administration of abx is VITAL to successful arthritis resolution

A

Local

60
Q

What is the first choice abx while waiting for synovial culture and sensitivity results?

A

Amikacin

61
Q

When should you stop local abx therapy?

A

Stop w/resolution of CS and normalization of affected area

62
Q

How are local ab administered to the joint?

A

Intra-articular

63
Q

500mg Amikacin provides _____ concentration >MIC for most common pathogens

A

72hr

64
Q

When treating multiple joints with local abx, what must you be cautious of?

A

Do not exceed total systemic dose

65
Q

Performed QOD w/esmarch tourniquet and a 25-27G butterfly catheter

A

Regional limb perfusion

66
Q

What topical NSAID helps limb and vessel maintain and stay usable for duration of regional limb perfusion treatment?

A

Surpass

67
Q

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

A

1/3 systemic dose

68
Q

How do you dilute your abx for a distal limb regional limb perfusion?

A

Dilute to 30mL

69
Q

How do you dilute your abx for regional limb perfusion above the carpus/tarsus?

A

Dilute to 60mL

70
Q

What do you need to be cautious of when using florfenicol for regional limb perfusion in cattle?

A

High tissue concentration

71
Q

How do you deliver intraosseous abx?

A

Esmarch tourniquet, 4mm hole in bone, leur tip, inject slowly

72
Q

How long do you leave an esmarch tourniquet on after regional limb perfusion or intraosseous administration?

A

30min

73
Q

Why do septic arthritis patients need analgesia?

A

Extremely painful condition, contralateral limb laminitis

74
Q

What GI protectants can you use to counteract NSAID tox?

A

Omeprazole AND sucralfate

75
Q

What is the most reliable and important measure to assess response to arthritis treatment?

A

Clinical lameness

76
Q

What is Dr. L’s favorite adjunct treatment for septic arthritis?

A

Hylauronic acid

LA Sx Exam 1 (17 decks)

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