Approach to the Laminitic Horse Flashcards
Clinical signs of acute laminitis
Reluctant to come in from field
Characteristic stance & gait
Difficulty getting up
Pulse (>50-70/min)
Often pyrexic
Digital pulses ‘bounding’
Increased sensitivity to hooftester
Painful to coronary pressure
May be unable to pick up feet
Gas colic, hypermotile bowel often present
Outline of getting history if suspected laminitis
Feeding/grazing history
Number of laminitic episodes
Duration of current episode
Medications- Before/after onset
Recent/concurrent disease
Outline approach to a full physical examinations of suspected laminitis
Stance
Foot/hoof conformation
Lameness grade
Obel laminitis grade
Digital pulses
Palpation of coronary band
Evidence of concurrent Dz
Outline obel laminitis grading
Grade 1: frequent lifting of feet
Grade 2: willing to walk, laminitic gait, can lift forefoot without difficulty
Grade 3: vigorously resists lifting of forefoot, moves reluctantly
Grade 4: must be forced to move ± recumbent
Approach to diagnosis of acute laminitis
Haematology/Cytology
Radiographs
Search for underlying DZ
Pasture/feed assessment
Approach to diagnosis of Chronic/recurrent laminitis
Haematology/Cytology
Blood insulin
Testing for PPID and EMS
Radiographs
Prevention & Treatment of laminitis
↓digital metabolic rate; ↓glucose requirement
Continuous iceing for first 24-48 h
Clinical sign of equine PPID
hair coat changes- Retention of winter haircoat/Altered shedding pattern
weight loss
Changed demeanour & lethargy
laminitis
PU:PD
Hyperhidrosis
Hirsutism/hypertrichosis
Clinical features of equine PPID
Altered fat deposition- Bulging supraorbital fat pads
Tachypnoea
Immunosuppression
- Chronic respiratory infections
- Sinusitis
- Increased parasitism
Neurological signs (intermittent collapse)
Diagnosis of equine PPID
Signalment and history
Commonest in age group >12y but some younger cases
Clinical signs
Plasma endogenous ACTH or dynamic ACTH response
Characteristic haematology and biochemistry changes
Secondary insulin resistance
Treatment of Equine PPID
Dopamine agonist is most effective treatment
Pergolide (‘Prascend’), starting at 1-4 ug/kg once daily
Lifelong therapy required; dose increase may be required as pars intermedia continues to increase in size
Management of multiple other conditions required
Laminitis, hirsutism, sweating & electrolyte loss, body condition
Prevention of Equine PPID
Particularly if >10 y, with laminitis
Confirm diagnosis
Assess for concurrent insulin resistance
Reassess ACTH after initially starting pergolide
Re-evaluate at least every 6 months
Acute laminitis treatment
Reduce further absorption in carbohydrate model
Reduce stresses on laminae- Small box confinement/remove shoes/deep supportive bed
Pain relief
Cryotherapy
Suggest non steroidal analgesia for acute laminitis in horses
Ketoprofen
Paracteamol
Aspirin
Name analgesia for chronic laminitis in horses
Gabapentin
