DS - Swollen joint Flashcards
(47 cards)
1
Q
Arthrocentesis - septic arthritis
A
- fluid yellow and opaque, reduced viscosity
- typically leukocyte count ? 30,000 cells/microL (>90% neutrophils)
- elevated TP (>2.5g/dl) ** mainstay of dx
- culture may be negative (blood culture medium and synovial biopsy can increase sensitivity)
2
Q
Rads - septic arthritis
A
- often normal initially
- lysis within few days
- osteomyelitis presence may affect px (or dictate prolonged AB)
- repeat weekly until resolution of CS
3
Q
Tx - septic arthritis
A
- BS AM (cephalosporins or penicllin/aminoglycoside combinations)
- foals should have joing lavage (needle through and through OR arthroscopic lavage, especially more established cases where debridement of fibrin may be required. Can be done in field - foals sedated/anaesthetised)
- resample joint fluid q48 h
- Oral AB duration based on sensitvity
4
Q
Management - septic arthritis
A
- minimise joint mvt, reduces damage to AC
- passive mvt may reduce fibrin adhesion
- box rest and supportive bandages initially
- physio after to reduce adhesions and prevent periarticular fibrosis
5
Q
Px - septic arthritis
A
- improved with prompt recognition + aggressive tx + local AB
- multiple site involvement: detrimental impact on survival and future athleticism
- Consider: intended use, structures involved, concurrent bone involvement
6
Q
What do replacement gilts weighing 110kg suggest?
A
underweight - likely DJD
7
Q
Ddx - acute onset lameness in pigs (gilts), one recumbent
A
- Mycoplasma hyosynoviae
- DJD
- Erysipelas infection
- Glassers disease (Haemophilus parasuis)
- trauma
8
Q
Post- mortem - Mycoplasma hyosynoviae
A
- if early, joint fluid may be blood tinged
- synovial membrane red and thick
- joint surface cartilage normal
9
Q
PM - DJD
A
- radiolucency and sclerosis
- joint cartilage has craters, exposed bone and synovial fluid, OPs
10
Q
Erysipelas - PM
A
- skin lesions (diamond shape)
- inflammatory exudates
- thickening of joint capsule
- splenomegaly
- hepatomegaly
11
Q
PM - Glasser’s dz
A
- septicaemia
- congestion of internal organs
- excessive fluid and fibrin tags within abdomen and chest
12
Q
Tx - Mycoplasma hyosynoviae
A
Lincomycin or tiamulin
13
Q
Prevention - Mycoplasma hyosynoviae
A
- in feed medication
- lower stress
- respiratory spread control
14
Q
How shold you justify an investigation?
A
- clinically
- financially
- ethically
15
Q
What equipment can you use to remove a chip from joint space of horse?
A
Ferris-Smith fragment rongeurs (rotate to tear fragment free of soft tissue attachments)
16
Q
What is a common racehorse fx?
A
Intermediate carpal bone (2nd most common site in intercarpal joints)
- excellent px
- return to performance decreases with chronicity and consequent loss of AC and subchondral bone
17
Q
What is periosteal proliferativ arthritis?
A
= an idiopathic inflammatory arthritis
- linked to FeLV, FIV, FeSFV
18
Q
Tx - periosteal proliferative arthritis
A
- prednisolone (immunosuppressive dose then taper down)
- poor reaction (add cyclophosphamide or azathioprine - never in cats, for canine IMPA)
- monitor response: SF cytology, WBC, secondary infections
- Physio (improve ROM)
19
Q
Px - periosteal proliferative arthritis
A
- guarded to poor
- if joint deformity severe, euthanise on humane grounds
20
Q
If NSAIDs have been given to manage joint pain, what should you question>
A
- dose?
- is this high enough to have an effect on pain?
- has dz progressed such that more pain now being experienced?
21
Q
What biochemical analysis is done of joint tap?
A
- WBC, TP and differential count
- WBC >3000/microL (inflammatory)
- WBC
22
Q
What to note on appearance of joint fluid:
A
- viscosity
- colour
- elasticity
- clarity
23
Q
Describe joint fluid in DJD and IMPA (non-erosive)
A
- DJD: increase in macrophages, often WBC 3000 WBC/microL, negative culture
24
Q
Tx - IMPA
A
steroids 3-6w, after this time about 56% are ‘cured’
25
What hx to take with iguanas that are lame:
- balanced diet?
- what exactly are they fed?
- adequate water access?
- if nutritional deficit suspected, iguana may also have cracked skin/scales
26
Differentiate primary and secondary gout
- accumulation of urate crystals in organs and joints d/t chronic hyperuricaemia, generally d/t excess protein in diet
- secondary gout: d/t chronic hyperuricacemia d/t causes such as renal insufficiency or dehydration
27
Aetiology - secondary nutritional hyperparathyroid
- poor diet (low Ca:P ratio, vit D3 deficiency)
| - poor husbandry (lack of UVB light/ inadequate thermal provision)
28
Aetiology - secondary renal hyperparathyroidism
renal dz
29
Ddx - lame iguana
- gout (primary/secondary)
- MBD (secondary nutritional hyperparathyroidism or secondary renal hyperparathyroidism)
- immune-mediated
- inflammatory/ infectious
30
Radiographs - lame iguana
- GOUT: mineralisation in affected organs/joints. Ca can be deposited along with uric acid crystals (needle shaped crystals)
- MBD: generalised skeletal demineralisation
- RENAL DZ: kidneys enlarged/smaller
31
Bloods - lame iguana
- determine hydration
- secondary nutritional hyperparathyroidism: low plasma 25-DHC, late stage = hyperphosphataemia, low total and ionised Ca
- Secondary renal hyperparathyroidism: hyperphsphataemia, hypocalcaemia, signs reduced renal function
- GOUT: increased uric acid
32
How useful is USG in reptiles?
limited value for assessing kidney function in reptiles because filtrate is isosthenuric (changes in kidney are not reflected in USG)
33
Tx - gout
- Pain relief - lack of evidence! (NSAIDs - ketoprofen monitor for GIT side effects, butorphanol, morphine)
- Diet (primary gout); reduce/eliminate high-protein food
- Re-hydrate (secondary gout): water baths, fluid therapy, drinking water, moisture laden foods
- Allopurinol to reduce blood uric acid levels, drugs must usually be long term because signs typically recur if tx discontinued (not during acute outbreak!)
- euthanasia (painful mvt, suppressed appetite)
34
Differentiate gout and pseudogout
- GOUT: deposition of monosodium urate crystals in joints d/t hyperuricaemia, needle shaped crystals in synovial fluid
- PSEUDOGOUT: deposition of crystals not formed from sodium urates in the joins (e.g. calcium crystals), rhomboid shaped crystals in synvoial fluid
35
T/F: Lots of infectious agents causing lameness in pigs can be tested by Ab titre in sera to investigate systemic problem.
True
36
T/F: Osteochondral doesn’t mean OCD.
It just means bone and cartilage involvement.
37
What type of sling is used to stop a hip dislocating?
Ehmer sling – to stop a hip dislocating
38
Pin and cerclage wire opposes all 3 forces
False
39
How do you tell if physes are abnormally wide?
Physes abnormally wide – hard question, if physis width is very similar to joint width, then no they aren’t abnormally wide
40
T/F: Femoral neck osteophytes don’t directly relate to degree of hip subluxation.
True
41
How do you look for collateral ligament damage on a radiograph?
– look at a cr-cd radiogrpah, not a lateral one.
42
What do you expect to see radiographically with calcaneal bursitis?
soft tissue swelling on tip of the calcaneus.
43
Name 3 acceptable tendon sutures
locking loop, 3-pulley loop, bunnel suture
44
Which animals get true Vit C deficiency?
guinea pigs and humans (v rarely others)
45
Outline polydioxanone
only 10% strength loss, lasts 90 d,
46
Outline polyglycolic acid
loses 90% strength and lasts less time vs polydioxanone which lasts 90d
47
Origin lateral collateral ligament
lateral malleolus
