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Flashcards in DS - Swollen joint Deck (47)
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1

Arthrocentesis - septic arthritis

- 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

Rads - septic arthritis

-often normal initially
- lysis within few days
- osteomyelitis presence may affect px (or dictate prolonged AB)
- repeat weekly until resolution of CS

3

Tx - septic arthritis

- 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

Management - septic arthritis

- 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

Px - septic arthritis

- 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

What do replacement gilts weighing 110kg suggest?

underweight - likely DJD

7

Ddx - acute onset lameness in pigs (gilts), one recumbent

- Mycoplasma hyosynoviae
- DJD
- Erysipelas infection
- Glassers disease (Haemophilus parasuis)
- trauma

8

Post- mortem - Mycoplasma hyosynoviae

- if early, joint fluid may be blood tinged
- synovial membrane red and thick
- joint surface cartilage normal

9

PM - DJD

- radiolucency and sclerosis
- joint cartilage has craters, exposed bone and synovial fluid, OPs

10

Erysipelas - PM

- skin lesions (diamond shape)
- inflammatory exudates
- thickening of joint capsule
- splenomegaly
- hepatomegaly

11

PM - Glasser's dz

- septicaemia
- congestion of internal organs
- excessive fluid and fibrin tags within abdomen and chest

12

Tx - Mycoplasma hyosynoviae

Lincomycin or tiamulin

13

Prevention - Mycoplasma hyosynoviae

- in feed medication
- lower stress
- respiratory spread control

14

How shold you justify an investigation?

- clinically
- financially
- ethically

15

What equipment can you use to remove a chip from joint space of horse?

Ferris-Smith fragment rongeurs (rotate to tear fragment free of soft tissue attachments)

16

What is a common racehorse fx?

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

What is periosteal proliferativ arthritis?

= an idiopathic inflammatory arthritis
- linked to FeLV, FIV, FeSFV

18

Tx - periosteal proliferative arthritis

- 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

Px - periosteal proliferative arthritis

- guarded to poor
- if joint deformity severe, euthanise on humane grounds

20

If NSAIDs have been given to manage joint pain, what should you question>

- dose?
- is this high enough to have an effect on pain?
- has dz progressed such that more pain now being experienced?

21

What biochemical analysis is done of joint tap?

- WBC, TP and differential count
- WBC >3000/microL (inflammatory)
- WBC

22

What to note on appearance of joint fluid:

- viscosity
- colour
- elasticity
- clarity

23

Describe joint fluid in DJD and IMPA (non-erosive)

- DJD: increase in macrophages, often WBC 3000 WBC/microL, negative culture

24

Tx - IMPA

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