Exam 2: Septic Arthritis/ Physitis Flashcards by Preeti Gulve

What 3 types of septic arthritis are seen in foals?

S, E, P

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Which type of septic arthritis seen in foals usually only effects 1 site?

P-type

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Which type(s) of septic arthritis seen in foals usually effects multiple sites?

S and E

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What is the most common etiology of septic arthritis?

Bacterial

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What is the greatest risk factor for septic arthritis/physitis in foals?

Failure of passive transfer

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Why do you NEVER debride in cases of P-Type septic arthritis in foals?

Debridement damages the physis and causes premature closure!

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What do you expect the cell count to be of synovial fluid analysis

in a foal with S or E-Type septic arthritis?

greater than 50,000

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What do you expect the neutrophil percentage to be of synovial fluid analysis

in a foal with S or E-Type septic arthritis?

greater than 90% neutrophils

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What abnormalties do you see on bloodwork in

cases of S or E-Type septic arthritis?

Increased fibrinogen ± leukocytosis

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In cases of S or E-Type septic arthritis,

Fibrinogen is usually ______mg/dL with bone involvement

>900 mg/dL

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What is the prognosis for septic arthritis in foals?

77% survival in foals

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What are the iatrogenic risk factors for septic arthritis in adults?

Iatrogenic: synovial sx, fracture repair, arthrocentesis

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This pathogen is seen as the causative agent in a third of the iatrogenic cases

of septic arthritis in adults, especially in arthrocentesis

Staphylococcus spp.

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What is the gold standard for diagnosis of septic arthritis?

Microbiology

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At what age is S-type septic arthritis seen in foals?

Less than 1 week old

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What solutions should (and shouldn’t) be used for lavage in a case of septic arthritis?

USE: Balanced electrolyte solution (LRS, Normosol) +/- DMSO

Do NOT add chlorhexidine, povidone iodine- cytotoxic and unhelpful

Do NOT give 5% dextrose solution- will be feeding the bacteria!

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What organism is most commonly isolated in a case of septic arthritis?

Staphylococcus spp.

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T/F: In a case of septic arthritis in adults and foals,

it is important to check the umbilicus as a source of infection

FALSE

Only check umbilicus in foals

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When is it acceptable to stop antibiotic treatment for septic arthritis?

Minimum 30 days and 2 weeks beyond resolution of clinical signs (whichever is longer)

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T/F: Arthrotomy is contraindicated in the treatment of septic arthritis in cattle.

False

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What is the mainstay of treatment for septic arthritis?

LAVAGE- Early and often; large volumes (5-10 liters)

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What type of septic arthritis in foals typically presents with swelling, but usually without effusion?

P-Type

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What are the three types of septic arthritis in foals?

S, E, P (Synovial, Epiphysis, Physis)

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With what type of septic arthritis in foals might you be able to see subchondral lysis on radiographs?

E-Type

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This is the most distal nerve block performed in the horse:

Palmar digital nerve block

Horses undergoing arthrodesis of this joint have an 80% prognosis for return to work:

Hindlimb pastern arthrodesis

This is the primary collagen found in tendons:

Type 1

Which type of septic arthritis seen in foals usually only effects 1 site while the others effect multiple sites?

P-type

Which type(s) of septic arthritis seen in foals usually effects multiple sites?

S and E-Types

What is the most common etiology of septic arthritis?

Bacterial

What is the greatest risk factor for septic arthritis/physitis in foals?

Failure of passive transfer

Why do you NEVER debride in cases of P-Type septic arthritis in foals?

Debridement damages the physis and causes premature closure!

What do you expect the cell count to be of synovial fluid analysis in a foal with S or E-Type septic arthritis?

Greater than 50,000

What do you expect the neutrophil percentage to be of synovial fluid analysis in a foal with S or E-Type septic arthritis?

Greater than 90% neutrophils

What abnormalities do you see on bloodwork in cases of S or E-Type septic arthritis?

Increased fibrinogen ± leukocytosis

In cases of S or E-Type septic arthritis, Fibrinogen is usually \_\_\_\_\_\_mg/dL with bone involvement

\>900 mg/dL

What is the prognosis for septic arthritis in foals?

77% survival in foals

What are the iatrogenic risk factors for septic arthritis in adults?

Iatrogenic: synovial sx, fracture repair, arthrocentesis

This pathogen is seen as the causative agent in a third of the iatrogenic cases of septic arthritis in adults, especially in arthrocentesis

Staphylococcus spp.

In order to determine failure of passive transfer in a foal, you look at IgG levels. What is the normal level in a foal?

IgG greater than 800

What sites are most common for S-Type septic arthritis in foals?

Stifle, Tibiotarsal

What sites are most common for E-Type septic arthritis in foals?

Distal femur, talus, tibia, radius

What sites are most common for P-Type septic arthritis in foals?

Distal physis of MC3/MT3, radius, tibia

Acute, severe, very painful lameness in a foal less than 1 week old with effusion present is most characteristic of this type of septic arthritis.

S-Type

Mild, intermittent lameness in a foal a couple weeks old is seen. Suddenly, the lameness is exacerbated and effusion is seen. The foal had a history of diarrhea and its IgG levels at birth were low. What is your most likely diagnosis?

E-Type Septic Arthritis

A 2 month old foal is normal and healthy. All of a sudden, he becomes lame. You have localized the problem to the distal MT3. There are no signs of joint effusion, but on radiographs, soft tissue swelling is seen along with lysis around the physeal plate. What is your most likely diagnosis?

P-Type Septic Arthritis

How do you confirm your diagnosis of P-Type Septic Arthritis?

Aspirate the physis and submit for culture

If you cannot get a physis aspirate, what can you do to confirm your diagnosis of P-Type?

Bone biopsy

When running diagnostics for suspected septic arthritis, culture _______ treating with antibiotics

Culture **_before_** treating with antibiotics

Can you still culture if antibiotics have been given?

YES, but make sure to put the sample in the appropriate culture broth

Why do you tap AWAY from the wound in cases of septic arthritis?

To avoid bringing bacteria into the joint in case the joint isn’t actually involved. Distend joint to determine joint involvement!

What are the 4 main goals of treatment of septic arthritis?

Eradicate infection Eliminate inflammation Minimize matrix loss Minimize cartilage damage

After sample has been acquired, what type of antibiotics are given to treat septic arthritis?

Broad-spectrum (PEN/GEN) AND local antibiotics

Needle, or through-and-through lavage, uses ________ gauge needles, which are placed in all compartments

14 – 16G

Needle, or through-and-through lavage requires sedation and local anesthesia. What drugs are used in the joint to accomplish this?

2% Mepivicaine or Carbocaine

Why is Amikacin (Aminoglycoside) used as a first line defense locally in the treatment of septic arthritis even though bacteria are only intermittently susceptible to it?

Putting Amikacin directly into the joint allows for a HIGH MIC

\_\_\_\_\_\_\_mg of **Amikacin** provides _______ hours concentration, which is greater than the MIC for most common pathogens

**_500 mg_** of Amikacin provides **_72 hours_** concentration, which is greater than the MIC for most common pathogens

This type of tourniquet is used to accomplish regional limb perfusion and is left on for 30 minutes

Esmarch tourniquet

This agent is used topically to help keep inflammation down during regional limb perfusion

SURPASS®

In cattle, this agent is used via regional limb perfusion in the treatment of septic arthritis

Florfenicol

In cattle, Florfenicol is used via regional limb perfusion because it is effective against these 2 bacterias responsible for causing septic arthritis

F. necrophorum, A. pyogenes

What is the general rule of thumb for dosage of antibiotics via regional limb perfusion?

1/3 of the systemic dose

A 25-27G ______ catheter is used to deliver antibiotics via regional limb perfusion

Butterfly catheter

This joint replacement fluid is the best adjunct therapy for treatment of septic arthritis because it is chondroprotective and not immunosuppressive while it replaces synovial fluid.

HA- Hyaluronic Acid

What medication is contraindicated in the treatment of septic arthritis?

STEROIDS (immunosuppressive!)

What agent is instilled into the joint after arthrocentesis in order to prevent septic arthritis?

Ceftiofur

Describe the pathogenesis of septic arthritis

Synovitis--\>Fibrin deposition--\> Cellular infiltrates (inflammatory mediators)--\> decreased HA synthesis + loss of PG--\> Joint effusion **Creates a cycle of cartilagenous matrix destruction**

What do you see on radiographs of E-Type Septic Arthritis?

Subchondral lysis

In a suspected case of septic arthritis, C&S was inconclusive. What do you do next if you still think it is, in fact, SA?

submit for FUNGAL culture and repeat culture if the initial sample is negative

This is an important complication of septic arthritis and can be the rate-limiting step

Contralateral limb laminitis

Which antibiotic can be given CRI to treat septic arthritis?

Beta-lactam abx

For regional limb perfusion: qs to _______ mL for DISTAL limb and qs to _______ mL if ABOVE carpus/tarsus

qs to **_30_** mL for DISTAL limb and qs to **_60_** mL if ABOVE carpus/tarsus

What analgesic agents are used to treat patients with septic arthritis due to it being excruciatingly painful

**NSAIDS** (Monitor for toxicity) **OPIATES** **LIDOCAINE/KETAMINE** (CRI) **OPIATES and DETOMIDINE** (Via Epidural Catheter for hindlimb SA) **OMEPRAZOLE *AND* SUCRALFATE** (GI Protectants to prevent ulcers)

Exam 2: Septic Arthritis/ Physitis Flashcards

(73 cards)