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what are examples of endocrinopathic laminitis?
- Cushings (Pars Pituitary Intermedia dysfunction)
- Equine metabolic syndrome
although not proven, what is likely the initiating factor to laminitis?
- inflammatory mediators
- (any process that decreases perfusion or decr. protein synthesis)
what are inflammatory mediators capable of activating that lead to swelling in the hoof compartment?
- excess metalloproteinases cause laminar attachments to break down even before onset of clinical signs
- (MMPs are normally present for remodeling and epidermal growth)
what is the primary inflammatory cell that extravasates from laminar capillaries in acute laminitis?
mainly neutrophils which cause oxidative damage w/in laminar interstitium
what are causes of endocrinopathic laminitis, which is more insidious onset than other forms?
- glucocorticoid excess,
- insulin resistance
- impaired glucose utilization
- inflammatory upregulation
what are some clinical signs of acute laminitis?
- bounding pulses, heat in hoof wall
- shifting wt/refusing to pick up feet or turn in tight circles
- rotation of P3/sinking of P3 felt as depression at coronary band
what should angle of p3 in relation to the ground be in health? greater than what angle is poor prognosis?
- 0-5 degrees in health
- >15 degrees = poor prognosis
what is Obel score for horse that moves willingly at walk but gait is stilted; foot lifted off ground without difficulty?
- grade 2
- (in grade 1, gait not stilted til the trot)
what is obel score for horse that moves reluctantly and vigorously resists attempts to have foot lifted?
grade 3 (most common grade from acute laminitis)
which nerve block would elicit improvement for acute laminitis case?
- *abaxial nerve block *
- (not the digital nerve block since this does not block the toe)
what are radiographic signs during acute laminitis?
may be normal rads or thickened/inflamed dorsal hoof wall as only indicator (want these for comparison later in later stages)
what projections do you want? where should markers be placed?
- latero-medial with hoof on block
- marker at coronary band, dorsal wall, apex of frog
what does it mean to see linear radiolucencies in dorsal hoof wall?
gas/air pockets or abscess formation where corium (hoof wall) has separated from lamina
what are primary means of prophylactic therapy?
cryotherapy and antiinflammatory treatment (NSAIDs/Lidocaine)
what dose of flunixin is given for purpose of scavenging endotoxin?
0.25mg/kg IV q 8hr
what are two other prophylactic therapies that mediate effects of endotoxin?
polymyxin B and DMSO
What do you need to know about shoes for acute laminitis patient? what about bedding?
- take shoes off!!!
- sand or peet moss so able to bury the toe
describe the changes seen grossly in chronic laminitis patient?
- flat or dropped sole
- wider white line
- uneven growth on hoof wall; irregular growth rings around hoof
how can you distinguish a flare up of chronic laminitis vs. acute laminitis?
flare up is usually only associated with one foot and is not often accompanied by anorexia/depression/tachycardia
what are common problems you have to deal with in chronic laminitis cases?
frequent abscesses, sole bruises, hoof crack/chip and pain
what type of shoeing is appropriate for chronic patients?
shorten the toe and elevate the heal to ease break over and remove stress on DDF (which pulls on P3)
what is important to note about nutrition when maintaining chronic laminitis patient?
low CHO/grain is imperative
do all acute cases that survive, develop into chronic cases?
what findings lead to guarded prognosis? when is it definitely time to humanely euthanize?
- rotation is guarded for return to exercise
- sinking is even worse (only 5-10% ever pasture sound)
- euthanize for sure if complete detachment of hoof capsule from dermal lamina