Surgery > joint fluid > Flashcards

joint fluid Flashcards

(39 cards)

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1
Q

role of synovial fluid

A
  1. Lubricate joints
  2. Shock absorption
  3. Nutrient absorption + waste removal
  4. Barrier against cell entry/fluid exit
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2
Q

ddx for increased soft tissue opacity in the joint space

A

degen, inflam, infectious, traumatic, neoplasia

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3
Q

necessary equipment for arthrocentesis

A
  • 21G needle, 40mm
  • 5ml syringe (dogs)/2ml (cats)
  • EDTA blood tube
  • Blood culture tube
  • Slides
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4
Q

technique of carpus arthrocentesis

A
  1. Flexed 90degrees
  2. Depression at radiocarpal jt
  3. Needle medial to cephalic vein, btwn CDE (lateral) + ECR (medial)
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5
Q

technique of talocrural joint arthrocentesis

A
  1. No flexion
  2. Needle medial to lateral malleolus at dorsomedial aspect of joint
  3. Direct needle plantar + medial
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6
Q

technique of stifle jt arthrocentesis

A
  1. Slight flexion + external rotation
  2. Needle lateral to patella lig, midway btwn patella + tibial tuberosity
  3. Direct needle 45degrees to skin + parallel to patella tendon + lateral to patella
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7
Q

normal gross appearance of joint fluid

A
  1. Volume: <0.5ml (distal joints)
  2. Viscosity: strand test - 2.5cm stretch
  3. Colour: colourless
  4. Turbidity: clear
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8
Q

gross appearance of infectious OR inflammatory joint fluid

A
  1. Volume: increased/normal
  2. Viscosity: reduces
  3. Colour: yellow, serosanguinous
  4. Turbidity: increased
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9
Q

preparation of joint fluid samples

A
  1. Slides for cytology - air dry + diff quik
  2. EDTA tube 0.1ml
  3. Blood culture tube 0.5ml
    • aerobic media = blood
  • *anaerobic media = transport
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10
Q

info gained from cytology

A

bacteria in 50% of septic arthritis cases
RBCs
neuts

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11
Q

normal TP of synovial fluid

A

<2.5g/dL

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12
Q

cell count characteristics of infectious/inflammatory synovial fluid

A

neut heavy

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13
Q

percentage of false negatives w/ joint culture

A

20-50% of cases thus neg. culture is not definitive

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14
Q

pathogens assoc. w/ septic arthritis in a dog

A

Strep. intermedius, beta-haemolytic strep

Staph. aureus

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15
Q

pathogens assoc. w/ septic arthritis in a cat

A

Bacteroides (fights)

Pasteurella multocida

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16
Q

Tx of septic arthritis

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A

initial IV ABs, + ongoing PO 1month

ie. amoxiclav

17
Q

when is sx intervention indicated in septic arthritis

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A
  1. Gross contamination (FB/implant)

2. No response to medical management

18
Q

resolution of septic arthritis is confirmed by….

Study These Flashcards
A

repeat synovial analysis consistent w/ OA fluid

<3% neuts

19
Q

prognosis of septic arthritis

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A

resolves in 95% of cases

note: ongoing OA management indicated

20
Q

synovial structures in the distal forelimb of a horse

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A
  1. Coffin jt + navicular bursa
  2. Pastern jt
  3. Fetlock jt

+ assoc. DFT sheath

21
Q

synovial structures in the carpus of a horse

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A
  1. Carpometacarpal jt + carpal sheath
  2. Middle carpal jt + CDE + LDE tendon sheath
  3. Radiocarpal + ECR tendon sheath
22
Q

synovial structures in the shoulder of a horse

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A

bicipital bursa + glenohumeral jt

23
Q

signalment of neonatal synovial sepsis in foals

Study These Flashcards
A

<30d, failure of passive transfer –> haematogenous spread from other source
ie. pneumonia, umbilical infection, gastroenteritis

24
Q

organisms commonly involved in foal synovial sepsis

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A

Enterobacteriaceae
Salmonella
Satphylococcus

25
pathogen assoc. w/ iatrogenic synovial sepsis in adult horse
Staph. aureus
26
pathogens assoc. w/ synovial sepsis in adult horse
enterobacteriaeceae, clostridium, staph.aureus
27
ddx for adult horse synovial sepsis
subsolar abscess, fractures, severe cellulitis
28
method of synoviocentesis for horses
US guided is best | - if diff. to collect inject 5-10ml saline + aspirate --> cytology is still relevant
29
what test can you use to test communication of joints/wounds?
pressure testing (injecting saline at pressure - watching exit wounds for fluid)
30
what neut and protein parameters indicate synovial sepsis of a horse?
>90% >40g/L protein *must interpret in light of case
31
aims of treatment of equine synovial sepsis
1. Eliminate causative organisms 2. Remove inflammatory mediators 3. Maintain normal joint function
32
components of treatment of equine synovial sepsis
1. ABs: systemic and local 2. Lavage of synovial cavity: arthroscopic or needle 3. Analgesia and anti-inflams 4. Chondroprotective therapy 5. Physiotherapy
33
routes of local antibiotics to tx equine synovial sepsis
- intra-synovial | - regional perfusion: IV or intraosseous
34
examples of intra-synovial ABs to tx equine synovial sepsis
- 250mg ceftiofur - 250-500mg amikacin - 150mg gentamicin
35
describe admin of intra-synovial ABs in tx of equine synovial sepsis
direct injection of ABs into synovial cavity q24h 3-5days
36
describe admin of intravenous regional perfusion ABs in tx of equine synovial sepsis
1. Sedate 2. Tourniquet proximal to affected synovial structure 3. 20G butterfly cath into SF vein; saphenous, cephalic, palmar digital 4. Inject 10ml lignocaine or mepivacaine first 5. Infuse over 5 min 6. Remove tourniquet after 20-30minutes 7. Rpt q24-36h after 3-5tx
37
describe frequency of lavage to tx equine synovial sepsis
1. Initial arthroscopic lavage preferred | 2. 3-5 subsequent lavages may be required --> rps if lameness increases, synovial fluid cytology deteriorates
38
appropriate NSAIDs to tx equine synovial sepsis
Bute 2.2mg/kg BID | OR flunixin, meloxicam, firocoxib
39
prognosis of equine synovial sepsis
1. Success can be up to 80% if early aggressive therapy and arthroscopy 2. Prognosis reduced if: - bone involvement - failure to remove fibrin at lavage that can harbor bacteria - recrudescence of infection following discontinuation of tx - resistant organisms - chronic change in the jt causing persistent lameness 3. Tx can be expensive and protracted --> unresponsive infection/tx failure can necessitate euthanasia on humane grounds
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