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75 Cards in this Set
- Front
- Back
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List 3 nonsurgical Diseases of the Spine discussed in Runyons lecture.
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Discospondylitis
Degenerative myelopathy Fibrocartilaginous emboli (FCE) |
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What is Discospondylitis and what regions of the spine are usually affected?
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Discospondylitis is an infection of the intervertebral disc and adjacent vertebral end plates and bodies. It affectes the cervicothoracic, thoracic, thoracolumbar and lumbosacral vertebral (ie...the whole damn thing)
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T/F Discospondylitis is usually seen in middle aged to older large breed dogs, and females are more commonly affected than males.
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FALSE-males more commonly than females
True = - middle aged to older dogs - large breed |
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What 4 types of bacteria are commonly associated with discospondylitis? Which one is most common?
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1-Staphylococcus sp = most common
2-E.coli 3-Streptococcus 4-Brucella canis (especially in male dogs with prostatitis |
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T/F With Discospondylitis, the infection usually originates in a non-vertebral location such as the urinary bladder, and spreads hematogenously
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True - less frequently dicso can be a postop sequelae to disc sx or is the result of FB migration (grass awns)
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A dog comes in who doesn't want to put his head down to drink, his owners tell you he's become anorexic and depressed. You do a physical exam and find he has a fever, and is painful over the spine in certain areas. The owners tell you his signs have been getting progressively worse. He also shows some mild lameness from time to time...what is the most likely diagnosis?
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Discospondylitis
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What diagnositic tests/procedures would you perform to determine if discospondylitis is present?
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-signalment, Hx, PE, neuro exam
-survey rads, myelography or bone scan - collapse of disc space on rads and moth eaten appearance of end plates -bacterial culture of urine, bone, and or blood -serology to dx Brucella canis in male dogs or females who were recently bred |
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How would you medically treat a patient with discospondylitis?
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Analgesics, strict rest/confinement, and long term abx treatment (4-12 weeks)
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If medical treatment of discospondylitis was unsuccessful and the patient was showing neurologic deterioration, what would you do next?
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Surgically decompress and curettage/stabilize the vertebrae depending on the amount of damage to the spinal cord. Also take a bone sample for culture and sensitivity testing.
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T/F Discospondylitis patients with spinal hyperpathia only or spinal hyperpathia and ambulatory paresis have an excellent prognosis?
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True
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T/F if your discospondylitis patient is not responding to medical treatment and the clinical signs are severe the prognosis is worse
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True
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What is degenerative myelopathy?
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degenerative myelopath is a neurologic disease of unknown etiology causing widespread demyelination of the long tract fibers beginning in the thoracolumbar spinal cord.
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Who does degenerative myelopathy affect?
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it affects adult large breed dogs especially German Shepherds
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T/F Males are more commonly affected by degenerative myelopathy than females?
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False - males and females are equally affected by degenerative myelopathy
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You are presented with Harry - a 9 year old male German Shepherd. He has hindlimb proprioceptive deficits, ataxia and weakness. On palpation there does not appear to be any back pain. His owner tells you that Harry seems to be scuffing his toenails as he walks, he also has difficulty rising up on his hind legs. What is the most likely dx, and what is one ddx
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This is most likely degenerative myelopathy and a differential dx = hip dysplasia.
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Early in the degenerative myelopathy dz the animal is _________(Hyper/hyporeflexive), as the dz progresses the animal may become ___________(hyper/Hyporeflexive)?
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initially hyperreflexive
Later Hyporeflexive |
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T/F With chonic discospondylitis a crossed extensor reflex may be present as well as urinary and fecal incontinence?
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True - deterioration to these stages can take months to years
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T/F Degenerative myelopathy is easily diagnosed by CT and myelography?
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FALSE!! Degenerative myelopathy is a dx of exclusion - need to rule out LS dz, hip dysplasia etc. The CT and myleography are NORMAL, MRI MAY demonstrate spinal cord lesions in later dz, and cerebrospinal fluid may be normal or have mildly elevated protein level.
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T/F In German Shepherds with disc protrusion and degenerative myelopathy, the disc protrusion should be surgically corrected
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False - treatment of disc protrusion in the face of degenerative myelopathy is not warranted
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What is the one medical treatment that has showed some promise in the treatment of degenerative myelopathy? what is the one huge downfall of this therapy?
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Aminocaproic acid (EACA, Amicar) slows the deterioration in some dogs, it is thought to decrease the enzymatic destruction at the cellular and subcellular level.
The downfall - it is really expensive (500-800$/month) |
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What is the prognosis for degenerative myelopathy?
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Poor
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How does a fibrocartilaginous emboli cause a neurologic disease?
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A focal embolism of intervertebral disc material in the spinal cord vasculature causes ischemic necrosis of a spinal cord segment (ischemic myelpathy)
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What age group and type of dogs are most commonly affected by FCE?
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Young adult (3-5 years) non-chondrodystrophied large breed dogs. Males = females
Also occasionally reported iin small breedsof dogs and cats |
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What 4 breeds of dogs are over-represented in the case of FCE?
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Labs, German Shepherds, Great Danes and St. Bernards
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Discuss the etiology of FCE.
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An Embolus/emboli originates from the nucleus pulposis, enters the vertebral venous sinus or ventral spinal artery and then passes into the small vessels supplying the spinal cord parenchyma producing ischemic necrotic myelopathy.
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An owner calls your clinic and says she was just out in the back yard playing with her dog, she herd the dog yelp, and suddenly the dog appeared lame - dragging one leg. You ask the owner if there seems to be any back pain, and she says there is not. What is the most likely dx?
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Fibrocartilaginous Emboli
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T/F diagnosing FCE is mainly a dx of exclusion, however if a myelogram is performed within the first 24 hours of injury spinal cord swelling may be apparent on the myelogram, CSF may also have elevated protein and xanthochromia (yellow appearance due to hemolyzed blood)
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True
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When will improvement of clinical signs caused by an FCE lesion generally occur?
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within the first 14days
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If there is deep pain present in a patient with an FCE lesion does the patient have a good or poor px?
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presence of deep pain is the best indicator for recovery = good px
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T/F with respect to an FCE lesion, if the motor fxn is intact, or if the lesion is UMN rather than LMN the prognosis is more favorable?
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True
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When should physiotherapy be performed on ambulatory dogs? Non-ambulatory dogs?
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On ambulatory dogs for 2 weeks after sx and on non-ambulatory dogs until they are ambulatory
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What are the 4 goals of physiotherapy in the management of a neurologic patient?
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1- minimize jt stiffness and muscle atrophy
2-prevent decubital ulcers (get them up and moving) 3-Encourage urination and defecation (bladder expression 4x/day, avoid indwelling catheters to decrease risk of UTI 4-to speed recovery |
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What are 3 types of physiotherapy or 3 things that can be done to help out a neuro dog.
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1. passive flexion and extension of affected limbs on animal that is weakly or non-ambulatory
2- hydrotherapy or whirlpool swimming to encourage limb movement and prevent decubital ulcers and help keep them clean 3- provide the animal with a sling or cart so they can eat/drink/void more normally, to encourage movement in animals with motor fxn, to facilitate physiotherapy (easier when they are standing) |
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List 3 types or slings/carts
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Walk-about
K-9cart Doggon wheels |
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What 5 nerves are related to the eye?
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Optic
Oculomotor Trochlear Trigeminal Abducens |
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Which of the following is not a blood vessel of the orbit?
Maxillary a/v ophthalamic a/v cephalic a/v ciliary a/v |
Cephalic
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What are the 4 things that make up the nasolacrimal system?
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1-upper and lower puncta
2-lacrimal lake 3-duct 4-nasal puncta |
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List the 4 foramen associated with the orbit.
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optic
orbital infraorbital sphenopalatine |
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What are the 3 glands associated with the orbit?
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dorsal lacrimal gland
gland of the 3rd eyelid zygomatic gland |
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Where are the meibomian glands located, what is their fxn?
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The are located on the palpebral margin of the upper/lower eyelid. They secrete meibum.
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Which muscle is responsible for the closure of the eyelids?
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orbicularis muscle
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Which muscle is responsible for opening the eye?
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levator palpebral superioris muscle
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What is the fxn of the eyelids? How does it attain this goal?
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protect the eye by distributing tear film and producing lipid and mucus layers of the tear film
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What is the fxn of the 3rd eyelid?
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to produce tears which protect the eye and are part of the local immune system
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What is the 3rd eyelid comprised of?
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The 3rd eyelid is formed by a central T-cartilage, it is covered by palpebral and bulbar conjunctiva. The lacriaml gland surrounds the cartilage and there are lymphoid nodules on the bulbar conjunctiva
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What 3 things make up the fibrous layer of the globe?
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Sclera (white)
Conjunctiva (pink) and Cornea (transparent) |
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What does the palpebral conjuctiva produce?
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The palpebral conjunctiva contains goblet cells for mucous prodn
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What are the 3 layers of the cornea?
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Epithelial layer
Stormal Layer Endothelial layer |
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Describe the Epithelial layer of the cornea.
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Is is comprised of transparent non-keratinized stratified squamous cells, wing cells and basal cells
It is lipophilic and therefore doesn't take up fluorescein stain it provides a mechanical barrier to fluids and organisms |
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What is the turnover time of the epithelial layer of the cornea?
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7 days
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Describe the stromal layer of the cornea.
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It is made of parallel collagen fiber bundles which are transparent.
It is hydrophilic (takes up fluorecein) it is the major component of the cornea (90%) there are no blood vessels in the stromal layer There is sensory innervation in the anterior stroma (CN V) |
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Describe the endothelial layer of the cornea (Decemet's membrane)
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It is a monolayer of endothelial cells that do not undergo mitosis
It has/is an active metabolic pump which serves to maintain the dehydrated state Bacteria cannot penetrate Decemet's membrane but fungus can |
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T/F Bacteria can penetrate Decements membrane?
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False...fungus can penetrate decemets membrane
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What is the common name for the vascular layer of the Globe? And what are its three componenets?
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Uvea - iris, ciliary body and choroid
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T/F the iris is the posterior uvea and has no epithelial coverage on the anterior margin?
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False- The Iris is the anterior uvea- with no epithelial coverage on the anterior margin
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Discuss the iris
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The iris has a double epithelial layer on the posterior margin, it has smooth dilator and sphincter muscles. It has a connection to the limbus which forms the iridocorneal angle
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What are the ciliary bodies? What do they do?
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The ciliary bodies are a continuation of the posterior iris epithelium, they are the site of aqueous humor formation and zonules attach to the ciliary body extremities
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What is the choroid? What is its fxn?
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Part of the vascular layer of the globe, it forms the posterior part of the uvea, it is covered by the tapetum in the dorsal region.
fxn- choriocapillaries supply blood to the retina |
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What is the common name for the neurosensory layer of the globe?
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the retina
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How many layers are in the retina?
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9 layers + the retinal pigment epithelial layer (RPE)
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What are the two types of photoreceptors in the retina?
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Rods (black/white)
Cones (Color) |
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What are the ganglion cells of the retina?
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They are cells bodiies to the axons of the optic nerve
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What are the 2 chambers of the eye?
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Anterior (aqueous humour)
and vitreal (vitreal humor) |
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Which has a faster turn around, aqueous humor or vitreous?
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Aqueeous - 24hrs
vitreous - weeks |
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Discuss aqueous humor.
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Aqueous humor is a water consistency, clear, made by non-pigmented ciliary body epithelium. The Aqueous molecules are born in the posterior chamber and filter through the pupil to exit at the iridocorneal angle.
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Discuss Vitreous humor
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Vitreous is similar to eggwhite consistency. It is attached to the posterior lens capsule and retina.
Vitreous is formed by retinal cells |
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How is the lens attached/held in position?
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Zonules
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T/F The lens grows throughout life?
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True
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When does nuclear sclerosis of the lens occur?
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after 7 years of age
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Which of the following is not true?
1-the anterior capsule of the lens contains lens epithelial cells that proliferate at the equator 2-well aligned lens fibers are transparent 3-lens fibers are all equal length and attach at the suture line 4- the lens does not grow after 1 year of age |
4 is not true - the lens grows continually through life
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In the development of the globe at which stage are congenital malformations most likely to occur?
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When the optic fissure edges fuse to enclose the hyaloid vessels in the optic cup and stalk
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In what aspect of lens development are congenital malformations likely to arise?
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When the posterior cuboidal cells elongate and become the primary lens fibers which then occlude the lens vesicle (embryonic nucleus)
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in what aspect of retinal development is a congenital malformation likely to arise?
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The embryonic space between the posterior layer (retinal pigment epithelium) and the inner layer (neurosensory retina) is called the subretinal space - this space/lack of attachment predisposes animals to retinal detachment
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In what aspect of the ciliary body and iris formation is a congenital malformation likely to occur?
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When the pupil forms after central degeneration of the mesectodermal sheet
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What are 3 common congenital anomalies related to embryology?
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Coloboma (absence of tissue or hole)
Persistent pupillary membranes (failure of degeneration of the iris leads to iridal strands) cataracts (opacity in the embryonic nucleus -remains stable for the life of the animal) |
