LAMINITIS. Kolegij: Bolesti i liječenje konja (faramakologija)
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1 LAMINITIS Kolegij: Bolesti i liječenje konja (faramakologija)
2 tri teorije o nastanku laminitisa na molekularnoj razini: 1.klasična upala,koja uključuje lokalnu infiltraciju bijelim krvnim stanicama. 2.ishemijsko-reperfuzijska ozljeda. 3.metabolički poremećaj koji vodi do oštećenja stanica i aktivacije proteolitičkih enzima
3 mehanizam nastanka: promjene u cirkulaciji distalnih dijelova ekstremiteta ishemija laminarnih arteriola i venula krv se preusmjerava u druge tokove čime se zaobilazi korijum zastoj krvi te kongestija i trombembolija kapilara nekroza tkiva. Bez obzira na to da li je početno oštećenje ishemija ili je pak to direktna ozljeda epitela il bazalne menbrane, lezije kod akutnog laminitisa su degeneracija i nekroza epitelnih stanica lamina, odvajanje epitelnih stanica od bazalne membrane, i gubitak bazalne membrane.
4 uzroci Alimentarni čimbenici i endotoksemija. - preobilje nestrukturalnih ugljikohidrata(nsc,šećeri, škrobili fruktani) neprobavljeni UH fermentiraju u cekumu, višak mliječne kiseline aciditet - endotoksini, egzotoksini krv, poremećena cirkulacija, osobito u nogama laminitis
5 Organska oboljenja Nakon težih Kolika Neliječene infekcije Vazoaktivni amini, histamin Zaostala posteljica Cushing sindrom
6 Mehaničko odvajanje (road founder), kombinacija nekorigiranih kopita i tvrde podloge. Nedovoljno kretanja smanjena cirkulacija
7 tijek Prema tijeku bolesti može biti akutni, subakutni i kronični. Obzirom na etiologiju laminitis je podjeljen na sistemski i mehanički sistemski laminitis bilateralan i to na prednjim nogama a rijeđe na stražnjimin Akutno ili kronično? Kronično stabilno ili nestabilno?
8 Sagittal section of a horse s foot with severe chronic laminitis. The distal phalanx has separated from its connection to the inner hoof wall and has descended into the hoof capsule causing the sole to bulge downward. Note the haemorrhage and bruising in the corium at the coronet and sole (arrows).
9 . Histology of the tip of a normal epidermal lamella (left) and one affected by acute laminitis of 48h duration (right). In the normal lamella the basement membrane (arrows) is firmly attached to the basal cells of the hoof epidermis. When laminitis intervenes the epidermal cells detach from their basement membrane allowing the hoof to separate from the distal phalanx and cause the clinical sign of foot pain (bar=25mm).
10 epidermal lamellar basement membrane (BM) has been immunolabelled using monoclonal antibodies specific for the basement membrane protein laminin (arrows). The top picture shows the basement membrane of normal secondary epidermal lamellae (SELs) and capillaries. The lamellae in the bottom picture are affected by acute laminitis. The BM has separated from the tips and is being lysed by matrix metalloproteinases at the bases of the SELs. Note the decrease in the number of capillaries between the SELs affected by laminitis (bar=100mm).
11 terapija Liječenje započinjemo konzervativnim metodama kao što su krioterapija, aplikacija NSPUL-a, korigiranje kopita i pravilno potkivanje te promjene u hranidbi konja U akutnim slučajevima se p/o aplicira mineralno ulje koje ima laksativno djelovanje i spriječava apsorpciju endotoksina iz želučano-crijevnog trakta. Lokalno se primjenjuju hladni oblozi ili se konja smjesti u bazen s ledom, apliciraju se antihistaminici i periferni vazodilatatori
12 NSPUL analgeziju i ublažavanje upalnih procesa. Najčešće se koristi phenylbutazone, flunixin i ketofen. Suxibuzon COX-2 specifični lijekovi ( firocoxib i diclofenac) koji spadaju u skupinu ne selektivnih NSPUL-a.
13 vazodilatatori Acepromazin kao vazodilatator uz manji sedacijski učinak nema znatnije djelovanje kao vazodilatator. Lokalno se vazodilatacija pokušava postići primjenom nitroglicerina no i to ne daje zadovoljavajuće rezultate. Phenoxybenzamine hydrochloride, blokator α- adrenoceptora izaziva vazodilataciju u trajanju od 24 sata. Zbog opasnosti da izazove centralnu depresiju ne primjenjuje se u konja u šok
14 Zbog poremećaja u cirkulaciji i tromboemboličnih promjena u krvnim žilama indicirano je primjeniti heparin kroz 3 dana u dozi od 40 U/kg
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