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Laminitis in equines
Part 2:(Main Line of Treatment of Laminitis)
‫ا‬
.
‫د‬
‫عطية‬ ‫حامد‬
‫الحيوان‬ ‫طب‬ ‫استاذ‬
–
‫البيطرى‬ ‫الطب‬ ‫كلية‬
‫الزقازيق‬ ‫جامعة‬
-
‫مصر‬
‫الخبربالرياض‬ ‫اوميجا‬ ‫بمؤسسة‬ ‫الفنى‬ ‫المستشار‬
‫البيطرية‬ ‫لألدوية‬
‫الخيول‬ ‫فى‬ ‫الحمرة‬ ‫عالج‬
‫الحافر‬ ‫حمى‬ ‫تشخيص‬ ‫فى‬ ‫تساعد‬ ‫مهمة‬ ‫نقاط‬

‫يالحظ‬
‫على‬
‫الحيوان‬
‫المصاب‬
‫العرج‬
‫والذي‬
‫يزداد‬
‫أثناء‬
‫تدوير‬
‫الحي‬
‫وان‬
.

‫يحمل‬
‫على‬
‫القوائم‬
‫الخلفية‬
‫عبر‬
‫مد‬
‫القوائم‬
‫األمامية‬
‫لألمام‬
‫وأرجاع‬
‫الجسم‬
‫للخلف‬
.

‫النبض‬
‫الزائد‬
‫للشريان‬
‫اإلصبعي‬
‫في‬
‫القوائم‬
‫األمامية‬

‫وزيادة‬
‫عرض‬
‫الخط‬
‫االبيض‬
‫للحافر‬
.

‫اختبار‬
‫األلم‬
‫إيجابي‬
‫باستخدام‬
‫كماشة‬
‫الحافر‬
‫عند‬
‫الضغط‬
‫على‬
‫م‬
‫قدمة‬
‫الحافر‬
(
‫مهم‬
‫للتشخيص‬
‫التفريقي‬
‫عن‬
‫خراج‬
‫الحافر‬
)
.
Line of treatment
Line of treatment
Acute
Laminitis
Chronic
Laminites
Rotating Sinking
Main Line of treatment
‫العالج‬ ‫من‬ ‫الهدف‬
Eliminate of the cause.
Eliminate the clinical signs.
Relief the pain.
Improve the blood circulation in the
foot.
Aim of treatment
‫العالج‬ ‫من‬ ‫الهدف‬
Provide support for the foot.
Promote healing.
Prevent complications.
Prevent recurrence.
Main Line of Treatment
1- Medical
2- Supportive
1- Medical treatment
Remove the cause
NSAIDs for their anti-inflammatory and
analgesic effects
Vasodilators (acepromazine or
glyceryl trinitrate)
Frog supports (usually with a deep
bedding)
•
‫النقاط‬
‫األساسية‬
‫للعالج‬
:
•
1
-
‫ازالة‬
‫المسبب‬
‫الرئيسى‬
•
2
-
‫ازالة‬
‫االلم‬
•
3
-
‫تحسين‬
‫الدورة‬
‫الدموية‬
‫للقدم‬
•
4
-
‫عمل‬
‫دعامة‬
‫لتثبيت‬
‫الحافر‬
•
5
-
‫اعادة‬
‫توزيع‬
‫الوزن‬
‫على‬
‫الحافر‬
•
5
-
‫تقليم‬
‫الحافر‬
‫وعمل‬
‫جراحة‬
‫عند‬
‫اللزوم‬
•
1
-
‫ازالة‬
‫المسبب‬
‫الرئيسى‬
:
•
‫ايقاف‬
‫العليقة‬
‫والغذاء‬
‫على‬
‫البرسيم‬
‫أو‬
‫الرودس‬
.
•
‫اعطاء‬
‫زيت‬
‫برافين‬
‫فى‬
‫حاالت‬
‫المغص‬
‫الناتج‬
‫من‬
‫لكمة‬
‫االمعاء‬
• Administration of 4 liters of mineral oil four
times /day may be beneficial in the case of
laminitis developing from grain overload.
•
‫عالج‬
‫التوكسيميا‬
‫عن‬
‫طريق‬
‫عالج‬
‫المسبب‬
(
‫التهاب‬
‫رحمى‬
-
‫تنفسى‬
-
‫مغص‬
-
‫اسهال‬
–
‫أمراض‬
‫الكبد‬
)
.
• Fluid and electrolytes, antibiotics and NSAIDs are
• administered as required.
• Horses with septic metritis/retained placenta also require
uterine lavage.
•
‫عالج‬
‫مشكلة‬
‫التمثيل‬
‫الغذائى‬
‫واالضطراب‬
‫الهرمونى‬
.
2-Cryotherapy
2
-
‫والحافر‬ ‫القدم‬ ‫على‬ ‫بارد‬ ‫ماء‬ ‫كمادات‬
Cold therapy, with cold water,
 or ice boots
to reduce the heat and
inflammation within the foot.
•
3
-
‫ازالة‬
‫األلم‬
• ‫استرودى‬ ‫غير‬ ‫التهاب‬ ‫مضاد‬ ‫اعطاء‬
• R/Phenyl butazon
• And or
• R/flunixin meglumine
• Phenylbutazone and flunixin meglumine at the
lower dose rate can be used concurrently; the
former to control severe foot pain and the
latter to control the effects of endotoxaemia
• Acetaminophen(Paracetamol)
• which offers some analgesic benefit and is
reasonably cost-effective and appears to be
safe to use in horses
•
‫ممكن‬
‫نكمل‬
‫به‬
‫بعد‬
5
‫ايام‬
‫من‬
‫العالج‬
‫باليوتافنيل‬
.
Acute Laminitis
‫الحاد‬ ‫االلتهاب‬ ‫حالة‬ ‫فى‬
• Gabapentin is effective against neuropathic
pain in people and is now commonly used in
horses with acute and chronic laminitis.
• ‫االعصاب‬ ‫التهاب‬ ‫واالم‬ ‫الصرع‬ ‫حاالت‬ ‫عالج‬ ‫فى‬ ‫يستخدم‬ ‫بشرى‬ ‫دواء‬
Chronic Laminitis
‫المزمن‬ ‫االلتهاب‬ ‫حالة‬ ‫فى‬
2-dimethyl sulfoxide DMSO
‫لأللم‬ ‫مسكن‬
(
‫موضعى‬
–
‫وريدى‬ ‫حقن‬
)
In horses, DMSO is applied as a topical
gel or administered in liquid form
intravenously or through a nasogastric
tube.
It is classified as a nonsteroidal anti-
inflammatory drug (NSAID) because it has
antioxidant properties
dimethyl sulfoxide DMSO
Dose:
20-100 mg/Kg Bw. I/V.
•
4
-
‫تحسين‬
‫الدورة‬
‫الدموية‬
:
• Vasodilators:
• R/acepromazine
• or
• R/ glyceryl trinitrate)
5
-
‫الحافر‬ ‫تثبيت‬
Hoof boot
•
‫غلى‬
‫بيتادين‬
‫مع‬
‫كمية‬
‫من‬
‫السكر‬
‫على‬
‫نار‬
‫هادية‬
‫مع‬
‫التقليب‬
‫حتى‬
‫يتكون‬
‫اللون‬
‫االصفر‬
.
•
‫دهان‬
‫منطقة‬
‫الحافر‬
‫من‬
‫االسفل‬
•
‫تغطية‬
‫بحفاظة‬
‫أطفال‬
•
‫تثبيت‬
‫قطعة‬
‫من‬
‫الفلين‬
‫بشري‬
‫ط‬
‫الصق‬
‫حول‬
‫الحافر‬
.
‫الحافر‬ ‫لتثبيت‬ ‫اخرى‬ ‫طريقة‬
3-Wooden clogs:
Made from plywood
can help horses
recover after bouts
of acute laminitis,
Chronic Laminitis
Radiographic and venographic examination of
the feet should be performed as soon as
clinical
signs of laminitis appear and during the
course of treatment.
Radiograph
‫االشعة‬ ‫طريق‬ ‫عن‬ ‫يتم‬ ‫الطبية‬ ‫الحدوة‬ ‫تركيب‬
Normal
Distance: 17 mm
Chronic
Distance: 20 mm
‫التحديات‬
‫التى‬
‫يواجهها‬
‫الطبيب‬
‫أثناء‬
‫عالج‬
‫حالة‬
‫حمرة‬
‫فى‬
‫حصان‬
1
-
‫هل‬
‫سيقوم‬
‫صاحب‬
‫الحالة‬
‫باستكمال‬
‫العالج‬
‫الذى‬
‫وضعه‬
‫الطبيب‬
‫؟‬
Main line of Treatment of chronic Laminitis
1- 1-Therapeutic Shoeing
2-placing affected horses in sand or shavings
3-placing soft foam pads on their soles.
4-Corrective trimming/shoeing
1-Therapeutic Shoeing
1-Mechanical support of the distal phalanx:
Significant mechanical support of an unstable
distal phalanx can be achieved by the
application of a frog/sole support device.
Therapeutic Shoeing
1-Foam sole support
Foam blocks, 50-60mm thick, cut to the size of
the foot, supply relief to foundered horses when
taped in place over the sole.
2-Heart-bar support shoe
Supports the damaged lamellae and loads the
palmar structures of the foot to shift the weight
bearing function back from the toe.
‫باألش‬ ‫باالستعانة‬ ‫الطبية‬ ‫الحدوة‬ ‫تركيب‬ ‫طريقة‬ ‫يوضح‬ ‫فيديو‬
‫عة‬
3- HOOF WALL RESECTION
After the resection, the area
was treated with a betadine-
sugar solution to help keep the
tissues clean and dry.

‫السكر‬ ‫مع‬ ‫بيتادين‬ ‫استخدام‬
maggot therapy
‫المزمنة‬ ‫االتهابات‬ ‫الحاالت‬ ‫فى‬ ‫باليرقات‬ ‫العالج‬
MDT to control infection or
debride wounds, which
could not easily be reached
surgically or were not
responding to conventional
therapy
‫الحالة‬ ‫تحسن‬ ‫وبعد‬ ‫العالج‬ ‫فترة‬ ‫أثناء‬ ‫التغذية‬

‫أثناء‬
‫فترة‬
‫العالج‬
‫اليعطى‬
‫الحصان‬
‫مركزات‬
‫ويعطى‬
‫فقط‬
‫برسيم‬
‫او‬
‫رودس‬
.

‫الماء‬
‫والرودس‬
‫يعطى‬
‫للحصان‬
‫على‬
‫االرض‬
‫اذا‬
‫كان‬
‫الحصان‬
‫اليستطيع‬
‫الو‬
‫قوفز‬

‫عليقة‬
‫التزيد‬
‫نسبة‬
‫البروتين‬
‫عن‬
10
%
‫ونسبة‬
‫األلياف‬
14
%
‫بعد‬
‫الشفاء‬
‫من‬
‫الحمرة‬
.

‫زيادة‬
‫نسبة‬
‫الحديد‬
‫تؤثر‬
‫على‬
‫االوعية‬
‫الدموية‬
‫الطرفية‬
‫والكبد‬

‫زيادة‬
‫كرات‬
‫البيضاء‬
(
‫الخاليا‬
‫المناعية‬
)
‫البد‬
‫من‬
‫اعطاء‬
‫مضاد‬
‫حيوى‬

‫اليعطى‬
‫اي‬
‫نوع‬
‫من‬
‫الكورتيزونات‬
‫النه‬
‫يساعد‬
‫على‬
‫زيادة‬
‫سرعة‬
‫انفصال‬
‫الصفائح‬
2- Supportive Treatment
‫الحالة‬ ‫تحسن‬ ‫وبعد‬ ‫العالج‬ ‫فترة‬ ‫أثناء‬ ‫التغذية‬
‫اعطاء‬
‫فيتامين‬
‫ج‬
‫النه‬
‫يقوى‬
‫من‬
‫جدار‬
‫االوعية‬
‫الدموية‬
.
‫اعطاء‬
‫ميثايونين‬
‫يحافظ‬
‫على‬
‫جدار‬
‫الحافر‬
.
‫الحنة‬
‫نوع‬
‫من‬
‫األعشاب‬
‫تستخدم‬
‫فى‬
‫التهاب‬
‫األوتار‬
.
‫فى‬
‫حالة‬
‫التهاب‬
‫الحمرة‬
‫فى‬
‫االرجل‬
‫االمامية‬
‫يفضل‬
‫عمل‬
‫كمادات‬
‫باء‬
‫بارد‬
‫على‬
‫الحافر‬
‫فى‬
‫األرجل‬
‫الخلفية‬
‫كوقاية‬
.
‫للمحاليل‬ ‫بالنسبة‬ ‫مالحظات‬

‫فى‬
‫حالة‬
‫اعطاء‬
‫محاليل‬
‫اليجب‬
‫االكتفاء‬
‫بمحلول‬
‫ملحى‬
9
.
%
‫لن‬
‫يسبب‬
‫زيادة‬
‫البول‬
‫وزيادة‬
‫خروج‬
‫البوتاسيوم‬
‫عن‬
‫طريق‬
‫الكلية‬
‫ويجب‬
‫اعط‬
‫اء‬
‫محاليل‬
‫تحتوى‬
‫على‬
‫بوتاسيوم‬
.
‫المربين‬ ‫فيها‬ ‫يقع‬ ‫أخطاء‬
(
‫وضع‬
‫الحدوة‬
‫المقلوبة‬
)
:

‫يؤدى‬
‫الى‬
‫زيادة‬
‫االلتهاب‬
‫وخرج‬
‫الدم‬
‫والصديد‬
‫بعد‬
‫فترة‬
‫من‬
‫منطقة‬
‫ال‬
cornet

‫يجب‬
‫تحديد‬
‫زاوية‬
‫الحافر‬
‫بعمل‬
‫اشعة‬
‫كل‬
‫شهر‬
‫وب‬
‫ناء‬
‫عليه‬
‫نعرف‬
‫مدى‬
‫تحسن‬
‫الحالة‬
‫من‬
‫عدمه‬
.
Euthanasia
‫الرحيم‬ ‫القتل‬
Indications:
Case study
Intestinal impaction in pregnant mare
‫عشار‬ ‫مهرة‬ ‫فى‬ ‫االمعاء‬ ‫فى‬ ‫لكمة‬ ‫حالة‬
‫مهره‬
‫عشار‬
‫فى‬
‫األشهر‬
‫االخيرة‬
‫اكلت‬
‫كمية‬
‫زائدة‬
‫من‬
‫المركزات‬
‫تعانى‬
‫من‬
‫مغص‬
‫وعدم‬
‫االخراج‬
‫تم‬
‫عمل‬
‫تحليل‬
‫دم‬
‫ووظائف‬
‫كبد‬
‫وكلى‬
‫العالج‬ ‫قبل‬ ‫كلى‬ ‫ووظائف‬ ‫دم‬ ‫صورة‬ ‫تحليل‬
‫العالج‬
‫محاليل‬
10
‫ليتر‬
‫يوميا‬
(
5
‫ليتر‬
‫صباحا‬
‫و‬
5
‫ليتر‬
‫مساء‬
)
‫لمدة‬
‫اسبوع‬
‫مضاد‬
‫التهاب‬
‫غير‬
‫استرودى‬
‫زيت‬
‫برافين‬
4
‫ليتر‬
‫عن‬
‫طريق‬
‫انبوب‬
‫اللى‬
‫المعدى‬
‫العالج‬ ‫بعد‬ ‫كلى‬ ‫ووظائف‬ ‫دم‬ ‫صورة‬ ‫تحليل‬
‫العالج‬ ‫بعد‬ ‫الحالة‬ ‫تطورات‬
‫تحسن‬
‫الحالة‬
‫من‬
‫المغص‬
‫اخراج‬
‫طبيعى‬
‫ظهور‬
‫أعراض‬
‫حمرة‬
‫الحمرة‬ ‫عالج‬
‫مضاد‬
‫التهاب‬
‫غير‬
‫استرودى‬
(
‫فينايل‬
‫بيوتازون‬
)
‫عمل‬
‫فصد‬
‫للمهرة‬
(
‫اخراج‬
‫دم‬
‫من‬
‫اوردة‬
‫القدم‬
‫االمامية‬
‫عمل‬
‫كمادات‬
‫ماء‬
‫بارد‬
‫تحسن‬
‫الحالة‬
‫بعد‬
3
‫ايام‬
‫من‬
‫العالج‬
‫المهبل‬ ‫فتحة‬ ‫من‬ ‫شفاف‬ ‫مخاط‬ ‫نزول‬
‫عمل‬
‫سونار‬
‫واالطمئنان‬
‫على‬
‫الجنين‬
‫الجنين‬
‫يتحرك‬
‫وبصحة‬
‫جيدة‬
Main line of treatment of laminitis prof Dr Hamed Atttia
Main line of treatment of laminitis prof Dr Hamed Atttia

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