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ag animal medicine final
from the objectives for the final
41
Veterinary Medicine
Professional
04/30/2010

Additional Veterinary Medicine Flashcards

 


 

Cards

Term
Describe both clinical signs and physical findings that you might expect when presented with an anemic ruminant.
Definition

a.    Clinical signs: weakness, depression, lethargy, dementia, exercise intolerance, pallor, tachycardia, tachypnea
b.    Physical findings: pallor, icterus, abnormal urine, fever, systolic murmur (hemic murmur), blood loss (internal or external), associated hypoproteinemia

Term
Recognize several examples of conditions that could represent both acute and chronic blood loss in ruminants
Definition

a.    Acute: rapid loss internally/externally (expistaxis, large vessel, rupture of internal organ, clotting defect, gastric ulcer
b.    Chronic: loss over time (parasitism, GI ulceration, other site of chronic hemorrhage-bladder)

Term
Be familiar with the geographic distribution of each of the common infectious causes of hemolytic anemia seen in ruminants
Definition

a.    Anaplasmosis: worldwide, enzootic in coastal and intermountain western US
b.    Babesiosis: eradicated from North America in ruminants
c.    Eperythrozoonosis (Mycoplasma): worldwide, but considered minor dz unless in immunocompromised animal
d.    Leptospirosis: I think it’s everywhere. Zoonotic
e.    Bacillary hemoglobinuria: sporadic in western US   predominantly in irrigated areas

Term
What is the age distribution commonly seen in association with clinical anaplasmosis in cattle?
Definition
Clinical dz in cattle >3yrs. Younger can be infected carriers with no signs
Term
Why should anaplasmosis be considered a DfDx for shipping fever pneumonia in an endemic area or in cattle originating from an endemic area?
Definition
Stressed carrier cattle can develop clinical signs with stress.
Term
Review the pathophysiology related to anaplasmosis that we presented in pathology lectures
Definition
Incubation 2-5 wks, 1% parasitemia → signs when 35-50% ↓ in RBCs, no hemoglobinuria
Term

What is the current significance of Babesia infections in cattle in the United States ?

To third world countries?

Definition

It has been eradicated in the United States.

I imagine that it is still a big problem in third world countries, but don’t think he said
c.    Key point is that still causes hemoglobinuria (red water) b/c is intravascular hemolysis
d.    Obligate intracellular protozoan transmitted by ticks, incubation 2-3 wks, diagnose by history and area, reg. anemia, parasites in rbc, serology, treat with imidocarb, diminazene, phenamidine, and tick control

 

Term
Be familiar with those species and under what circumstances that the Haemoplasmas are associated with clinical disease.
Definition

a.    Eperythrozoonosis, with some name changes to Mycoplasma and Haemoplasma
b.    Mycoplasma haemolamae is a common disease of camelids found throughout the country, anemia associated with immunosuppression. JLIDS (Juvenile llama immunodeficiency syndrome) used to be a predisposing problem to this, but don’t see JLIDS much anymore
c.    Generally a minor disease and signs usually in stressed and immunosuppressed animals, once infected are life-long carriers.
d.    Rare clinical disease in cattle: fever, stiff gait, ↓ milk yield, diarrhea, l.n. enlargement, scrotal and hind leg edema
e.    Yellow lamb disease in sheep, rare, sudden death with hemoglobinuria and icterus
f.    Treat with oxytetracyclines

Term
Leptospirosis is important zoonotic infection that can cause hemolytic anemia from serovars L. pomona and L. icterohemorrhagica
Definition

a.    See hemolytic crisis in young animals and sometimes adults, hemoglobinuria and hemoglobinemia are key signs
b.    Treat with oxytetracycline and supportive care, prevent with vaccination and hygiene

Term
Be familiar with the circumstances of occurrence of Bacillary Hemoglobinuria in cattle
Definition

a.    One of the Redwater diseases
b.    acute, fatal Clostridial diseases, see liver infarct, toxemia, and intravascular hemolysis and hemoglobinuria
c.    Caused by Clostridium hemolyticum snails and liver fluke can carry it, but not necessary part of life cycle, spores survive in alkaline soils.
d.    See sudden death usually after latent spores in the liver are activated and proliferate and produce exotoxin. If don’t die, look bad clinically and die w/in 3-4 days
e.    On necropsy the ischemic liver infarct is a key sign with rapid rigor, bloat, and autolysis, subq edema and hemorrhages, icterus, bloody fluid in cavities, abomasitis and enteritis and hemoglobinuria
f.    Diagnose based on area (western US- MT, NV, WA, ID, OR in irrigated areas), history, clinical signs and necropsy
g.    R/O postparturient hemoglobinuria, Heinz body anemia, Brassica, onions, chronic Cu toxicity, hematuria or myoglobinuria and Anthrax (sudden death)
h.    Usually dead, but can try to treat with penicillin/tetracyclines and supportive care if catch before die. Prevent with vaccination and destroy affected carcasses.

Term
Be familiar with the underlying mechanism where in Brassica species as well as members of the Allium (onion) family of plants are associated with hemolytic anemias
Definition

a.    Brassica: Usually get hemolytic disease within 1 week of introduction, cattle more susceptible
i.    Toxins induce oxidative damage to RBC leading to extravascular removal, can have intravascular hemolysis if concurrent with Pi, Se, or Cu deficiency
ii.    Heinz bodies formed from S-methyl cystine sulfoxide – dimethyl disulfide
b.    Allium: Toxins are N-propyl disulfide and s-methyl cystine sulfoxide → Heinz bodies and usually extravascular removal, so no red urine

Term
Review the common mechanisms associated with copper toxicity and hemolytic anemia in ruminants (sheep and pre-ruminant calves)
Definition

a.    Usually come from rations or supplements high in copper → accumulation in liver with and acute event, liver damage may enhance storage
b.    Acute or chronic copper toxicity leads to hemoglobinuria from hemolytic anemia
c.    In pre-ruminant calves they don’t chew their cud → don’t produce as much saliva which normally will bind the Copper

Term
Geographically, where in the PNW would one find the highest incidence of hypophosphatemia and associated diseases?
Definition
The Great Basin area
Term
Be familiar with mechanisms where in iron and copper deficiency can lead to anemia
Definition

a.    Iron deficiency: Associated with chronic blood loss due to parasitism or all milk diets and no dirt, ↓ Fe → ↓ hemoglobin production
i.    Dx by ↓ PCV, normal TP, ↓ iron stores in tissue biopsy, ↑ serum iron-binding capacity, ↓ serum iron, microcytic hemolytic anemia
ii.    Tx with oral iron or parenteral iron
b.    Copper deficiency: Cu needed for iron transport, so ↓ Cu → ↓ Fe transported → ↓ hemoglobin production, looks similar to iron deficiency, also may get abnormal bone and growth plates, abnormal myelin formation, ↑ risk for infectious dz b/c immune system affected, diarrhea, ill thrift and hypotrichosis
i.    Dx by ↓ PCV, ↓ Cu levels, microcytic to normal hypochromic anemia
ii.    Tx with mineral supplements, oral copper oxide needles, copper injections

Term
List several examples of drugs that can adversely affect bone marrow function
Definition
NSAIDs –phenylbutazone, estrogens, Bracken fern, Chloramphenicol
Term
Understand the etiologies and clinical forms of lymphosarcoma that are seen in ruminants
Definition

a.    Four occur spontaneously (non-viral associated and T cell related)
i.    Calfhood form (either B or T cell related)
1.    Birth to 2, symmetrical lymphoid lesions, ill-thrift, anemia, leukemia, liver, kidney, spleen involvement
ii.    Thymic form (pretty common in goats)
1.    6 months to 2, beef > dairy, mass near thoracic inlet, dyspnea, dysphagia, anemia and lymphadenopathy uncommon
iii.    Cutaneous and Multicentric

1.    1 to 3 yrs, multiple skin nodules with hair loss, regress and re-appear, eventual multicentric to other lymphoid tissues and/or thymus, debilitation comes with multicentric expansion
b.    Enzootic bovine lymphosarcoma (doesn’t happen in other spp. readily)
i.    Retroviral associated, B-cell type tumors usually
ii.    Spread by blood, colostrum/milk, palpation sleeves, needles, insects, body fluids, in utero
iii.    Most common form of LSA, infection > dz, >2 yrs old
iv.    Signs: symmetrical or nonsymmetrical lymphadenopathy, weight loss, ↓ milk, exopthalmia, posterior paralysis, cardiac failure, melena, uterine involvement
v.    1° sites are in lymph nodes or lymphoid tissues
vi.    Metastasis to heart, abomasum, intestine, uterus, or spinal canal
vii.    One of common clin path signs is a persistent lymphocytosis
c.    Dx by BLV history in herd, clinical signs, biopsy, virology, serology
d.    Don’t usually treat (most infected animals are euthanized), control by identifying and isolating or removing infected animals, insect control, and colostrum management

Term
Define BLAD’s
Definition

a.    Bovine Leukocyte Adhesion Deficiency
b.    Autosomal trait of Holsteins where affected calves lack surface glycoproteins that inhibit adhesion and so the neutrophils don’t have chemotactic factors and thus more and more neutrophils are made to compensate → profound neutrophilia (>40,000/mcL)
c.    Most animals get bacterial infections and premature death
d.    Can be traced to single male ancestor and is starting to be bred out of herds
e.    Dx by recurrent infection, marked neutrophilia and DNA-PCR test

Term
Review the routine urinalysis, the parameters commonly assessed and general interpretations
Definition
a.    Pigmenturias
i.    Hematuria: if at beginning of urination→ urethra, or reproductive tract, if at end → bladder, if throughout → kidney, ureters
ii.    Hemoglobinuria: (deep red to black urine) plasma reflects hemolytic state, throughout urination (Lots of causes: acute lepto, bacillary hemoglobinuria, babesiosis, Cu toxicity, onion, rape, turnips, postparturient hemoglobinuria, isoerythrolysis, drugs given as bolus, tetracyclines, DMSO, Heinz body anemias, phenothiazine, Red maple leaves)
iii.    Myoglobinuria: (red/brown urine) plasma is clear (clostridial dz, myopathies, plant toxicosis, Cassia spp.
iv.    Bilirubinuria: (dark brown urine), only conjugated bilirubin is excreted (1° hepatic dz, cholestatic dz, intravascular hemolytic crisis)
v.    Tx by maintaining perfusion and alkalinize the urine
b.    Pyuria:  rule in or out sepsis, examine repro tract 1st and then urinary system
i.    UA >5-8 WBC/HPF suggests UTI
ii.    If culture >105 organisms on voided sample indicative of UTI and any on cystocentesis
c.    Anuria: pre-renal- dehydration, ↓ perfusion, renal- acute tubular nephrosis, end stage renal dz, post-renal – urethral obstruction
d.    Oliguria: dehydration and ARF and CRF
e.    Polyuria: ↑ water intake, diuretics, fluids, young animals(all liquid diet), nephrosis, diabetes insipidus
f.    Crystalluria: Calcium carbonate and triple phosphate crystals are normal in herbivores (possible risk for urolithiasis)
g.    Glycosuria: (renal threshold is >180 mg/dL) DM (rare), clostridial dz, severe stress, often with ketonuria
h.    Ketonuria: neg. energy balance, 1+ is normal in early lactation in dairy cows
i.    Proteinuria: false positives on dipsticks in alkaline urine, normally see in neonates in first 48 hrs
j.    Normal UA:
i.    Specific gravity: >1.022 is normal
ii.    Protein: neg. to 1+
iii.    Glucose, ketones, blood: neg.
iv.    pH: 7.0 to 8.5
v.    WBC: 0-3/HPF
vi.    RBC: 0-5/HPF
vii.    Casts: none, crystals: rare,
viii.    Culture should be neg. with catheter
k.    Should also do a rectal examination of kidneys and bladder and neurologic exam
l.    Other exams include rads, US, scintigraphy, biopsy and endoscopic exams
Term

Understand the common presenting issues regarding cystitis in ruminants including:

gender issues: 
 time of occurrence:
 predisposing factors:
etiologic agents:
Signs:

Definition

gender issues: female>males
b.    time of occurrence: Not common in ruminants and camelids,
c.    predisposing factors: usually 2° to urine stasis or bladder injury
d.    etiologic agents:
i.    trauma with ascending bacteria and ↓ urine flow
ii.    E. coli most common bacteria isolated (others are Strep., Proteus, Pseudomonas, Klebsiella, Enterobacter, Corynebacterium)
iii.    Corynebacterium renale (bovis) is the cause of infectious contagious cystitis and pyelonephritis
iv.    Also associated with urolithiasis, bladder paralysis, dystocia, reproductive sepsis, catheterization, patent urachus
e.    Signs: pollakiuria, stranguria, abnormal urine (hematuria or purulent), urine scalding/dribbling, fever early on, abnormal bladder on rectal exam, abnormal cystoscopic findings (females)
f.    CBC: sepsis; Chem: BUN, Cr usually normal; UA: protein, pyuria, hematuria, other cells and debris; urine culture and sensitivity: basis of tx
g.    DfDx: urolithiasis, urinary incontinence, Pyelonephritis, neoplasia, bladder prolapsed, renal failure, urethritis, etc.
h.    Tx predisposing problems/conditions, hydration and urine flow, Abx based on C/S (7-14 days min.), urinary acidification, acute prognosis> chronic, relapses common

Term
Provide a brief DfDx for bladder paralysis in ruminants
Definition

a.    Injury to cauda equine or 2° to obstructive urolithiasis
b.    Signs: incontinence,, dribbling/overflow, bladder full on rectal, ataxia or tail paralysis, 2° cystitis
c.    Treat cystitis and underlying causes, trauma has best prognosis

Term
Under what circumstances is Pyelonephritis a risk to occur in ruminants
Definition
a.    Most common in female cattle, most are ascending infections
b.    Corynebacterium renale (bovis) is transmitted from carrier cows, E. coli comes from environment
c.    Will see Hardware dz-like signs, thickened bladder, palpable ureters, enlarged kidneys
d.    In general prognosis is poor
e.    Tx with prolonged abx after culture and sensitivity, or could do nephrectomy for unilateral
Term
What are the major risk factors that predispose ruminants (cattle, sheep, goats) and camelids to urolithiasis?
Definition

a.    Most common obstruction site is the sigmoid flexure, also in small ruminants have the urethral process, where uroliths can get stuck
b.    Urolith formation risk factors: water deprivation, high salt intake, hot arid climates high Pi from grain, high Mg intake, young animal, pelleted rations, silicates in feed, estrogenic and oxalate containing plants (alfalfa)
c.    Obstruction facilitated by an early castration, urine stasis, and nidus formation
d.    Not usually seen in renal pelvis or ureters, but will have Hardware-like signs
e.    Signs from urethral obstruction are colic like signs, frequent stretching to urinate, but can’t, dribbling urine, maybe blood tinged, pain in sigmoid area, dry prepuce or crystal on hair, rectal prolapsed could some from straining
f.    On CBC/Chem see systemic Hyponatremia, hypochloremia and normal or ↓ K
g.     
h.    Prevent by:
i.    Manage pasture or hay type
ii.    Put females on the more dangerous pasture types (will still get stones, but w/o as many complications
iii.    Put 2-3% NaCl, NH4CL, NH2SO4 in ration, Ca:P 1.2:1, salt available (helps with Mg problems), delay castration, adequate water at all times
iv.    High risk for reoccurrence
v.    Smoother the stone the better the prognosis

Term
Describe the nutritional risk factors associated with each type or chemical composition or urolith seen in ruminants
Definition

a.    Silicate: on dry pasture (semi-arid) in fall or on grass hay → “Jack stones”
b.    Struvite: (Mg ammonium Phosphate, triphosphate, calcium phosphates) get from high concentrate diets with high Mg → sand-like stones (lots of them)
c.    Calcium carbonate: clover pastures or legumes → smooth, pearl-like stones
d.    Calcium oxalate: oxalate containing plants → rough and irregular stones (rare in ruminants, but most common type in people)

Term
What are the common sites of individual urolith obstruction in the urethra of common domestic ruminants?
Definition
a.    Sigmoid flexure or urethral process
b.    Dorsal surface of the bladder is the most likely site for rupture
Term
    What is meant by the term “water belly”?
Definition
Hydrouroperitoneum usually from urethral or bladder rupture, or can get subcutaneous accumulation of urine that must be drained
Term
    How would you differentiate uroperitoneum from simple ascites?
Definition
Check the fluid creatinine versus the serum creatinine, if high is urine
Term
What are the general causes of renal failure in ruminants?
Definition
a.    Toxicity: oxalate containing plants, acorns, oxytetracycline, aminoglycosides, ethylene glycol
b.    hemodynamic (ischemia): ↓ renal blood flow, hypovolemia, abdominal distention
c.    obstruction: urethral or bladder
Term
Signs of Amyloidosis
Definition
see a 4+ proteinuria (know it’s a glomerular dz); presents with history of chronic infectious dz, bottle jaw
Term
How will you differentiate between pre-renal and renal azotemia in the ruminant?
Definition

a.    BUN > 200 mg/dl and Creatinine > 5-6 mg/dl may be seen in prerenal
b.    If azotemia with low specific gravity (<1.022) tentatively diagnose as renal
c.    Casts are frequently found with acute tubular disease
d.    Ruminants are more commonly in metabolic acidosis when in renal failure b/c of sequestration of HCl within the abomasum from GI atony
e.    ↓ K (anorexia, salivary losses), ↓ Ca (anorexia), ↑ P (b/c of lack of loss in the GI tract from anorexia, main losses of P is from the salivary glands), ↑ Mg (↓ FE of Mg in renal dz, most Mg lost through the kidneys), ↓ Na (lost in kidneys), ↓ Cl (sequestered in abomasum in anorexia and GI atony)
f.    ↑ fibrinogen not related to inflammation, but from azotemia activating the intrinsic coag pathway
g.    Bleeding disorders; be aware of these before renal biopsy

Term
Describe how the salivary glands in ruminants could be considered “secondary kidneys”
Definition
They are responsive to ADH and can recycle urea because of the bacteria in the mouth that can split urea → oral ammonia smell
Term
Most common reasons dairy cows are culled
Definition
lameness, mastitis and ↓ reproduction
Term
what % of musculoskeletal dz is in the foot?
Definition
90%
Term
Osteomyelitis and Joint infections clinically look similar- what do they look like?
Definition

i.    Local invasion or hematogenous
ii.    Signs depend on site, duration and extent of damage
iii.    Infection est. from trauma (local invasion) or hematogenous
iv.    Infection in joint is probably in the synovial membrane, so can do synovial biopsy to diagnose
v.    Prognosis is guarded to poor

Term
Osteodystrophy and osteoarthropathy- what do they look like?
Definition

i.    Defective or abnormal bone/joint formation in both young and old
ii.    See angular limb deformities, enlargement of or pain over growth plates, lameness, DJD, pathologic fractures, systemic findings
iii.    Etiology: nutritional- Ca, Mg, and Vit. D deficiencies (Rickets), Cu def., ↑ or↓ Vit A, chronic parasitism, spondylitis in breeding bulls, chemicals, congenital or inherited, environment, unknown

Term
Clostridial myonecrosis and the specific etiologic agents associated with these varied diseases
Definition

i.    A group of acute diseases affecting primarily skeletal muscle caused by various species of clostridial organisms
ii.    Common clinical signs: young, prospering animals at risk, rapid course, often find dead, severe depression, high fever, tachypnea and anorexia, lameness in 1+ limbs, any muscle group, vulva, tongue, diaphragm, recent injection sites, one site/animal!!, initially skin hot and painful then cool and insensitive, possible crepitus, ~100% mortality
iii.    Blackleg: Cl. chauvoei animals <2 and taken in by mouth, sudden death
iv.    Malignant edema: Cl. septicum  deep wound associated or traumatized sites in repro tract or udder, “Braxy” is form that affects the abomasum
v.    Black neck: Cl. sordelli feedlots usually from wound or oral, black hemorrhage and muscle necrosis at base of neck and brisket
vi.    Black disease: Cl. novyi rare in cow/calf, more common in feedlot
vii.    Exposure common, disease is far less common, spores can remain quiet in tissues for long period of time
viii.    Horses have best prognosis, but grave for all spp. (treat with penicillin or tetracycline or metronidazole)
ix.    Prevent by proper disposal of carcasses and vaccinate ruminants with 2 doses initially and an annual booster while pregnant to ↑ colostral immunity

Term
Issues of recumbency – i.e. Downer syndromes- explain causes, stages, and history associated with them
Definition

i.    Group of syndromes in animals causing inability to rise (1°ly in rear end)
ii.    Hypocalcemia is most common cause of initial recumbency in dairy cattle
iii.    Dystocia is most important cause of recumbency in beef cattle
iv.    Any condition or event that causes prolonged recumbency will cause downer animals
v.    More common in females than males
vi.    Irreversible events may occur w/in as little as 6 hours of recumbency
vii.    Stage 1: Initial event that caused animal to be recumbent (can be BAR or dull and depressed)
viii.    Stage 2: Common to all recumbent ruminants, weight leads to ischemia and pressure damage to muscles and nerves
ix.    Stage 3: Further injuries or even death from struggling (fractures, dislocations, muscle ruptures)
x.    History is very important for Dx, take blood samples before treatment to check Ca, Mg, P
xi.    Splayed legs is very bad sign and the longer recumbent the poorer the prognosis
xii.    Need to check every 2 hours and provide physical therapy or support, long, time intensive process to recovery, make sure owner is aware of this

Term
Nutritional muscular dystrophy – i.e. White muscle disease- signs, age, causes, and treament
Definition
i.    Myodegeneration due to dietary deficiency of selenium and/or vit. E
ii.    Occurs most often in rapidly growing animals (2-4 month calves and 1-2 wk lambs)
iii.    Kind of like total body Charlie horse, feel hard, corded muscles
iv.    Cardiac form: sudden onset, often found dead, acute resp distress, pulmonary edema w/ pink foam, weakness, irregular HB, murmur, etc.
v.    Skeletal form: exercise associated, slower onset, stiff gait, in supporting muscles of trunk, dyspnea, lesions are symmetrical
vi.    Selenium and Vit. E both act as detoxifiers
vii.    Selenium deficient in acidic or volcanic soils, with high sulfur fertilization, and legumes are poor uptakers of selenium, dam is source for newborn
viii.    Signs are unthrifty animals with poor performance and retained placentas in adult cows
ix.    Treat with supportive care and rest, prevent 2° infections and provide Vit. E (it is active as given, if give selenium takes ~3 wks before it is active and useful)
x.    Prevent by providing supplemental vit. E and Selenium where needed, should have 3 ppm in total ration, 90-120 ppm in salt mixture
Term
Lameness is the 3rd most frequent primary health reason for culling dairy cattle and >90% of lameness seen in cattle is in one or more feet- how does it effect productivity, how to diagnose, and treat
Definition
i.    Lameness ↑ days open, ↓ milk production, 2° dz (like mastitis), ↓ body weight, ↓ pregnancy rates, ↓ longevity in herd
ii.    Observe the cow walking, check all feet, wash the feet before trimming, using proper equipment, examine all parts of the foot (interdigital space, bulbs of heel and skin adjacent to the claws), check with pressure tool, can use local anesthesia during examination, schedule lame cows for recheck
iii.    Most of pressure when walking is on the outside of the feet and medial claw bears more weight on the front limbs and the lateral claw on the fore limbs
Can do locomotion scoring: 1 is normal, 5 is severely lame (arched posture in both standing and walking), score on flat, even surfaces, best to do after milking; target is to have 65% of the herd with a score of 1 and only 5% with a score of 4
iv.    Provide a comfortable stall long enough to lay in, but not too long so they defecate in the stall, need enough lunge space to facilitate getting up
v.    Watch for vesicular diseases 
Term
Classify and differentiate diseases of the claw where in underlying laminitic changes in the foot are a prime issue and where in  infectious agents are the inciting cause
Definition

i.    Laminitis associated
1.    White line hemorrhages
2.    Under running of the heel
3.    White line abscesses
4.    Sole hemorrhage
5.    Double sole
6.    Sole ulcer
7.    Toe ulcer
ii.    Infectious
1.    Interdigital dermatitis
2.    Heel horn erosion
3.    Digital dermatitis
4.    Toe abscess
5.    Foot rot
6.    Warts
7.    Corns

Term

Recognize the importance of subclinical laminitis and issues involving the rumen, such as SARA, in the origin of the laminitic basis
Definition
i.    Subclinical laminitis is the most common form of laminitis in the modern dairy operations and probably beef cattle also
ii.    SARA = repeated bouts of depressed rumen pH between 5.2 and 5.6 → ↓ feed intake, loose feces, ↓ milk production, liver abscesses, rumenitis, lameness/laminitis
1.    After rumen is disturbed → neutrophil activation and get arachadonic cascade that ↑ thromboxane → horn circulatory disturbances and sensitive laminae damage leading to poor horn quality → sites of damage and hemorrhage
2.    Key point: ridges, grooves, and concavity of the outer hoof wall are other indicators of laminitis and claw bone alterations that occurred previously Claws normally grow ¼ inch/month
3.    Key point: Outside, rear claw is most frequently ‘diseased’ claw in subsequent processes (maybe because further from heart and more likely to have hypoxia problems and cows pivot on the rear outside claw when turning
d.    Specific claw diseases related to the above will be presented and the student will learn to recognize and provide basic diagnostics and therapeutics for each
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