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Alimentary - Icterus and Hepatic Encephalopathy > Equine > Flashcards

Equine Flashcards

1
Q

What can cause haemolysis in horses?

A

Neonatal isoerythrolysis

Infections

Drugs

Toxins

Autoimmune HA - relatively rare in horses

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2
Q

What are the two common causes of hyperbilirubinaemia in horses?

A

Anorexia

Acute hepatocellular disease

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3
Q

What percent of normal horses will look mildly icteric?

A

10-15%

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4
Q

What is the most common cause of icterus in horses?

A

Anorexia

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5
Q

What three things should be eliminated before thinking liver disease with an icteric horse?

A

Not anorexic

Not a foal

Not pale

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6
Q

What are the six functions of the liver?

A

Protein metabolism

Carbohydrate metabolism

Lipid metabolism

Detoxification

Immune system

Bile excretion

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7
Q

Why is hepatic disease not always followed by hepatic failure?

A

Liver has capacity to regenerate

Various functions giving varied clinical signs

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8
Q

What are the six common signs of liver disease in horses?

A

Depression

Anorexia

Colic

Abnormal behaviour

Weight loss

Icterus

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9
Q

What are the six less common signs of liver disease in horses?

A

Photosensitization

Diarrhoea

Bilateral laryngeal paralysis

Haemorrhagic diathesis

Ascites

Dependent oedema

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10
Q

Describe how photosensitization occurs with horses and how the liver is involved

A

Phylloerythrin formed by bacteria in gut

Absorbed, conjugated and excreted by the liver

With liver dysfunction increased levels of phylloerythrin

Exposure to UV light causes cell membrane damage and necrosis

Lesions occur in areas of non-pigmented skin as UV light absorbed more efficiently

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11
Q

What four things can be used to diagnose liver disease?

A

Clinical signs

Blood work

Ultrasonography

Biopsy

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12
Q

What are the three liver specific tests that can diagnose liver disease?

A

Increased bile acids

Increased SDH

Increased GGT

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13
Q

What percent of the liver can be imaged with ultrasonography in horses?

A

20%

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14
Q

What things could be seen on an ultrasonography in the liver in horses?

A

Dilated bile ducts

Choleliths

Abscesses

Neoplasia

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15
Q

What three things can a hepatic biopsy provide information for?

A

Diagnosis

Prognosis

Treatment options

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16
Q

What are the general principles for treatment of liver disease in horses?

A

Primarily supportive

Maintain animal until liver regenerates

With severe fibrosis regeneration unlikely

Correct fluid deficits and acid-base imbalances

Provide intravenous glucose if horse anorectic

Antibiotics if suspect bacterial aetiology

Anti-inflammatories

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17
Q

What is the treatment for hepatic encephalopathy in horses?

A

Sedation

Mannitol/hypertonic saline: cerebral oedema

Oral lactulose: limit ammonia absorption

Oral BCAA

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18
Q

What dietary modifications should be provided to a horse with liver disease?

A

High carbohydrate with limited protein

Protein rich in branched chain amino acids

Need to provide sufficient protein to ensure malnutrition does not occur

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19
Q

What are some recommended diets for a horse with liver disease?

A

Beet pulp

Cracked corn

Molasses

Sorghum, bran or milo

Oat hay

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20
Q

What anti-inflammatories can be provided to a horse with liver disease?

A

NSAIDs - flunixin meglumine

DMSO (dimethyl sulfoxide)

Corticosteroids - dexamethasone/prednisolone

Pentoxifylline

21
Q

What is the main cause of pyrrolizidine alkaloid toxicity?

A

Ragwort poisoning

22
Q

Describe the pathogenesis of pyrrolizidine alkoloid toxicity

A

Pyrrolizidine alkaloids metabolized by liver to toxic pyrrole derivatives

Pyrroles are antimitotic

DNA becomes cross-linked

Pyrroles bind to nucleic acid and proteins within hepatocytes

Cells can’t divide leading to megalocyte production

Proceeds to death and fibrosis

23
Q

What are the clinical signs of PA toxicity?

A

Non-specific - diagnose upon biopsy with megalocytosis present

24
Q

What is the prognosis for PA toxicity in horses?

A

Poor

Typically death within 10 days of clinical signs of liver failure

  • Regeneration not possible if fibrosis present
25
Q

What are the five causes of acute hepatitis in horses?

A

Theiller’s disease

Tyzzer’s disease

Toxic

Viral - equine herpesvirus infection

Parasitic - Parascarus equorum

26
Q

What is the cause of Theiller’s disease in horses?

A

Unknown

27
Q

What occurs with Theiller’s disease?

A

Widespread hepatic necrosis

Small liver at post mortem

28
Q

What is the prognosis for Theiller’s disease?

A

Poor if severe hepatic encephalopathy

29
Q

What causes Tyzzer’s disease in horses?

A

Clostridium piliformis

30
Q

When is Tyzzer’s disease seen in horses?

A

Foals 7-42 days old

31
Q

What are the clinical signs of Tyzzer’s disease?

A

May be none

Non-specific

Loss of suckle, depression and recumbency

32
Q

Describe the treatment for Tyzzer’s disease

A

Antibiotics

Supportive therapy

33
Q

What is seen with Tyzzer’s disease?

A

Multifocal hepatitis

Enteritis

34
Q

What is the prognosis for Tyzzer’s disease?

A

Grave

35
Q

What three things would present that are strongly suggestive of cholelithiasis and cholangiohepatitis?

A

Fever

Icterus

Colic

36
Q

What are the three causes of stone formation in horses with icterus?

A

Parasites

Ascending biliary infection or inflammation

Biliary stasis

37
Q

How can cholelithiasis be diagnosed in the horse?

A

Liver enzyme activity

  • GGT
  • SDH
  • AST

Ultrasound

  • Dilated bile ducts
  • Cholelith

Biopsy

  • Histopathology
  • Culture
38
Q

What is the threatment for cholelithiasis in horses?

A

Antimicrobials

Supportive care

DMSO

Anti-inflammatories

39
Q

What is the prognosis for a horse with cholelithiasis?

A

Depends on:

  • Fibrosis
  • Number of choleliths
  • Extent of choleliths
  • Severity of clinical signs
40
Q

Which horses is hyperlipaemia seen in most commonly?

A

Shetlands

Miniature horses

Other pony breeds

41
Q

Which horses have an increased risk of hyperlipaemia?

A

Obese horses

42
Q

How does hyperlipaemia occur and what may cause it?

A

Negative energy balance leads to hyperlipaemia

Caused by:

  • Disease
  • Stress
  • Pregnancy
  • Lactation
43
Q

What are the clinical signs of hyperlipaemia?

A

Lethargy

Anorexia

Weakness

Icterus

Mild colic/diarrhoea

Recumbency

44
Q

How can hyperlipaemia be diagnosed?

A

Breed

History

Clinical signs

Measure Tg in serum

45
Q

How is hyperlipaemia treated in horses?

A

Reverse negative energy balance

  • Encourage to eat
  • Enteral nutrition
  • Parenteral nutrition

Treat hepatic disease

  • Supportive therapy

Eliminate stress

Treat concurrent disease

Inhibit further fat mobilization

  • Restore positive energy balance

Increase triglyceride uptake by peripheral tissues

  • Heparin as increases activity of lipoprotein lipase
46
Q

What is the prognosis for a horse with hyperlipaemia?

A

Poor once severe clinical signs become apparent

47
Q

How can hyperlipaemia be prevented in horses?

A

Monitor at-risk animals closely

Measure Tg levels in sick ponies

Ensure adequate nutrition

Prevent obesity

48
Q

How will fasting a horse for 24 hours affect bilirubin levels?

A

Increases levels

Alimentary - Icterus and Hepatic Encephalopathy (3 decks)

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