Equine Liver Disease and Hyperlipaemia

Question 1

What are 3 signs of liver disease in the horse?

Answer 1

1. Jaundice
2. Photosensitisation
3. CNS signs (head pressing)

Question 2

What is photosensitisation caused by?

What must you differentiate it from?

Answer 2

Phyloerythrin accumulation

Differentiate from primary cause (St John’s Wort) or pruritus

Question 3

Which liver enzyme is liver specific?

Which enzyme is also from muscle (use CK to differentiate)?

Answer 3

GGT: Liver specific, Indicates biliary tree and hepatocellular disease
AST:
Also from muscle
Indicates hepatocellular disease

Question 4

On which side do you take a liver biopsy?

Answer 4

Right side (left is close to the heart)

Question 5

How are liver biopsies assessed?

What is a poor prognosis?

Answer 5

Scored from 0-14

>6 is a poor prognosis

Question 6

What does ragwort toxicity cause?

What respiratory dysfunction does it cause

Answer 6

Pyrrolizidine alkaloid toxicity
Anti-mitotic (but cells increase in size) and alkylates DNA
Dyspnoea due to laryngeal paralysis

Question 7

What is Cholangiohepatitis and Cholelithiasis?
What would you see on ultrasound?
What is the treatment?

Answer 7

Ascending bile duct infection from GIT
Bacteria deconjugate bilirubin
Choleliths
Long-term antibiotics (penicillin, metranidazole, gentamycin)

Question 8

What is the treatment for Chronic Active Hepatitis?

Answer 8

Often immune mediated, corticosteroids

Question 9

What is the pathogenesis of hyperlipaemia?

Answer 9

Negative energy balance
Breakdown of stored fat into fatty acids
Overwhelms liver capacity (to convert to energy)
Accumulates as triglycerides in liver and plasma
TGs can cause liver failure and azotaemia

Question 10

How do you differentiate between hyperlipaemia and hyperlipidaemia?

Answer 10

Triglycerides in serum
TG’s > 5 mmol/l = hyperlipaemia
– TG’s < 5 (but > 1.5) = hyperlipidaemia

Question 11

What is the treatment and prognosis for hyperlipaemia?

Answer 11

Insulin therapy? Care with hypoglycaemia and risk of laminitis, not if insulin already high
Poor/guarded prognosis
(worse if female, poor response to treatment, or failure to eat)

Question 12

What are the 3 differential diagnosis for hyperbilirubinaemia?

Answer 12

1. Anorexia (e.g. innapetance) if <120umol/l
2. Hepatocellular disease
3. Haemolysis

Question 13

What is the normal WBC for peritoneal fluid analysis?

Answer 13

5x10^9/L

Question 14

What two signs would you see in Cholangiohepatitis?

Answer 14

1. Elevated GGT

2. Neutrophilic inflammation

Question 15

What is the cause and treatment of Chronic Active Hepatitis?

Answer 15

Immune mediated

Corticosteroids

Question 16

What supplement can be given to help treat liver disease?

Answer 16

Vitamin E (antioxidant)

Question 17

What biochemistry abnormalities may you see with Cholangiohepatitis?

Answer 17

Increased GGT

Neutrophilic elevation