Final: Liver and Skin Flashcards
How is cutaneous Habronemiasis treated?
Corticosteroids
Ivermectin
NSAIDs (Banamine)
What diet is recommened in a horse recovering from hepatic encephalopathy?
Low protein, high carb
Avoid alfalfa
Give branch AAs - beet pulp
T/F: Equine sarcoids are benign tumors since they do not metastasize.
False- progressive and invade/destroy surrounding tissue
Where do summer sore lesions occur?
Stomach (gastric nodules)
Distal extremities (proud flesh)
Lips
Medial canthus of eye (Dracocytitis)
What are common causes of chronic liver disease in adult horses?
Chronic Active Hepatitis - cholangiohepatitis
Cholelithiasis
Pyrrolizidine Alkaloids/hepatotoxins
What are the 3 types of equine sarcoids? How do the lesions look?
Occult: circular area of alopecia
Verrucous: sessile or pedunculated
Noduar: invasive and destructive to adjacent tissue +/- nerve and lymphatic infiltration
What does BUN <10 indicate?
Liver dysfunction
Which liver enzme can represent an acute ongoing liver condition? Damage to what is this enzyme associated with?
a. AST/SGOT
b. SDH
c. GGT
d. ALP
b. SDH
Parenchymal damage
Note: While very specific, it is too sensitive because even mild trauma causes an increase
What is the histopathological traid of findings in a horse with pyrrolizidine alkaloid toxicity?
Fibrosis
Bile duct proliferation
Megalocytosis
_________ bilirubin is taken up in the hepatocytes by a cytosolic binding protein.
_________ bilirubin is passed into the intestine via the bile duct.
Unconjugated
Conjugated
What infection of the SQ tissues on the limbs causes reluctance to move and severe lameness, prominent limb edema, and possibly fever? It can occur following an injury, trauma or surgery. How is it diagnosed? What is an important rule-out?
Equine Staphylococcal Cellulitis
Usually an exclusion diagnosis
Rule out joint infections (BUT DONT TAP JOINT!)
What types of amino acids cross the BBB into the CNS? What increases as a result? What can be given to improve the neurologic state?
Aromatic amino acids
Inhibitory neurotransmitters, GABA, L-glutamate
Alterations in catecholamines and monoamine NTs also occur
What drug therapy is indicated for equine staphyloccal cellulitis?
Enrofloxacin or Oxytetracycline
NSAIDs
Which live enzyme is useful with chronic liver disease?
a. AST/SGOT
b. SDH
c. GGT
d. ALP
c. GGT
Not exclusive to the liver
What liver enzyme is helpful to monitor horses during outbreaks of IAHD?
GGT
What is the disorder that causes intra-epidermal acantholysis and intracellualr deposition of immunoglobulins in addition to painful lesions? What is the treatment?
Pemphigus foliaceus
Tx= Immunosuppressive therapy
How are aural plaques treated?
DO NOT RESOLVE SPONTANEOUSLY
Imiquimod (Aldaran 3M) ($$$$$$$$$$$$)
Cryosurgery (Carefully!!!! Probably only by a trained doc)
You obtain the following histopathological findings from a liver sample:
Infiltration of the portal areas with inflammatory cells
Necrosis and fibrosis in the portal areas
Gram negative enteric bacteria
Grossly the liver is firm, and pale brown- greenish
Is this more consistent with IAHD or Chronic Active Hepatitis?
Chronic Active Hepatitis
IAHD liver is a dishrag w/cell necrosis, accumulation of mononuclear and neurtrophils, and bile duct proliferation
What is the treatment protocol for ring worm?
Topical ketoconazole shampoo
Anti-inflammatory meds (topical (hydrocortizone) or systemic (Banamine))
Systemic griseofulvin (only if you really need it)
Disinfect the equiptment on the farm
Where do you find the liver when using US? Where do you take a US - guided biopsy?
Right side caudal to lungs, in 6-14th ICS
Very good modality
Biopst at 14th ICS at intersection of line drawn from tuber coxae to point of shoulder, direct needke toward diaphragm
Do coag panel first
What class of photosensitization is hepatogenous? What porphyrins is associated with this?
Type III
Phylloerythrin
What is Swamp Cancer and where do lesions occur? How do the lesions look?
Pythium insidiosum (Pythiosis)
Limbs, abdomen, neck, and lips
Dense granulation tissue with masses of yellow-gray necrotic tissue; can have calcifications as cores in fistulas (Kunkers)
Why are bile acids a good indicator for liver disease?
Levels increase with liver disease (especially acute), but are not affected by fasting or poor appetite
They increase within 24-48hours of disease onset
Normal serum BA can rule out significant liver disease
What is the most common cause of acute hepatitis and hepatic failure in horses? What viral disease does it present like? What has it been linked to? Who is at risk?
Idiopathic Acute Hepatic Disease/IAHD
Theiler’s Disease (TDAV)
Use of tetanus antitoxin (TAT) - but any equine serum product can induce it potentially
At risk= Broodmares 1-3 months post-partum
What is bromsuphalein dye used for?
To test liver excretory function
What form of bilirubin increases if the bile duct is blocked?
Both conjugated and unconjugated
What type of fluid do you expect when you do an abdominocentesis in a horse with liver disease?
Modified transudate (high protein, >3g/dl)
How long do you need to ice a horse’s legs to prevent laminitis?
48 hours
Name some plants that can cause Pyrrolizidine Alkaloid Toxicity
Senecio
Crotalaria
Heliotropium, Amsinckia, Echium, Cynoglossum, and Trichodesma
Foals born in which months are more likely to develop Tyzzer’s Disease?
March and April
What is the chemotherapy for SCCs? Where do they occur?
Intra-lesional cisplatin
Eyelids, third eyelids, penis, sheath
What form of liver disease causes cutaneous lesions such as moist exfoliative dermatitis and necrotic leathery skin at the coronary band and skin?
Chronic Active Hepatitis
May be the main sign indicating this disease until you get histo path results
What disorder caused by M.equinum and T.verrucosum causes alopecia in affected areas and circular lesions on the face and axillary reigion that then spread to the trunk?
Dermatophytosis (Ring worm)
What virus causes papillomas in horses? What are the treatment options?
BOVINE papilloma virus 1-10
Tx:
Crush, pinch off, or surgically remove warts
Cryosurgery
Autogenous vaccine
T/F: With rain rot, the lesions can be palpated before they can be seen.
True
What is the triad of clinical signs in adult horses with cholelithiasis?
Colic
Pyrexia
Icterus
What disorder affecting Quarter Horses (and related breeds) is caused by a mutation in procollagen I N-prontinease? What part of the body is affected and how does it present?
Hereditary equine regional asthenia (HERDA)
Skin on neck and back - easily torn or stretched, often develop sermonas or hematomas, heal with significant scarring
Cornea- ulcers
What horses get equine melanoma? Where on the body do lesions occur (name a few)?
Gray horses
Ventral tail, perineum, external genitalia, lip, udder, periocular
What clotting factors are produced in the liver?
I, II, V, VII, IX, X
(1, 2, 5, 7, 9, 10)
What organisms tend to be cultured in cases of cholelithiasis?
- Bacteriodes vulgtus*
- E.coli*
Why can hepatotoxity occur in foals being treated for neonatal isoerythrolysis?
Iron accumulation occurs in the liver due to repeated blood transfusions
How is cholelithiasis medically treated?
Broad-spectrum AMs
Fluids
Anti-inflammatories
DMSO
Dietary mgmt
You get this from an impression smear from a dorsal crusty skin lesion on a horse. What is your diagnosis? What is the treatment?
Dermatophilosis (rain rot)
Tx:
- Remove from wet envrionment
2. Carefully remove all crusts
- Wash with ionophores (rinse well or risk skin irritation) or lime sulfur
- Antimicrobial therapy (only if needed)
What subtle non-specific clinical signs are associated with hepatic encephalopathy?
Frequent yawning
Abnormal behavior
Apparent blindness (aimless wandering)
Foot stomping
Head pressing, circling, seizures
What is the agent that causes Tyzzer’s Disease? What horses are affected?
Clostridium piliformis
Foals 7-14 days old
What does pre-colostral iron fumarate injections cause in foals?
Hepatic failure
T/F: Vitamin K3 should be given to horses with liver disease.
False, NEVER K3 because it causes renal failure
Can give K1 though
What tumor, that is very common in horses, is locally agressive, non-regressing, and fibroblastic affecting the dermis and SQ?
Equine sarcoids
What oral medication can be used to treat equine melanomas?
Cimetidine (PO q16 weeks)
Should you biopsy a suspected sarcoid?
Yes
What is hepsidin?
Liver-produced hormone that regulates iron distribution in the body
Decreases absorption of iron from intestine and sequesters circulating iron in phagocytes (WBCs that engulf bacteria)
What is the best sample to send for culture when you suspect pythiosis? What is the main Ddx?
Kunkers
Habronemiasis/summer sores
What are the 3 major skin layer (from outer to inner)?
Epidermis (has glands)
Dermis (has fair follicles and sweat glands)
Subcutis
What is the best way to diagnose cholelithiasis? What part of the liver are most choleliths seen in?
Ultrasound
Most found in cranioventral part of right hepatic lobe
- Hepatomegaly and bile duct dilation*
- Hyperechoic liver*
- Hyperechoic stones casting acoustic shadows*
What does increased fibrinogen with liver disease indicate? What about low fibrinogen?
High= Inflammation (hepatitis)
Low= Liver failure
You submit a skin biopsy and it reveals multifocal areas of abnormally staining collagen surrounded by granulomatous inflammation containing eosinophils, lymphoctes and histocytes. What is your top ddx?
Eosinophilic granuloma
Can be caused by silicone-coated hypodermic needles (so use non-disposable needles for IM injections)
What can you give to treat abnormal behavior in horses with liver disease? What should you avoid?
Give xylazine
Avoid diazepam
Give glucose IV
Maybe give flumazenil (benzo antagonist)
What are the 3 conditions that must be present for dermatophilosis (rain rot) to occur?
Carrier animal
Moisture
Skin abrasion
What aspect of the animal is commonly affected when they get Dermatophilus congolensis?
Dorsal
(this is Rain Rot)
What horses develop Chronic Progressive Lymphedema? How does it present?
Draft horses
Starts early in life and progresses with swelling, hyperkeratosis, and fibrosis of the skin on the distal limbs (often ends in disfigurement and disability of the limb)
What drug can be given to prevent bridging fibrosis in the liver?
Colchine
What disease, common in California, causes single or multiple abscesses or nodules with draining tracts in the pectoral region?
Equine Corynebacterium Pseudotuberculosis /Pigeon Fever
