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Your horse’s liver is similar to our own, which means that it is needed to process the blood by filtering out the toxins before being recycled back into the body. It also stores vitamins and triglycerides. Horses do not have a gall bladder, though, so they do not have an extra supply of bile. Even though this disease is uncommon in horses, you should suspect that your horse has cholangiohepatitis if you see signs of jaundice, colic, or abnormal behavior.
Cholangiohepatitis is described as the inflammation of the liver and bile system which can result in liver failure and death without treatment. This disease can affect any horse of any age, sex, or breed. However, it is relatively uncommon in horses and not very well understood, although it often follows a bacterial infection, metabolic condition, neoplasia, toxins, parasites, intestinal obstruction, duodenitis, or cholelithiasis.
In many cases, jaundice is the first sign of cholangiohepatitis, but sometimes there are no signs until the disease has progressed into liver failure. Here are some of the most often reported signs of cholangiohepatitis:
There are several types of cholangiohepatitis, which include:
Bacterial infection (Acinetobacter spp., Aeromonas spp., Actinobacillus spp., Citrobacter spp., E. coli, Klebsiella spp., Salmonella spp.)
In order to make a diagnosis of cholangiohepatitis, the veterinarian will require your horse’s medical history and a description of recent changes in appetite or behavior. Diagnostic testing, such as peritoneal fluid samples and a bacterial and fungal culture may be useful as the veterinarian considers your horse’s condition. Laboratory tests, including glucose and insulin amounts, vitamin B1 levels, blood urea nitrogen, and chemistry panel may be suggested. A complete blood count, total bile acid, bilirubin assessment, and analysis of markers such as γ-glutamyl transpeptidase or transferase, aspartate transaminase, and sorbitol dehydrogenase can be helpful as an indication of liver function.
Let your veterinarian know if you have given your horse any kind of medication, even if it is over the counter drugs. A physical examination will include assessing your horse from a distance and watching for behavior, attitude, posture, and conformation. Additionally, breath sounds, reflexes, blood pressure, heart rate, mucous membrane color and capillary refill time will be assessed. The veterinarian will palpate and auscultate each vital area individually. If further testing is required or warranted as a method to rule out other conditions that may present in a similar manner, the veterinarian may do imaging tests such as an ultrasound, x-ray, CT scan, MRI, or liver biopsy.
Treatment of cholangiohepatitis depends on the cause, which has to be treated first. Some of the treatment choices include antibiotics, antifungals, surgery, and supportive therapy.
Finding the right medication includes a culture and sensitivity test. Antibiotics such as penicillin, ampicillin, gentamicin, or metronidazole are given for infections. Trimethoprim-sulfa, aminoglycoside, pentoxifylline, enrofloxacin and steroids may be prescribed for hepatitis, intravenous fluids for supportive therapy, and antifungals or antimicrobials for other types of infection. In some cases, pentoxifylline and colchicine are given to prevent fibrosis and scar tissue of the liver.
If your horse has a blocked biliary duct, surgery to clear the duct is done. This procedure is usually done with laparoscopic surgery when possible, and is very successful and has very few risks.
The veterinarian will likely put your pet on a low protein and high glucose diet. This will help reduce ammonia buildup, which tends to happen when the liver is affected in horses.
If your horse was in good health before cholangiohepatitis, the prognosis is promising. However, this will depend on whether fibrosis is present and what the extent of it is. Proper nutrition and consistent monitoring of your horse will be necessary to prevent chronic liver failure and other complications. Proper feeding for horses with liver disease includes lower dietary protein; this is important to keep the amount of ammonia in the body from becoming too high.
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My daughter's mare had no obvious signs of illness. No jaundice or fever. Around May 5 she looked like she lost a tiny bit of weight and her footing was just barely off. (Her right foot stumbled a few times, but nothing major.) We hadn't changed anything, no new feed, or types of hay. Almost 2 weeks passed, she lost a bit more weight. Contacted a vet, no worrying comments from them. We wormed her. We'd been getting a lot of rain, so thought maybe we needed to put her in a paddock and control her feed. The change was drastic. She lost more weight, seemed off. This was within a literal 3 week period. Made an appointment for the vet to come out on a Monday. Friday night before that Monday appointment, we came home and she was stumbling. Pacing, leaning on our Gelding, and walking funny. Called the emergency vet. He was horrible at communicating. Seriously. He said she probably had EPM, and drew some blood. He really wanted to put her down right then, despite this all happening so fast. I asked if he could give her fluids or something to make her comfortable until the test results came back.... he said nothing could be done. Bull. That night was awful. We tried to get her to eat and drink, she had no interest. But, then we tried a watery bran mash, and she started showing interest. By Sunday she was eating and drinking on her own. However, she would urinate every single time she ate. The emergency vet was supposed to come back on Sunday to put her down and actually stood us up. Didn't even call, which at the time was good, since she was starting to show she was trying. Monday came, the regular vet came out and she thought EPM as well. However, they wanted to get her in to the clinic to start fluids, antibiotics, and do a sonogram. Our mare went to the clinic, did incredibly well, and had the sonogram. Also received results to the initial blood work. She had an enlarged liver and cholangiohepatitis. The toxins were causing her to pace, not act like herself, and the pressure of her enlarged liver on her bladder, was causing the strange urination. The vet still suspected EPM as well, but wanted to treat the cholangiohepatitis first. Around 6-7 days later we got the other tests back showing a low titer of EPM antibodies. Our mare came back home, eating, drinking and showing improvement. Then, on Tuesday night this last week, something happened. (We actually had her scheduled to go back to the vet to start treatment for EPM and a different antibiotic for Thursday morning.) Well, the vet thinks her liver must have released a massive amount of toxins. As a result, she went wacky again. We have no clue how she did this, but she pushed through an interior fence, then somehow got out to a neighboring ranch, without damaging any other fences, and with no gates opened. She wasn't a jumper, so we're clueless how she did this in a weakened state. She got caught in a fence and died. We don't think she ever realized what she was doing. She was only 9. We're devastated. This took less than 2 months, around 6 weeks since noticing she lost a little bit of weight. We'd never even heard of cholangiohepatitis. Seriously. I've been around horses for 38 years, and never heard of EPM either. None of my horse owner friends have. I'm angry the emergency vet did nothing to help her that weekend. I'm angry I didn't have Echo taken back to the vet a day earlier than she was scheduled for. Maybe this wouldn't have happened. I'm angry about the whole d**n thing. *** I describe the confusion or way Echo acted when her illness was strongest as a sort of dementia. She didn't recognize us, she paced, wouldn't stop even if things were in front of her or in her way. She was difficult to control, and walked like she was drunk, all traits that were opposite of how she was normally. If your horse changes personality drastically, get a vet asap and have blood work done. Sadly you can't watch them 24/7, but you can learn in advance what to look for. I wish I'd heard of this before.....it might have helped me to prevent this from happening to our beautiful Echo.
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