What are Cholangiohepatitis?
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.
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Symptoms of Cholangiohepatitis in Horses
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:
- High body temperature
- Yellowing of the whites of the eyes
- Weight loss
- Refusal to eat
- Rapid breathing
- Fast heart rate
- Strange behavior
- Colic (teeth grinding, kicking at abdomen, pawing)
- Liver failure (yellow eyes and mucous membranes, extreme lethargy)
There are several types of cholangiohepatitis, which include:
Causes of Cholangiohepatitis in Horses
Bacterial infection (Acinetobacter spp., Aeromonas spp., Actinobacillus spp., Citrobacter spp., E. coli, Klebsiella spp., Salmonella spp.)
- Biliary stones
- Hepatic lipidosis
- Hepatic torsion
- Neoplasia (tumor)
- Portal vein thrombosis
- Toxins (toxic plants, iron, mycotoxins)
Diagnosis of Cholangiohepatitis in Horses
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 in Horses
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.
Recovery of Cholangiohepatitis 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.