veteran medical conditions - 1 colin mitchell bvm&s certep mrcvs scottmitchellassociates, hexham
TRANSCRIPT
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Veteran Medical Conditions - 1
Colin Mitchell BVM&S CertEP MRCVSScottMitchellAssociates, Hexham
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Veteran Medical Conditions
• Common causes of debilitation
• Insidious onset
• Usually progressive
When appropriately managed :-
individuals can maintain a reasonable quality of life
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Medical Conditions
• Equine Cushings Syndrome ( ECS )
• Liver Disease
• Recurrent Airway Obstruction
• Colic
• Weight Loss
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Equine Cushings Syndrome
• Normal ageing feature• No convincing
gender / breed predisposition
• Average age at diagnosis – 19yrs
• Rarely seen in horses <10yo
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The Syndrome
Pituitary (under brain)
Adrenal glands (kidneys)
CORTISOL
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Clinical Signs
• Hirsutism• Laminitis• Excessive drinking /
urinating• Lethargy• Sweating (patchy)• Weight loss
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Clinical Signs
• Increased susceptibility to infections (immuno – suppression)
• “pot-bellied” appearance
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Diagnosis
• Many tests available
• None that reliably confirm diagnosis
Problems :-
1. Variable time course of the disease
2. Periodically “normal” hormone production
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Diagnosis
• Often done on clinical signs only
• Especially if “classic” signs
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Laboratory Aids
• Overnight Dexamethasone Suppression Test
• Basal ACTH concentration
• Many others…..
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Treatment
• Value of treatment judged anecdotally
• Difficult to compare
• Subjective assessment only
• Owner led
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The Treatment ??
Pituitary (under brain) pergolide
Adrenal glands (kidneys)
aminoglutethimidine
trilostane CORTISOL
metyrapone
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Summary
• Normal ageing feature
• Not invariably fatal / even problematical in many cases
• Many cases – hirsutism only
• Laminitis only genuine problem
• Diagnostic tests – unsatisfactory
• Treatment – owner led / subjective
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Liver Disease
• Common cause of chronic weight loss
• Many cases of disease sub – clinical
• 60% of liver function lost before liver failure
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Liver Disease
• Common cause of chronic weight loss
• Many cases of disease sub – clinical
• 60% of liver function lost before liver failure
Liver disease more common than liver failure
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Liver Disease
1. Clinically normal horses may be suffering from liver disease
2. Presence of overt clinical signs implies considerable degree of disease – relevant to prognosis
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Liver Disease
Relatively poor prognosis with overt signs of liver disease
Considerable advantages in identification and treatment of sub-clinical cases
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Clinical Signs
• Weight loss• Depression• Behavioural changes• Photosensitisation• Jaundice
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Clinical Signs cont’d
• Anorexia• ‘belly oedema’• Colic• Diarrhoea
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Investigation
3 Aims :-
1. Find those genuinely suffering from liver disease
2. Determine type of disease
3. Determine those likely to survive from those that are not
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Investigation
• Blood tests ( structure & function )
• Ultrasonography
• Liver biopsy
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Liver Biopsy
• Ultrasonographic guidance
• Sedation & local anaesthetic
• Hospitalised overnight
• Adverse effects / complications rare
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Treatment
• Biopsy may offer precise therapy – antibiotics or steroids may be required
• Non specific supportive care
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Supportive
• Diet – quantity & quality of protein very important
• Too much protein – more ‘work’ for liver
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‘Liver Diet’
Low protein
Avoid cereals ( oats / barley )
Avoid alfalfa / clover
High Carbohydrate
Mollassed sugar beet : maize
2:1
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‘Liver Diet’
• Feed a little & often ( 5 – 6 feeds daily )
• Turn-out for ad-lib grass / grass hay if not photosensitive
• Vit / min supplement – one without Iron