Uncle Mo diagnosis

[RolloTomasi]

Originally Posted by Riot

As I said, damn sorry I added my professional opinion based upon my experience and my local contacts in the veterinary community.

Apology accepted.

Now that you have proven that you have the inside scoop on such matters, can you please distinguish Uncle Mo's case from Devil May Care's?

Going by the threadbare DRF and Blood-Horse articles that us peons have to rely on, the parallels between the two are remarkably similar.

Why has the most recent of the two garnered from you a "nothing to worry about" prognosis, while the earlier one resulted in a dead horse?

[Riot]

Originally Posted by RolloTomasi

Why has the most recent of the two garnered from you a "nothing to worry about" prognosis, while the earlier one resulted in a dead horse?

Here's a link to the Merck Manual Online. Just enter "hepatic" as your search term and go from the page of topics that comes up. "Enzymes" are at the bottom.

Edit: so, sorry, here's the Merck Veterinary Manual Online. Best to start with that. Same search terms.

http://www.merckvetmanual.com/mvm/index.jsp

[Princess Doreen]

From on-line Merck Vet Manual -

Cholangiohepatitis is a severe inflammation of the bile passages and adjacent liver, which sporadically causes hepatic failure in horses and ruminants. It is occasionally associated with cholelithiasis in horses.

Etiology:

Bacteremia due to an organism (eg, Salmonella ) eliminated in the bile, an ascending infection of the biliary tract after intestinal disturbance, or ileus are thought to be related to the development of cholangiohepatitis. In foals, duodenal ulceration and duodenitis may result in bile stasis, hepatic duct obstruction, and cholangiohepatitis. Parasite migration through the liver may predispose to cholangiohepatis in some animals. Gram-negative organisms, including Salmonella sp , Escherichia coli , Pseudomonas sp , and Actinobacillus equuli are frequently isolated from the liver. Clostridium sp , Pasteurella sp , and Streptococcus sp are less frequently recovered.

Clinical Findings:

Depending on the severity of infection and virulence of the organism, clinical signs may be acute with severe toxemia, subacute, or chronic. Most typically, cholangiohepatitis is a subacute or chronic disease process with affected animals showing signs of weight loss, anorexia, intermittent or persistent fever, or colic. Icterus, photosensitivity, and signs of hepatic encephalopathy are variable. SDH, AST, GGT, bilirubin, and total bile acid concentrations are usually increased. Peripheral WBC counts are variable, depending on the degree of inflammation and endotoxemia present. Acute, suppurative cholangiohepatitis may occasionally result in severe septicemia and death.

Lesions: In acute cases, the liver is swollen, soft, and pale. Suppurative foci may be visible beneath the capsule or on cut surface. Lesions in other systems may reflect septicemia and jaundice. Microscopically in acute cases, neutrophils are present in the portal triads and degenerate parenchyma. Purulent exudate is evident in the ducts. In subacute or chronic cholangiohepatitis, the inflammation is more proliferative and bile duct proliferation more pronounced. Areas of atrophy, regenerative hyperplasia, and periportal fibrosis may be evident.

Diagnosis:

Liver biopsy should be performed to confirm the diagnosis and to obtain a liver sample for aerobic and anaerobic culture and sensitivity. Differential diagnoses include other causes of acute to chronic hepatic disease, weight loss, colic, or sepsis. If neurologic signs are present, cerebral diseases must be considered. Because cholangiohepatitis is frequently associated with cholelithiasis in horses, the presence of one or more calculi must be ruled out.

Treatment:

Treatment based on culture and sensitivity results from liver tissue often gives favorable results. Therapy should be continued for 4-6 wk or longer. Liver enzyme (GGT) levels and biopsies should be repeated to monitor response to therapy. If no organism is cultured, broad-spectrum antimicrobial therapy against gram-negative, gram-positive, and anaerobic organisms should be administered. A combination of penicillin with either a trimethoprim-sulfa or an aminoglycoside or enrofloxacin may be used. Ampicillin or a cephalosporin can be used instead of penicillin. Metronidazole can be used in horses to treat anaerobic bacteria. Prognosis is good if fibrosis is not severe.

[GenuineRisk]

Originally Posted by Riot

Here's a link to the Merck Manual Online. Just enter "hepatic" as your search term and go from the page of topics that comes up. "Enzymes" are at the bottom.

Edit: so, sorry, here's the Merck Veterinary Manual Online. Best to start with that. Same search terms.

http://www.merckvetmanual.com/mvm/index.jsp

That was informative; thank you. For those of us not trained in the medical fields, we have no knowledge base to use in distinguishing severe hepatic conditions from less severe. We hear "hepatitis," especially from a stable where a horse has died from a hepatic condition, and it's easy to jump to conclusions, without knowing how distinct from each other the two cases may be.

Here's the direct link to cholangiohepatitis from the link Riot posted.
http://www.merckvetmanual.com/mvm/in...m&word=hepatic

So basically, hepatitis is any inflammation of the liver, but can be caused by a variety of things?

[Riot]

Devil May Care had a hepatitis caused by lymphosaroma, and Uncle Mo has a cholangiohepatitis secondary to intestinal infection. Two very different things, these horses had very different presentations reported, the only commonality with both was/is "the liver" was involved.

There are a hundred things that can cause inflammation in the liver ("hepatitis"). It's a description of an organ system condition, not a disease.

BTW, a "steroid hepatopathy" secondary to exogenous steroid use doesn't really present like either of the above two things, and is easy to diagnose, even if the owner was lying to you about giving steroids.

[TouchOfGrey]

Uncle Mo to Begin Light Training Next Week

[RolloTomasi]

Originally Posted by Riot

Devil May Care had a hepatitis caused by lymphosaroma, and Uncle Mo has a cholangiohepatitis secondary to intestinal infection. Two very different things, these horses had very different presentations reported, the only commonality with both was/is "the liver" was involved.

You're using hindsight with respect to Devil May Care. She wasn't diagnosed with lymposarcoma until just prior to being euthanized.

What was so "very different" about the abnormalities displayed between the two horses?

Both were off-feed, losing weight, and performing poorly.

[freddymo]

Originally Posted by RolloTomasi

You're using hindsight with respect to Devil May Care. She wasn't diagnosed with lymposarcoma until just prior to being euthanized.

What was so "very different" about the abnormalities displayed between the two horses?

Both were off-feed, losing weight, and performing poorly.

Please refrain from making believe you understand this stuff..Dr Riot is a Vet not some internet nobody who makes bad calls about horses..lol

[Princess Doreen]

Originally Posted by Riot

Devil May Care had a hepatitis caused by lymphosaroma.

Wasn't it the other way around? At least, that's what was reported.

[Riot]

Originally Posted by RolloTomasi

You're using hindsight with respect to Devil May Care. She wasn't diagnosed with lymposarcoma until just prior to being euthanized.

What was so "very different" about the abnormalities displayed between the two horses?

"Off-feed, losing weight, and performing poorly" can presage hundreds of medical problems, from pneumonia to a tooth abcess.

DMC had a different liver enzyme profile, and didn't respond well to treatment from day one. That's often pathognomonic for lymphosarcoma, which yes, can be difficult to diagnose even with biopsy/imaging until very late in the disease course, especially when the animal is put on glucocorticoids to help treat the presenting clinical symptoms (as that dampens down many markers of the clinical presentation of lymphosarcoma, and extends life)

UM responded well from day one, with a different blood profile, and a small relapse with a subacute cholangiohepatis isn't an uncommon sequela to a GI tract infection.

The different hepatic conditions present clearly differently upon a good diagnostic workup: liver/lymph biopsy, diagnostic imaging (ultrasound), bloodwork, response to different treatments, etc.

What was relayed publicly about both horses was entirely consistent with the subsequent individual conditions announced, and inconsistent with much of the casual speculation.

That's my opinion. Others may feel free to continue to mock it.

Good luck to Uncle Mo, I hope he gets back to racing. Training for breeding season doesn't start until December.

[my miss storm cat]

Uncle Mo to Begin Light Training Next Week

http://www.bloodhorse.com/horse-raci...eek?source=rss

[freddymo]

Originally Posted by Riot

"Off-feed, losing weight, and performing poorly" can presage hundreds of medical problems, from pneumonia to a tooth abcess.

DMC had a different liver enzyme profile, and didn't respond well to treatment from day one. That's often pathognomonic for lymphosarcoma, which yes, can be difficult to diagnose even with biopsy/imaging until very late in the disease course, especially when the animal is put on glucocorticoids to help treat the presenting clinical symptoms (as that dampens down many markers of the clinical presentation of lymphosarcoma, and extends life)

UM responded well from day one, with a different blood profile, and a small relapse with a subacute cholangiohepatis isn't an uncommon sequela to a GI tract infection.

The different hepatic conditions present clearly differently upon a good diagnostic workup: liver/lymph biopsy, diagnostic imaging (ultrasound), bloodwork, response to different treatments, etc.

What was relayed publicly about both horses was entirely consistent with the subsequent individual conditions announced, and inconsistent with much of the casual speculation.

That's my opinion. Others may feel free to continue to mock it.

Good luck to Uncle Mo, I hope he gets back to racing. Training for breeding season doesn't start until December.

Unfortunately you are making your case based on information which you assume is accurate and not engineered I have no reason to believe anything about any of the horses is indeed factual

[RolloTomasi]

Originally Posted by Riot

DMC had a different liver enzyme profile, and didn't respond well to treatment from day one. That's often pathognomonic for lymphosarcoma, which yes, can be difficult to diagnose even with biopsy/imaging until very late in the disease course, especially when the animal is put on glucocorticoids to help treat the presenting clinical symptoms (as that dampens down many markers of the clinical presentation of lymphosarcoma, and extends life)

UM responded well from day one, with a different blood profile, and a small relapse with a subacute cholangiohepatis isn't an uncommon sequela to a GI tract infection.

The different hepatic conditions present clearly differently upon a good diagnostic workup: liver/lymph biopsy, diagnostic imaging (ultrasound), bloodwork, response to different treatments, etc.

What was relayed publicly about both horses was entirely consistent with the subsequent individual conditions announced, and inconsistent with much of the casual speculation.

So you do have access to the bloodwork on both horses. I presumed that you were merely going off the same DRF and Blood-Horse reports that everyone else was. As no real specific details were given in those related to the diagnostic work, you can see how, superficially, both cases seemed to progress in near parallel fashion (not that Uncle Mo's is over just yet).

Having personally reviewed the pertinent information collected from all the workup done, you no doubt are in a better position to distinguish between the two horses' respective illnesses.

Mo obviously needs a colon cleanse and 3-day fast. Then add some chlorella and spirulina to his feed.

This will work because I read a lot on alternative medicine websites.

[GenuineRisk]

Originally Posted by Riot

There are a hundred things that can cause inflammation in the liver ("hepatitis"). It's a description of an organ system condition, not a disease.

That's what I didn't understand from the original article- since all of my experience with hepatitis in humans has been limited to getting the vaccine for Hep A, I assumed "hepatitis" was a disease, not a condition, and I didn't know if it was a curable, like Hep A, or an incurable, like Hep C. Thanks for the clarification.