Veteran Medical Conditions - 1 Colin Mitchell BVM&S CertEP MRCVS ScottMitchellAssociates, Hexham.
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Transcript of Veteran Medical Conditions - 1 Colin Mitchell BVM&S CertEP MRCVS ScottMitchellAssociates, Hexham.
Veteran Medical Conditions - 1
Colin Mitchell BVM&S CertEP MRCVSScottMitchellAssociates, Hexham
Veteran Medical Conditions
• Common causes of debilitation
• Insidious onset
• Usually progressive
When appropriately managed :-
individuals can maintain a reasonable quality of life
Medical Conditions
• Equine Cushings Syndrome ( ECS )
• Liver Disease
• Recurrent Airway Obstruction
• Colic
• Weight Loss
Equine Cushings Syndrome
• Normal ageing feature• No convincing
gender / breed predisposition
• Average age at diagnosis – 19yrs
• Rarely seen in horses <10yo
The Syndrome
Pituitary (under brain)
Adrenal glands (kidneys)
CORTISOL
Clinical Signs
• Hirsutism• Laminitis• Excessive drinking /
urinating• Lethargy• Sweating (patchy)• Weight loss
Clinical Signs
• Increased susceptibility to infections (immuno – suppression)
• “pot-bellied” appearance
Diagnosis
• Many tests available
• None that reliably confirm diagnosis
Problems :-
1. Variable time course of the disease
2. Periodically “normal” hormone production
Diagnosis
• Often done on clinical signs only
• Especially if “classic” signs
Laboratory Aids
• Overnight Dexamethasone Suppression Test
• Basal ACTH concentration
• Many others…..
Treatment
• Value of treatment judged anecdotally
• Difficult to compare
• Subjective assessment only
• Owner led
The Treatment ??
Pituitary (under brain) pergolide
Adrenal glands (kidneys)
aminoglutethimidine
trilostane CORTISOL
metyrapone
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
Liver Disease
• Common cause of chronic weight loss
• Many cases of disease sub – clinical
• 60% of liver function lost before liver failure
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
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
Liver Disease
Relatively poor prognosis with overt signs of liver disease
Considerable advantages in identification and treatment of sub-clinical cases
Clinical Signs
• Weight loss• Depression• Behavioural changes• Photosensitisation• Jaundice
Clinical Signs cont’d
• Anorexia• ‘belly oedema’• Colic• Diarrhoea
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
Investigation
• Blood tests ( structure & function )
• Ultrasonography
• Liver biopsy
Liver Biopsy
• Ultrasonographic guidance
• Sedation & local anaesthetic
• Hospitalised overnight
• Adverse effects / complications rare
Treatment
• Biopsy may offer precise therapy – antibiotics or steroids may be required
• Non specific supportive care
Supportive
• Diet – quantity & quality of protein very important
• Too much protein – more ‘work’ for liver
‘Liver Diet’
Low protein
Avoid cereals ( oats / barley )
Avoid alfalfa / clover
High Carbohydrate
Mollassed sugar beet : maize
2:1
‘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