This is an archived Horseadvice.com Discussion. The parent article and menus are available on the navigation menu below:
HorseAdvice.com » Diseases of Horses » Colic, Diarrhea, GI Tract » Mouth, Esophagus, and Liver » Liver Disease and Failure »
  Discussion on Liver - acute attacks (corticosteriods?) and metabolism
Author Message
Member:
kristia

Posted on Sunday, Apr 27, 2008 - 11:47 am:

DrO,
This is a long one...again...

First I will tell you the history...
My horse has experienced 2 acute liver attacks. When the 1st attack occurred we had a liver biopsy done and all they could tell was that he must have ingested something toxic. Over a period of 6 months his GGT returned to normal. The second time it occurred, I opted to not do a biopsy and just gave it time to heal, that only took 2 months.
The coincidental part is that both times, some time before the liver insults, he had been on corticosteroids. The first time was decreasing Dexamethasone for 8 weeks due to his chronic diarrhea and the second time he had just finished a short 10 day course of liquid prednisone for dermatitis (thought to be leukoclaustic vasculitis), later determined to be photosentization by biopsy. Both times he was on alfalfa hay as well, a flake to 2 flakes a day. Since the second attack, I no longer feed alfalfa.

Now, here are my questions...
I want to give my horse Weight Builder (40% fat) and as he is still a little bit under weight, but don't want to add more grain as he is about at his limit. I have read that the liver has to work harder to process fat, so giving him this 40 % fat, would that harm his liver? Before you answer this, when I took him to the vet just recently for x-rays and we had to sedate him I told him that my horse was a "light weight" with sedatives. He said that a slow metabolism liver is the cause of him being a "light weight". Does this explain why I have had two acute liver attacks that took so long to heal? And back to my original question, would the 40% fat cause damage to the liver or cause over work for the liver?
New Member:
rtrotter

Posted on Sunday, Apr 27, 2008 - 5:25 pm:

Kristi,

Can you describe what you mean by a liver attack? How high was your horse's GGT? I have a 5 year old Standardbred mare ( racing) that I have had ongoing problems with high GGT numbers. The highest was 121, at which point the vet said he had never seen numbers that high before in a racehorse. In the past I was able to get the number down by giving her B vitamins and liver flush, but even that did not get her down to "normal"{less than 35). I tried to find some type of cause and effect between the higher than normal numbers and what had changed in her environment that might have caused the problem. Both times when she had extremely high numbers, she had been wormed and or had yearly vaccinations or both very close to the timeframe of the bloodwork.

We tried everything on this mare to get her numbers down including antibiotics. Nothing worked. About a month ago, my vet suggested changing her diet to a high fat-lower protein ration. She was on a 14% protein and 6% fat diet(grain) and is now on 11% fat and 11% protein with timothy hay. I will be doing bloodwork on her this week, but I can already tell by how she is acting( she is eating very well and her performance has greatly improved) that her GGT will be much closer to normal. Which is good because she will be racing Saturday and I expect a good effort.

Rachelle
Member:
kristia

Posted on Sunday, Apr 27, 2008 - 7:07 pm:

Rachelle,
Sit down....here comes the numbers...

The 1st time his GGT was 330 (normal 5 to 25)

The 2nd time his GGT was 418 (normal 5 to 25)

Both times the AST was just above normal range.

Additional information - the 1st time, he was referred to A & M and the ammonia levels were tested as well and resulted as 58 (normal less than 20). Put him on Metronidazole (had to take him off quickly as we didn't know what was causing the severe diarrhea) The second time we did not test as the vet clinic does not have the ability to do so.

To help the liver recover, it was suggested to put him on a low protien/high fat diet. Vet's idea was 1 lb cracked corn, 1 lb milo and 1 lb Beet pulp, all for each feeding. I didn't get past the 3rd day as this is how we figured out my horse was allergic to corn - diarrhea. So, basically, he was on grass hay only. I have been told by others to give him Milk Thistle, but never tried it as my horse had food allergies that weren't identified. I think Uckele sells MT.

The 1st time, he never did display liver disease symptoms. I had asked for a CBC and they asked if I wanted a Chemistry and I said "sure". Well, the vet and I were totally shocked when the results came in. The second time, we checked since he had photo sensitivity, which is a symptom of liver issues.

Let me know how things go.
Moderator:
DrO

Posted on Monday, Apr 28, 2008 - 7:53 am:

Hello Kristi,
No I don't think there is an explanation for the elevated GGT and ammonia level increases in your posts. Considering the problems you have had I would consider starting the high fat supplement slowly and monitor the blood for changes in enzymes and signs of increased amount of unprocessed fats (lipids) in the blood. However I would consider problems unlikely from such a dietary supplement in a thin horse.
DrO
Member:
kristia

Posted on Monday, Apr 28, 2008 - 11:14 pm:

Thanks DrO. I will start slowly and monitor.
Member:
kristia

Posted on Saturday, May 3, 2008 - 11:46 pm:

DrO,
I am planning to start the Weight Builder, so I had a Chemistry Panel ran this morning. All is good except for:

GGT 47 (normal 10-37)
Albumin 2.7 (normal 2.7-3.7)
AST 341 (normal up to 340)

His liver enzymes are a little elevated and his protein is still at the low end of normal. This makes me wonder about my horse. He has 1/2 a cecum and probably lost some of his small intestine from his colic episode at the age of 8 months. He had chronic diarrhea for 2 years. It was recently suggested to me that maybe I should try Succeed to help him absorb the nutrients better. I am also thinking that the 14% protein is just too much for him. I stopped giving him alfalfa last year when he battled an extreme case of Scratches, probably due to the excess protein that was being feed. I wonder if he has protein-losing enteropathy. He's been on 14% protein for a year now (plus alfalfa for 1/2 that year) and his albumin never goes above the low/normal. Maybe he just needs probiotics all the time. Any thoughts?
Moderator:
DrO

Posted on Sunday, May 4, 2008 - 10:04 am:

These values may be normal for your horse Kristin and not the result of treatable disease but a thorough exam would be necessary to determine this. It is not clear to me that probiotics will be helpful. For more on this controversy see the article on Probiotics.

With the cecum removed your horse has lost much of its ability to ferment structural carbohydrates and absorb fatty acids and the vitamins created by such fermentation. As a result your horse should be supplemented in both easily digested and absorbed energy and vitamins. We have articles on both of these.
DrO
Member:
kristia

Posted on Sunday, May 4, 2008 - 12:01 pm:

Thanks DrO. I was having trouble getting to the articles you have posted, and finally found how to get to them this morning. Very good information out there.
I read about the Probiotics and I think he needs the Prebiotics to help absorb the nutrients due to his small cecum. There is a product called Ultra-Elite Digest that I think will help my horse. It is a pre/probiotioc that contains a combination of mannan oligosaccharides (MOS) from Saccharomyces cerevisiae plus a complex blend of direct fed microbials and enzymes to help support G.I.
My horse has had several thorough exams, but the focus has been on the GGT issues and we just didn't discuss the albumin issue as he was always in the normal, just on the borderline of low.
We did a fecal egg count yesterday and it was negative. He's been on StrongidC 2x since November, was dewormed regularly before that, has his teeth floated twice a year, appears very normal and healthy. He is just a little bit on the ribby side and I think he needs maybe 50-75 lbs.
I am bound and determined to help this horse to become as healthy as he can be.
Can you give me an idea on how to determine easily digested and absorbed energy and vitamins, or point me to a link to find this?

Thanks,
Kristi
Moderator:
DrO

Posted on Monday, May 5, 2008 - 9:12 am:

Let me emphasize that the elevated GGT is not a disease: what is causing the rise is the disease. Until that is uncovered it is a number of uncertain significance. To pursue it an ultrasound and biopsy would be the next step.

For vitamins I would use our recommendation in the vitamin article. For energy the removal of the cecum makes this a bit more experimental, but I believe fats are digested and absorbed in the small bowel making it a good choice after all other nutrient needs, particularly protein, are met.
DrO
Member:
kristia

Posted on Wednesday, May 7, 2008 - 10:06 pm:

DrO, I understand that the elevated GGT is not a disease. I don't want to pursue another ultrasound and biopsy. I am hoping to manage his liver enzymes by watching what he is digesting.

I spoke with my regular vet today and he thinks my horse may have malabsorption, which is what you and I think as well. He suggested I change his feed to Ultium at 6 lbs daily instead of Strategy 10 lbs daily. He also suggested Platinum Performance. I have given this to my horse 2 years ago, but he had so many illnesses we couldn't tell if it was working and it was expensive. I spoke with the barn owner and she is willing to offer the Ultium. It is expensive, but you don't have to feed as much. Let hope that he is not allergic to any of the ingredients!
I will keep you updated.
Moderator:
DrO

Posted on Thursday, May 8, 2008 - 8:32 am:

Kristi, I see where you list the procedure in your first post but I have never seen the results of the biopsy, only the interpretation of "something toxic". Do you have the actual histology report, I would be interested in looking at it.
DrO
Member:
kristia

Posted on Thursday, May 8, 2008 - 7:15 pm:

I will try to get the results for you. Get back with you shortly.
Kristi
Member:
kristia

Posted on Monday, May 12, 2008 - 9:00 pm:

DrO, I got the results and some comments between the vet and the pathologist. Here you go:

HISTOPATHOLOGY REQUEST
Tissues Submitted on 7/13/06: A. Liver
Clinical DIANOSIS: None
Previous BIOPSY: 11/1/05 Cecum apex: Moderate to marked, diffuse, subacute, eosinophillic typhilitis, with diffuse mucosal congestion and hemorrhage, and marked submucosal edema.
HISTORY: Elevated liver enzymes

HISTOPATHOLOGY REPORT
GROSS:
Liver: A 16 x 1 mm Tru-cut needle biopsy is submitted.
MICROSCOPIC:
Liver: Centrilobular and midzonal hepatocytes are moderately separated and surrounded by fibrosis, admixed with mild to moderate numbers of neutrophils, lymphocytes plasma cells, and few macrophages, some of which contain intracytoplasmic, brown-green, granular pigment (lipofuscin / bile). Hepatocytes are multifocally degenerate with cytoplasmic, well-defined clear vacuoles (lipid) or atropic with shrunken borders and loss of cytoplasm. Hepatocyte nuciei are occasionally mildly enlarged with coarsely stippled chromatin and prominent nucleoll (regeneration, presumed).
HORPHOLOGIC DIAGNOSIS:
Liver: Fibrosing hepatopathy, centrilobular to midzonal, diffuse moderate, with mild to moderate, chronic-active hepatitis, and hepatocyte vacuolar degeneration and atrophy.
COMMENTS:
Liver changes are most likely representative of a chronic, smoldering hepatotoxicity.

Comments re: biopsy findings:
To Dr. P (pathologist) - Recently, Dr. K examined a young horse that l’d managed as a weanling for some sort of enterocolitis (the horse also experienced a ceco-cecal intussusception during hospitalization, and had a partial typhlectomy). After a protracted course of doxycycline followed by dexamethasone, the yearling now appears to have a subclinical hepatopathy. A liver biopsy was performed by Dr. K and submitted for your review.
The biopsy report indicates that the liver changes most likely represent a chronic, smoldering hepatotoxicity. I have the following questions for you to consider:
1) any idea of what toxin might likely cause these changes? biopsy findings doesn't sound like steroid hepatopathy to me, and I could only find 1 case report of possible hepatotoxicity associated with administration of doxycycline in a Europe journal. but I am uncertain; the horse was fed a number of supplements and kept at pasture.
2) is it possible the hepatopathy is related to the enteropathy? this horse has a marked eosinophilic inflammatory response in its cecum at the time of surgery for the intussusception; although the response may have been non-specific, I wondered about MEED or other form of IBD that might extend to the liver.

Response from pathologist:
This is a most unusual and uncommon pattern of liver disease in my experience. I haven't been able to find a similar pattern described in either animal or human texts so far. I placed a call to a liver pathologist at NC State but learned from a phone message that he is away until late July. Dr. W also agrees that this is an uncommon pattern in his experience.
I only suggested some type of toxicity since the changes are zonal be located in the central (i.e around the central vein) to midzonal areas of all hepatic liver lobules. Most toxicities affect the periacinar, i.e. around the portal triades, areas where the agent of disease first arrives in the liver and usually causes so type of edema and bile ductule proliferation in the port areas which are absent in the lobules sampled. Recall that hepaocytes in each zone of the three zones of the liver lobule have different enzyme arrays and functions. The central zone (around the central vein) is
furtherest from the hepatic arteriole located in the portal area and the hepatocytes in that zone are most likely to experience lipidosis from a variety of insults including an episode of hypoxia, interference with lipid metabolism, etc. But in the biopsy from this horse, lipidosis is not a significant feature while individual hepatocyte degeneration and death with hepatocyte cord disarray; sinusoidal collapse and early centrilobular fibrosis are striking features.
Moderator:
DrO

Posted on Tuesday, May 13, 2008 - 9:09 am:

Kristen, has anyone suggested that the early serious colic episode caused an acute hepatitis by seeding the liver with bacteria and toxins from the damaged bowel and though the acute problem has resolved it leaves your horse with a chronic active hepatitis? This can be a progressive disorder which sometimes is hard to explain but one hypothesized reason is the liver on longer functions properly and ongoing trauma (decreased blood supply, inability to detoxify or excrete normal toxic loads, etc..) to the cells results in progressive fibrosis eventually leading to cirrhosis? Run this by your veterinarian and pathologist and see what they say.
DrO
Member:
kristia

Posted on Thursday, May 15, 2008 - 11:12 pm:

DrO,
Sorry took so long to respond. I have been researching this CAH a little bit, but I want to learn more. Hopefully this weekend I can spend some more time researching. My horse has been seen by several vets over the past 2 years, that they may have not put two and two together to figure out this maybe his problem. I have kept in touch with the vet/professor that handled his colic/diarrhea case over the years, but we would discuss only the current issues. I might just go ahead and bring him up to speed and give him a recap as I have done for you. I have a choice of two local vets that I can discuss this issue, but I am having trouble trying to decide which one would take the time to figure this out. I plan to take my horse in next month for x-rays of his tibial crest and growth plates as well as diagnostics of his lameness/delayed patella ligament release. This maybe the vet I want to discuss the CAH, but I will have to bring him up to speed as well.

Thank you so much for taking the time to figure this out. It seems we may finally have a diagnosis for my horse and now I know what I am dealing with.

Kristi
Member:
kristia

Posted on Sunday, May 18, 2008 - 11:21 am:

DrO,
To give you an update, I have not changed grain yet, but have added Sho Glo vitamin/minerals as well as a weight gain supplement Ultra-Elite Weight (soy based vegetable fat 40% with pre/probiotics). I swear his stool looks much better. I don't see the little bits of hay in it and it is moist looking.
Anyhow, my question is regarding his liver. The vet that is handling his lameness case mentioned to me that because he is a "light weight" for sedatives and his past liver issues, that I might consider adding vitamin E to his diet. I know that vitamin E usually goes with Selenium, but have read about too much Selenium is toxic. I looked at a map on areas with Selenium and it seems our soil is perfect. Also, the horse is out on green pasture during the day, so I am assuming he must be getting Vitamin E as well.
Should I consider an antioxidant product, like Phyto-Quench by Uckele. It's for horse's with chronic health problems and inflammation. I see most people use it with lamanitic horses. Here is a link:
https://www.uckeleequinenutrition.com/ezecommerce.cfm?fuseaction=productdetail&pr oductid=404
Or, should I just stick with what I am doing now by adding a general vitamin/mineral supplement?

Thanks,
Kristi
New Member:
rtrotter

Posted on Monday, Jun 2, 2008 - 6:53 pm:

I Just thought I'd give everyone an update on my 5 year old race mare. I waited a full month before I checked her bloodwork. Remember this mare has not had a "normal" GGT number in over 2 years.

The only change I made was with her feed. Her schedule has stayed the same and she has been racing.

While I expected the number to go down, I was very surprised and happy to see that not only was it down but it was well within the normal range (1-35) her number was (17). This was one of the best blood results I have seen on this mare. The only high number was AST (SGOT)at 450 (reference range 180-380)and that was to be expected since this blood was taken the day after she raced (on a rest day)

In case anyone is interested. Her feed changed from Purina Strategy ( 14% Prot/6% fat) to Purina Horsemans Edge HF (10% protein, 10% fat) and Blue Seal Vintage Performance (11% Protein/11 % fat). fed in equal portions. The Vintage Performance is an extruded pelleted feed with a low NSC.

I am going to wait until after she races this week and then worm her to see if the GGT changes significantly.
Member:
kristia

Posted on Tuesday, Jun 3, 2008 - 7:19 am:

Wow - that is so cool about the GGT finally normal after two years! Thanks for posting what you are feeding as I am always looking for ideas on how to keep the GGT low on my horse. I plan to recheck my guy next week or so.
I am amazed that you can run a race horse on such low protein and a low NSC feed. I went to a horse owner's workshop and they said that low NSC feeds did not provide the long lasting energy that a race horse needs. Well, for whatever it is worth, I bet you horse feels much better now and will perform better.
Again, I am so happy for you!

Oh, I am wondering, does you horse get small scabs on his pasterns, kind of like scratches without infection. They even look like scabs from ant bites, but they just don't seem to go away completely. I have read that horses that can't handle the high protein may get these and my horse has them. He has them on his red legs, not the white ones so I know it's not photo sensitivity.
Member:
rtrotter

Posted on Tuesday, Jun 3, 2008 - 2:23 pm:

Kristi,

In this mares case, I think the higher protein was contributing to her tying up problems, which may have contributed to the higher liver enzymes. I am just really glad this wound up being the feed and that I did not have to go through a liver biopsy. I did do a bile analysis which was normal.

I am also beginning to think that the feed was some of the cause of my other horses' performance problems because since I switched them all to this feed combination everyone's performance has improved. I do have to watch their weight I do not feed them a lot even though they are working relatively hard. They all look like Mack trucks, even the two year old.

As far as the cracked heals, my horses are bathed just about every day and I keep up on the heals by making sure they are thoroughly dried and apply either nolvasan, Tri-care or desitin ointment. I've noticed that the horses who have had the hair clipped off their ankles ( fetlock hair) seem to have more of a problem with their heels than the ones that still have their fetlock hair. I think the water drips further away from their heels and causes less of a problem.
Moderator:
DrO

Posted on Thursday, Jun 5, 2008 - 8:24 am:

Currently we do not know of any relation between protein levels and tying up. More likely is was the move away from feeds higher in NSC's (sugars) and replacing that energy with structural carbs and fat that would help with tying up. For more on this see the article on tying up.
DrO
Home Page | Top of Page | Join Us!
Horseadvice.com is a BBB Accredited Business. Click for the BBB Business Review of this Horse Training in Stokesdale NC