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  Discussion on Colitis, foaling and now elevated liver enzymes
Author Message
Member:
carocbr

Posted on Monday, May 9, 2011 - 7:08 pm:

My shire mare has been at ISU vet hospital for nearly 4 weeks after initially going onto foal watch for signs of an early foal 3-4 weeks before her due date. After she arrived and was ultrasounded, she was diagnosed with placentitis and put on antibios (TMPS) and steroids (I think) and regumate to treat and try to prolong her pregnancy. All was going well.
About 4 days before her due date, she developed severe diarrhoea and immediately was given fluids, off her antibios and other treatments. She was depressed and miserable with very little appetite but kidney enzymes improved a lot and she delivered her filly on 4th with no help and no complications.
Now, 9 days after the initial diarrhoea she's still not recovering her appetite, not passing much stool (still not firm) and is very depressed - in my opinion worse than pre-foaling.

Her hydration is good, kidney enzymes back to normal and no infectious bacteria were found in her stool. So things were looking better except that today she has moderately elevated liver enzymes and is still as depressed. Something is not right.
Is this normal for recovery from colitis, or does it sound like there is something else going on too? I am getting very worried about her - though luckily, her filly is doing fine so far. ISU is doing a liver biopsy today so sometime soon they should know more.
Moderator:
DrO

Posted on Tuesday, May 10, 2011 - 3:01 pm:

Hello Elizabeth,
Liver enzymes themselves do not mean much as fairly small events can cause remarkable increases in liver enzymes. For instance the toxins absorbed from a infectious colitis case can raise the enzymes. More important is how liver function is effected. We discuss this in detail at HorseAdvice.com » Diseases of Horses » Colic, Diarrhea, GI Tract » Mouth, Esophagus, and Liver » Liver Disease and Failure. I would expect for them to have run bilirubin and bile acid levels. Do you have the results including the normal ranges?

There is no typical recovery from colitis, it is a very variable disease but you should be seeing steady improvements in vital signs and CBC (particularly WBC counts) values. Is this happening? For more on this see HorseAdvice.com » Diseases of Horses » First Aid » Taking Temperature, Pulse, and Respiration.

Concerning treatment I suspect Banamine/flunixin (a nonsteroidal antiinflammatory drug) was used instead of steroids when placentitis was discovered.
DrO
Member:
carocbr

Posted on Sunday, May 15, 2011 - 7:56 pm:

Thank you Dr O.
She is now back home with her foal. Tests revealed she did not have liver failure. The increase in enzymes could be the result of infection going up the bile duct (so she is getting gentamicin and metronidazole) to clear up anything there and the results of cultures after biopsy are coming. In addition, the liver biopsy showed hepatolipidosis - likely becasue she is not eating well but also feeding her foal and mobilizing fat stores (she's lost a lot of weight). She has a large ventral oedema too.

Its clear she's glad to be home and is calm but alert which is a big improvement. She wants to eat but seems very reluctant, and personally, I think she is trying to chew with her front teeth. She's not chewing well at all. She is also quidding and I can't get her to eat much though she wants most to eat grass and she does try.

She did have her teeth floated a year ago after weight loss and I will have them checked again tomorrow. Clearly there could be lots of things going on with her, but if something as simple as teeth are making things worse, then its one more thing to rule out.

Otherwise, I am at a loss what to do other than support and encourage her to eat and hope she can get a positive energy balance back so she can continue to feed her foal without losing much more weight.
Moderator:
DrO

Posted on Tuesday, May 17, 2011 - 8:14 pm:

Elizabeth, what instructions have you been given to achieve those ends?
DrO
Member:
carocbr

Posted on Monday, May 30, 2011 - 9:06 am:

I have been through the release treatment for Xena - 7 days of metronidazole treatment. I also had her teeth floated by my local vet. This made a HUGE difference as she had lots of very sharp points. She is now eating much better.

Overall, she's getting better but still a long way from normal. She is still producing cow patty stools after another 2 weeks have gone by. She eats quite well but lacks energy. She has gained a little weight but has a long way to go. I guess its a case of wait and see and keep feeding her up. I am hoping her stools return to normal in the next few weeks.
Moderator:
DrO

Posted on Tuesday, May 31, 2011 - 7:22 am:

I am glad to hear things are improving and hope they continue to do so.
DrO
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