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