Veteran Medical Conditions - 1 Colin Mitchell BVM&S CertEP MRCVS ScottMitchellAssociates, 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