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

2. Veteran Medical Conditions Common causes of debilitation Insidious onset Usually progressive When appropriately managed :-  individuals can maintain a reasonable quality of life

3. Medical Conditions Equine Cushings Syndrome ( ECS ) Liver Disease Recurrent Airway Obstruction Colic Weight Loss

4. Equine Cushings Syndrome Normal ageing feature No convincing gender / breed predisposition Average age at diagnosis – 19yrs Rarely seen in horses <10yo

5. The Syndrome Pituitary (under brain) Adrenal glands (kidneys) CORTISOL

6. Clinical Signs Hirsutism Laminitis Excessive drinking / urinating Lethargy Sweating (patchy) Weight loss

7. Clinical Signs Increased susceptibility to infections (immuno – suppression) “pot-bellied” appearance

8. Diagnosis Many tests available None that reliably confirm diagnosis Problems :- 1.Variable time course of the disease 2.Periodically “normal” hormone production

9. Diagnosis Often done on clinical signs only Especially if “classic” signs

10. Laboratory Aids Overnight Dexamethasone Suppression Test Basal ACTH concentration Many others…..

11. Treatment Value of treatment judged anecdotally Difficult to compare Subjective assessment only Owner led

12. The Treatment ?? Pituitary (under brain)  pergolide Adrenal glands (kidneys) aminoglutethimidine trilostane CORTISOL metyrapone

13. 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

14. Liver Disease Common cause of chronic weight loss Many cases of disease sub – clinical 60% of liver function lost before liver failure

15. 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

16. 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

17. Liver Disease Relatively poor prognosis with overt signs of liver disease  Considerable advantages in identification and treatment of sub-clinical cases

18. Clinical Signs Weight loss Depression Behavioural changes Photosensitisation Jaundice

19. Clinical Signs cont’d Anorexia ‘belly oedema’ Colic Diarrhoea

20. 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

21. Investigation Blood tests ( structure & function ) Ultrasonography Liver biopsy

22. Liver Biopsy Ultrasonographic guidance Sedation & local anaesthetic Hospitalised overnight Adverse effects / complications rare

28. Treatment Biopsy may offer precise therapy – antibiotics or steroids may be required Non specific supportive care

29. Supportive Diet – quantity & quality of protein very important Too much protein – more ‘work’ for liver

30. ‘Liver Diet’ Low protein Avoid cereals ( oats / barley ) Avoid alfalfa / clover High Carbohydrate Mollassed sugar beet : maize 2:1

31. ‘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