Cholangiohepatitis in race horses - DVM
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Cholangiohepatitis in race horses
Caring for those affected by the disease that caused champion Uncle Mo to be scratched from the Derby


Photo 1: An ultrasonogram of the liver next to the spleen in a horse with cholangiohepatitis. Sludge can be seen in the bile duct. (Image courtesy of Dr. T.J. Divers, Cornell University.)
Diagnostics should include biochemical tests (SDH, AST, LDH, ALP, GGT, serum bile acids, serum or plasma bilirubin) to determine whether there's liver involvement.

Photo 2: An ultrasonogram of a distended bile duct in a horse with cholangiohepatitis. (Image courtesy of Dr. T.J. Divers, Cornell University.)
Transabdominal ultrasonography is another tool that can help diagnose cholangiohepatitis (Photos 1-3). While ultrasound-guided liver biopsy is required to make a definitive diagnosis, repeat ultrasonographic evaluations of the liver can also be useful in assessing the success of therapy.

Photo 3: An ultrasonogram of a stone in the bile duct casting a shadow in a horse with cholangiohepatitis. (Image courtesy of Dr. T.J. Divers, Cornell University.)
"Ultrasound can reveal the presence of abscessation or neoplasia, dilation of bile ducts, presence of stones and an assessment of the hepatic texture or changes in the liver lining consistent with nodular formation," says Byars.

Ultrasonographically, cholangiohepatitis may appear with both dilated bile ducts, reflecting reduced bile flow, and textural changes to the hepatic parenchyma. However, the findings may be highly variable in many horses that appear relatively normal but have abnormal chemistry results, according to Byars.

"Many veterinarians will skip a full chemistry, maybe just run a CBC, looking for infection, etc.," says Byars. "Practitioners should take the clinical complaints, combine those with a complete blood chemistry panel and use ultrasound. A biopsy would be definitive. If you have 100 suspected liver-involved horses in the field, maybe 10 percent get biopsied, but those at referral hospitals typically are biopsied."

Recognizing certain liver enzymes that are failing to be cleared appropriately in conjunction with increased liver-specific enzymes (GGT and AP) would help to support a diagnosis of cholangiohepatitis.


Source: DVM360 MAGAZINE,
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