Liver count 6x normal but horse seems fine?

[islandrider]

Well, the vet is perplexed. This is the horse who was stocked up in the back legs like stovepipes. The stocking up went down with banamine and antibiotics, but 2 sets of bloodwork a week apart show liver enzymes are 6 x normal. At worst the vet is thinking a PF abcess on liver, but horse's white cell count is normal. At best he is thinking blocked bile duct. Owners don't have the bucks to send him up to Davis right now- since he looks so much better and is acting pretty normal, they are playing a "wait and see." Everyone is confused. Anyone have any feedback on this weird situation?

[deltawave]

Is it the liver enzymes (transaminases) that are elevated, or the bilirubin and alkaline phosphatase? The former would suggest injury to the liver (maybe from the illness itself, maybe the NSAID/antibiotics) while the latter would suggest a mechanical/obstructive problem with the bile ducts. It's important to follow these numbers serially--if they drop sharply you might be fine, and just looking at a temporary case of "NQR" that will pass. Good luck. It's hard to be more specific without knowing the whole picture--hopefully your vet will keep a close eye on things with you.

[BornToRide]

Horse is NOT fine. Something is definitely affecting the liver. Could be a toxins, blocked duct maybe (would the levels be that high if it was and should the WB cell count not be elevated then too?) or a horse that has possibly severe IR.

If in doubt, I would possibly treat for toxins ASAP which should not negatively affect the horse. Consult the vet about it.

[deltawave]

Jeez, why is EVERYTHING a sign of IR any more? :rolleyes:

And how does one "treat for toxins" when one doesn't even know what they ARE? What is a "toxin", precisely?

[Ghazzu]

Jeez, why is EVERYTHING a sign of IR any more? :rolleyes:

And how does one "treat for toxins" when one doesn't even know what they ARE? What is a "toxin", precisely?

I was wondering that, myself...

[BornToRide]

Jeez, why is EVERYTHING a sign of IR any more? :rolleyes:

And how does one "treat for toxins" when one doesn't even know what they ARE? What is a "toxin", precisely?

If it is a possibility it should be mentioned and considered. Would you not agree???!! As a horse owner I would want to know ALL the possibilities, not matter how remote. Would you not too?? :confused: I have seen it too many times that diseases are missed because the vet was incapable of thinking outside of the box just because the horse does not present textbook perfect. A friend and client recently lost a nursing mare to lactation tetany, because the attending vet insisted it was a colic, even though she did not present with typical colic signs (she kept seizuring). By the time the owner finally got through and convinced the vet that it was NOT colic and even if it was, the treatement for lactation tetany would not do any harm to a colicking horse, it was too late and she lost the mare, leaving a 1 month old colt behind. :mad::(

I simply don't get the antagonistic reaction by some of the folks here when something gets mentioned that could definitely be a possibility. Makes absolutely no sense :rolleyes: I rather be wrong than not having said anything at all!

You use charcoal to pull any possible toxins out of the digestive tract and support the liver with fluids and other meds. Any vet should be familiar with that.

[Ghazzu]

If it is a possibility it should be mentioned and considered. Would you not agree???!!

And I suspect toxicosis is a possibility that has been duly considered by the attending DVM. Yet you appear to assume it has not.


As a horse owner I would want to know ALL the possibilities, not matter how remote.
Space aliens. Feeding the horse an experimental TMR.


Would you not too?? :confused: I have seen it too many times that diseases are missed because the vet was incapable of thinking outside of the box just because the horse does not present textbook perfect.

You make more assumptions than Carter has little liver pills.


A friend and client recently lost a nursing mare to lactation tetany, because the attending vet insisted it was a colic, even though she did not present with typical colic signs (she kept seizuring). By the time the owner finally got through and convinced the vet that it was NOT colic and even if it was, the treatement for lactation tetany would not do any harm to a colicking horse, it was too late and she lost the mare, leaving a 1 month old colt behind. :mad::( And I had a client who was convinced by a fellow boarder that his perfectly healthy TB stallion was severely hypothyroid, because she'd just read an article about it. Your point?



I simply don't get the antagonistic reaction by some of the folks here when something gets mentioned that could definitely be a possibility. Makes absolutely no sense :rolleyes: I rather be wrong than not having said anything at all! Well hell, then, why not throw out Theiler's disease, cholangiocarcinaoma, or bacterial cholangiohepatitis ?


You use charcoal to pull any possible toxins out of the digestive tract and support the liver with fluids and other meds. Any vet should be familiar with that.Any vet would also know that after two weeks, it is unlikely there is anything in the GI tract to be "pulled out".

[EqTrainer]

Well...

in the Merck manual, it does mention that bile duct dysfunction (blockage) can cause insulin resistance in horses. Ghazzu, I am sorry, I do not remember the exact reference, it was read to me at the vet school when we were having a fun conversation about liver function and parasites. Maybe you have one there and can find it?

[BornToRide]

And I suspect toxicosis is a possibility that has been duly considered by the attending DVM. Yet you appear to assume it has not. I mentioned it in case it was not considered, which can happen. Happened to me with my cat after she reacted to Frontline. Dropped her off at the vet with clear information about the concerns I had and that I felt she had reacted to Frontline. I was called later that morning and told that her vital signs were all normal. I insisted on liver function test. The results were not pretty and the attending vet started to lecture me about fatty liver disease, when I knew she clearly had a reaction to the Frontline application the day before. I had to suggest to the vet to put her on fluids. I should not have to do that - any vet should know that!! Yet, unfortunatly things like this happen.

I do agree that 2 weeks after it would not do any good unless the horse continues to eat something toxic unbeknownst to the owner and vet. Did not realize that much time had lapsed between tests already.

Not sure about your irritation about what I posted - why don't you simply add to what I said if you have better ideas. As far as I know charcoal is used frequently in dogs if they ingested something toxic. Why would it not work on horses if in case they might have too ??!!

[Ghazzu]

Whatever. I bow to your obviously superior veterinary knowledge.

[deltawave]

Coming up with a comprehensive differential diagnosis is a fine and noble thing. I was wondering more along the lines of why are certain "hot topic" diagnoses always at the top of EVERY list of possible maladies, from thrush to odd swellings to bad behavior to weepy eyes? Not everything is a sign of insulin resistance, for pity's sake. Thinking outside of boxes is great, but not if "outside the box" always ends up in the same place.

[JSwan]

Jeez, why is EVERYTHING a sign of IR any more? :rolleyes:

And how does one "treat for toxins" when one doesn't even know what they ARE? What is a "toxin", precisely?

I'm pretty sure it's anything that throws off ones chi.

I can tell from here that the horse needs his colon cleansed. Because you know, the intestine is a disgusting sewer. ;)

Seriously - hope the OP's horse is A-OK.

[flyracing]

"Spherochytosis" possible, but usually presents with slightly low RBCs and high MCHC, since you don't mention anything else being abnormal it's likely something more acute. Continue to have vet monitor closely. Best of luck!