very high biliruben/ jaundice...

[jmbnsyd]

To make a long story short, my horse showed signs of colic that didn't resolve itself. We oiled him, with no signs of impaction. Horse very depressed, not drinking or eating. On my vets recommendation, we took him to New Bolton where they determined: Mild dehydration, glucose, triglyceride, and some other things (sorry not scientific) levels were all very high. Vet suspected all related to dehyrdation and not eating. Gave fluids. Slowly interduced hay to diet, blood work returned to normal, but his biliruben levels remained extremely high (severe). Did full blood work on liver functions: very normal, no indication of a problem with the liver.
Very Jaundice, a result of the biliruben levels. (never knew a horse could get jaundice, his gums are yellow:very weird looking!). Vets didn't know why biliruben levels wouldn't come down, but released him asking me to have blood pulled in 1-2 weeks to check levels.

Anyone have experience with high biliruben levels and jaundice?? How long should I expect the jaundice to last and is there anything I can do to help the process?

TIA!

[sid]

Yes, I had a 5 yr. old who developed acute hepatitis. Presumably, he developed hepatitis from ingesting something toxic over the fenceline. He was almost 18hh and could pick at things over the fence like a giraffe.

With supportive care at home, it ran its course. Very unhappy and uncomfortable horse though and it was a fairly long saga before he returned to normal.

We used a very low dose of ace for many, many day which helped stop him from pawing, going down, rolling and, I believe, antibiotics. It was so long ago, I don't remember the specifics.

[BornToRide]

What sid said and I am also wondering if your horse may be insulin resistant? The high triglyceride and glucose levels could be a sign for that. Does the horse show any other possible IR symptoms? Is it an easy keeper?

[deltawave]

Not enough information to make an educated guess, unfortunately. High bilirubin can be caused by massive hemolysis (destruction of red cells) or by obstruction in the bile ducts. Usually the latter also comes along with a high alkaline phosphatase level, which is part of the usual "liver function tests". If that is normal and JUST the bilirubin is high, I'd be looking at destruction of blood cells somewhere. It's possible for the transaminases (other parts of the liver function tests) to be normal and to have liver obstruction, though. Again, need more info. :) Did the vet do a CBC? (blood cell count)

[SquishTheBunny]

AIHA in end stages can also cause increased bilirubin/jaundice. Get a CBC done. Look at her gums,any pinprick bruises?

What about an abdominal ultrasound, may want to take a close peek of her gallbladder.

Also,not so sure if horses get this,but a PSS can also lead to high bilirubin levels. Again, an ultrasound can probably help diagnose this.


Also, if your horse IS healthy now (crossingfingers!) Icterus does take a while to disappear. You should note slight improvement every day,but may take a week or so to completely clear up.

GOODLUCK Keep us updated!

[merrygoround]

What sid said and I am also wondering if your horse may be insulin resistant? The high triglyceride and glucose levels could be a sign for that. Does the horse show any other possible IR symptoms? Is it an easy keeper?

Oh ! Will you please get off the IR!!!!!!

At NBC you are dealing with the best in the business.

The ingestion of something "over the fence" is not an uncommon happening, particularly if your pasture borders a hay field, or a property that might be subjected to commercial sprays.

[BornToRide]

Oh ! Will you please get off the IR!!!!!!

At NBC you are dealing with the best in the business.

The ingestion of something "over the fence" is not an uncommon happening, particularly if your pasture borders a hay field, or a property that might be subjected to commercial sprays.:confused: It is a possibility - why should it not be considered?? Doctors ar only humans too - not Gods in white robes......:rolleyes:

Perhaps you missed what Oprah recently experienced with FOUR doctors who all failed to diagnose her thyroid problems and treated her for the symptoms only?? You don't think this is not possible in veterinary medicine as well??

From the Equine Cushings group - Dr. Kellon:


The yellow discoloration could be from backed up bile pigments (jaundice), caused by his liver
not functioning properly. With the insulin resistance and hyperlipidemia the liver can be heavily loaded with fat. Should also mention that overgrazed pastures can be the most dangerous. This is
because the simple sugars in grasses are concentrated at the base/ground surface of the plants.

Per the test resulst, the above horse appears to have hyperlipidemia!

[jmbnsyd]

NBC was great and they did do the recommended tests, with everything coming back normal. The vet explained it to me that a high biliruben level can be caused by the following:
-destruction of red blood cells rupturing
-liver disease, dsyfucntion
-stone in the bile duct
-unknown---some horses have been known to walk around with a high level
I know the vet felt confident there was nothing wrong with his red blood cells or his liver, based on the tests they did.

His gluc & Tri levels were high because he hadn't eaten in several days...they returned to normal after fluids were given and diet resumed. So I don't think IR is a concern. He's a 9yr old TB gelding.

I am not 100% sure he had a CBC done (I don't have the full written report yet...that will come with the bill). I know that when everything but the biliruben levels normalized, they ran more tests: which came back normal.

We discussed ultrasoundingt the liver, but the blood work was normal and you can only see 10% of the adult horses liver through ultrasounds, so we decided against it. If the jaundice and bililruben level remains, that may be an option. We never discussed the gallbladder, what would be the connection/reason?(sorry...I'm so biology challenged!)

Gums are yellow, no bruising.

I read somwhere that the biliruben level can be looked at like a "recovery" time...some horses recover quicker then others. So it could just take him a coupke days to a week. Make sense?

I'm hoping the sun comes out thinking that might help? I know they put babies under the light to help with jaundice. Who knows...

[BornToRide]

His gluc & Tri levels were high because he hadn't eaten in several days...they returned to normal after fluids were given and diet resumed. So I don't think IR is a concern. He's a 9yr old TB gelding.

I agree, then probably not, but is this a normal reaction in horses who have not eaten in a few days?

[deltawave]

I'm not sure Oprah would bother to share any stories about anything that was perfectly routine. She has a flair for the overly dramatic, wouldn't you say? :)

I'm no expert on equine metabolism, but from what little I've read it's not terribly unusual in a sick, fasting or confined horse to see elevated triglycerides, etc. I wouldn't jump to the conclusion of IR, necessarily. But then I'm not a very brave jumper, really. :) Neither over real jumps nor to conclusions. :)

[SquishTheBunny]

NBC was great and they did do the recommended tests, with everything coming back normal. The vet explained it to me that a high biliruben level can be caused by the following:
-destruction of red blood cells rupturing
-liver disease, dsyfucntion
-stone in the bile duct
-unknown---some horses have been known to walk around with a high level
I know the vet felt confident there was nothing wrong with his red blood cells or his liver, based on the tests they did.

His gluc & Tri levels were high because he hadn't eaten in several days...they returned to normal after fluids were given and diet resumed. So I don't think IR is a concern. He's a 9yr old TB gelding.

I am not 100% sure he had a CBC done (I don't have the full written report yet...that will come with the bill). I know that when everything but the biliruben levels normalized, they ran more tests: which came back normal.

We discussed ultrasoundingt the liver, but the blood work was normal and you can only see 10% of the adult horses liver through ultrasounds, so we decided against it. If the jaundice and bililruben level remains, that may be an option. We never discussed the gallbladder, what would be the connection/reason?(sorry...I'm so biology challenged!)

Gums are yellow, no bruising.

I read somwhere that the biliruben level can be looked at like a "recovery" time...some horses recover quicker then others. So it could just take him a coupke days to a week. Make sense?

I'm hoping the sun comes out thinking that might help? I know they put babies under the light to help with jaundice. Who knows...

I wouldnt worry about IR...doesnt seem to add up to your horses symptoms. I really know nil about large animal internal medicine, but in dogs/cats we often will do a liver screen/CBC and abominal ultrasound with any cases relating to possible liver issues. I suppose in a horse, AST would be more important than ALT. So if AST and TBili.levels are increased then that DOES indicate serious liver issues. Often, increased AST with low level TBili is indicative of trauma. Bilirubin, well, usually indicative of "other"....meaning RBC's gone mad, portal systemic shunt, blockage or concurrent gall bladder issues. Although, there are other reasons in small animals, Iam not familliar with horses.

The reason I ask about bruising, is it is often indicative of AIHA and thrombocytopenia. But, if the CBC was normal (includes red blood cell indicies) then you likely are not dealing with that (Which is Great!!!)

Liver bx's are often are done for cytology and histology. Pretty much screening for cancer. However, they are also done to rule OUT cancer and physical liver problems.

Ultrasounds are usually quite beneficial in small animals, but I guess with only being able to see 10% inhorses, it may (or may not!) be a waste ofmoney.

As far as the gallbladder goes (in small animals...again, I dont even know if horses have a gallbladder lol), if they are anorexic, they gallbladder dialates, this CAN cause pressure and damage to the liver.-- hehe ok so no gallbladder in thehorse....I knew that lol....

Cats often get what is called "fatty liver" or hepaticlipidosis, which will often plague a fat kitty that decides not to eat. They get quite jaundiced, and even after force feeding them for days, they do take a long time to comearound.


One more thing that I do know horses can get are portal systemic shunts...and not just infoals. Pretty serious, but if your horse is doing ok than it likely isnt that.

If the AST is Normal, I would run a BILE ACID profile, your local vet can do this. It is THE most specific blood test for liver problems in horses/dogs.


Should be interesting to see what the blood results are next week.... hope your guy is still feeling good!!!

[deltawave]

No gallbladder in a horse. But they do have a "gallbladder meridian" in acupuncture-land. Never could quite wrap my head around that one. ;)

[jmbnsyd]

Thanks for the explanations. I guess I really do have to just wait and see. I'm just so inpatient I was hoping somebody could offer a magical cure.

I will try and post again once I have the detailed report and when I pull blood again next week.

[deltawave]

I'm just so inpatient

No, that was your HORSE. :)

Hopefully all will be well. Horses can look pretty awful on paper but if he's feeling and looking better that is a good sign, usually. :)

[merrygoround]

Ah! One does appreciate literate, intelligent posters. Ta!, Delta.

[McVillesMom]

We just talked about hyperbilirubinemia in horses in GI! Horses, specifically, get unconjugated hyperbilirubinemia when fasting. It's possible, since he just didn't eat for a while, that that is why his bilirubin is elevated. If there was liver or biliary disease, I would expect elevation in other liver values as well. I'm not sure how long it takes to return to normal, however.

There are basically three mechanisms for jaundice: prehepatic - due to excessive breakdown of red blood cells, in which case I would expect indications of anemia on the bloodwork; hepatic - due to an acquired or congenital (unlikely) liver disorder; or post-hepatic, due to bile duct obstruction.

If you already have high bilirubin, it's not indicated to perform a serum bile acids test - it doesn't provide any additional information. If I remember correctly, if the problem is primary liver disease, the bile acids would increase before you would see elevated bilirubin, so if you see elevated bilirubin, you already have elevated bile acids - IF the problem is the liver.

That's probably more than you wanted to know, and maybe more confusing, but it sounds like they have ruled out most of these things, and I would guess that it may just be from not eating for several days. :)

[deltawave]

Do horses get Gilbert's syndrome: transient and isolated elevations of bilirubin (totally benign) made worse or simply made evident by fasting, stress, etc? That's what this horse sounds like, now that you mention it. Although Gilbert's in people rarely causes major jaundice, maybe just a very slightly noticeable "tinge".

[McVillesMom]

DW, I don't know. All that I know is that they do get transient hyperbilirubinemia after fasting. That's probably a question to ask an internist - I will ask my GI professor about it, and if she doesn't know I'll ask around! :)

[x]

Yes, had a horse with Jaundice and elevated bilireuben; vet felt problem was liver infection and put horse on course of Doxycline and horse's problem cleared up.

[jmbnsyd]

I just had the vet out again (2 weeks after the colic episode) to pull blood. The results came back and his biliruben level is still high at 5.6 (it was 11.2 when he left NBC). So it has come down, but still in the higher then normal range. His ASP was low also, vet thought this was because he has lost weight.

The plan is to wait another two weeks and re-check blood...if levels haven't returned to normal then vet recommends going back to NBC to discuss liver problems.

I am trying to do a bunch of research but can't seem to find much on the biliruben levels. Anyone know what the normal number is? I forgot to ask my vet that...I'd like to know what the goal is.

Horse is doing good, eating plenty of hay and drinking great. Not as into his grain/beet pulp as he was before, so we have started him on UG as we feel he is a good candidate for ulcers (may be what caused the mild colic).

What a mess, it's hard when you think you have a healthy happy horse but the blood, internal stuff says different.

[McVillesMom]

I was just thinking about this thread yesterday, since we had the lecture on equine liver disease and I talked to Dr. Kohn about some of the things we had talked about on this thread. I'm glad to hear your horse is feeling OK!

The hyperbilirubinemia that horses get from fasting can be high enough to cause visible jaundice, but it usually comes back down within a few days of when they start eating again, so it sounds like you do have something else going on. :( The normal reference range will vary with the laboratory, but the Ohio State lab's reference range is 0.6-1.8 mg/dL.

To answer DW's question - horses do not get Gilbert's syndrome, but Southdown sheep do! Dr. Kohn was nice enough to research it for me and printed off several articles, which I hope to find time to read this weekend. :)

[jmbnsyd]

Thanks for the info on the normal range. Gosh, he still has a ways to go!

I guess I'll just cross my fingers and wait till re recheck his blood. It's frustrating because when at NBC we did a full liver work up and everything came back normal, the only thing that has us puzzeled is the biliruben levels.