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:horse:CHRONIC ACTIVE HEPATITIS IN HORSE:horse: :racehorse: a descriptive…
:horse:
CHRONIC ACTIVE HEPATITIS IN HORSE
:horse:
:racehorse: a descriptive term for a group of conditions characterized by active, progressive, inflammatory liver disease of long duration
Epidemiology
:hospital:
Exact etiology is unknown / idiopathic
might be due to :
autoimmune diseases
hypersensitivity reactions
chronic cholangitis
infection
toxic processes
:thermometer::
Clinical Signs
Icterus, diarrhea, photosensitization, and hemorrhage
Intermittent / persistent pyrexia
Recent / concurrent abdominal diseases
Depression, weight loss, anorexia, and lethargy
Moist, exfoliative coronary dermatitis
Hepatic encephalopathy
Behavior change, lethargy, ataxia, head pressing, circling, yawning, dysphagia, seizures, coma
Ascites
:memo:
Differential Diagnosis
Cholangiohepatitis
Amyloidosis
Theiler's disease
Biliary obstruction secondary to colon displacement
Toxic hepatopathy
Hepatic neoplasia
Cholelithiasis
Tyzzer's disease
Control and Treatment
:pill:
Supportive care - fluid therapy with potassium chloride, glucose, and vitamin supplementation
Dietary management - low protein, high branched-chain amino acids and carbohydrates
Prevention of exposure to the sun if photodermatitis is present
In cases of immune etiology (with lymphocytic-plasmacytic infiltrate predominates) :
Corticosteroid therapy
:white_small_square:to enhance appetite, stabilize cell membranes, and reduce inflammation and connective tissue formation
Initial administration of dexamethasone (0.05–0.1 mg/kg/day PO) for 7 days, followed by a gradual reduction in dosage over 30 days
Prednisolone (1 mg/kg/day, PO) may be required for additional several weeks
In cases of septic cholangiohepatitis (with neutrophilic infiltrate predominates) :
Broad-spectrum antimicrobial therapy
Potassium benzylpenicillin (22,000–44,000 IU/kg IV q.i.d.) and gentamicin (6.6 mg/kg IV s.i.d.) for several weeks to months
Ideally, antimicrobial therapy should be based on bacterial culture and sensitivity from the biopsy specimen
:microscope:
Diagnosis
Liver ultrasonography
safe, non-invasive
able to measure liver size, position, masses or fat, dilated ducts, parenchymal pattern or stones
Increased echogenicity in the liver - indicative of hepatic fibrosis
Liver biopsy :
with ultrasound guided
tissue can be used for bacterial culture, isolation and identification
tissue can be used for toxicology screening
precaution if suspected peritonitis, hemorrhage, pneumothorax
Presence of periportal hepatocellular degeneration or necrosis - causing bridging necrosis, leading to fibrosis and cirrhosis
Inflammatory cell infiltrate (indicate the nature of the primary disease process)
:white_small_square:mononuclear cells, lymphocytes and plasma cells
:white_small_square:neutrophils with bacteria
Biliary hyperplasia
Haematology, Liver enzymes (serum biochemistry), Urinalysis
Decreased albumin (hypoalbuminemia)
General elevation of total plasma protein
Elevation of serum bilirubin and serum bile acids
Elevation of liver-derived serum enzyme activities (GGT and AP)
Leukocytosis, neutrophilia, monocytosis
Presence of bilirubin in urine (bilirubinuria)
Pathophysiology
:syringe:
Autoimmune diseases
Infiltration of lymphocytes and plasma cells
Body's immune system attack liver cells
Chronic active hepatitis
Inability to conjugate bilirubin
Icterus
Hepatocellular degeneration
Fibrosis
Cirrhosis
Prevents normal conjugation of
phylloerythrin and excretion
Photosensitization
Failure to detoxify
Hepatic encephalopathy
Failure to anabolize amino acids and protein
Fall in plasma protein
Oedema/Ascites
Cholangitis
Bile, bacteria and toxic wastes build up,
causing damage to liver tissue
Infiltration of neutrophils in response to inflammatory reactions
Cholangiohepatitis