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Hyperlipidemia and Hepatic Lipidosis - Coggle Diagram
Hyperlipidemia and Hepatic Lipidosis
risks?
species predisposed to excessive fat mobilization
mini-horses
donkeys
camelids
ponies
regular horses are lower risk
illness causing anorexia
dietary restriction
poor feed quality
increased E demands
late gestation
lactation
winter
obesity
insulin resistance
PPID
defintions
hyperlipidemia
mild to moderate elevations on serum triglycerides (100-500 mg/dL) (normal is <50)
hyperlipemia
massive fat mobilization (serum TG >500 mg/dL) leading to hepatic lipidosis and liver dysfunction
sustained leads to...
heaptic lipidosis
liver disease/dysfunction
pathogenesis
negative E balance
activation of hormone-sensitive lipase
converts fat in adipose tissue to NEFAs, glycol
taken up by liver
hepatic lipodosis when rate of hepatocyte accumulation of trigs exceeds rate of metabolism + VLDL export
VLDL exports from liver increase serum [TG]
lipid infiltration of kidneys causes by progressive renal dysfxn
azotemia
metabolic acidosis
ponies mobilize more than horses
unchecked lipolysis can be up to 40x higher than mornal
lipoprotein lipase activity cannot keep pace with the rate of FA mobilization
CS
non-specific
sick, sad patient
often obscured by primary disease process
anorexia
depression
weakness
colic
diarrhea
icterus
hepatic encepalopathy
diagnosis
white/yellow opaque plasma
TGs > 500mg/dL
NEFAs and VLDLs are also dramatically increased
if clinical/lab evidence of liver disease, suspect hepatic lipidosis
treatment
treat underlying disease causing anorexia
restoring a positive E balance
if severe,
hospitalize
enteral/pareneral nutritional support
IV fluids
correct e- and acid/base derangement
+/- heparin
helps to reduce [TG]
:warning:
alters coagulation
increaes risk of hemorrhage
contraindicated if concurrent coagulopathy!
analgesia
manage liver dysfxn
insulin
inhibits hormone sensitive lipase
stimulates lipoprotein lipase
aids in preventing hyperglycemia related to IV dextrose therapy in IR patients
prognosis
hperlipemia should resolve in approx 1 if they're going ot sruvive it
recommend enteral/parenteral feeding until voluntary feed intake is adequate
severe hyperlipemia + hepatic failure = poor prognosis
prevention
anticipate it in high risk species
prompt treatment of primary disease
ensure adequate nutritional support if off-feed
avoid crash diets