The medical approach to treatment of cholangiohepatitis and cholelithiasis in 9 horses is described. Seven horses were treated successfully and returned to normal use, with a minimum follow-up period of 12 months. Long-term antimicrobial therapy was believed to be critical in those cases that survived, with a median treatment duration of 51 days (range 17-124 days). Treatment failure was associated with severe periportal and bridging hepatic fibrosis from biopsy material obtained at admission in 2 horses, one of whom also presented with hyperammonaemic hepatic encephalopathy. Transabdominal ultrasound was used diagnostically in each case to obtain hepatic biopsy material for histopathology and bacterial culture, to evaluate hepatic size and echogenicity and to identify and monitor the dissolution of hepatoliths. Histologically, all horses had evidence of suppurative cholangiohepatitis with varying degrees of periportal and bridging fibrosis. Discrete hyperechoic calculi were identified in 4 cases, but all horses had ultrasonographic evidence of biliary obstruction with numerous dilated bile ducts. Aerobic and anaerobic cultures of liver biopsy material were negative from 7 horses, but 2 different species of Escherichia coli were obtained from one horse, and Bacteroides vulgatus and Escherichia coli were isolated from another. In all 7 horses that survived, clinical recovery was seen before normalisation of biochemical indices of hepatobiliary function including gammaglutamyl transaminopeptidase (GGT), alkaline phosphatase (AP), bile acids and serum bilirubin. Serum GGT levels were monitored extensively as a marker of hepatobiliary disease and actually increased during the initial period of clinical improvement in horses that recovered. Supportive medical therapy with i.v. fluids was also a critical part of the therapy of several cases in this report, both acutely and in the management of chronic cases that deteriorated clinically during treatment. Previous therapeutic failures may well be related to treatment periods of inadequate duration, and the authors recommend that antimicrobial therapy should be continued until GGT values are normal.

Medical treatment of cholangiohepatitis and cholelithiasis in mature horses: 9 cases (1991–1998)

A 4.0-kg cholelith was found within the abdominal cavity of a dead wild African elephant (Loxodonta africana) in Eritrea. Analysis of this cholelith by histochemistry, electron microscopy, electrospray mass spectroscopy, and energy-dispersive x-ray spectroscopy revealed it was composed of bile alcohols but no calcium, bilirubin, or cholesterol. Bacteria were also found in the cholelith. Similar, but smaller, bile stones have been identified previously in other wild African elephants and an excavated mammoth (Mammuthus columbi). Choleliths have been reported only once in a captive Asian elephant (Elephas maximus). Elephants, along with hyraxes (Procavia capensis) and manatees (Trichechus manatus), are unique among mammals in producing only bile alcohols and no bile acids, which may predispose them to cholelithiasis, particularly in association with bacterial infection. Dietary factors may also play an important role in cholelith formation.

The elephants of zoba gash barka, eritrea: part 4. cholelithiasis in a wild african elephant (loxodonta africana)

.... ............................................................................................................................. ii ACKNOWLEDGMENTS..................................................................................iv DEDICATION............................................................................................................................... v LIST OF TABLES ........................................................................................................................ x LIST OF FIGURES ..................................................................................................................... xi LIST OF ABBREVIATIONS ................................................................................................... xiii Chapter 1: GENERAL INTRODUCTION ............................................................................ 1 Chapter 2: LITERATURE REVIEW ..................................................................................... 3 2.1 The Basic Structure and Functions of the Liver and Its Role in Disease ......................... 3 2.2 Reaction Patterns of the Liver in Disease .................................................................................. 6 2.2.1 Hepatic inflammation ................................................................................................................................... 6 2.2.2 Hepatic fibrosis ............................................................................................................................................... 7 2.2.3 Hepatic regeneration .................................................................................................................................... 8 2.2.4 Biliary hyperplasia ...................................................................................................................................... 10 2.3 Metallothionein .................................................................................................................................11 2.3.

A Retrospective Study of Equine Liver Lesions in Western Canada and the Expression of Metallothionein by Immunohistochemistry

Secondary Biliary Hepatic Fibrosis Caused by Cholelithiasis in Two Horses

Diseases of the Hepatobiliary System

Hepatolithiasis in an Arabian mare.

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Hepatolithiasis in an Arabian mare.