Hepatic encephalopathy in a pregnant mare: identification of histopathological changes in the brain of a mare and fetus.
An 11-year-old Thoroughbred broodmare was evaluated for suspected hepatic dysfunction. Clinical signs of hepatic encephalopathy were evident at admission. Hepatic ultrasonographic evaluation revealed an increase in hepatic size, rounded borders and normal echogenicity. There was no evidence of cholelithiasis or bile duct distention. Increased activity of hepatic enzymes, increased bile acid and bilirubin concentration and an increased ammonia concentration were supportive of a diagnosis of hepatic disease and hepatic encephalopathy. Histopathological evaluation of a liver biopsy specimen was consistent with chronic active hepatitis. The mare was treated with intravenous fluids and antimicrobials, pentoxyfilline, branched-chain amino acids and dietary manipulation. Clinical improvement was observed initially; however, 3 weeks later, deterioration in the mare's condition necessitated euthanasia. Pathological lesions at necropsy were restricted to the liver and brain. The liver was diffusely firm with a prominent reticular pattern on the cut surface. A large choledocholith was present in the main bile duct of the left liver lobe. Histopathological examination of the liver revealed severe fibrosis, with hyperplastic bile ducts and mononuclear and neutrophilic inflammation. Pathological changes consistent with hepatic encephalopathy, (Alzheimer type II cells), were evident in the cerebrum of both the mare and the fetus.
Johns
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Department of Clinical Studies, University of Pennsylvania, Kennett Square, PA, USA. imogen@vet.upenn.edu
Del Piero
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Wilkins
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D000818:Animals; D001921:Brain / Q000473:pathology; D003937:Diagnosis, Differential; D017809:Fatal Outcome; D005260:Female; D006501:Hepatic Encephalopathy / Q000150:complications / Q000473:pathology / Q000662:veterinary*; D006520:Hepatitis, Animal / Q000150:complications / Q000175:diagnosis / Q000473:pathology; D006734:Horse Diseases / Q000175:diagnosis / Q000473:pathology*; D006736:Horses; D008099:Liver / Q000473:pathology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000473:pathology / Q000662:veterinary*