Liver Biopsy

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dozzie

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How painful is a liver biopsy for a horse?

What does the vet actually do?

How long does it take to get the results back?

Might have to consider it for my old chap.
 
From what I understand, a liver biopsy is quite invasive. Done at home under a local, they take the biopsy through a cut in the skin and draw directly from the liver. One of my horses was showing ESPM symptoms and the livery biopsy was the only way to diagnose for sure (I think), but I decided not to have it done.

Box of Frogs may have more info on this as she was considering it for her rescue mare, Angel who had up to 70% liver damage from St Johns/Ragwort poisoning. Again, she decided against it due to its invasiveness.
 
I believe the area is numbed with an injection of local anaesthetic and the horse is lightly sedated. An incision is made in the appropriate area and a sample is taken.
 
It's a relatively safe procedure that can provide a huge amount of information. It's done under sedation and local anaesthetic and is best done under ultrasound guidance - I would insist on this if it were my horse.

The major risk is bleeding, but a few simple tests to check clotting before hand can minimise the risk of this.

A thick springloaded needle is used to collect a sliver of liver and this is then sent away for histology. The results take about a week.
 
My vet was going to consider this when Cairo was ill, but they would only do it in hospital as it can have a risk of infection, but I know some vets will do it on the yard.

Friend had this done on hers and I am sure he was back in work fairly soon, again pretty sure her one was done at a hospital and involved a local. Results were back in a couple of days.
 
Hi DM. I think the actual biopsy isn't any more painful than any other relatively minor surgical procedure. As GG says, the horse is standing sedated and the skin around the incision is numbed. I also understand, as GG says, that inspecting the biopsied liver tissue itself - rather than looking at the blood biochemistry which is a RESULT of how well (or not) the liver is functioning - gives the vets a much clearer idea of the details of what is going on.

However, be aware that one effect of a damaged liver is poor blood clotting. My horse Angel had a "liver flush" where a vast bag of minerals/vits was dripped directly into a vein in her neck through a small surgical incision. The process took about 2 hours and was relatively uneventful until we withdrew the needle. It then took a further 3 hours for the wound to stop bleeding and was scary. There is also the possibility of infection.

However, what really decided me against Angel having a liver biopsy was Professor Knottenbelt of Liverpool University. He is a world expert on liver disease in horses. He very wisely asked me to consider what difference knowing the results of a biopsy would make. We already knew Angel had severe liver damage and that it was caused by ragwort poisoning. If she was a human, she would be on a list for a liver transplant but this can't happen for horses. I already knew how to support what remained of her liver function. So what good would knowing more detail of the damage do? It wouldn't change a thing. He said you will know without a biopsy if your horse is unable to cope any longer or if she is doing ok. So what's the point of an expensive, invasive and potentially dangerous biopsy??? I thought this over carefully and can see that he is exactly right. For Angel, it would have had no impact whatsoever on how she was supported or managed. And whatever it had showed, I still wouldn't have had her pts as long as she was content, eating, and showing none of the signs of end-stage liver damage that would have meant it was time to call it a day. So I decided not to have it done. Angel still has a badly damaged liver but she has enough remaining function to allow her to live a relatively normal life with the right diet and support. I will know if that ever changes.

I have no idea if this helps at all DM but it was such wise counsel from such a knowledgeable expert that it helped me make what I believe was absolutely the right decision for Angel. Got everything crossed for you. Let me know if I can do anything xxx
 
Thank you BOF. That is so clear. I dont think there is much point in performing a biopsy from what you say on 32 year old. He seemed to be putting weight on but two days ago I thought he was looking thin again but it may have been the way he was standing.

I wasnt sure what the procedure involved tbh but having read these replies, I dont want to put an old horse through a risky and expensive procedure. It also sounds as if the proceudure would be very stressful for him which he doesnt need. I have already said no to steroids so now I will say no to a biopsy and just continue to treat the symptoms for as long as I feel he is coping. It is just frustrating not knowing what is causing the problem.
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Oh DM. So sad for you. But I think you're right. Just keep loving him and supporting whatever remains of his liver function and letting him do lots of whatever makes him happy. Then when he lets you know he's too tired to go on and needs a long, long sleep, stay with him and hold his head and with every ounce of love in your heart, give him a peaceful and dignified end xxxxx
 
a liver biopsey is not painfull some times it is very usfull other times it is not coz if they draw out the bit of healthy liver that is left you have to do it again and again until they get the damaged bit to do there searches on i know this due to i was offered this to my mare with liver diease witch so sadly i had o put to sleep 2 months ago!
 
Hi my horse has LD and my vet has suggested giving him a steroid inj on tues - can you give me any info on steroids - you say you refused it - can you explain the pros and cons or why you decided not to have it - i am wondering if i should say no to the injection ?

thanks
 
I refused because of his age and the high likelihood of some degree of Cushings which can predispose them to laminitis. He has had mild laminitis in the last few years which was not weight related so therefore I was not willing to risk the steroids as a side effect can be serious laminitis. I am not about extending his life but I am about making his last years as comfortable for him as possible. He is 32!
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I dont want him to be in pain due to lammi on top of everything else. If he was ten years younger I would have considered it.
 
DM - you're so right about extending life. My lovely small animal vet put it exactly right when I was struggling to help Spencer, my moggie, through a critical illness. She said it's not about adding QUANTITY of years but QUALITY of years. xxx
 
Thanks all for response - my horse is only 6 and has never had laminitis - also just to let anyone else know my horse had a biopsy and was absolutely fine afterwards he had it done at my vets under sedation guided by ultrasound - one small staple in the incision which healed fine.
 
hi it would not of been the biopisy thatmade it better. some poeople choice for them and a lot dont if your granteeded 1oo% sound advice i think everyone would it it but when its is less coz of them getting a good piece of liver over a bad piece that what makes every one thinl is it worth it that includes me. to steriods i would say no but what do they want to give them for? do you know?
 
sorry probably did not make my self clear - i just meant that the biopsy itself did not seem to cause him any problem - it cant help the condition but as my vet said it can help with the prognosis - i have decided against steroids for now - vet said they would help if he was not eating well as it helps them feel better and more like eating but my boy is eating ok and looks well covered at the moment. my vet said it doesn't matter which part of the liver they get in the actual biopsy as any part will show up any damaged cells. trouble is like you say you get different versions from different vets.
 
Both of my horses are due to have liver biopsies tomorrow, what do I expect? We have taken this option as two months ago when my mare had colic and we discovered she had an odd result when blood tests were run. A couple of weeks after this, the vets tested both of my horses and they both had an odd blood result. We decided to have the other horse kept in our field tested and he also had a strange result, they have been on antibiotics for three weeks and my two horses' results had changed dramatically. Originally we had a result of about 800 on one of the tests when it was meant to be about 200. If one of our horses' result had gone up, the other had come down. Our vet didn't understand it and neither did the veterinary practice where we sent our results to for a second opinion. My gelding is a 16.1hh Welsh D 5yo who is as full of himself as always and is loving work still! My other horse is a 13.2hh 11yo NF mare who seems a little quieter than usual but still relatively bright. I have a XC lesson booked on Sunday for my 5yo and I was wondering whether I'd still be able to take him after the biopsy? I will put my horse's health first no matter what! I don't know what to expect and I am really worried about it and I'm not sure whether I can face being there incase something goes wrong as I can't imagine life without them! Any help or advice please? :( x
 
My mare had a liver biopsy (at home) about a year ago. She was sedated and a small area on her off side clipped and thoroughly cleaned.
The vet used an ultrasound to pick the best place to biopsy. The area was numbed and a long hollow spring loaded needle used to take 2 samples of liver.
Can't say it bled at all really. The incision is really small and didn't even need a staple to close it. She did have a sticky plaster tho!
I think vet said she was ok to work afterwards but to avoid getting too sweaty. I gave her a few days off to make sure the cut healed well.
I think results were back after about a week.
Who is doing your biopsy? I had Tim Brazil and he was excellent.
I opted for a biopsy because her enzymes had been going down then spiked again and we wanted to get to the bottom of why.
As it was it told us that there was no irreversible damage and that it wasn't caused by ragwort.
It couldn't tell us what did cause the problem. My girl was on prednisilone (sp) steroid tablets for a month and after that her enzymes got back to normal.
Our best guess as to the cause was a virus.
 
I had five horses go down with liver disease as yours have Beth. All were biopsied twice, light sedation, ultrasound and needle to take liver sample from two places. They showed firstly very high iron which would never have been found without biopsy, also major inflammation. A year later we have found the land is somehow causing it. All much improved when moved. After thousands of pounds worth of drugs!
 
My horse's bloods showed LD. Another blood test will show if there has been any change and I must admit I am thinking against a biopsy. But while I wait I have been looking into the apparent increase in equine liver disease. A simple search on this forum will show so many posts lately concerning this. I have access to a number of veterinary research sites and have come to the conclusion that, although yet to be confirmed, a great many may be caused by the toxins in the pasture, hay or feedstuffs. Since my horse has had companion grazers who appear to be unaffected I don't think my pasture is to blame. But the hay and feed is a possibility. Manufacturers crow about dust free, or mould free but that doesn't mean anything is free of the toxins that were a result of the original initial fungal/moulds. Killing the moulds doesn't affect the mycotoxins, and very worryingly one research paper suggests that mycotoxins can even be metabolised from the destroyed moulds. Eating mycotoxins from contaminated feed ingredients such as concentrates, or from hay or from contaminated pasture will lead to liver damage and it seems the only way to help a horse is to feed a mycotoxin binder, which I am now doing. Its about time the feed industries woke up to this I think. They know that there is a huge problem in the feeds of cattle, pigs, sheep and poulty as it causes liver damage, skin problems, low milk yield, and reproductive problems. Farmers are, for the most part, advised to feed a mycotoxin binder. The testing is difficult as there are a great many different mycotoxins and the testing methods slow and costly but advances in testing procedures are occuring all the time.
Ragwort poisoning used to be the obvious cause but is seldom seen nowadays. And although infections are a cause it can't be that so many 'mild' LD cases are coming from this can it?
 
HappyHooves said:
My horse's bloods showed LD. Another blood test will show if there has been any change and I must admit I am thinking against a biopsy. But while I wait I have been looking into the apparent increase in equine liver disease. A simple search on this forum will show so many posts lately concerning this. I have access to a number of veterinary research sites and have come to the conclusion that, although yet to be confirmed, a great many may be caused by the toxins in the pasture, hay or feedstuffs. Since my horse has had companion grazers who appear to be unaffected I don't think my pasture is to blame. But the hay and feed is a possibility. Manufacturers crow about dust free, or mould free but that doesn't mean anything is free of the toxins that were a result of the original initial fungal/moulds. Killing the moulds doesn't affect the mycotoxins, and very worryingly one research paper suggests that mycotoxins can even be metabolised from the destroyed moulds. Eating mycotoxins from contaminated feed ingredients such as concentrates, or from hay or from contaminated pasture will lead to liver damage and it seems the only way to help a horse is to feed a mycotoxin binder, which I am now doing. Its about time the feed industries woke up to this I think. They know that there is a huge problem in the feeds of cattle, pigs, sheep and poulty as it causes liver damage, skin problems, low milk yield, and reproductive problems. Farmers are, for the most part, advised to feed a mycotoxin binder. The testing is difficult as there are a great many different mycotoxins and the testing methods slow and costly but advances in testing procedures are occuring all the time.
Ragwort poisoning used to be the obvious cause but is seldom seen nowadays. And although infections are a cause it can't be that so many 'mild' LD cases are coming from this can it?
Click to expand...

May i ask what you are feeding as a mycotoxin binder?
 
This is no advert! But there are very few about. I am using mycosorb which is made by Alltech. They have just produced another one called mycosorb A but I haven't found a suppplier for this. Alltech products tend to go to farm product distributors for use in cattle, for example, so come in bags of 25kg at an eye watering £250+ and since little is neded for each horse, would last longet than the shelf life. You can buy the ordinary mycosorb in smaller amounts through various suppliers. pm me for the cheapest I have found if you want.
The only other inorganic adsorber I have seen mentioned in research on mycotoxins in hay is zeolite. In the liquid form it has been the subject of a scam, and the powdered version is more expensive than the mycosorb. Other inorganic adsorbants are used in poultry farming but there is no research on use for horses. All binders are said to be most effective if applied at the time of feed production ( but no manufacturer does this?) but they can be added to a horse's daily feed.
 
HappyHooves said:
This is no advert! But there are very few about. I am using mycosorb which is made by Alltech. They have just produced another one called mycosorb A but I haven't found a suppplier for this. Alltech products tend to go to farm product distributors for use in cattle, for example, so come in bags of 25kg at an eye watering £250+ and since little is neded for each horse, would last longet than the shelf life. You can buy the ordinary mycosorb in smaller amounts through various suppliers. pm me for the cheapest I have found if you want.
The only other inorganic adsorber I have seen mentioned in research on mycotoxins in hay is zeolite. In the liquid form it has been the subject of a scam, and the powdered version is more expensive than the mycosorb. Other inorganic adsorbants are used in poultry farming but there is no research on use for horses. All binders are said to be most effective if applied at the time of feed production ( but no manufacturer does this?) but they can be added to a horse's daily feed.
Click to expand...

Thanks Happyhooves, i have seen the online. The only thing that worried me was it needed to be added to steamed hay? do you do this or add into a hard feed?:confused:
 
The hay steamer companies say to sprinkle it onto the hay prior to steaming. OK that gets rid of toxins in the hay but what about the feeds? Yep, I add a little to each feed.
 
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