Liver enzymes raised - Biopsy?

[Dunpony]

Bloods were run for my pony for something completely different but came back with raised GGT (387) and bile acids (high) - no other symptoms of liver problems. My vets have jumped straight to recommending a scan and biopsy.

I'm a bit bothered by the biopsy - I know they are generally safe but am wondering if the results will actually make any difference to the treatment?

I will talk to the vets but it's a hospital so different vets are treating him for different things and I get flustered speaking to people on the phone!

 

[criso]

I had one done but after 6 months of treatment and the levels not coming down. Most horses on the yard were affected. Mine had moderately raised enzymes 200 and bile acids normal so not as severe.

It wasn't conclusive in that it didn't give a reason, however it did rule some things out. Conclusions was it was something in the environment.

It didn't make any difference to the treatment which was liver tonics and milk thistle.

 

[ester]

I didn't have one done, horse was photosensitive, other horse on grazing ok (albeit mine had only been back there a couple of months). Over the 3 following times we tested bloods they did improve slowly but didn't reach perfect as such but no photosensitivity albeit we do take more precautions.
Never did come to any conclusions what triggered it as no problematic plants, hay all home made etc. Horse has remained on milk thistle since (3 years ago in october)

 

[Pearlsacarolsinger]

As I assume it requires a GA, I would be very wary of jumping into a biopsy straightaway. I would certainly want to speak to the vet hospital and ask about medical alternatives to surgery at this early stage.

 

[ester]

Standing sedation

 

[criso]

No GA required and reasonably straightforward. Tiny risk of bleeding or infection from where the needle goes in or missing the liver.

I got the sense from my vets, rvc so practice vet part of big teaching hospital, that they go for biopsy if the horse isn't responding and the levels aren't coming down enough.

Mine were going down slowly but then stopped improving and then went up slightly. It was discussed as an option but not essential however i was 9 months into an insurance claim so decided to go ahead while it was covered.

 

[Goldenstar]

Has the pony got cushings ?

 

[SEL]

I didn't biopsy just got her on liver tonics. Took 18 months and a yard move for them to get back to normal.
Most biopsies seem to come back as inconclusive when I asked around

 

[Meredith Brouillette]

I think the treatment is the same in any case, except in the case of the tumors which is pretty rare in horses.

 

[ester]

and fluke if there's been sheep.

I did want to add that my vet didn't actually suggest a biopsy so I wasn't activeley refusing one if that makes sense.

 

[doodle]

A long time ago but sultan became photosensitive. Bloods ran showed showed liver issue. Biopsy suggested. Can’t remember how old he was but late 20s. Treatment wouldn’t have changed so we didn’t do it. Had to keep fly chaps or mud chaps on his back white legs but that was it. He lived to be 38.

 

[missmatch]

My horse has had three liver biopsies. Each one showed worsening fibrosis plus regeneration. None gave a reason for why he had this although things like ragwort poisoning were ruled out. Put down to environmental issues, most likely from moulds and mycotoxins. Mycosorb A and milk thistle are now daily essentials
The biopsy and recovery were really straight forward all three times but I wouldn’t do another one as I don’t feel they offer any real benefit.

 

[Dunpony]

Has the pony got cushings ?

No, he was tested last year with low ACTH

 

[Dunpony]

Thanks everyone

I'll speak to the hospital as it sounds like a biopsy is jumping the gun a bit.

 

[ester]

I think without symptoms it would make sense to milk thistle it and then retest. Ours did go down pretty slowly. We have been careful to keep his nose covered since but vet always said that if he was photosensitive again it would probably still happen, covering or no covering.
Fwiw that was his only symptom, not lethargic, 25 but no cushings and still in work quite happily.

 

[little_critter]

Mine had a biopsy years ago. Standing sedation, very straight forward. It ruled out ragwort poisoning but otherwise didn’t add much to the diagnosis. We went for it because we had been treating with steroids for a few months, enzyme levels were gradually reducing, but then started rising again...cue the biopsy.
If in that position again I think I’d be asking what benefit the biopsy brings.

 

[Dunpony]

Thanks everyone. I've spoken to the head of internal medicine and as I've removed a potential cause (dusty hay) and started on milk thistle and Mycosorb she's happy to retest in a month and only biopsy if more aggressive treatment is indicated