Weight loss: Case discussions (Proceedings)

Case 1: Recurrent colic and weight loss

A 5-year-old Oldenburg gelding used for dressage, was presented for evaluation of mild bouts of recurrent colic, more frequent over the past month. The colic signs included flank watching and intermittent sternal recumbency and were either self-limiting or responsive to a single dose of Banamine. Additional history included that the gelding was sometimes slow to finish its grain and moderate weight loss had developed over the past 3 months. Evaluation by the referring veterinarian included unremarkable physical exam findings on several occasions and results of a complete blood count and serum chemistry profile were normal. A fecal exam for parasites was negative.

The gelding was referred for further diagnostic evaluation including gastroscopy and abdominal ultrasonography. The latter exam had normal findings while gastroscopy revealed several mild erosions above the margo plicatus. Treatment with GastroGard was pursued for 4 weeks with little improvement observed.

About 4 months later, the horse developed an acute abdominal crisis with abdominal distension and gas distension of the large colon was found on rectal examination. Passage of a nasogastric tube recovered 12 liters of serosanguinous gastric fluid and fluid collected via abdominocentesis appeared grossly normal. The horse continued to show moderate colic signs despite administration of multiple analgesic medications and, consequently, was referred for further diagnostic evaluation.

At presentation, the gelding was dull but not showing signs of colic pain. Rectal temperature was normal, heart rate was 50/min, and oral membranes were mildly toxic. Rectal palpation revealed several loops of mildly distended small intestine and gas distension of the cecum. Passage of a nasogastric tube recovered 13 liters of serosanguinous reflux and abdominocentesis recovered a grossly normal looking peritoneal fluid. The following images were observed via abdominal ultrasonography of the inguinal region:

Case 2: Recurrent colic, weight loss, decreased appetite, and intermittent fever

A 12-year-old Thoroughbred hunter-jumper gelding, was presented for evaluation of a decreased appetite and intermittent mild fever over the past week. The gelding had been purchased about 1 year previously and had been in somewhat poor body condition at that time but had gained weight with the current owner. Two mild colic bouts that resolved with a single dose of Banamine had also been observed over the past 6 months.

During the past week the gelding had been treated with oxytetracycline and Banamine for suspected Potomac Horse Fever but a lack of expected improvement prompted submission of blood samples that revealed elevated liver enzyme activities (AST 545 IU/L and GGT 111 IU/L), prompting referral for further evaluation

At presentation, the gelding was had normal vital parameters but was mildly dull and dehydrated. Rectal palpation was normal and abdominocentesis recovered normal looking peritoneal fluid. The following images were observed via abdominal ultrasonography:

The following image was observed via transabdominal ultrasonography:

Case 3: Weight loss and intermittent colic

A 12-year-old Quarter Horse mare was presented for evaluation of six bouts of mild colic over the past 60 days. The first bout of colic developed about 2 weeks after the mare had been treated with phenylbutazone (2 g PO q 12 h for 5 d followed by 2 g PO q 24 h for an additional 10 d) for a lameness problem. Each colic bout was mild and responded to hand walking and a single dose of Banamine. Examination by the referring veterinarian revealed normal vital parameters on several occasions and rectal palpation during the colic episodes was unremarkable, although feces were mildly soft (cowpie consistency). The mare was referred for further evaluation because the colic episodes were becoming more frequent over the past 2 weeks.

Left kidney:

At presentation, the mare was bright and alert but mildly thin (body condition score 4/9). Vital parameters were normal and rectal palpation was unremarkable. The lameness had resolved and no other physical abnormalities were detected. A complete blood count had results within reference ranges but a serum chemistry profile revealed hypoproteinemia (4.4 g/dl) and hypoalbuminemia (1.9 g/dl). The following images were observed via gastroscopy:

Right kidney:

Case 4: Weight loss, decreased appetite, and intermittent fever

An 11-year-old Standardbred stallion was presented at the end of the breeding season for evaluation of a 3 week history of a decreased appetite and intermittent mild fever, accompanied by weight loss. Additional history included that the stallion had sustained a wound over the left hock about a year ago and had been intermittently treated with antibiotics (penicillin G and gentocin) and phenylbutazone by the owner. The owner had again instituted treatment with these antibiotics and phenylbutazone over the past week but a lack of response prompted calling the referring veterinarian. Examination revealed that the horse was moderately dehydrated and blood work revealed marked azotemia (BUN 200 mg/dl ad Cr 14.9 mg/dl) and hypercalcemia (17.1 mg/dl). These findings prompted referral for further evaluation and treatment.

At presentation, the stallion was quiet and had normal vital parameters but dry oral membranes and cool extremities supported moderate to severe dehydration. Rectal palpation revealed bilateral enlargement of the ureters and a 1.5 cm firm mass was palpable in the distal left ureter (consistent with an ureterolith). A sample of urine collected from the bladder had a specific gravity of 1.012 and reagent strip analysis was ++ for pigment. The following images were observed via transabdominal ultrasonography: