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The history may include administration of an equine-derived biologic product, often four to six weeks prior to the onset of clinical signs.  They are generally sudden in onset and rapidly progressive.  
 
The history may include administration of an equine-derived biologic product, often four to six weeks prior to the onset of clinical signs.  They are generally sudden in onset and rapidly progressive.  
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Signs may range from mild lethargy or inappetance to signs of acute or chronic hepatic failure. They may be non-specific such as depression, anorexia or weight loss. Affected horses are often severely icteric and may pass dark urine due to the presence of bilirubin. Signs relating to hepatic encephalopathy may be present, such as head pressing, excitement, yawning or aimless wandering. The course of the disease is usually around five days, with death ususally occuring within ten days.  
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Signs may range from mild lethargy or inappetance to signs of acute or chronic hepatic failure. They may be non-specific such as depression, anorexia or weight loss. Affected horses are often severely icteric and may pass dark urine due to the presence of bilirubin. Signs relating to hepatic encephalopathy may be present, such as head pressing, apparent blindness, yawning or aimless wandering. The course of the disease is usually around five days, with death ususally occuring within ten days.  
    
Mild forms of the disease have also been reported, characterised by a mild malaise and increased serum hepatic enzyme concentrations.  
 
Mild forms of the disease have also been reported, characterised by a mild malaise and increased serum hepatic enzyme concentrations.  
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==Diagnosis==
 
==Diagnosis==
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Diagnosis of ESH and evaluation of hepatic function may be achieved using three types of diagnostic test. Serum biochemistry may indicate the following abnormalities:
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* Increased conjugated and unconjugated bilirubin
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* Increased liver enzymes- SDH, AST, GGT and ALP
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* Hypoglycaemia
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* Reduced urea
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* Bilirubinuria
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In several studies, biopsy is considered as the ‘gold standard’ technique for hepatic disease diagnosis. Biopsy is usually performed on the right hand side, between the twelth and fourteenth intercostal spaces. A coagulation profile is often performed prior to performing the procedure.
     
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