The urinary bladder was mildly thickened with a mild amount of slightly shadowing echogenic debris and sand consistent with ammonium biurate calculi that was previously found in recent surgery. The kidneys presented mildly swollen contour with corticomedullary calculi and mild to moderate diffuse interstitial changes for this age of the patient. No obstruction was noted at this time. The liver was mildly subnormal in size with no significant parenchymal changes from a sonographic perspective. However a Portosystemic shunt was noted at the level of the pancreatic duodenal vein at the portal hilus just prior to the entrance of the portal vein in which a small vessel deriving from the portal vein measuring 0.25cm expanded to a maximum width of 0.5cm just caudal to the pylorus and looping ventrally and then dorsally with tortuous contour passing through the diaphragm at the level of the esophagus and continuing into the azygos vein. This is most consistent with a gastro azygos shunt though not a large one. The right medial and left lobes of the liver were atrophied.