– 6 year old FS Jack Russel cross shelter dog presented for a dental procedure
– pre-op bloodwork mild elevation in ALT, pre-post bile acids elevated; pet is asymptomatic
– u/s showed a slightly smaller liver than normal; normal kidneys and urinary bladder
– PV is small compared to the aorta
– CVC velocity is increased in area that I am suspicious of a shunt
What do you think?
– 6 year old FS Jack Russel cross shelter dog presented for a dental procedure
– pre-op bloodwork mild elevation in ALT, pre-post bile acids elevated; pet is asymptomatic
– u/s showed a slightly smaller liver than normal; normal kidneys and urinary bladder
– PV is small compared to the aorta
– CVC velocity is increased in area that I am suspicious of a shunt
What do you think?
Comments
Excellent views of
Excellent views of splenocaval shunt JP! When you make your report be sure to include the pv cvc ao diameters prior to the shunt and those after the shunt to demonstrate the portal flow differential. Then whoever reads the report will not contest your findings. Also the max diameter of the shunt is important for the surgeon to place the ameroid.
Excellent views of
Excellent views of splenocaval shunt JP! When you make your report be sure to include the pv cvc ao diameters prior to the shunt and those after the shunt to demonstrate the portal flow differential. Then whoever reads the report will not contest your findings. Also the max diameter of the shunt is important for the surgeon to place the ameroid.
Yeh! I think I have enough
Yeh! I think I have enough images to do those recommended measurements.
Unless we can find a super cheap surgeon, this dog will unlikely go to surgery for the shunt repair. She is clinically well and has bad dental disease, so for QOL isssues, I think we need to get her dental disease dealt with. Should I start medical management now?
Yeh! I think I have enough
Yeh! I think I have enough images to do those recommended measurements.
Unless we can find a super cheap surgeon, this dog will unlikely go to surgery for the shunt repair. She is clinically well and has bad dental disease, so for QOL isssues, I think we need to get her dental disease dealt with. Should I start medical management now?
Yes medical for sure and
Yes medical for sure and for life… these dogs do not deal with acute phase disease well so have to keep him clean with everything heading upstream into the portal system. Here is my liver protocol based on latest info out of ecvim/acvim last few years for liver based elevated bile acids and can match the latter meds according to the pathology but the recs up to ursodiol are essential in this case:
Hepatic Support For Bile Acid Elevation +/- Hepatic Encephalopathy
Royal Canin Hepatic Support diet or Hills L/D, Metronidazole (7.5 mg/kg PO bid)over the next 14 days, Lactulose (Oral: 3.1-3.7 g/5 ml lactulose in a syrup base) long term to target 2-3 soft stools/day, with a high quality protein supplement of minor amount of yogurt or cheddar cheese. Monitor bile acids, with attention paid to dropping albumin, BUN or cholesterol. SAMe and neutraceuticals as needed. Urosodiol (10-15 mg/kg p.o.q24h) can be considered as hepatoprotectant and to enhance bile flow. Zinc serum level keep between 200—500 ug/dl. If deficient then tx zinc acetate 1-3 mg/kg/day. Gi protect if anorexic
Yes medical for sure and
Yes medical for sure and for life… these dogs do not deal with acute phase disease well so have to keep him clean with everything heading upstream into the portal system. Here is my liver protocol based on latest info out of ecvim/acvim last few years for liver based elevated bile acids and can match the latter meds according to the pathology but the recs up to ursodiol are essential in this case:
Hepatic Support For Bile Acid Elevation +/- Hepatic Encephalopathy
Royal Canin Hepatic Support diet or Hills L/D, Metronidazole (7.5 mg/kg PO bid)over the next 14 days, Lactulose (Oral: 3.1-3.7 g/5 ml lactulose in a syrup base) long term to target 2-3 soft stools/day, with a high quality protein supplement of minor amount of yogurt or cheddar cheese. Monitor bile acids, with attention paid to dropping albumin, BUN or cholesterol. SAMe and neutraceuticals as needed. Urosodiol (10-15 mg/kg p.o.q24h) can be considered as hepatoprotectant and to enhance bile flow. Zinc serum level keep between 200—500 ug/dl. If deficient then tx zinc acetate 1-3 mg/kg/day. Gi protect if anorexic
Great post JP!
Great post JP!
Great post JP!
Great post JP!