12 yr old MN Golden retriever with up and down weight loss/poor appetite requiring homemade diet. Proteinuria and hypertension treated with benazapril. Two previous ultrasounds have shown a stable hyperechoic nodules dorso-lateral to the cystic duct, otherwise unremarkable liver. ALP was in 300’s initially, blood work and UA/UPC has not been repeated in last few months. Chest rads clear. Additional IM recommendations have been to pursue NuQ or similar testing, bile acids to evaluate liver function (owner not interested in bx). Concerned he may be developing a liver shunt (not seen prev)
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Not seeing any obvious tortious vessels on these clips and generally acquired shunts tend to be multiple rather than single ones. Would recommend bile acids as well as an echo to rule out any possible right heart/pericardial pathology.
lots of dropout and dark image owing to lack of acoustic penetration and large overweight dog. There is plenty of good looking liver there to maintain function so i doubt the liver function is an issue unless an acute insult occurs and is not typical of a shunt liver. 99% of shunt dogs would have shown signs well before 12 years as well so i dont think shunting is a player here.