A 4-year-old MN Maltese dog was presented for a dental procedure. On physical examination, tachycardia, normal thoracic auscultation, and a normally palpated abdomen were present. CBC showed lymphopenia and monocytosis, whereas, on blood chemistry, hypoalbuminemia, hyperglobulinemia low Albumin/Globulin ratio, hyperbilirubinemia, elevated ALT and elevated AST activity, and hypocholesterolemia were evident. Both markedly elevated pre-prandial and markedly elevated post-prandial bile acids were seen.
A 4-year-old MN Maltese dog was presented for a dental procedure. On physical examination, tachycardia, normal thoracic auscultation, and a normally palpated abdomen were present. CBC showed lymphopenia and monocytosis, whereas, on blood chemistry, hypoalbuminemia, hyperglobulinemia low Albumin/Globulin ratio, hyperbilirubinemia, elevated ALT and elevated AST activity, and hypocholesterolemia were evident. Both markedly elevated pre-prandial and markedly elevated post-prandial bile acids were seen.
Case Study
Gastric portocaval shunt and microvascular dysplasia (MVD) in a 4 year old MN Maltese dog
DX
Sonographic Differential Diagnosis
Portocaval shunt likely left gastrocaval shunt, possible concurrent left portal vein hypoplasia. Guarded prognosis.
Image Interpretation
The liver in this patient was significantly subnormal in size with an excessive amount of gallbladder debris with early non shadowing concretions, none of which were obstructive. The liver appeared coarse, consistent with degenerative disease, and was also hypovascular. The left branch of the portal vein was subnormal in size at 0.22cm and the left liver was subnormal in size. If liver biopsy is to be performed, left medial lobe should be sampled in order to rule out concurrent portal vein hypoplasia, primarily suspected of the left branch. The right branch of the portal vein was approximately 0.55cm in width. The residual portal vein itself was 0.4cm. The caudal vena cava in this region was 0.9cm and the aorta 0.6cm. A 0.6cm portocaval shunt was noted likely gastrocaval with a large looping aberrant vessel prior to the portal hilus. This should be amenable to ameroid constrictor therapy.
Outcome
Shunt closure with an ameroid constrictor was recommended. Prior to surgery, the patient was treated with lactulose, L/D diet, and metronidazole. Patient subsequently underwent surgery at a referral facility to repair a large left gastric portosystemic shunt, and have a dental scaling with extractions. Recovery from anesthesia and surgery was uneventful. Low protein diet was continued and on follow up bile acids profile one month later, both pre-and post-prandial BA had completely normalized.
Clinical Differential Diagnosis
Liver pathology: Chronic liver disease, chronic-active liver disease, portocaval shunt, micro-vascular dysplasia.
Sampling
Full-thickness surgical liver biopsy showed hepatic microvascular dysplasia.
Video
Patient Information
Exam Finding
- Tachycardia
Images
Blood Chemistry
- Albumin, Low
- Albumin/Globulin Ratio, Low
- ALT (SGPT), High
- AST (SGOT), High
- Cholesterol, Low
- Globulin, High
- Post-Prandial Bile Acids, High
- Pre-Prandial Bile Acids, High
- Total Bilirubin, High
CBC
- Lymphocytes, Low
- Monocytes, High