Is there an extra-hepatic shunt? Is there an abnormal vessel caudal to the spleen?
– 11 yo F/S Shepherd mix, 52# with chronic elevation of liver enzymes and intermittent Vomiting/diarrhea for years. Responds to metro/cerenia/probiotics.
– Last bloodwork in April 2020: ALT 875, ALP 959, GGT 34, Bil 0.3>0.1, no BA done. Lymphopenia 758, u/a WNL SG 10.14, T4 WNL.
– Hx of hair loss on tail and head.
– On Proin for years (post spay).
– Poor body condition, BSC 4/9, ribs showing. Good appetite.
Is there an extra-hepatic shunt? Is there an abnormal vessel caudal to the spleen?
– 11 yo F/S Shepherd mix, 52# with chronic elevation of liver enzymes and intermittent Vomiting/diarrhea for years. Responds to metro/cerenia/probiotics.
– Last bloodwork in April 2020: ALT 875, ALP 959, GGT 34, Bil 0.3>0.1, no BA done. Lymphopenia 758, u/a WNL SG 10.14, T4 WNL.
– Hx of hair loss on tail and head.
– On Proin for years (post spay).
– Poor body condition, BSC 4/9, ribs showing. Good appetite.
– U/S: super small liver (PSS vs portal vein hypoplasia vs microvascular displasia vs fibrosis), midly hyperechoic, poor vasculature. PV/Ao 0.68, grey zone. Sludge+++ in GB. Normal kidneys and bladder. Normal SI and right pancreas.
– Question: is this an abnormal vessel near the portal vein caudal to the spleen or just a normal vein? I know shunts are “Blue and squiggly” but I always have a tough time finding them! I included the Doppler signature of the 3 vessels.
– Or can we have EPI with a normal R pancreas and can EPI cause a small liver?
Thank you!
Julie
Comments
Your images are too far
Your images are too far caudal in the mesenteric vasculature to assess shunting.
You need to move cranially to positions sdep 13 and 14 to get the pv cvc ao ratio and follow the pv to the branching.
an 11 year old GSD more likely is dealing with chronic hepatitis and maybe seconday shunting as opposed to a primary shunt but i have seen 10-11 yr old primary shunts twice in my career but not the norm.
Intercostal views sdep 9/10 and 12/13 should help with small livers especially position 10 and 12.
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Thanks Eric! Yes, a primary
Thanks Eric! Yes, a primary shunt on a old dog would be weird! I wanted to make sure the vessel I imaged was nothing significant.
My intercostal views were not great, I could barely see my vessels to measure them. I am planning on getting the shunt hunt material.
Clinically, the dog looks like EPI, skin and bones (for years!). I couldn’t find much info on EPI pancreas on ultrasound. Any input? I recommended a TLI test.
Julie