Portosystemic shunt in an alpaca cria

A 5-month-old alpaca cria was examined for chronic poor growth and repeated episodes of diarrhea. Examination of feces for parasites yielded negative results. Serum bile acid and blood ammonia concentrations were high. Subsequent examination by ultrasonography, percutaneous splenic portography, and colonic scintigraphy did not reveal evidence of a portosystemic vascular anomaly. Exploratory celiotomy with mesenteric vein portography revealed a colonic vein shunt in the caudal portion of the abdomen from the caudal vena cava to the portal vein. The shunt vessel was ligated without incident. Following surgery, the cria began to gain weight and was more alert. Eighteen months after surgery, the cria was doing well, although it had loose feces and was slightly small for its age. Portosystemic shunts are rare in cattle and horses but should be considered in alpacas with chronic poor growth when parasitism has been ruled out.     

Clinical and diagnostic features of portosystemic shunt in a foal

Portosystemic shunt was diagnosed in a 6-month-old Quarter Horse filly with acute onset of apparent blindness and a 3-month history of depression, lethargy, and ataxia. Clinicopathologic test results indicated slightly high gamma-glutamyl transpeptidase activity and serum total bilirubin concentration. Sulfobromophthalein half time was prolonged, and plasma ammonia and serum bile acid concentrations were high as well. Histopathologic findings of percutaneous liver biopsy included widespread hepatocyte atrophy and numerous prominent small arterioles in the area of the portal triad. On the basis of history, clinical findings, and clinicopathologic abnormalities, a presumptive diagnosis of portosystemic vascular anomaly was made. To confirm the tentative diagnosis, nuclear hepatic scintigraphy and operative mesenteric portography were performed. Medical treatment was unsuccessful, and the foal was euthanatized. Portosystemic shunts have been described in dogs and cats, but few cases have been reported in large animal species. Other, more common causes of neurologic abnormalities in foals, such as trauma, vertebral body abscesses, brain abscesses, and meningitis, must be ruled out before portosystemic shunt is considered.     

Transvenous retrograde portography for identification and characterization of portosystemic shunts in dogs

Transvenous retrograde portography for identification and characterization of portosystemic shunts in dogs A method for transvenous retrograde portography (TRP) in dogs suspected to have a portosystemic shunt (PSS) and results in 20 dogs are described. For TRP, dogs were anesthetized and positioned in left lateral recumbency A dual-lumen balloon-tipped catheter was inserted into the right jugular vein and advanced into the azygos vein. The balloon was inflated to occlude the azygos vein, and contrast material was injected during fluoroscopic evaluation. The catheter was then positioned in the caudal vena cava just cranial to the diaphragm. The balloon was again inflated to occlude the vena cava, and contrast material was again injected. Once a shunt was identified, selective catheterization was attempted with a guide wire and angled catheter. A PSS was identified in 18 of the 20 dogs. In 10 of the 18, the shunt vessel could be selectively catheterized, allowing measurement of portal pressures while the shunt was occluded with the balloon. In 1 dog, results of TRP were normal, but subsequent exploratory celiotomy revealed a single extrahepatic PSS, which was surgically attenuated. The other dog in which results of TRP were normal did not have a macroscopic PSS. In dogs suspected to have a PSS, TRP may be a useful adjunctive diagnostic test that is less invasive than operative mesenteric vein portography and allows measurement of portal pressures before and after temporary shunt occlusion.     

The Diagnosis and Surgical Correction of Congenital Portosystemic Vascular Anomalies in Two Calves and Two Foals

Two calves and two foals presented with episodic clinical signs of diffuse central nervous system disease. Portosystemic anomalies were tentatively diagnosed based on the history, clinical signs, and increased serum concentrations of blood ammonia and total serum bile acids with normal concentrations of liver derived enzymes. One calf died before intraoperative contrast portography, whereas the other calf and both foals had marked clinical improvement after intensive medical therapy. Surgical correction was attempted in these three animals and was successful in one foal. A right paracostal celiotomy was superior to a ventral median approach for exposure to the portal vascular system and shunt access.     

ANGIOGRAPHY OF THE HEPATIC AND PORTAL VENOUS SYSTEM IN THE DOG AND CAT: AN INVESTIGATIVE METHOD*

The investigators studied the hepatic angiographic technics used in human medicine with respect to their applicability for the investigation of circulatory liver diseases in the dog and cat. The technics were performed in 11 normal dogs and 2 normal cats, and the normal radiographic anatomy of the hepatic portal system and its tributaries was described. The potential indications for the angiographic technics were defined and their respective advantages and disadvantages discussed. Splenoportography was a valuable method for outlining the intrahepatic portal vein branches and for percutaneous prehepatic portal vein pressure determination. Percutaneous transhepatic portography was more difficult to perform, but it provided better detail of the intrahepatic portal veins than splenoportography. Transjugular transhepatic portography was the most versatile but also the most cumbersome of all technics tested. Percutaneous kinetic hepatography proved impractical in dogs and cats. The mesenteric tributaries to the hepatic portal system were best outlined by cranial mesenteric arterial portography or by operative mesenteric venous portography. Operative mesenteric venous portography, in contrast to cranial mesenteric arterial portography, was also useful for prehe-patic portal vein pressure determination. Free and wedged hepatic venography provided an opportunity for the functional and morphologic investigation of the hepatic sinusoid circula-tion.     

A suspected case of ornithine transcarbamylase deficiency in a cat

An 18 month-old, intact female American Shorthair cat was presented for evaluation of stunted growth and postprandial depression. Fasting serum ammonia and serum bile acid concentrations were above reference ranges at 396 microg/dl and 6.5 micromol/ l and their postprandial concentrations were 785 microg/dl and 9.5 micromol/l, respectively. The initial tentative diagnosis of a portosystemic shunt was excluded by mesenteric portography and histopathology of the liver. The cat was then suspected of a urea cycle enzyme deficiency and its urine was analyzed by gas chromatography-mass spectrometry. A presumptive diagnosis of ornithine transcarbamylase deficiency was made on the basis of the detection of orotic acid and uracil.     

Portosystemic shunts in cats: seven cases (1976-1984)

Congenital portosystemic venous shunt causing signs of hepatic encephalopathy was diagnosed in 7 cats. The left gastric vein served as the shunt in four of these. Increases in blood ammonia and postprandial serum bile acids were the most consistent serum biochemical abnormalities. Excessive variation in red blood cell shape was a common but nonspecific hematologic finding. The jejunal-mesenteric venous injection of contrast material was the preferred method of portography to diagnose portosystemic shunts. Two cats were treated successfully by partial surgical occlusion of their shunts.     

Diagnostic imaging of congenital porto-systemic shunts in dogs and cats: a review

An overview of clinical, laboratory, and diagnostic imaging features of congenital porto-systemic shunt (PSS) in dogs and cats is presented through the analysis of recent literature, and personal case log. Particular emphasis is given to diagnostic accuracy of ultrasonographic examination of PSS in the evaluation of shunt vessel anatomy, and of ancillary findings such as abnormalities of portal vein flow, portal branches, and liver size. Operative mesenteric portography to obtain information on PSS morphology and position, and quantitative hepatic scintigraphy, which allows the calculation of shunt fractions, are also described. Limitations for each diagnostic imaging technique are given.     

Intraoperative ultrasonography of the portal vein during attenuation of intrahepatic portocaval shunts in dogs

A method for intraoperative measurement of portal blood flow velocity with duplex Doppler ultrasonography in 7 dogs with congenital intrahepatic portosystemic shunts is described. The aims of the study were to determine whether intraoperative ultrasonography was an acceptable alternative to mesenteric portography in such dogs and to identify quantitative portal hemodynamic variables that might correlate with clinical outcome better than portal pressure does. Ultrasonographic measurements did not influence decision-making by the surgeon, who attenuated the shunt on the basis of appearance of the viscera and change in mean systemic arterial blood pressure. All dogs recovered without complications, and surgery was considered to be successful in all 7. Intraoperative B-mode ultrasonography provided real-time information about the anatomy of the shunt and the portal branches, suggesting that it may be a useful alternative to mesenteric portography. The time-averaged mean portal blood velocity ranged from 6.5 to 33.7 cm/s before shunt attenuation and from 5.0 to 9.5 cm/s after shunt attenuation. This narrow range of postligation velocities suggested that intraoperative ultrasonography might be an alternative to intraoperative portal pressure measurement.     

Effect of left hepatic vein ligation on hepatic circulation, function, and microanatomy in dogs.

Eighteen healthy dogs were allotted to 3 groups (n = 6 dogs each). All dogs were evaluated at the beginning of the study by complete physical examination; total and differential WBC counts; serum biochemical analysis (alanine transaminase and alkaline phosphatase activities and bilirubin and albumin concentrations); sulfobromophthalein excretion, ammonia tolerance, and glucagon response testing; portal and intraparenchymal pressure determinations; operative mesenteric portography; and histologic assessment of hepatic biopsy specimens. The left hepatic vein was ligated completely in dogs of groups 1 and 2. Group-3 (control) dogs had a ligature placed loosely around the left hepatic vein. Dogs of groups 1 and 3 were reevaluated 24 hours after surgery by use of the aforementioned hematologic and biochemical tests. Group-1 dogs were reevaluated by use of portal and intraparenchymal pressure determinations, jejunal vein portography, and complete necropsy at 48 hours after surgery. At 4 weeks after surgery, dogs of groups 2 and 3 were reevaluated by use of all aforementioned tests. Results indicated transient hepatic congestion, which resolved by the fourth postoperative week. Longstanding effect on hepatic structure, circulation, or function was not found. We concluded that left hepatic vein ligation in clinically normal dogs does not cause severe or permanent liver damage.     

COMPARISON OF TRANSPLENIC MULTIDETECTOR CT PORTOGRAPHY TO MULTIDETECTOR CT-ANGIOGRAPHY IN NORMAL DOGS

We evaluated transplenic injection of iodinated contrast medium for computed tomography (CT) assessment of the portal vasculature. Specific aims were to: (1) establish a protocol for transplenic transplenic CT portography using a 40-row multidetector scanner; (2) compare transplenic CT portography to dual-phase CT angiography in terms of image quality, opacification of the portal system, and contrast enhancement of the portal vasculature and liver; (3) compare personnel exposure during transplenic CT portography and transplenic portal scintigraphy. Seven juvenile dogs underwent transplenic portal scintigraphy, CT angiography, and transplenic CT portography. Transplenic portal scintigraphy and CT angiography were performed using previously established protocols. For transplenic CT portography, a 20- or 22 gauge needle attached to an extension set was placed into the splenic parenchyma using CT guidance. Iodinated contrast medium (175 mg I/ml) was administered, and CT acquisition was started at the time of the injection. Transplenic CT portography was simple, rapid and provided more intense enhancement of the splenic and portal veins, with a lower contrast medium dose (median dose: 525 mg I for transplenic CT portography, 7700 mg I for CT angiography), but caused inconsistent intrahepatic portal branches and parenchymal opacification due to streamlining and streak artifacts. Despite significantly lower attenuation values in the portal vein, CT angiography provided sufficient enhancement for vessel identification and more consistent parenchymal hepatic enhancement. Personnel radiation exposure rate was higher during transplenic CT portography (0.0725 mSv/min) compared with transplenic portal scintigraphy (0.000125 mSv/min). As transplenic CT portography requires an average injection time of 1 min per study; over 650 [corrected] studies must be performed before reaching the maximum permissible whole body dose of 0.05 [corrected] Sv.     

Congenital portosystemic shunts in dogs and cats

Congenital portosystemic shunts (PPS) are abnormal vascular communications that allow blood from the intestine to bypass the liver, and are classified as intrahepatic or extrahepatic. Clinical signs are generally related to the nervous, gastrointestinal or urinary systems, and are often vague. In addition, changes present on routine blood analysis are often mild and non-specific. For this reason, alternative tests are required for a diagnosis. Diagnostic tests include serum bile-acid concentrations, ammonia tolerance test, portography, ultrasonography and/or scintigraphy. Medical therapy involves reducing absorption of encephalopathic toxins from the gastrointestinal tract and may prolong survival. Surgical therapy is aimed at attenuation of the shunting vessel and provides improved survival rates. The traditional approach has been complete or partial ligation of the shunt. More recent approaches have involved slow, progressive attenuation with ameroid constrictors or cellophane banding. Overall, prognosis following surgical therapy is good in dogs and fair in cats.     

HELICAL COMPUTED TOMOGRAPHIC PORTOGRAPHY IN TEN NORMAL DOGS AND TEN DOGS WITH A PORTOSYSTEMIC SHUNT

Contrast enhanced helical computed tomography (CT) of the liver and portal system is routinely performed in human patients. The purpose of this project is to develop a practical protocol for helical CT portography in the dog. Ten clinically normal dogs were initially evaluated to develop a protocol. Using this protocol, ten dogs with confirmed portosystemic shunts (PSS) were then evaluated. Each patient was anesthetized, and a test dose of sodium iothalamate (400 mg I/ml) at 0.55 ml/kg was injected. Serial images were acquired at the level of T12-13 or T13-L1. The time to maximum enhancement of the portal vein was determined. This time period was used as the period between the second injection (2.2 ml/kg) and the start of the helical examination of the cranial abdomen. Delay times for normal dogs ranged from 34.5 s-66.0 s (median: 43.5 s) or 1.41 s/kg-4.12 s/kg (median: 2.09 s/kg). For patients with a PSS, the delay times were 16.5-70.5 s (median: 34.5 s) or 1.47-19.17 s/kg (median: 3.39 s/kg). The aorta, caudal vena cava, portal vein, shunt vessels, and their respective branches were well visualized on the CT images. Clinical case results were surgically confirmed. The surgeons reported that the information gained from the CT portography resulted in a subjective decrease in surgical time and degree of dissection necessary compared with similar surgeries performed without angiographic information. We believe that helical CT portography in the dog will be a useful adjunct in the diagnosis of PSS. The use of helical CT portography may allow clinicians to give clients a more accurate prognosis prior to surgery and will allow patients with lesions that are not surgically correctable to avoid a costly and invasive procedure.     

Suspected ammonium nitrate fertiliser poisoning in cattle

The occurrence of a suspected mixed ammonia and nitrate fertiliser poisoning that led to acute illness and fatalities in cattle is described. The circumstances leading to the incident included the method of application of the fertiliser, low rainfall and the absence of subsequent irrigation of the fertilised pastures. The clinical and gross post mortem findings, principally dehydration and fluid distension of the rumen, were not pathognomonic. The complex of nitrate, nitrite and ammonia toxicity is discussed.     

Urea poisoning in suckler cows.

Accidental urea intoxication resulted in the death of 17 of 29 suckler cows within six hours after the contamination of their drinking water with urea fertiliser. The other cows showed no lasting ill effects and neither their three-month-old calves nor the stock bull were affected. The urea concentration in the water was 86 mmol/litre, and the concentrations of ammonia nitrogen in the rumen fluid of two of the cows which were examined after death were 1825 and 957 mg/litre. The clinical signs and post mortem findings are described.     

Medical management of a patent ductus venosus in a dog

A 2.5-year-old dog with signs of weight loss, vomiting, and hepatic encephalopathy was diagnosed with a patent ductus venosus, based on serum biochemical analysis, jejunal portography, and biopsies, and treated with lactulose, antibiotics, and a reduced protein diet. Two years after initial presentation, the dog is still being managed medically.     

Maintenance in vitro of adult Fasciola hepatica in a continuous-flow system

A continuous-flow apparatus is described for the maintenance of groups of adult Fasciola hepatica. The ammonia produced by the flukes was used as a measure of their metabolic activity and it was shown that this is best maintained in culture fluids containing a large proportion of bovine serum. More ammonia per fluke was consistently produced when the flow rate of the medium was increased but including small pieces of clotted sheep blood or increasing the number of flukes per culture had no significant effects.     

Protein-Losing Enteropathy in a Dog

Abstract— —A protein-losing enteropathy in a dog is described. There was a history of chronic gastrointestinal upset and examination revealed hypoproteinaemic oedema and ascites. Antemortem laboratory findings indicated a protein-losing enteropathy and these, together with the results of clinical and necropsy examination, are described.     

Influence of patient positioning on sensitivity of mesenteric portography for detecting an anomalous portosystemic blood vessel in dogs: 34 cases (1997-2000).

OBJECTIVE: To determine whether sensitivity of detecting an anomalous portosystemic blood vessel during operative mesenteric portography varied with patient positioning. DESIGN: Retrospective study. ANIMALS: 34 dogs with a portosystemic shunt diagnosed via scintigraphy or surgery. PROCEDURE: Portograms were evaluated for a portosystemic blood vessel. Sensitivity was calculated from results obtained with dogs in left lateral, right lateral, and dorsal recumbency and from results obtained with dogs in 2 or 3 positions. Differences in sensitivity among positions and between 2 examiners were evaluated. RESULTS: Sensitivity was 85, 91, and 100% in dorsal, right lateral, and left lateral recumbency, respectively. Sensitivity was lower in dorsal recumbency than in left lateral recumbency, although differences were not significant. There was no significant difference between sensitivity of results obtained in dorsal and right lateral recumbency or right lateral and left lateral recumbency. Sensitivity for combined right lateral and dorsal positions was 97%, which was better than that in dorsal recumbency alone, although the difference was not significant. Because sensitivity in left lateral recumbency was 100%, there was no need to evaluate the improvement obtained by combining the result of this position with the results of other positions. CONCLUSION AND CLINICAL RELEVANCE: Results of mesenteric portography varied with patient positioning. The optimal position varied among patients but left lateral recumbency may be better and dorsal recumbency worse. Sensitivity may be improved by performing the test with the patient in orthogonal recumbent positions.     

Intravascular Occlusion for the Correction of Extrahepatic Portosystemic Shunts in Dogs

Background: Congential extrahepatic portosystemic shunts (EHPSS) are common in dogs. An effective minimally invasive technique for correction of EHPSS could result in reduced morbidity, reduced costs, and reduced hospitalization times. Hypothesis: Use of an intravascular occlusion device can effectively and safely result in acute complete occlusion of EHPSS in dogs. Animals: Seven dogs with naturally occurring EHPSS that presented to the Purdue University Veterinary Teaching Hospital. Methods: Prospective, clinical trial. The 7 dogs were consecutively enrolled over a 2‐year period. Results of serum biochemistry, total serum bile acids, fasting plasma ammonia, abdominal radiography, and ultrasonography suggested the diagnosis of portosystemic shunts in all dogs. Definitive diagnosis of EHPSS was achieved with cranial mesenteric arterial portography and acute occlusion was attempted by the deployment of the Amplatzer vascular plug (AVP). Results: EHPSS were identified in all dogs consisting of 5 portocaval and 2 portoazygous variants; 1/7 dogs (14%) were intolerant to temporary complete occlusion of the EHPSS. Of the remaining 6 dogs, 5 (83%) had complete occlusion of the EHPSS by the AVP. There were no complications and resolution of abnormal clinical signs and laboratory values was achieved in 4/5 (80%) dogs with complete occlusion. Conclusions and Clinical Importance: Intravascular correction of EHPSS by the AVP is a viable option to surgical correction while larger studies will be required to determine the clinical applicability of this procedure in the broader portosystemic shunt population.