scholarly journals Recanalisation of a congenital extrahepatic portosystemic shunt previously attenuated with cellophane banding in a cat

2018 ◽  
Vol 4 (2) ◽  
pp. 205511691879571
Author(s):  
James Crowley ◽  
Timothy Foo ◽  
Lara Boland ◽  
Laurencie Brunel
Keyword(s):  
Hepatic Encephalopathy ◽  
Bile Acids ◽  
Clinical Signs ◽  
Reference Interval ◽  
Portosystemic Shunt ◽  
Liver Size ◽  
Long Term Follow Up ◽  
Stimulation Tests ◽  
Congenital Extrahepatic Portosystemic Shunt ◽  
Liver Changes

Case summary A congenital extrahepatic portosystemic shunt was attenuated with commercial roll cellophane banding in a cat and postoperative liver changes were monitored using CT angiography (CTA). The patient clinically improved after cellophane banding, characterised by resolution of hepatic encephalopathy, weight gain, reference interval (RI) bile acid stimulation tests, as well as CTA-documented increased liver size, increased hepatic vasculature and shunt attenuation. Six months later the cat re-presented with recurrence of clinical signs and increased bile acids. CTA confirmed recanalisation of the shunt. Shunt attenuation was repeated using pure cellophane banding and nearly complete closure of the shunt was later documented by CTA. Seven months later, recanalisation was again documented via CTA and associated with clinical signs and increased bile acids. Complete ligation of the shunt was achieved using a polypropylene ligature and a titanium ligating clip. At long-term follow-up, the cat was clinically well, and bile acids and biochemistry were within the RIs. Relevance and novel information This is the first report of CTA-documented recanalisation of an extrahepatic portosystemic shunt previously attenuated with cellophane banding. Recanalisation should be considered as a differential for recurrence of hepatic encephalopathy following cellophane banding.

scholarly journals Peripartum clinical manifestations of a mesentericorenocaval shunt in a Burmese cat

2020 ◽  
Vol 6 (2) ◽  
pp. 205511692096136
Author(s):  
QiCai J Hoon ◽  
Jia Wen Siow ◽  
Elizabeth Jenkins ◽  
Wilson So ◽  
Mark Krockenberger ◽  
...  
Keyword(s):  
Bile Acids ◽  
Clinical Signs ◽  
Clinical Manifestations ◽  
Reference Interval ◽  
Portosystemic Shunt ◽  
Lactation Period ◽  
Serum Bile Acids ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Mild Anaemia

Case summary A 3-year-old entire female Burmese cat was presented for investigation of intermittent lethargy during gestation followed by persistent hypersalivation and ataxia postpartum. The cat had queened three litters in total, with clinical signs worsening during the most recent lactation period. Mild anaemia (26%), hypoglycaemia (2.4 mmol/l; reference interval [RI] 3.9–8.3 mmol/l) and increased postprandial serum bile acids (74 µmol/l; RI <25 µmol/l) were identified on initial bloodwork. Multiphase contrast-enhanced CT identified a mesentericorenocaval portosystemic shunt; this was attenuated surgically with an ameroid constrictor. Clinical signs resolved after surgery. Follow-up 3 months postoperatively revealed normal pre- and postprandial serum bile acids (2 µmol/l and 3 µmol/l, respectively) with repeat CT identifying evidence of shunt attenuation. The cat continued to be healthy and free of clinical signs 12 months postoperatively. Relevance and novel information Mesentericorenocaval portosystemic shunt morphology has not been previously reported in the cat and should be considered as a differential diagnosis for cats presenting with peripartum onset of malaise, ptyalism or ataxia.

scholarly journals Resolution of Severe Neurologic Signs Following Intravenous Lipid Emulsion Therapy in a Young Dog With a Portosystemic Shunt: Case Report

2021 ◽  
Vol 8 ◽  
Author(s):  
Amanda M. Spillane ◽  
Jenica L. Haraschak ◽  
Maureen A. McMichael
Keyword(s):  
Hepatic Encephalopathy ◽  
Lipid Emulsion ◽  
Reference Interval ◽  
Ammonia Concentration ◽  
Acute Onset ◽  
Portosystemic Shunt ◽  
Dramatic Improvement ◽  
Intravenous Lipid Emulsion ◽  
Life Threatening ◽  
Patient’S History

A 5-month-old male intact Great Pyrenees was presented for an acute onset of severe neurologic signs (stupor, absent menace, intermittent head turn to the left). The patient's history included possible naproxen ingestion with a maximum ingested dose of 59 mg/kg, exceeding the reported dose of &gt;50 mg/kg known to cause neurologic signs. Blood sampling for baseline bloodwork was performed, and intravenous lipid emulsion (ILE) was subsequently administered, for treatment of the suspected toxicosis. Due to severe and life-threatening neurologic signs, other methods of decontamination were contraindicated and unlikely to be effective; extracorporeal therapy was also unavailable. Complete resolution of neurologic signs occurred 30 min after completion of ILE therapy. At this time, the owners found the missing naproxen tablets after returning home and the bloodwork results returned revealing findings consistent with hepatic encephalopathy. The fasted blood ammonia concentration immediately prior to ILE administration was 702.1 μg/dL (reference interval, RI: 24–36 μg/dL) and decreased to 194.1 μg/dL 24 h later. In the first 24 h, the patient also received three doses of lactulose, N-acetylcysteine, and intravenous fluids. The patient was subsequently diagnosed with a single, large intrahepatic portosystemic shunt via computed tomography and underwent an endovascular coil embolization procedure. Given the rapid and dramatic improvement in severe neurologic signs after ILE therapy alone, it is strongly suspected that this treatment resulted in improvement of hepatic encephalopathy.

scholarly journals Born Again: Recurrent Hepatic Encephalopathy in an Adult without Cirrhosis

2019 ◽  
Vol 02 (01) ◽  
pp. 039-040
Author(s):  
Tom George ◽  
Sasidharan Rajesh ◽  
Cyriac Abby Philips
Keyword(s):  
Hepatic Encephalopathy ◽  
Systemic Circulation ◽  
Portosystemic Shunt ◽  
Type Ii ◽  
Adult Onset ◽  
Significant Clinical Improvement ◽  
Congenital Extrahepatic Portosystemic Shunt ◽  
Born Again

AbstractCongenital extrahepatic portosystemic shunt (CEPS) develops between the por-to-mesenteric and systemic veins. The splanchnic venous system drains directly to systemic circulation in this condition. We present a case of an adult onset Type II CEPS presenting with hepatic encephalopathy. The patient underwent PARTO (plug-assisted retrograde transvenous obliteration) and had a significant clinical improvement on subsequent follow-up. Our case highlights the importance of imaging and the role of an interventional radiologist in the management of the condition.

Diagnosis of Congenital Portosystemic Shunt in Miniature Schnauzers 7 Years of Age or Older (1997–2006)

2010 ◽  
Vol 46 (4) ◽  
pp. 235-240 ◽  
Author(s):  
Michelle Mertens ◽  
Theresa W. Fossum ◽  
Michael D. Willard ◽  
Geoffrey T. Fosgate ◽  
Angel Garcia de la Paz ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Hepatic Encephalopathy ◽  
Confidence Interval ◽  
Clinical Signs ◽  
Prevalence Ratio ◽  
Portosystemic Shunt ◽  
Older Age ◽  
Congenital Portosystemic Shunt ◽  
Relative Prevalence ◽  
Exploratory Surgery

Dogs with congenital portosystemic shunt (PSS) are typically diagnosed before 2 years of age. The objective of this study was to determine if miniature schnauzers are more likely to be diagnosed with congenital PSS at an older age than are other breeds. This retrospective study examined the case records of 171 dogs diagnosed with congenital PSS; dogs were included if they were definitively diagnosed as having congenital PSS by nuclear scintigraphy, contrast portography, and/or exploratory surgery. Seven (23%) of 31 miniature schnauzers diagnosed with congenital PSS were 7 years of age or older at the time of diagnosis, compared to 3.4% for all other breeds. Miniature schnauzers had a relative prevalence ratio of 6.3 (95% confidence interval 2.2 to 18.6; P=0.001) for being diagnosed at or after 7 years of age when compared to all other breeds of dogs. Clinical signs of congenital PSS may not manifest sufficiently to cause an owner to seek veterinary care for some dogs until they are older. Congenital PSS should be considered in mature dogs, particularly miniature schnauzers, that are presented with signs potentially consistent with hepatic encephalopathy.

scholarly journals Surgical correction of a splenophrenic shunt in a dog: a case report

2014 ◽  
Vol 59 (No. 8) ◽  
pp. 396-402
Author(s):  
H. Yoon ◽  
M. Roh ◽  
S. Jeong
Keyword(s):  
Bile Acids ◽  
Clinical Presentation ◽  
Clinical Signs ◽  
Portosystemic Shunt ◽  
Postoperative Results ◽  
Lack Of Information ◽  
Normal Ranges ◽  
Portosystemic Shunts ◽  
Different Types ◽  
History Of

A 4.3 kg, nine-year-old, spayed female Shih Tzu was presented for a two-month history of seizures, ataxia, and hyper-salivation. A diagnosis of a splenophrenic shunt was made by use of computed tomography angiography with volume-rendered imaging. A cellophane band was placed around the shunt after its isolation from the central tendon of the diaphragm. Clinical signs continued to wax and wane. Preprandial and postprandial bile acids levels were still elevated 10 months after surgery. An ameroid ring constrictor was placed around the shunt vessel before the vessel entered the diaphragm from its caudal aspect. At three months after the second surgery, the dog was near the normal ranges of preprandial and postprandial bile acids. Although a study of the anatomy of different types of extrahepatic portosystemic shunts has been reported in dogs, to the authors&rsquo; knowledge, there is a lack of information on clinical presentation, treatment, and postoperative results in a specific type of extrahepatic portosystemic shunt, such as a splenophrenic shunt. Cellophane banding should be avoided for occlusion of a splenophrenic shunt passing along the central tendon of the diaphragm. &nbsp;

MRI findings in two West Highland White Terrier dogs with hepatic encephalopathy secondary to portosystemic shunt

2019 ◽  
Vol 7 (3) ◽  
pp. e000814 ◽  
Author(s):  
Ricardo Fernandes ◽  
Colin Driver ◽  
J H Rose ◽  
Clare Rusbridge
Keyword(s):  
Hepatic Encephalopathy ◽  
Vascular System ◽  
Clinical Signs ◽  
Systemic Circulation ◽  
Brain Parenchyma ◽  
Portosystemic Shunt ◽  
Medial Longitudinal Fasciculus ◽  
Mri Findings ◽  
Weighted Sequences ◽  
The Brain

A portosystemic shunt is an abnormal communication between the portal vascular system and the systemic circulation. A significant number of clinical signs associated with portosystemic shunting result from hepatic encephalopathy (HE); a syndrome encompassing neurological signs such as including changes in behaviour, ataxia, unresponsiveness, pacing, circling, blindness, seizures, coma and death. We present two West Highland White Terrier dogs diagnosed with HE based on clinical signs, bile acid stimulation test and imaging of the abnormal vessel communicating the portal and the systemic circulation. Magnetic resonance sequences of the brain revealed a poorly marginated and diffuse, bilateral and symmetric hyperintense lesions on T2-weighted, fluid attenuation inversion recovery and diffusion-weighted sequences relative to the brain parenchyma including the medial longitudinal fasciculus and reticular formation in the brainstem. No abnormalities were detected on T1-weighted sequences.

Risk Factors for Hepatic Encephalopathy after Transjugular Intrahepatic Portosystemic Shunt in Patients with Hepatocellular Carcinoma and Portal Hypertension

2015 ◽  
Vol 24 (3) ◽  
pp. 301-307 ◽  
Author(s):  
Jiannan Yao ◽  
Li Zuo ◽  
Guangyu An ◽  
Zhendong Yue ◽  
Hongwei Zhao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hepatocellular Carcinoma ◽  
Portal Hypertension ◽  
Hepatic Encephalopathy ◽  
Pressure Gradient ◽  
Transjugular Intrahepatic Portosystemic Shunt ◽  
Meld Score ◽  
Portosystemic Shunt ◽  
Portal Flow ◽  
Intrahepatic Portosystemic Shunt

Aims: This study aimed at assessing the risk factors for hepatic encephalopathy (HE) after transjugular intrahepatic portosystemic shunt (TIPS) in patients with hepatocellular carcinoma (HCC) and portal hypertension. Method: Consecutive patients (n=279) with primary HCC who underwent TIPS between January 1997 and March 2012 at a single institution were retrospectively reviewed. Patients were followed up for 2 years. Pre-TIPS, peri-TIPS and post-TIPS clinical variables were reviewed using univariate and multivariate analyses to identify risk factors for HE after TIPS. Results: The overall incidence of HE was 41% (114/279). Multivariate analysis showed an increased odds for HE in patients with: >3 treatments with transcatheter arterial chemoembolization (TACE) and/or trans-arterial embolization (TAE) (odds ratio [OR], 4.078; 95% confidence interval [95%CI], 1.748-9.515); hepatopetal portal flow (OR, 2.362; 95%CI, 1.032-5.404); high portosystemic pressure gradient (OR, 1.198; 95%CI, 1.073-1.336) and high pre-TIPS MELD score (OR, 1.693; 95%CI, 1.390-2.062). Odds for HE were increased 1.693 fold for each 1-point increase in the MELD score, and 1.198 fold for each 1-mmHg decrease in the post-TIPS portosystemic pressure gradient. Conclusion: The identification of clinical variables associated with increased odds of HE may be useful for the selection of appropriate candidates for TIPS. Results suggest that an inappropriate decrease in the portosystemic pressure gradient might be associated with HE after TIPS. In addition, >3 treatments with TACE/TAE, hepatopetal portal flow, and high MELD score were also associated with increased odds of HE after TIPS. Key words:  –  –  – .

Sign in / Sign up

Export Citation Format

Share Document