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Update in diagnosis and therapy of portosystemic shunts
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Portosystemic shunts are sometimes seen in dogs. They can be difficult to diagnose, and also the surgical therapy is not always as effective as planned. This retrospective study including a large number of patients gives interesting new informations about the detection and the therapy of portosystemic shunts in dogs. For example: all animals had still abnormal liver function after surgery!
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Cases diagnosed with portosystemic shunting between the years 1993 and 2001 were reviewed. Sensitivities of screening tests and abdominal ultrasonographic evaluation for the detection of portosystemic shunting were evaluated.
Prognosis for surgically treated shunts was also evaluated.
Results indicated that both paired serum bile acids and blood ammonia levels were useful screening tests for portosystemic shunting. However, paired bile acid tests were significantly more sensitive than blood ammonia levels.
Overall postoperative mortality rates for extrahepatic shunts and intrahepatic shunts were 8.7% and 20%, respectively.
Postoperative mortality rates were slightly higher for animals treated with partial ligation when compared to those treated with ameroid ring placement, although this did not reach statistical significance.
Long-term complication rates for animals with single extrahepatic portosystemic shunts treated with complete ligation, ameroid ring placement, and partial ligation alone were 9%, 15.4%, and 42%, respectively.
Animals >2 years of age with extrahepatic shunts had almost identical postoperative mortality and long-term complication rates as animals 2 years of age.
No animal in this study had paired bile acid samples within the reference range postoperatively, indicating continued abnormal liver function after surgery.
Source: James T. Winkler, Mark W. Bohling, D. Michael Tillson, James C. Wright, Antonio J. Ballagas (2003): Portosystemic Shunts: Diagnosis, Prognosis, and Treatment of 64 Cases (1993–2001). In: Journal of the American Animal Hospital Association 39:169-185 (2003)
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