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1.
Five cats with a congenital portosystemic shunt (CPSS) were examined using transcolonic portal scintigraphy before and after surgical ligation of the shunting vessel. The mean shunt index before surgery was 52 per cent (range 45 to 61 per cent). Repeat portal scintigraphy, six to eight weeks after surgery, indicated a significant reduction in shunt index (mean 13 per cent, range 5 to 25 per cent) in four cats. In one of these cats a marked reduction in the shunt index, as determined by scintigraphy, preceded normal fasting blood ammonia. In the fifth cat there was no significant change in the shunt index, fasting serum bile acids and blood ammonia six months after surgery, although its clinical signs of hepatic encephalopathy had improved. Portal scintigraphy is useful in the diagnosis of CPSS and enables a quantitative assessment of the effects of surgery and may be a more accurate indicator of the degree of shunting after surgery than blood ammonia and serum bile acids.  相似文献   

2.
Ultrasonographic diagnosis of congenital portosystemic shunt in 14 cats   总被引：2，自引：0，他引：2  
Twenty-four cats with clinical and, or, clinico-pathological signs compatible with portosystemic shunting were examined prospectively using two-dimensional grey-scale, duplex and colourflow Doppler ultrasonography. Diagnosis of congenital portosystemic shunt was subsequently confirmed in 14 cats using operative mesenteric portography and surgery. Of the 14 affected cats, nine were purebred; eight were male and six female. The mean age at the time of diagnosis was nine months (range four to 27 months). Ultrasonographic evidence of a small liver was present in seven cats (50 per cent); visibility of intrahepatic portal vessels was reduced in three (21 per cent). An anomalous blood vessel was identified ultrasonographically in each cat; in 10 cats (71 per cent) the vessel was observed to originate from the portal vein and drain into the caudal vena cava. Abnormally variable portal blood flow waspresent in eight of the 10 cats in which it was measured. At surgery, six shunts were intrahepatic and eight extrahepatic; the ultrasonographic diagnosis of intra- versus extra-hepatic shunt was correct in 13 cats (93 per cent). No anomalous blood vessels or abnormalities affecting the portal vein were detected ultrasonographically in any of the 10 cats that did not have congenital portosystemic shunting. Hence, the accuracy of ultrasonography for diagnosis of congenital portosystemic shunting in this series was 100 per cent.  相似文献   

3.
A 3-year-old female neutered ferret presented with progressive weight loss was diagnosed with portosystemic shunting based on increased fasting bile acids, rectal ammonia tolerance testing and advanced imaging. Ammonia reference values were determined in 16 healthy ferrets. A congenital extrahepatic spleno-caval shunt was visualised with ultrasonography and CT angiography of the abdomen. Complete surgical shunt closure by suture ligation was performed, without clinical improvement after surgery. Euthanasia was elected 4 months postoperatively because the clinical condition deteriorated. This is a case report of advanced diagnostics and surgical treatment of a congenital extrahepatic portosystemic shunt in a ferret, demonstrating rectal ammonia tolerance testing and imaging as feasible techniques for the diagnosis.  相似文献   

4.
Five hundred and sixty-six Irish wolfhound puppies aged six to 15 weeks were tested for congenital portosystemic shunts by the dynamic bile acid method. Plasma ammonia concentration was also measured in 165 of the puppies both fasting and postprandially. Nineteen puppies (3.4 per cent), nine males and 10 females, had portosystemic shunts. Smaller litters appeared to be more likely to contain affected puppies. The postprandial bile acid concentration was a reliable predictor of the presence of a shunt, with the highest concentration in a normal puppy being 38 mumol/litre and the lowest in an affected puppy being 43 mumol/litre. In contrast, fasting bile acid concentrations were normal in the majority of the affected puppies. There was considerable overlap in fasting plasma ammonia concentrations between normal and affected puppies (26 puppies, 15.8 per cent of those tested). Postprandial ammonia concentration appeared to give better separation between the two groups, apart from two individuals which produced bizarre results. It was concluded that the postprandial or dynamic bile acid test is an appropriate test for the mass screening of Irish wolfhound puppies for portosystemic shunts, and guidelines are proposed for the interpretation and follow-up of the test.  相似文献   

5.
Only two of 49 cats undergoing surgical ligation of congenital extra- and intrahepatic portosystemic shunts died perioperatively, a mortality rate comparable with the mortality rates of dogs undergoing surgical attenuation of congenital portosystemic shunts and cats in which the shunts are attenuated with an ameroid ring constrictor. Thirty (83 per cent) of the 36 cats for which long-term information was available were still alive at a median follow-up period of 47 months (range six to 105 months); the outcome was excellent (no clinical signs) in 20 of them (median follow-up 37 months, range six to 105 months) and good (minimal clinical signs) in seven (median follow-up 39 months, range 10 to 73 months) and none of these 27 cats was on any long-term medication or special diet. The only major cause of morbidity was the development of neurological signs in 18 (37 per cent) of the cats. These included seizures and a wide variety of other neurological signs, and their development and persistence was not affected by the presence of preoperative seizures, the type of shunt, the degree of shunt attenuation or the age of the cat. The serum concentrations of ammonia and preprandial bile acids were normal or significantly below normal in the cats with neurological signs. Liver histopathology was similar in the cats with and without neurological signs. Ten (56 per cent) of the 18 cats that developed neurological signs recovered normal neurological function long term.  相似文献   

6.
OBJECTIVE: To evaluate outcomes after attenuation of extrahepatic portosystemic shunts in dogs using surgical silk. DESIGN: Retrospective study. PROCEDURE: Case records were reviewed for degree of surgical attenuation, experience of the primary surgeon, perioperative mortality and problems related to persistent portosystemic shunting or shunt ligation. Presence of portosystemic shunting after surgery was evaluated by ammonia tolerance testing, measurement of postprandial serum bile acid, plasma urea and cholesterol concentrations and liver enzyme activity. The influence of age, postocclusion portal pressure, primary surgeon, degree of attenuation and postoperative biochemical findings on the occurrence of postoperative problems was assessed. RESULTS: The mortality rate was 2.1%. Shunt attenuation was complete in 34% and partial in 66% of dogs. Portal hypertension necessitating ligature removal was encountered in only one dog. Five dogs experienced neurological abnormalities (seizures or ataxia), possibly as a manifestation of 'postligation seizure syndrome'. Postoperative liver function was normal in 78% of dogs, including 70% with partial shunt attenuation. Experience of the surgeon was related positively to outcome after partial attenuation (P = 0.002). Postoperative biochemical evidence of abnormal liver function was the most sensitive predictor of recurrence of clinical signs referable to persistent portosystemic shunting. CONCLUSIONS: In the hands of an experienced surgeon, surgical attenuation of single extrahepatic shunts was safe and effective, even in animals with partial attenuation. Most dogs with biochemical evidence of persistent shunting suffer relapse of clinical signs within 18 months of surgery. Postligation neurological syndromes of variable intensity may be more common than previously thought.  相似文献   

7.
OBJECTIVE: To evaluate the efficacy of cellophane banding of single congenital extrahepatic portosystemic shunts in dogs using transcolonic portal scintigraphy. To investigate the portal circulation of those dogs with elevated postoperative shunt fractions to determine the cause of the persistent shunting. Further, to evaluate whether presenting signs, clinical pathology findings and liver histopathology are predictive of outcome. DESIGN: Prospective study of 16 dogs presenting with single congenital extrahepatic portosystemic shunts. PROCEDURE: Dogs with single extrahepatic portosystemic shunts attenuated by cellophane banding underwent portal scintigraphy and bile acids tolerance testing pre- and post-operatively. Dogs identified with elevated shunt fractions at 10 weeks post-operatively underwent mesenteric portovenography. Qualitative hepatic histopathology from all dogs was reviewed by a veterinary pathologist and assigned a semi-quantitative score to identify any abnormalities that may predict surgical outcome. RESULTS: At 10 weeks post cellophane banding, 10 of 16 cases (63%) had normal shunt fractions, whilst six dogs (37%) had increased shunt fractions and seven dogs (44%) had increased serum bile acids. Of these dogs, mesenteric portovenography revealed incomplete closure of the shunt in three dogs (18.6%) and multiple acquired shunts in three dogs (18.6%). Liver histopathology findings were similar for all dogs, regardless of outcome. CONCLUSIONS: Cellophane banding is an efficacious method for complete gradual occlusion of single extrahepatic shunts when the shunt vessel is attenuated to < or = 3 mm. Transcolonic portal scintigraphy is a reliable method for assessment of shunt attenuation and, unlike serum bile acids, is not influenced by other causes of liver dysfunction.  相似文献   

8.
Congenital portosystemic shunts in the cat: A report of nine cases   总被引：2，自引：0，他引：2  
The clinical features, diagnosis, management and outcome of nine cases of congenital portosystemic shunt in the cat are reported. Neurological signs associated with hepatic encephalopathy and ptyalism were the main clinical signs. Six cases were presented as kittens less than six months of age and the remaining three cases were presented as adults, although in one of these signs were first noted at eight to 12 weeks of age. Fasting hyperammo-naemia was the only consistent abnormal biochemical finding. Medical management was instituted in all cases and surgical partial ligation was later performed in four with recanalisation of the ligated vessel occurring in three cases. The condition in the cat is compared and contrasted with that in the dog.  相似文献   

9.
Objectives : To compare the serum level of hyaluronic acid in dogs with congenital portosystemic shunt with that in healthy dogs and to investigate the perioperative change in serum hyaluronic acid following shunt attenuation. Methods : Blood samples were obtained from 29 congenital portosystemic shunt dogs before the operation, and 2 and 4 weeks after the operation from 17 and 7 dogs, respectively. The serum hyaluronic acid level of these dogs was measured and compared with that of 10 healthy beagles. Results : The median preoperative hyaluronic acid level in dogs with congenital portosystemic shunt was significantly elevated compared with that in healthy dogs. Furthermore, the median postoperative hyaluronic acid level significantly decreased compared with the median preoperative levels in congenital portosystemic shunt dogs. Clinical Significance : In the case of dogs with congenital portosystemic shunt, the reduction of intrahepatic portal blood flow might lower the clearance rate of hyaluronic acid in hepatic sinusoidal endothelial cells, so hyaluronic acid clearance could be improved by attenuation of a shunt vessel. Hence, serum hyaluronic acid levels might be useful to evaluate liver function and also have the potential to evaluate successful attenuation of a shunt vessel in dogs with congenital portosystemic shunt. Further investigations are required to clarify whether serum hyaluronic acid offers significant benefits over existing markers such as serum bile acid or ammonia concentrations.  相似文献   

10.
An anomalous shunt between the bronchoesophageal artery and pulmonary artery was diagnosed in a 1-year- old, 3.5 kg female Miniature Dachshund by selective contrast angiography. A cardiac murmur had been observed in the dog during examination at another hospital. The machinery murmur was auscultated at the left side of the base of the heart. Although thoracic radiography revealed mild cardiomegaly, the characteristic findings of patent ductus arteriosus (PDA), including as aortic arch enlargement and pulmonary artery enlargement were not observed. Echocardiography demonstrated shunting of blood flow presumably from the arterial duct at the pulmonary artery carina. Based on the above findings the case was diagnosed as PDA. Angiocardiography was performed to confirm the diagnosis in preparation for surgical treatment, but later we confirmed that the shunt vessel was not PDA, but apparently a branch of the bronchoesophageal artery. The shunt vessel was branching in a complicated manner and shunted to the pulmonary artery.  相似文献   

11.
The case records of 98 dogs with a left-to-right shunting patent ductus arteriosus (PDA) were reviewed. There were 35 breeds represented, with a female to male ratio of 3:1. Forty per cent of the dogs were older than one year at initial presentation and 31 per cent had clinical signs attributable to PDA. A left heart base continuous murmur of grade IV/VI or higher was noted in 90 per cent of the dogs. On electrocardiography, the most common abnormalities were tall R waves (63 per cent) and deep QII waves (62 per cent). The radiographic triad of dilation of the descending aorta with enlargement of the main pulmonary artery segment and left atrium, typical of PDA, was noted in only 26 per cent of cases. Two-dimensional (2D) and M-mode echocardiography detected left atrial enlargement (35 per cent) and an increased left ventricular diameter in diastole (82 per cent) and systole (84 per cent) as the most common abnormalities. Doppler echocardiography demonstrated increased aortic outflow velocities in 66 per cent of cases. The overall short-term successful outcome in this study was 95 per cent. There was no significant difference between surgical ductal ligation using a standard technique or the Jackson-Henderson technique in terms of survival, occurrence of haemorrhage or residual shunting. The number of interventional procedures used in this study was too low for statistical comparison, but there appeared to be a trend towards a higher rate of residual shunting and a lower fatality rate using a coil occlusion technique.  相似文献   

12.
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 < or = 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.  相似文献   

13.
Phacoemulsification has been successfully employed in humans and animals for lens extraction. This ultrasonic extracapsular surgical technique induces hydroxyl radical formation in the anterior chamber, which accumulates despite irrigation and aspiration. In this paper we determined the total antioxidant status of aqueous humor after phacoemulsification by measuring aqueous humor ascorbic acid levels. Mixed-breed dogs (n = 11; weighing about 10 kg) with normal eyes as determined by slit-lamp biomicroscopy, applanation tonometry, and indirect ophthalmoscopy had phacoemulsification performed in one eye with the other eye used as a control. Samples of aqueous humor were obtained by anterior chamber paracentesis before surgery and at days 1, 2, 3, 7, and 15 after surgery. Total aqueous humor antioxidant status was inferred from the capacity of aqueous humor to inhibit free radical generation by 2,2-azobis (2-amidopropane) chlorine. Ascorbic acid concentrations were measured by high-pressure liquid chromatography with UV detection. Protein content was determined with the biuret reagent. Statistical analysis was performed by anova followed by the paired t-test. Total antioxidant capacity was reduced from 48 to 27 min during the first 24 h with a gradual increase thereafter, remaining statistically lower than the control eye until 7 days postoperatively. Reduced levels of ascorbic acid followed this reduction in antioxidant capacity (from 211 to 99 microm after 24 h), remaining lower than the control eye until 15 days postoperatively. Protein concentration in aqueous humor increased from 0.62 mg/mL to 30.8 mg/mL 24 h after surgery, remaining statistically lower than the control eye until 15 days postoperatively. Paracentesis alone did not significantly alter the parameters measured. These results indicate that after phacoemulsification, the aqueous humor ascorbic acid levels and antioxidant defenses in aqueous humor are reduced, indirectly corroborating free radical production in the anterior chamber as a result of phacoemulsification. The inflammatory process consequent to the surgical procedure demonstrated by increased protein content in aqueous humor can also contribute to free radical production and ascorbic acid consumption.  相似文献   

14.
Examination of a 2-month-old male golden retriever presented to the hospital revealed malnutrition, ascites, cardiac murmur and hyperammonemia. Identification of subaortic stenosis and hepatic arteriovenous fistula was made through ultrasonography and angiocardiography. In addition, intrasurgical mesenteric portography showed an intrahepatic portosystemic shunt. The dog did not show portal hypertension and secondary multiple extrahepatic portosystemic shunts. Surgical correction was attempted after medical treatment. The hepatic artery branch which was connected to the hepatic arteriovenous fistula was separated, and completely ligated using silk ligature. However, the separation of the intrahepatic shunt blood vessel was unsuccessful and the dog died 15 hr postoperatively.  相似文献   

15.
A Miniature Dachshund, 3-month-old, 3.1 kg, was diagnosed as an intrahepatic portosystemic shunt (PSS) with the shunting vessel in 6-mm diameter. Percutaneous transvenous coil embolization (PTCE) was performed with a stainless steel coil in 8-mm diameter. Intraoperative portal pressure elevated about 2.5 times after one-stage coil occlusion. Two weeks after the PTCE, serum bile acid levels reduced within the normal range. The portogram showed complete occlusion of the shunting vessel 4 months after the PTCE. Approximately 3 years after the PTCE, the patient has shown no clinical signs. PTCE could be performed more easily and less invasively in a small-breed dog. It is therefore suggested that PTCE is a promising therapeutic technique in canine intrahepatic PSS.  相似文献   

16.
Eleven of 89 dogs (12 per cent) developed neurological signs within six days of surgical attenuation of a congenital extrahepatic portosystemic shunt. Neurological signs were not associated with hepatic encephalopathy or hypoglycaemia. Signs varied in severity from non-progressive ataxia (three dogs) to generalised motor seizures (four dogs), progressing to status epilepticus (three dogs). In a further four cases, ataxia and disorientation were treated vigorously with anticonvulsant medication, presumably preventing the development of seizures. Two dogs that developed status epilepticus died or were eventually euthanased. All other animals survived, although some had persistent neurological deficits. Postligation neurological complications were not prevented by gradual shunt attenuation. Prophylactic treatment with phenobarbitone (5 to 10 mg/kg preoperatively, followed by 3 to 5 mg/kg every 12 hours for three weeks) did not significantly reduce the incidence of neurological sequelae (2/31 [6 per cent] dogs with phenobarbitone vs 9/58 [16 per cent] without phenobarbitone; P = 0.2). However, no animal receiving phenobarbitone experienced generalised motor seizures or status epilepticus. In conclusion, these observations suggest that postligation neurological syndrome comprises a spectrum of neurological signs of variable severity. Perioperative treatment with phenobarbitone may not reduce the risk of neurological sequelae, but may reduce their severity.  相似文献   

17.
The biplanar mesenteric vein portovenograms of 10 cats with left divisional intrahepatic portosystemic shunts consistent with a patent ductus venosus (PDV) were reviewed. A corrosion cast of the hepatic portal vasculature was made post mortem from one individual that died post operatively following surgical attenuation of the shunting vessel. On the basis of the combined surgical, post mortem and imaging data, these left divisional shunts were found to have consistent anatomy, each having a straight vessel which drained into a venous ampulla before draining into the caudal vena cava at the level of the diaphragm. The left phrenic vein and left hepatic vein both entered the ampulla independently of the shunting vessel. The anatomical similarity between these findings in the cat and the PDV in the dog suggest that it is appropriate to describe this particular portosystemic shunt as a PDV.  相似文献   

18.
Lumbosacral osteochondrosis has been diagnosed with increasing frequency over the past few years. Nevertheless, poor recognition of the condition continues to lead to frequent misdiagnosis. A study was therefore undertaken over a 12-year period (1986 to 1998) to describe the use of a variety of radiological studies to define the syndrome and the use of different surgical techniques for optimal treatment of the condition. Dogs with clinical signs of cauda equina neuropathy and radiological signs of lumbosacral osteochondrosis were older than 14 months (mean age 6.3 years). German shepherd dogs, boxers and rottweilers were heavily represented. Of the 34 dogs with osteochondrosis in this study, the lesion appeared to be related to the sacrum in 31 dogs (91 per cent) and the seventh lumbar vertebra in the remaining three dogs (9 per cent). Twenty-seven male and seven female dogs were affected (4:1). Out of the 34 dogs, six (18 per cent) were treated conservatively and the remaining 28 (82 per cent) were treated surgically. The outcome of surgical treatment was considered to be satisfactory in 24 (86 per cent) of these latter dogs.  相似文献   

19.
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.  相似文献   

20.
An unusual congenital portosystemic shunt was identified in one dog and two cats with clinical signs and laboratory evidence of hepatic dysfunction. In all the animals, the abnormal vessel arose from the portal system between the left medial and quadrate liver lobes and travelled within the falciform fat, exiting the abdomen through the caudal ventral left diaphragm. The intrathoracic course of these vessels was not established. The anatomical location of this anomalous vessel may have hindered attempts at ultrasonographic identification since it was not visualised before surgery in any of the animals. In addition, while the anatomical location of the vessel may facilitate rapid identification and surgical attenuation, it could predispose the vessel to trauma during the coeliotomy approach. It is hypothesised that this form of portosystemic communication results from failure of a portion of the left umbilical vein to degenerate during embryogenesis. This is in contrast to other forms of congenital extrahepatic portosystemic shunt that are presumed to be developmental errors resulting in an abnormal communication between the embryonic vitelline and cardinal venous systems. The prognosis for animals with the vascular anomaly reported here is probably similar to that for animals with other forms of congenital portosystemic shunt.  相似文献   

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