Caring Hands Animal Hospital | Veterinary Topics

Little Parker, an 8 month old poodle/yorkie puppy, came in for a routine neuter surgery. He had a relatively healthy puppy hood, receiving all of his vaccinations on time, potty trained pretty well, and was growing normally. Only one episode of an upset stomach clouded his past history. What puppy doesn't have an upset stomach once in a while? His owner wisely chose to perform the recommended pre-anesthetic blood work prior to his surgery. However, Parker's blood work was anything but routine. His liver value called ALT (Alanine Aminotransferase) was elevated 10 times the normal level. This liver enzyme is very specific for cell damage within the liver. After discussing the results of the blood work with the owner, we decided to postpone the neuter surgery and look further into a possible liver problem.

We started our investigation by performing a radiograph of Parker's abdomen. This revealed a small liver for Parker's age and weight. Next, we sent off Parker's blood for a full blood panel and verified our abnormal liver values and confirmed the rest of Parker's systems looked fine. Our highest suspicion for these changes (elevated ALT and a small liver) was a congenital blood vessel abnormality called a portosystemic Shunt. We then tested the liver function by performing a bile acids test that assesses the liver's ability to clear toxins from the blood stream. This test was also very abnormal. Parker's liver was indeed compromised and he needed to see a specialist to determine if his problem was operable or not.

A Portosytemic shunt can involve two types of problems in the blood vessel "plumbing" of the liver. The first is a large vessel that inappropriately forms during the development of the embryo. This large vessel acts as a bypass from the stomach to the hart. The liver is left out of the blood path, therefore, not allowing the liver to be nourished with nutrient containing blood, nor allowing the liver to clear the toxins that are absorbed with the nutrients from the food in the stomach. This problem can be surgically fixed if the vessel can be isolated and repaired. The liver will grow and regenerate to begin to perform it's normal filtering function once the surgical correction is performed. The second is a Microvascular Shunt, in which the vessels form inappropriately within the liver to bypass the cells of the liver and not allow them to perform their functions. This type of multiple tiny shunts can not be surgically repaired and will significantly reduce the pet's quality and quantity of life. Some other clinical signs that we can see in dogs before or after they are diagnosed is a side effect of the build up of toxins in the blood. The most common signs are hyperactivity or derangement shortly after eating to a more severe seizure activity or head pressing after eating.

Parker was taken to a local Internal Medicine specialist who performed an abdominal ultrasound. This test can effectively image the vessels in the liver and can find the shunt 65% of the time.

Unfortunately for Parker, we could not confirm the large vessel with this test. Suspicions and signs still pointed to a shunt. The next step for Parker was to go to a surgical specialist. There he underwent a dye study to assess the blood pattern of his liver called an Angiogram. This study confirmed that Parker had a large Portosystemic Shunt vellel that could be isolated and repaired to allow Parker to live a normal live. Parker successfully underwent surgery and is recovering well at home.

Parker's successful diagnosis and resolution of a very severe congenital problem hinged on us performing the Pre-Anesthetic Blood Work Parker showed no other symptoms of the disease at home or during any of his puppy visits. Together Parker's owner and Caring Hands were able to minimize the risk of anesthesia and fix a Portosystemic shunt before it became a life threatening disease to Parker. This is a great example of one of the many reasons we encourage all pets to have Pre-Anesthetic Blood Work before any anesthetic event.