Portosystemic shunt

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Sections available in full article Introduction, Presenting signs, Age predisposition, Sex predisposition, Breed predisposition, Special risks (e.g. anesthetic), Pathogenesis, Etiology, Pathophysiology, Diagnosis, Presenting problems, Client history, Clinical signs, Diagnostic investigation, Confirmation of diagnosis, Gross autopsy findings, Histopathology findings, Differential diagnosis, Treatment, Initial symptomatic treatment, Standard treatment, Monitoring, Prevention, Control, Sequelae, Prognosis, Reasons for treatment failure, Sources, Publications, Vetstream contributor(s),
Contributors Prof Ed Hall MA VetMB PhD DipECVIM MRCVS
Synonyms Portocaval shunt, PSS.

Introduction

  • Congenital or acquired vascular anomaly in which portal blood bypasses the liver   →   systemic circulation via portal vein.
  • Signs :
    • Gastrointestinal - vomiting, diarrhea, anorexia, ptyalism.
    • Central nervous system (CNS) - depression/hyperactivity, head pressing, pacing/circling, stupor, seizures, coma.
    • Other - weight loss, polyuria/polydipsia, ascites, failure to metabolize sedatives and other drugs, urolithiasis.
  • Diagnosis : history, age, bile salt analysis, radiography, ultrasonography.
  • Treatment : surgical ligation of shunt; medical management in acute cases prior to surgery, in long-term cases where surgery impossible/failed/declined by owners.
  • Prognosis : guarded.

Diagnosis

Clinical signs

  • Ataxia.
  • Ptyalism.
  • Hyperactivity.
  • Pyrexia.
  • Ascites.
  • Pleural fluid.
  • Coma, stupor.
  • Cryptorchidism - ?increased incidence  Testicle: cryptorchid  .

Diagnosis

Differential diagnosis

  • Lymphocytic cholangiohepatitis  Liver: cholangitis  .
  • Toxic hepatitis  Liver: toxic hepatitis  .
  • Biliary cirrhosis  Liver: cholangitis  .
  • Infectious hepatitis, eg toxoplasmosis  Toxoplasmosis  , Feline infectious peritonitis (FIP)  Feline infectious peritonitis  .
  • Biliary tract disease  Bile duct: disease  .

Sequelae

Prognosis

  • Good: if surgery successful.
  • Reasonable: if managed medically - can survive long periods.

Reasons for treatment failure

  • Failure to locate or ligate shunting vessel(s).
  • Acute portal hypertension following surgery.
  • Failure to respond to medical management.

Sources

Publications

Refereed papers

  • Tillson DM & Winkler JT (2002)Diagnosis and treatment of portosystemic shunts in the cat.Vet Clin North Am Small Anim Pract.32(4), 881-899.
  • Langdon Pet al(2002)Acquired portosystemic shunting in two cats.J Am Anim Hosp Assoc.38(1), 21-27.
  • Heldmann Eet al(1999)Use of propofol to manage seizure activity after surgical treatment of portosystemic shunts.JSAP40, (12) 590-4.
  • Birchard S J & Sherding R G (1992)Feline portosystemic shunts.Comp Cont Educ Pract Vet14, 1295.

Other sources of information

  • Levy J K, Bunch S E & Komtebede J (1995)Feline portosystemic shunts.In:Kirk's Current Veterinary Therapy XII.W B Saunders. pp 743-749.

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