Liver shunt/ultra sound

[nailcorner]

They want Harley to have an ultra sound to ck for liver shunt. Cannot get in to one till tomorrow afternoon. We have been to the emergency vet the 3 times this weekend to cath him because of stones. Will the ultra sound tell us if it is shunt for sure? Will it tell us if it is the kind that can be fixed? I just dont know how much more I can put this little guy through.

Thank you for any information you can give me,
Kathy-ut

[Ellie May]

Ultrasounds are very easy on them but I would NOT recommend it. They are only 60-80% accurate at diagnosing shunts. Yes, sometimes they can see shunts but sometimes they can't. If they want to go further than blood work, why not a scintography?

What are his bile acids?
Have they done a Protein C test?

[Ellie May]

I was just reading your other post.

Ultrasound is the best way to go if ammonium urate stones are suspected.
They may or may not see a shunt on it though and more testing for that might have to be done.

[KathyinCali]

Poor baby...I hope he gets better soon

[ARCHIE]

Prayer's coming for your little guy. Hope all goes well for him.

[Patti]

Cali had the ultrasound which ruled out a external shunt and then had the liver biopsy when she was spayed and had a mild intrnal shunt or MVD. Did th vet do a Bile Acid test yet? I don't recall you mentioning it. The ultrasound will also help see if their are stones so I would do it if it were me. Good luck

[nailcorner]

Thank you so much for all of your responses.

I dont know what all tests they have run. 1st trip was to a vet (not mine, he was not in that day) next 3 trips and blood work up was done at the emerg vets. I have 3 pages of numbers that I have no idea what they are and the emergency vet just tells me I should have an ultra sound. My vet was not in again today but I faxed the blood results to him at home and he sent me back a text that says he thinks it might be some type of cancer! I just got back from having him cath again, and will have to go to the emerg vet again about 3am to have it done again. Not all vets here have ultra sounds so tomorrow at 3pm I have an apt with yet another vet to have that done.

If anyone knows anything about these tests, I know it is asking a lot, but if you could share your phone number with me through e mail I would jump at the chance to call and ask just what some of these tests are. Like I said, I have 3 pages of them and I dont know jack what they are. Even my husband came home from work today at 10 and was on the back porch just crying his eyes out because he feels so bad, and we just dont know what to do. We are not stupid people,.....why do we not seem to understand what the vets are telling us!!!!

I can be e-mailed at painter9@aol.com

Thanks for the shoulders,
Kathy-Ut

[Ellie May]

Is there any way you can type out the results and put them on here or scan and attach the picture to Yorkie Talk? There are people here who know what all of that means.

Do you see something on there that says ALT?
What is the number by it?
How about BUN?
AST?
They would've had to do a bile acid test if they want to go to ultrasound to look for a shunt.
Anything that says bile acid test?

I'm sorry that he thinks it might be cancer but if I understand this correctly, he went in not able to urinate, they are cathing him and have not found stones yet? If they haven't identified the kind of stones he has, why do they think it is liver shunt? What are his symptoms?

[nailcorner]

These are some of the blood test results. I have only listed the ones that are either high or low.

CHEMISTRY

abl....1.6...low
alkp...471..high
bun...20....ok
ca...12.7...high
glob...6.4....high
tbil....0.2...low

HEMATOLOGY

wbc...21.80..high
mono...3.30...high
neu...15.48...high
baso...011....high
plt...118. ...low

I do not see an AST listed on here.

after this it says...DIFFERENTIAL ALGORITHM ISSUES. CONFIRM WITH BLOOD FILM (D B1/3)

We go tomorrow for the ultra sound...and anything else they think will help.

Thank you all for the help,
Kathy-Ut

[Wrenee4]

This is from my vet...I hope it helps out a little on answering some of your questions. It certainly gives a TON of info!

Blood work is a very important diagnostic tool that provides a significant amount of information about your pet’s health. A biochemical profile is a blood test that assesses the function of internal organs, measures the electrolytes such as blood potassium, and identifies the levels of circulating enzymes. Understanding the biochemical profile can be difficult but reveals a wealth of information.

SAMPLE
Twenty of the most common tests are listed. Normal values are listed in parentheses and vary from lab to lab and those listed should not be considered universal.

Glucose..........................117 mcg/dl...(80-120)
BUN (blood urea nitrogen)........24 mg/dl...(8-29)
Creatinine…......................0.8 mg/dl...(0.4-1.2)
Sodium (Na)......................140 mEq/l...(139-164)
Potassium (K)....................5.2 mEq/l...(4.4-6.1)
Chloride.........................104 mEq/l...(10-118)
CO2 (carbon dioxide).............22 mEq/l...(22-285)
Calcium….........................9.6 mg/dl...(9.4-11.6)
Phosphorus.......................5.6 mg/dl...(2.5-6.2)
Total Protein (TP)...............6.3 gm/dl...(5.8-8.1)
Albumin..........................2.9 gm/dl...(2.6-4)
Bilirubin........................0.6 mg/dl...(0.2-0.7)
Cholesterol......................204 mg/dl...(129-330)
Triglyceride.....................82 mg/dl...(36-135)
ALKP (alkaline phosphatase)......65 U/l...(20-70)
AST (asparate aminotransferase)..30 U/l...(14-42)
ALT (alanine aminotransferase)...45 U/l...(15-52)
GGT (gamma-glutamyl transferase).5 U/l...(1-12)
Amylase..........................850 U/l...(280-950)
CK (creatine kinase).............47 U/l...(0-130)

WHAT DOES IT ALL MEAN?
Glucose is the end product of carbohydrate metabolism and is the primary source of energy for the body. High levels indicate stress, Cushing’s disease, diabetes, pancreatitis or can be due to certain medications. Low levels can indicate liver disease, insulin overdose, severe bacterial infection, hypothyroidism and Addison’s disease. Toy breed puppies are prone to low blood glucose for unknown reasons.

BUN stands for blood urea nitrogen and is the primary end product of protein metabolism. High levels indicate kidney failure or disease, dehydration, shock, high protein diet, certain toxin ingestions, poor circulation to the kidneys and urinary obstruction. Low levels indicate liver disease or starvation.

Creatinine is the end product of phosphocreatine metabolism, which is important in muscle contractions. High levels indicate kidney failure or disease, dehydration, shock, certain toxin ingestions, poor circulation to the kidneys and urinary obstruction. Low levels indicate liver disease or starvation.

Sodium works in combination with potassium and is very important in maintaining normal function of muscle and nerves. It is also an important electrolyte in every part of the body. High levels indicate dehydration, lack of water, diabetes insipidus, Cushing’s and excess salt intake. Low levels indicate starvation, severe diarrhea, vomiting, Addison’s disease, hypothyroidism and metabolic acidosis.

Potassium works in combination with sodium and is very important in maintaining normal function of muscle and nerves. High levels indicate diabetes, certain toxin ingestions, urinary obstruction, acute kidney failure, severe muscle damage and Addison’s disease. Low levels indicate vomiting and diarrhea, gastrointestinal cancer, insulin overdose, Cushing’s disease, overuse of diuretics and starvation.

Chloride is important in maintaining the acid balance in the blood as well as combining with hydrogen to form hydrochloric acid for stomach digestion. High levels indicate dehydration, metabolic acidosis, Addison’s disease and kidney disease. Low levels indicate vomiting and metabolic alkalosis.

CO2 indicates the current acid balance of the body and is the end product of metabolism. High levels indicate an acidic condition and can be due to kidney failure, vomiting, dehydration or overuse of diuretics. Low levels indicate a basic condition of the blood and can be due to starvation, kidney failure (can also cause acidosis), diarrhea and poor liver function.

Calcium is a mineral found throughout the body. It is the basis for bones, teeth and muscle contractions. High levels indicate certain forms of cancer, Addison’s disease, excess intake of vitamin D and an overactive parathyroid gland. Low levels indicate eclampsia, severe pancreatitis, dietary imbalance, intestinal absorption disorders, low intact of vitamin D, Cushing’s disease and certain toxin ingestions.

Phosphorus is often associated with calcium. It is important in all aspects of metabolism. High levels indicate kidney disease, dietary imbalance, excess ingestion of vitamin D and severe tissue trauma. Low levels indicate dietary imbalance, certain cancers, overdose of insulin, diabetes, eclampsia and an overactive parathyroid gland.

Total Protein (TP) is an important substance in all parts of the body. High levels indicate dehydration, inflammation, chronic infection and certain cancers. Low levels indicate intestinal absorption problems, liver disease, Addison’s disease, severe burns and losses through the kidneys.

Albumin is the major protein found in the body. It carries various substances through the blood and is important in maintaining pressure within the vessels. High levels indicate dehydration. Low levels indicate chronic inflammation, liver disease, kidney disease, starvation and blood loss.

Bilirubin is a bile pigment and is the end product of red blood cell breakdown. High levels typically result in jaundice and can be due to bile duct obstruction, gall bladder obstruction, liver disease and rapid breakdown of red blood cells. Low levels are not considered clinically relevant.

Cholesterol is important in the synthesis of certain hormones. High levels are not as important as in people. Low levels indicate liver disease, starvation, kidney disease, Cushing’s, pancreatitis, diabetes and hypothyroidism.

Triglyceride is important in storing fat and releasing fatty acids. High levels have been associated with seizures in schnauzers. Low levels indicate starvation or malnutrition.

ALKP is important in metabolism and is found in liver cells. High levels indicate bile duct obstruction, Cushing’s, liver disease, certain cancers and may be due to certain drugs such as steroids or phenobarbital. Low levels indicate starvation or malnutrition.

AST is important in the breakdown and elimination of nitrogen. High levels indicate muscle damage, heart muscle damage, liver damage, toxin ingestion, inflammation and various metabolic disorders. Low levels indicate starvation or malnutrition.

ALT is also important in the metabolism of nitrogen and is most often associated with the liver. High levels indicate liver damage, toxin ingestion, Cushing’s disease and various metabolic disorders. Low levels indicate starvation or malnutrition.

GGT is also important in nitrogen metabolism and is found within liver cells. High levels indicate bile duct obstruction, liver disease, pancreatitis, Cushing’s and can be caused by high levels of steroids. Low levels indicate starvation and malnutrition.

Amylase is secreted by the pancreas and is important in normal digestion of starch. High levels indicate pancreatic inflammation or cancer, kidney disease, prostatic inflammation, diabetic ketoacidosis and liver cancer. Low levels can indicate malnutrition or starvation.

CK is very important in storing energy needed for muscle contractions. High levels indicate muscle trauma or damage such as due to seizures, surgery, bruises, inflammation, nutritional and degenerative diseases. Low levels are not clinically relevant.

[Wrenee4]

Part #2

Blood work is a very important diagnostic tool that provides a significant amount of information about your pet’s health. A complete blood count (CBC) is a blood test used to measure and evaluate cells that circulate in the blood. The test includes an actual counting of red and white blood cells as well as an analysis of cells viewed on a blood smear. A CBC may be useful as a screening test for underlying infection, anemia and illness.

Sometimes, the CBC can help determine the underlying cause of an anemia or infection. Drugs that affect the bone marrow change the CBC. Certain types of cancers, especially leukemia, may be evident on a blood smear. Blood parasites and some microorganisms are found by careful inspection of the blood cells during the CBC. In some cases, the results of the CBC will prompt your veterinarian to recommend other diagnostic tests.

SAMPLE CBC
The following is an example of a complete blood count report. Normal values often vary from lab to lab and are represented in parentheses. These norms should not be considered universal.

WBC..... 10.6 x 10-3/mcl.........(4-12 x 10-3/mcl)
RBC....... 6.2 x 10-6/mcl........(5.7-10.5 x 10-6/mcl)
HGB........ 14 g/dl............(9-16 g/dl)
HCT..........48%................(38-52%)
MCV....... 55.9 fl............(40-60 fl)
MCH....... 18.2 pg............(15-20 pg)
MCHC...... 33.5 g/dl..........(32-36 g/dl)
PLT........ 210/mcl.............(160-420/mcl)

Differential

Segs......... 48%..............(51-72%)
Lymphs..... 40%..............(8-35%)
Monos........ 6%..............(1-9%)
Eos............ 4%...............(0-9%)
Baso.......... 2%...............(0-2%)

WHAT DOES IT ALL MEAN?
· WBC is an abbreviation for white blood cell count. These cells help fight infection and respond when an area of the body becomes inflamed. Elevated white blood cell counts indicate infection, inflammation and some forms of cancer or leukemia. Low white blood cells counts can indicate viral infections, bone marrow abnormalities or overwhelming infections and sepsis (blood poisoning). In this situation, the white blood cells are concentrated in the area of infection and are not circulating in the blood, resulting in a low count.

· RBC is an abbreviation for red blood cell count. These cells are responsible for transporting oxygen throughout the body. Oxygen is used as fuel for the body and is very important. High red blood cell numbers usually indicate dehydration but can also indicate uncommon diseases that cause an excess production of red blood cells from the bone marrow. Low red blood cell counts are referred to as anemia and can be a result of blood loss, active bleeding, bone marrow disease or excessive red blood cell breakdown that is seen in some immune diseases and toxin ingestion.

· HGB is an abbreviation for hemoglobin. This molecule is responsible for binding and releasing oxygen onto the red blood cells. Without hemoglobin, oxygen cannot be transported. High levels of hemoglobin usually indicate high red blood cell counts and dehydration. Low levels indicate anemia, bleeding or iron deficiency.

· HCT is an abbreviation for hematocrit. The hematocrit is a calculated percentage of red blood cells in the circulation. It gives similar information to the red blood cell count but the value is expressed as a percentage. The other part of the blood is serum, containing enzymes, proteins, electrolytes, etc. High hematocrits indicate dehydration or rare bone marrow disorders resulting in increased red blood cell production. Low hematocrits indicate anemia, bone marrow disorders, blood loss, active bleeding or excessive red blood destruction due to toxins or immune disorders.

· MCV is an abbreviation for mean corpuscular volume. This is the average size of the red blood cells. A high MCV usually indicated certain vitamin deficiencies. A low MCV indicated iron deficiency.

· MCH is an abbreviation for mean corpuscular hemoglobin. This is the average weight of hemoglobin in each red blood cell and is different than hemoglobin circulating in the blood. A high MCH indicates poorly oxygenated blood. A low MCH indicates iron deficiency.

· MCHC is an abbreviation for mean corpuscular hemoglobin concentration. This is the average percentage of hemoglobin in each red blood cell. A high MCHC indicates that there is too much hemoglobin in the red blood cell, indicating a high iron level since an important component of hemoglobin is iron. Iron excess is just as damaging to the body as iron deficiency. A low MCHC indicates anemia.

· PLT is an abbreviation for platelets. The platelets are responsible for sealing any leaks in the blood vessels. When platelet counts are low, spontaneous bleeding can occur. High platelet counts usually indicate a disorder of the bone marrow or an overwhelming response to an immune blood disease. Low platelet counts indicate bleeding or excessive destruction of platelets caused by parasites or immune diseases.

THE DIFFERENTIAL
A differential is an analysis of the different types of white blood cells. There are five types of white blood cells and the distribution of these cells can help determine an underlying cause of illness.

· Segs is an abbreviation for segmental neutrophils. These are the primary white blood cells responsible for fighting infections. High levels of neutrophils indicate infection. Low levels can indicate sepsis. The neutrophils are concentrated in the area of infection or are rapidly being used, leaving less circulating in the blood.

· Lymphs is an abbreviation for lymphocytes. These white blood cells are also responsible for fighting infection and also develop antibodies to protect the body against future attacks. High levels of lymphocytes can indicate infection, viral disease or certain cancers such as lymphosarcoma. Low levels can indicate viral infections affecting the bone marrow or sepsis.

· Mono is an abbreviation for monocytes. This white blood cell helps the neutrophils fight infections. High monocyte counts indicate infection. It is unlikely that there will be no monocytes and a differential with zero monocytes does not indicate any specific ailment.

· Eos is an abbreviation for eosinophil. This white blood cell is primarily involved in fighting allergies or parasites. High eosinophil counts indicate an allergy or parasite causing illness. Low levels are not possible since zero eosinophils are possible in normal blood samples.

· Baso is an abbreviation for basophils. This white blood cell is not very common but can be seen in certain parasitic infection, primarily heartworm. High levels indicate possible parasitism. Low levels are not possible since zero basophils are possible in normal blood samples.
The complete blood count provides a wealth of information – if you know how to read and interpret the results. For further explanation or interpretation of your pet’s CBC, consult your veterinarian.

[nailcorner]

Thank you so much for all the information. Had ultra sound and liver biopsy today...going in at 8 am tomorrow for bile acid.

I just got off the phone with the vet that did the tests today. He said to give Harley 2 more hours and see if he becomes more responsive, if not he wants me to take him in tonight.

Kathy-Ut

[yorkielovs2chat]

My dog had bladder stones and it was awful going through that. He was screaming in pain. Ultrasound showed the stones. But then...when they finally agreed to do surgery because he couldn't pass them after a few days, they did ultrasound and saw a smaller liver. I was SHOCKED!!!!!! My dog is one of the most energetic, healthy, hungry dogs you'd ever meet. I looked at the surgeon and said "there is no freakin way this dog has LS. he has been as healthy as a horse and comes from a show breeder and has shown NO symptoms".
They saw multiple shunts. Took liver biopsy, came out clean. No MVD, no liver disease. Vets concluded that they are genetic but multiple in nature. Cornell (went to visit them next) did ultra sound and could actually see the shunts. They must have better equipment???? They were very impressed with how he looked and told me to keep doing what I am doing.
I know his blood values were wonky when he was in stress with the bladder stones, but the blood values went to almost normal at Cornell.
yorkielovs2chat

[Ellie May]

Originally Posted by nailcorner

Thank you so much for all the information. Had ultra sound and liver biopsy today...going in at 8 am tomorrow for bile acid.

I just got off the phone with the vet that did the tests today. He said to give Harley 2 more hours and see if he becomes more responsive, if not he wants me to take him in tonight.

Kathy-Ut

Wow, bile acid testing should always be done first because if they are normal, you don't need to do a liver biopsy (and you still don't NEED to do one). The kind of liver biopsy they do with the needle/ultrasound isn't really a good way because they can't get a big enough piece of the liver.

I think this vet is doing things backwards.

I would've done the ultrasound because of the stones though.

[Patti]

I believe the ultrasound was needed due to the bladder issues. They needed to look for stones etc. Maybe they saw something on the ultrasound to warrant the biopsy. Also maybe he wasn't fasted so they couldn't do the BA. Hopefully with all the tests done they will get some answers and be able to treat him.