[Jenn in Vegas]

Below I typed out what I was given after the ultrasound was completed:

"Thank you for bringing Misty to the Las Vegas Veterinary Referral Center. Today we evaluated Misty for elevated bile acid results. We performed an abdominal ultrasound of the abdomen to evaluate the liver and see if there is an obvious aberrant vessel to the liver or past the liver could be found. Misty has a very small liver on ultrasound with decrease vessel amrkings within the tissue. Both of these abnormal findings suggest a prolonged deficiency in blood supply to the liver. The portal vein was difficult to find on ultrasound and appears to be smaller than expected. The vena cava and portal vein should be equal in size as they pass through or past the liver, but in Misty's case the portal vein is smaller than thne vena cava suggesting decreased blood supply as well. We were unable to find any evidence of an aberrant vessel between the portal vein and vena cava and no significant turbulence in the vena cava as we typically see with an extrahepatic shunt. As we already discussed, lack of identification of a shunt on ultrasound may not definitively rule out its presence if it is very small because Misty herself is quite small and ultrasound may not be sensitive enoughto catch a small shunt. We suggest, therefore, that surgery be performed to evaluate the abdomen and definitively prove that there is no abnormal vessel and to take a biopsy of the liver and determien if anything else can be done to prevent damage to the liver down the road. It is possible that the elevation in liver values, if not caused by a small shunt, is secondary to microvascular dysplasia as we already discussed. We spoke with our surgeons about the surgery and they quoted $2000 to $3000 for surgery depending on the extent of the procedure needed. They felt that the current medications you are giving should be sufficient and no additional medications are needed prior to surgery. Our surgeons usually recommend 2 total weeks of medications prior to surgery."