[Jenn in Vegas]

Ok...so after reading a few threads on others having liver shunts, I grew a bit concerned over my little girl.

She had an elevated bile acids count and I was sent to a specialist. They did an ultrasound and couldn't see the shunt (if there was one). I was told the next step would be to go in surgically to confirm there is not a shunt or if it could possibly be MVD. The specialist told me that since she is so small, the shunt could be teeny-tiny and only be found by going in surgically. I am currently giving her AmoxiDrops (twice daily) and have her on a low protein diet (Hill's Prescription Diet l/d - wet).

My question to you all is if I should even bother going in surgically? Ever since I put her on her diet and the Amoxi-Drops, she's been doing fabulous. It makes me very nervous to have her opened up like that since she is so small. The main nurse at the vets told me that she will probably be on the Amoxi-Drops for the rest of her life and the diet. Any feedback would help. Thank you so much!

Below is a copy of what the specialist gave me AFTER the ultrasound was done:

"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 markings 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 the 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 enough to 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 determine 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."