Quote:
Originally Posted by ladyjane  I thought she had multiple inoperable shunts...I am lost in space.
Anyway...that would be nice if all is good. |
Sorry, brain fog!
From the Surgery thread:
Urinalysis: a mild form of E-coli bacteria
Stone analysis: ammonium urate crystals
Liver Biopsy: Arteriolar Hyperplasia (mild), bile stasis
Acquired Extrahepatic Shunting caused by high blood pressure in the liver, probably due to the Arteriolar Hyperplasia.
No cirrhosis.
Plan: ABs for Ecoli x 3 weeks, then ursodiol to thin out the bile. Continue Lactulose and Denamarin, and L/D diet.
And:
the gall bladder can get backed up to the point where it blocks the duct that feed bile to it from the liver. This is what can cause the pressure in the liver to build up, causing the liver to 'throw' new shunts (acquired shunting). [prevents the liver from rupturing]
Acquired shunts are usually always smaller and branched (like a tree) than congenital shunts (being born with one) which are bigger and usually singular.
Just to clarify: There are different kinds of shunts. Portosystemic shunts start at the intestines and carry blood containing nutrients and waste products (intended for the liver) around the liver bypassing it and rejoin the system at some point on the the duct that carries the cleansed blood from the liver to the heart. All puppies have this type of shunt but it is normally absorbed by the body (disappears) a week before or after birth. In puppies in the womb, the liver is bypassed and their blood is sent on to the mother's liver for processing.
Acquired shunting is a failsafe manuever by the liver to save itself from rupture when conditions cause a build up of pressure in the liver. These shunts are small and start at the liver and go out to other parts of the liver and/or other organs and attach with the intent to relieve the pressure in the liver, by creating other pathways for the blood to go. Conditions that can cause a pressure buildup in the liver are tumors, cancer, blocked ducts, partially blocked ducts, bile stasis and maybe others. The liver makes bile, stores it, and sends it to the Gall Bladder as needed. Dogs can develope sludge (slow to non- moving, thick bile) which can eventually block the Bile Duct creating pressure in the liver.
Then there's the issue of liver enzymes. Dogs that test good have higher functioning livers, smaller or no PSShunt, no GB issues, MVD, etc. Ammonium Urate stones develope bc of too much ammonia in the blood, which is a product of protein digestion, and is normally removed by the liver. Liver enzymes have to reach a certain level before they accumulate enough to show up in bloodwork, so a dog over time can be having problems, but not bad enough to show on the bloodwork.
I hope this helps explain it better....
Note to Mods: the quotes are messing up at least in this post (I fixed it before posting)