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Old 06-08-2018, 05:53 PM   #1
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Default Stomach Issues

Our Toby is almost 11 months old and weighs 5 pounds. He started throwing up about two weeks after each meal.

We took him to the vet and they gave him a shot for nausea, prescription food, probiotics, and meds for parasites. After the nausea meds wore off, he began to throw up here and there. As soon as he finished the meds, he began throwing up again. We took him to the emergency vet for blood work and an xray (all came back normal) and we got more probiotics and nausea pills.

We then brought him in for an ultrasound this week and they thought he might have Addison's Disease or liver shunt. So, we did blood work for both. We got the results back today and both came back normal.

Bile Acid Test - fasting was 2.8 and then two hours after eating was 20.8.

I told them it makes no sense as he has a lot of symptoms for liver shunt. When he was 3 months he would walk in circles, he never really grew (both parents are 10-15 lbs), and now constantly throwing up.

I'm at a loss. I know once his nausea pills are complete next week, he is going to start throwing up again. I asked them to send everything to Texas A & M and will drive there if he starts throwing up again.

Anyone have a similar experience?
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Old 06-09-2018, 04:29 AM   #2
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I'm so sorry your little baby is sick, and with no answers coming...very scary to go through .

You are very smart to be thinking about going to Texas A&M or similar!!! I would do that asap.

There is much more you can do for diagnosis. The following is from a paper by Dr. Karen Tobias, a preeminent Vet in shunts:

Diagnosis of Portosystemic Shunts
Increased bile acids or ammonia or presence of ammonium urate crystals in a puppy with clinical signs of hepatic encephalopathy is suggestive of portosystemic shunting. On plain abdominal radiographs, a small liver may be seen. Animals with shunts may also have large kidneys or calculi in the bladder or kidneys (urate stones are usually radiolucent but will be radio-opaque if they also contain struvite). Shunts may be detected during ultrasound examination of the abdomen; intrahepatic shunts are easier to find with ultrasound because they are very large. Even if the shunt is not visualized on ultrasound, other clues may be found, including sediment in the kidneys and bladder, increased kidney size, decreased portal vein size (if there is a congenital extrahepatic shunt), and turbulent blood flow. Another method for detecting shunting is to inject agitated saline into the spleen and to simultaneously ultrasound the right atrium or distal caudal vena cava for air bubbles.

Portograms provide diagnosis and location of shunts in all animals. Radio-opaque, sterile, water soluble contrast is injected into a catheterized jejunal or splenic vein (maximum total dose, 2 ml/kg). Radiographs (left lateral is best) are taken 1-3 seconds after beginning the injection, or continuously if a fluoroscope is available. A direct injection of the spleen can also be performed; however, less contrast reaches the shunt quickly and contrast that remains in the spleen may obscure the shunt itself.

Diagnosis can also be made with nuclear scintigraphy. Trans-splenic scintigraphy (injection directly into the spleen) provides a portogram in some animals, and in about 70% of animals allows differentiation between multiple extrahepatic and single congenital PSS. An overnight stay is required because animals are radioactive after the procedure. The gold standard for shunt diagnosis is dual phase computed tomographic angiography, which allows reconstruction of the vessels and identification of vessel number, location, and termination.

Differential Diagnoses
Any liver disease can cause bile acids and ammonia to increase. Dalmatians and other breeds can have urease deficiencies that result in production of ammonium biurate crystals. Hepatic encephalopathy must be differentiated from distemper, hydrocephalus, hypoglycemia, toxicities, and epilepsy. PVH/MVD causes the same clinical signs and laboratory and biopsy changes as extrahepatic congenital portosystemic shunts; however, results of advanced imaging techniques are normal. Dogs with acquired multiple extrahepatic shunts may have ascites and coagulation abnormalities. In these dogs, coagulation should be checked before taking a liver biopsy.
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Old 06-11-2018, 12:25 PM   #3
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Thank you for the response, Wylie's Mom. Toby has not been throwing up, but there were heaving episodes over the weekend and his stomach was gurgling pretty loud this morning. Once his cerenia runs out on Tuesday, I'm sure the vomiting will return.
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Old 06-12-2018, 04:37 AM   #4
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Originally Posted by jnash21 View Post
Thank you for the response, Wylie's Mom. Toby has not been throwing up, but there were heaving episodes over the weekend and his stomach was gurgling pretty loud this morning. Once his cerenia runs out on Tuesday, I'm sure the vomiting will return.

Has IBD/IBS been ruled out? Also, ulcers? Vomiting and gurgling in dogs can sometimes be due to ulcers; for that, they usually give Sucralfate. It may worth trying that if for nothing else, to see if it has any effect.
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Old 06-12-2018, 05:42 AM   #5
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Has IBD/IBS been ruled out? Also, ulcers? Vomiting and gurgling in dogs can sometimes be due to ulcers; for that, they usually give Sucralfate. It may worth trying that if for nothing else, to see if it has any effect.
They didn't even bring up IBD/IBS as an option. I feel like they were focused on Addison's and liver shunt. All blood work and exams came back relatively normal, besides seeing gas in his stomach and bile test a little high.

I tried to get an appointment at A&M, but nothing available until July 9th. We'll be taking him in through emergency.
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Old 06-13-2018, 08:06 AM   #6
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My response never posted. The vet never questioned whether it could be IBD/IBS. She only focused on Addison's and liver shunt.

The next available appointment at A&M is July 9th, so we'll take him through emergency after work on Friday.

He finished the cerenia last night and we changed his diet to fish and potatoes. He is still heaving daily and trying to eat grass each time we take him out to potty. I'm sure the vomiting will return tonight or tomorrow.
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Old 06-15-2018, 04:26 PM   #7
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Originally Posted by jnash21 View Post
My response never posted. The vet never questioned whether it could be IBD/IBS. She only focused on Addison's and liver shunt.

The next available appointment at A&M is July 9th, so we'll take him through emergency after work on Friday.

He finished the cerenia last night and we changed his diet to fish and potatoes. He is still heaving daily and trying to eat grass each time we take him out to potty. I'm sure the vomiting will return tonight or tomorrow.
Prayers.
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