Post liver shunt surgery

[TammyV]

Hoping to get replies to this. My Stella is 3 1/2 years old and had liver shunt surgery June 4 and she did so well and I was so excited until we had her first blood work done 6 weeks post surgery (ALT 289 Alk 248). Her bile acid test was bad, over 100 before eating 325 after eating when it suppose to be <15 before meal and <25 after. All related liver counts were bad. I cant get any answers what this means from my vet or the specialist just let’s check again in 3 months. Has anyone else experienced this post liver shunt surgery? What do you suggest I do Now? This little dog is my everything and I will do whatever it takes. I’m in Southern California. These counts are no better than they were pre surgery maybe a bit worse. The vet gave her 3 months to live without surgery now post surgery her counts are still bad and I have no answers.

[pstinard]

Here is a link to an article by Dr. Karen Tobias, who is a nationally recognized expert on liver shunts: https://vetmed.illinois.edu/wp-conte...mic-Shunts.pdf

According to the article, high BATS and liver enzymes can be expected following liver shunt surgery. The important thing is to maintain close contact with your vet and follow their instructions to the letter. Here is a quote from the article:

Animals that undergo PSS ligation require supportive therapy and close monitoring for signs of portal hypertension (hypovolemic shock, progressive hypothermia, severe abdominal pain); if these signs occur, the animal should be taken back to surgery for ligature removal. A second partial ligation can be performed after the animal has recovered completely from the surgeries and portal hypertension. Mild portal hypertension may be seen in some animals 2-4 weeks after surgery and is usually evidenced by abdominal distension from fluid accumulation.No treatment is required unless the animal is having trouble breathing; in that case, the animal is treated with diuretics (e. g. furosemide) and, if albumin is low, hetastarch. Lactulose is continued for a minimum of 2-4 weeks, based on clinical signs and severity of the disease. Yogurt with active cultures or probiotics (live bacterial cultures) may be as beneficial as lactulose in some dogs. Protein restricted diets are fed until the animal shows signs of improved hepatic function (i.e. normal albumin or normal scintigraphy).

Serum bile acids often continue to be abnormal after shunt ligation; in one study, 75% of dogs had abnormal values a median time of 18.6 months after ligation. If bile acids are abnormal at 3 months, protein restricted diet is continued and the animal is started Marin or Denamarin (milk thistle or silymarin). If blood work is still abnormal 6 months after the surgery, the dog should be rechecked for shunting (portogram, scintigraphy, ultrasound) and undergo a liver biopsy to determine if the problem is caused by incomplete closure of the original constricting device, presence of a second congenital shunt or multiple acquired shunts, or hepatic microvascular dysplasia or another liver disease.

[pstinard]

Here is a link to another excellent brochure written by Dr. Tobias: https://vetmed.tennessee.edu/vmc/Sma...D-Brochure.pdf