fitting yorkie

Re: fitting yorkie

Mark Lowrie — Mon, 20 Feb 2012 14:29:48 GMT

I should have said that there was a case series reporting five mature dogs presenting with apparently acute onset neuro signs. The theories given in this paper as to why it occurred included:

increased sensitivity of the aging brain to ammonia and other metabolic products;
decreased liver function with age;
morphological or functional brain changes resulting from long-term, persistent, intermittent hyperammonaemia

So they weren't 100% sure of the cause either.

I’ve copied the abstract from pubmed below:

J Am Anim Hosp Assoc. 2007 Nov-Dec;43(6):322-31.

Congenital portosystemic shunts in five mature dogs with neurological signs.

Windsor RC, Olby NJ.

Abstract

Congenital portosystemic shunts are a common cause of hepatic encephalopathy and are typically first identified when dogs are <2 years of age. This case series describes five dogs with congenital portosystemic shunts; the dogs were presented for severe encephalopathic signs during middle or old age. Three dogs had portoazygos shunts, and four dogs had multifocal and lateralizing neurological abnormalities, including severe gait abnormalities and vestibular signs. All five dogs responded to medical or surgical treatment, demonstrating that older animals can respond to treatment even after exhibiting severe neurological signs.

Re: fitting yorkie

Mark Lowrie — Sun, 19 Feb 2012 15:58:32 GMT

It's a good point Kate and I'm not sure of the reason but we do see dogs and cats present with apparently sudden onset neuro signs due to hepatic encephalopathy. We've got 2 middle aged cats with us currently both with shunts due to progressive forebrain disease over just a few weeks. Have these owners missed previous neuro signs? I don't know...

Re: fitting yorkie

Kate Richardson — Sun, 19 Feb 2012 10:56:43 GMT

Just wondering, how likely is it to suddenly go from being a bright happy dog to a seizuring dog due to hepatic encephalopathy causing seizures? Would you not expect some prior neurological signs? Not questioning your work at all Lorna, just wondering. or were there any neuro signs over the previous few days/weeks? I totally agree that the liver needs some further investigation.

Re: fitting yorkie

Clive Ansell — Sun, 19 Feb 2012 10:21:05 GMT

It would be interesting to find out the results of a BAST, as well as what happened at surgery all those years ago; ligated or partially ligated shunt, or exploratory surgery with no repair if intra hepatic maybe???

Re: fitting yorkie

Lorna McHardy — Sun, 19 Feb 2012 08:16:59 GMT

Am happy to report that he's doing really well... no further seizures and very bright indeed. I'll send him home later with antibiotics and lactulose and his usual vets can run bile acids tomorrow when the labs open. Thanks for input... nice to feel less lonely with the more complex and less common ones :0)

Re: fitting yorkie

ilanit — Sun, 19 Feb 2012 06:34:44 GMT

Could just have been stress leukocytosis/monocytosis maybe? Did you check a blood smear to see if it's a mature neutrophilia or if there's a left shift/toxic neutrophils. You could also just repeat hematology to see if it normalised. But probably there's no need for it in the light of suspected shunt and better to spend money on bile acids. Anemia is probably just due to anemia of chronic disease.

Re: fitting yorkie

Lorna McHardy — Sat, 18 Feb 2012 21:19:31 GMT

Ok, thanks again! I wasn't sure, because of the haematology. He's a different dog after a few hours on fluids and antibiotics, bouncing all over the place and much much happier. Scrabbling away at the kennel door like mad. So far, so good, except he's winding himself up into a state!

Re: fitting yorkie

Mark Lowrie — Sat, 18 Feb 2012 20:55:25 GMT

Sorry Lorna, misread your post. The haem abnormailities mau be due to infection but i'm on rocky road here. The rest of the bloods are enough to say hepatic encephalopathy and high NH4 likely.

Re: fitting yorkie

Mark Lowrie — Sat, 18 Feb 2012 20:50:32 GMT

.... Just like you said, the low urea and albumin suggest hepatic dysfunction and usually on quite a large scale to see them below the ref range. Therefore IMO your hunch of a Liver problem is spot on.

Re: fitting yorkie

Lorna McHardy — Sat, 18 Feb 2012 20:37:33 GMT

Ok, thanks!... Why the haematological abnormalities? Have added lactulose.

Re: fitting yorkie

Mark Lowrie — Sat, 18 Feb 2012 20:30:52 GMT

Hi Lorna, given the biochem abnormalities I think the PSS is prime suspect. I'd definitely start ampicillin and lactulose and get bile acid stim sent asap. CSF not worthwhile at this stage. Given there's no history of shunt surgery we don't know if it was fully or partially ligated. Keep us posted.

Re: fitting yorkie

Lorna McHardy — Sat, 18 Feb 2012 19:20:48 GMT

No, ammonia and bile acids will have to wait until either monday, or a referral. I could add lactulose, and see how he responds to the fluids and meds... if he keeps having seizures though, I think I should phone a vet school.

Re: fitting yorkie

Clive Ansell — Sat, 18 Feb 2012 19:06:37 GMT

Can you measure NH3 in house? bile acid stim test might be useful too. maybe treat as hepatic encephalopathy with metronidazole and lactulose pending a diagnosis?

Re: fitting yorkie

Lorna McHardy — Sat, 18 Feb 2012 18:52:16 GMT

[quote user="robloxley"]

Sounds like a good working diagnosis; can you run bile acids? Lactulose enema; lactulose oral; antibiotics ?

[/quote]

I put him on iv fluids and synulox, and am monitoring him for any more seizures - he's had two rectal diazepam and so far has been fine... now sleeping peacefully. Can't run bile acids. I'm thinking what he needs a CSF tap, but that isn't something I've ever done before. Maybe I'll end up referring him.

Re: fitting yorkie

Rob Loxley — Sat, 18 Feb 2012 18:44:15 GMT

[quote user="Lorna McHardy"]So I'm thinking it's not terribly likely that a PSS repaired six years ago is now likely to be causing seizures[/quote]

Sounds like a good working diagnosis; can you run bile acids? Lactulose enema; lactulose oral; antibiotics ?