Portal Hypertension?

RE: Portal Hypertension?

Anthony Dennison — Fri, 24 Mar 2017 09:08:11 GMT

[quote user="grumpyoldman"]If the venous sinus formed by the portal v as it enters the liver and splits into left and right is enlarged that may be significant . Some scarred livers respond to colchicine , but they may need to take it off the pred and try a different route with the atopy. 5mg sid is not a lot for those changes ??? is it HAC as well possibly ? Adrenals? [/quote]

No obvious dilated sinus that I could see, but the vasculature was noticeably dilated.

I couldn't see the adrenals on the scan, and I normally can, so I presumed they were tiny from steroid use. The dog has previously been on higher levels of preds, 5mg is the lowest it's been for a while.

I have tried apoquel and atopica, and even with these if I stop the preds the dog becomes a red, scabby and pruritic mess!

I could possibly have iatrogenic Cushings, but as it's been on varying levels of preds for 2 years I'm not going to be successful with testing for it!

RE: Portal Hypertension?

grumpyoldman — Fri, 24 Mar 2017 00:08:20 GMT

If the venous sinus formed by the portal v as it enters the liver and splits into left and right is enlarged that may be significant . Some scarred livers respond to colchicine , but they may need to take it off the pred and try a different route with the atopy. 5mg sid is not a lot for those changes ??? is it HAC as well possibly ? Adrenals?

A venous phase CT may help

RE: Portal Hypertension?

Rach — Thu, 23 Mar 2017 22:27:24 GMT

I would be thinking iatrogenic cushings with that combination of signs and with the steroid history.

My understanding of the diarrhoea in portal hypertension is that the hypertension causes 'back-up' of blood in the splanchnic circulation and so an oedematous gut wall causing diarrhoea, I would expect that you would see that on scan, but have to confess to never having diagnosed it myself, I also would have thought you would have some ascites too if the hypertension was that significant, but I guess you can't use absence to rule it out. Any chance of a liver FNA? For what it's worth, if it were my case I would just see what pans out with the diarrhoea over the next few days before doing much else about it.

RE: Portal Hypertension?

Anthony Dennison — Thu, 23 Mar 2017 11:20:12 GMT

Sorry, on an iPad. I did write all in neat paragraphs!