Shunt in collie

RE: Shunt in collie

Beats — Fri, 04 Jan 2019 19:34:30 GMT

Some follow-up:

Came in again today with (presumed) acute hepatic encephalopathy having fitted last night and was dull.

Prior to yesterday, however, had been great as normal dog just on dietary control (RCW hepatic + whatever else owner fed him)

There was an incidence March 2018 when he was treated by another vet and it's not clear whether this was due to H-E, a separate illness, or a milbemax tablet. Had a competent ultrasound scan which reported multiple intrahepatic shunts (owners words, I don't have a copy of the info) deemed non-operable and was sent home to die (owners words). Been fine since.

I suspect the extra turkey dinners at Christmas are to blame for current ailment.

EDIT - I found notes from the scan in march 2018 if of interest:

"A doppler ultrasound examination showed the presence of what appears to be an intrahepatic portocaval shunt with turbulent flow evident. The kidneys were enlarged (~10cm long axis) and small nephroliths were noted.
Both surgical and interventional options for aaddressing this issue are available but the former is quite a high risk procedure with the risk of intra or per-operative mortality being quite high.
Interventional palliation of the shunt would be costly.
I will discuss the options with the owners but from an initial conversation, I suspect they may not wish to pursue further intervention. He did exhibit a low albumin on his most recent blood profile which is often a poor prognostic indicator."

RE: Shunt in collie

gerard mclauchlan — Tue, 05 Sep 2017 12:59:59 GMT

From an easy to remember point of view small dogs (Yorkies, Bichons predisposed) tend to have intra-hepatic and larger breeds (labradors predisposed) tend to be intra-hepatic

RE: Shunt in collie

Lou Dawson — Tue, 05 Sep 2017 12:53:31 GMT

I vaguely recall a snippet from a BSAVA lecture a few years back (can't remember the lecturer) saying that predisposed breeds tend to have simple extrahepatic shunts whilst non-predisposed breeds tend to have more complex intrahepatic shunts, would that fit with your experience Gerard?

RE: Shunt in collie

gerard mclauchlan — Tue, 05 Sep 2017 11:58:58 GMT

Sorry meant to say intra-hepatic shunts far less common

RE: Shunt in collie

gerard mclauchlan — Tue, 05 Sep 2017 11:46:17 GMT

The evidence for treatment of extra-hepatic shunts is clear that surgery leads to longer survivals. Intra-hepatic shunts far less common and often surgery not performed due to the associated mortality. With the advent of minimally invasive options this would be my preference (although obvioously equipment, training etc is needed).

RE: Shunt in collie

Sarah Keir — Tue, 05 Sep 2017 11:46:00 GMT

Hopefully this will be discussed in the article - as I say I haven't seen it yet.

RE: Shunt in collie

gerard mclauchlan — Tue, 05 Sep 2017 11:41:13 GMT

Hi Sarah

The concern is with the traditional surgery which has a very high mortality rate. With the advent of minimally invasive coiling I would regard this as the gold standard treatment (And I am a medic! )

Ger

RE: Shunt in collie

Sarah Keir — Tue, 05 Sep 2017 11:33:15 GMT

Have a read of this months JSAP - an article on evidence base in treating intrahepatic shunts. I haven't read it yet but basically if you ask a medic you get one answer, if you ask a surgeon you get another.

RE: Shunt in collie

Beats — Mon, 04 Sep 2017 21:27:31 GMT

Thanks both, in Northern Ireland.

We're mostly not very adventurous when it comes to travelling, but I'll add a holiday in sunny Surrey to the options to consider :-)

[If you private message me an approximate price and estimate of success, I'll get back to you if there's any realistic proposition of them following through with you]

RE: Shunt in collie

gerard mclauchlan — Mon, 04 Sep 2017 21:05:31 GMT

If bile acids high then likely shunt. The low b12 increases ammonia but shouldn't elevate bile acids. If clients up for a minimally invasive option and fancy a trip to Surrey let me know

RE: Shunt in collie

Andrew Kent — Mon, 04 Sep 2017 21:01:09 GMT

Hi Dave

[quote user="Beats"]I don't know of anyone offering minimally invasive coiling (and if they did I'd guess it would be well outwith budget)[/quote]

I'm not sure where you are based but there is a fair few places offering this now so probably an option at a referral centre in your area. But as you say it will never be a cheap option.

Andy

RE: Shunt in collie

Beats — Mon, 04 Sep 2017 20:50:11 GMT

Thanks Gerard,

That's helpful.

Was simply a 8mth collie that had been staring in cupboards for a month and a bit ill-thriven. Bile acids were >100. No diagnostics done other than bloods.

I don't know of anyone offering minimally invasive coiling (and if they did I'd guess it would be well outwith budget), but will try some B12 alongside the lactulose, amoxicillin and RCW hepatic diet and see if it helps - I'm sure it can't hurt!

Really appreciate you taking the time to answer such a basic query!

RE: Shunt in collie

gerard mclauchlan — Mon, 04 Sep 2017 20:35:27 GMT

Probably intra hepatic. If neurological and diagnosis based on high ammonia check cobalamin as border collies predisposed to low B12 which can result in increased ammonia and neuro signs.

If intrahepatic would be a good candidate for minimally invasive coiling