Questions and Answers on Liver Shunt
Question:
Who invented the Bile Acids Test?
Answer from Dr. Tobias:I Don't know who "invented" the test - it would take too long to find that since it's very old. The earliest online literature in people (1930's) describes bile acid assays, so the test has been around for awhile. Bile acid assays were performed in dogs by a variety of people in the 60's and 70's (primarily research papers) - some of the articles were focused on dogs that had surgically induced portosystemic shunts. Most of the early bile acid publications for liver disease in dogs and cats came out of Cornell (Sharon Center, and her resident Sue Bunch) and Purdue, I believe (Dennis Meyer). Sharon Center had the most early publications (1984-86) on use of bile acids to evaluate animals with clinical PSS.
From Dr. Tobias:
In 20% of dogs, fasting bile acids are higher than postprandial bile acids because of gall bladder contraction that probably occurs in the middle of the night. The samples should still fall within normal ranges which, for those 20%, would be the normal for fed samples and then the normal for fasting.
In dogs that have had shunt surgery, we retest bile acids at 3 months. If still high, we keep them on L/D and start them on milk thistle, then retest in another 5-6 months. If still high at that time, we would need to perform scintigraphy and liver biopsy to determine the cause. The most common cause would be presence of congenital portal atresia (hepatic microvascular dysplasia), which is hereditary and present in many Yorkies without shunts. Other causes would be development of mulitple acquired shunts for reasons other than portal atresia; presence of a second congenital shunt; incomplete closure of the shunt inside of the constrictor ring; or presence of another liver disease. These would occur in less than 10%.
Question:
My 11 month old Yorkie, Scarlett, just underwent liver shunt surgery. The shunt was a large one and extended into her esophagus. I am hoping for a full recovery. The vet is putting her on Hills Science ld diet. I am concerned about this dog food company. Is there any other company that you know of that is comparable? Thanks
Answer from Dr. Tobias:
The shunts can run along the esophagus and the diaphragm (they don't actually run into the diaphragm). Hill's pet food L/d was made specifically for shunt dogs and was designed by our nutritionist Dr.
Claudia Kirk. They can look at the contents of L/D (percentages of contents available on the Hill's website) and see if they can find one that is comparable in protein amount and type, percent carbs and fat, type of fiber, vitamina nd mineral amounts etc. Karen
Question:
Please advise if you have any information concerning Liver Shunts in cats. My vet will run some tests to see if this is the case with one of my cats, although she mentioned that she's never known of any prior cat-case. Is it any different than with a dog?
Answer from Dr. Tobias:
Cats can have single congenital liver shunts, either outside (most common) or inside of the liver. The most common sign they show is salivation and they also have neurologic problems. Sometimes the only bloodwork abnormality is high liver enzymes and bile acids. They have more complications than dogs and are much more likely to seizure before or after the surgery. Work-up and treatment are the same as in dogs.
We do liver shunt surgery on cats. If they are having neurologic problems (especially if they are seizuring), they will need to be on anticonvulsants for at least 2-3 weeks before the surgery and for at least 3 months after, so the owners should have their veterinarian call to speak to whatever referral surgeon they're seeing. The cost for surgery, anesthesia, and work-up are the same but, because at least 25% of cats have postoperative complications, we have to give a wider estimate (we have had cats in the ICU as long as 5 days after the surgery; at $200/day you can see how the cost can vary). So, we tell shunt cat owners $1200-2500.
KMT
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