Case Report: Portosystemic Liver Shunt

Jenna, a six and a half-year old intact female Jack Russell Terrier, went to her regular veterinarian for a dental cleaning. Preoperative bloodwork was performed since she would need to be anesthetized. The bloodwork showed elevated liver values. The dental cleaning was performed, and Jenna did well under anesthesia. She was placed on a liver support medication for two months. When Jenna’s bloodwork was rechecked, her liver values were still abnormal. Jenna remained on the liver support medication for another month and her liver values were checked again. Unfortunately, the liver values were still abnormal. Jenna was then referred to the Internal Medicine Division of the Veterinary Referral Center of Northern Virginia.

An ultrasound examination was performed and a small liver was noted. Next a bile acids test was performed and the pre- and post-blood values were high. This led the internal medicine specialist to conclude that that Jenna had a portosystemic liver shunt. This is a condition where the body’s circulatory system bypasses the liver. It requires surgical intervention.

Jenna was transferred to the Surgical Division. Before proceeding with surgery Dr. Morris performed a portogram. Dye is injected into a mesenteric blood vessel in the abdomen and an x-ray is taken to show the blood flow to the liver. In Jenna’s case the x-ray showed a single extrahepatic (outside the liver) shunt emptying into the caudal vena cava. The vena cava is the largest blood vessel in the body. There was no visible blood flow to the liver. Jenna was then prepped and taken into surgery.

During the exploratory Dr. Morris found a large shunt at the level of the kidneys near the vena cava. The shunt was so large Dr. Morris was unable to place even the largest ameroid ring. The ameroid ring is a constrictor that gradually occludes the blood vessel allowing the circulation to make adjustments over a period of time. Dr. Morris followed the vessel to a smaller one adjacent to the pancreas where he successfully placed the ameroid ring. Jenna recovered well from the surgery and has continued to thrive.

Liver shunts are relatively rare. They can be congenital or acquired. The most common breed affected is the Yorkshire Terrier. Symptoms include:

• Poor growth and failure to thrive
• Poor appetite
• Weight loss
• Increased thirst and urination
• Mental dullness
• Circling
• Head pressing
Intrahepatic (inside the liver) shunts cannot be surgically corrected but they can be medically managed.

We are very pleased that Jenna is doing so well as a result of the surgery!