Ch. 96: Hepatic Vascular Anomalies

Question 1

Amaha JAVMA 2019

CT-derived measurements of shunt fraction and hepatic perfusion in dogs with a single EHPSS in a clinical setting

Median shunt fraction different how between what group distinction?

Median SF bw L gastrophenic & L gastrocaval?

Answer 1

The median SF was higher in dogs < 3 years old (75%) versus dogs ≥ 3 years old (35%)

Median SF S lower in dogs with left gastrophrenic (28%) vs left gastrocaval (80%)

Correlations were identified between SF and hepatic perfusion variables

Question 2

Tamura VRU 2019

Contrast-enhanced US is a feasible technique for quantifying hepatic microvascular perfusion in dogs with extrahepatic congenital PSS

How did rising time, time to peak, and portal v to hepatic parenchyma transit time differ in shunt vs healthy dogs?

Answer 2

rising time (RT) of hepatic artery in EHPSS was significantly earlier than healthy dogs

Time to peak (TTP) and RT of hepatic parenchyma S earlier in EH congenital PSS than healthy dogs

portal vein-to-hepatic parenchyma transit time (ΔHP-PV) was S shorter in EH-congenital PSS than healthy dogs

CEUS effectively revealed changes in hepatic microvascular perfusion

Question 3

White JSAP 2020

Classification of portosystemic shunts entering the caudal vena cava at the omental foramen in dogs

How many anatomically distinct OF shunt types found?
What was overall main difference between types? what % dogs had each?
What vessel was final communication with CVC in all dogs?

Answer 3

Found 4 anatomically distinct omental foramen shunt types:

1 type showed no shunting blood flow through the right gastric vein (most common, 60% dogs)

3 types involved shunting flow through RGV (40% dogs)

In all cases, the left gastric vein was the final vessel that communicated with the caudal vena cava.

FYI - Proposed naming classification for congenital PSS entering the caudal vena cava at the level of the omental foramen:
Left gastro-caval subtype RGV(-) = most common
Left gastro-caval subtype RGV(i) (ii) or (iii)

Question 4

Plested VRU 2020

Canine intrahepatic portosystemic shunt insertion into the systemic circulation is commonly through primary hepatic veins as assessed with CT angiography

% that inserted into primary hepatic or phrenic v? into intrahepatic CdVC?

MC IHSS type and % dogs?
Right divisional inserted where?
Left divisional inserted where?
Central divisional inserted where?

Answer 4

92% of IHPSS inserted into a primary hepatic vein or phrenic vein

8% inserted directly into the intrahepatic CdVC

MC IHPSS type: single right divisional (45%) - inserted via the right lateral hepatic vein or the caudate hepatic vein

left divisional IHPSS (33%) inserted into the left HV or phrenic vein

central divisional shunts (13%) inserted into the quadrate HV, central HV, dorsal right medial HV or directly into the ventral aspect of the IH CdVC

Question 5

Wilson VRU 2021

Ferumoxytol-enhanced magnetic resonance angiography provides comparable vascular conspicuity to CT angiography in dogs with intrahepatic portosystemic shunts

Name of contrast and dose they gave with MR angiography?
Why may it be better than the current agent used with CE-MR (and what is the name of that agent) and CTA?
Overall finding - how did it compare to CTA?

Answer 5

Ferumoxytol at 4 mg/kg
= long-acting purely IV MRI contrast agent - offers potential to reduce complexity of MR angiography protocol planning by ensuring diagnostic contrast medium conc in all the targeted vessels

Current MR angio = gadolinium;
CTA & MR gad angio have limited brief first pass contrast peak

Ferumoxytol contrast-enhanced MRA at 4 mg/kg provided similar conspicuity of normal and abnormal vasculature compared to CTA with a minimal decrease in spatial resolution

Question 6

Seller VRU 2021

Intrahepatic venous collaterals in dogs with congenital intrahepatic portosystemic shunts are associated with focal shunt or hepatic vein narrowing

% with IHVC found?
IHVC associated with what?
Focal narrowing in shunt associated with what?

Answer 6

11/47 (23%) dogs had IHVCs identified

IHVCs were significantly associated with focal narrowing in the shunt or draining hepatic vein on CTA and fluoroscopic portovenograms

Focal narrowing in the shunt (circumferential soft tissue narrowing >20% of the shunt diameter) was significantly associated with intrahepatic portal branches >5 mm long on both modalities

Question 7

Walsh VRU 2023

Canine intrahepatic portosystemic shunts: Interlobar & intralobar classifications

Normal location of ductus venosus?
Interlobar IPSS found in % dogs? most common subtype?
Intralobar IPSS found in % dogs? most originated from where?

Answer 7

Appearance of the normal canine ductus venosus (DV) was confirmed to be between the papillary process and left-lateral liver lobe (in the fissure for ligamentum venosum).

IntERlobar IPSS found in 43%, all but 1 arising from left portal branch
These had 4 subtypes; with ~46% having patent DV as a subtype

IntrAlobar IPSS found in 57% dogs, most (88%) originated from the right portal branch and were in the right-lateral liver lobe

Question 8

Strickland VSURG 2018

** big retrospective

Incidence and risk factors for neurological signs after attenuation of single congenital portosystemic shunts in 253 dogs

% with PANS, % of those with seizures?
% PANS that did not survive?
2 RF for PANS + Odds R?
2 RF for seizures + OR?
Association of shunt location and PANS/seizures?
Association of pre-op Keppra?

Answer 8

11% dogs developed PANS, including ~5% dogs with seizures

18% dogs with PANS did not survive to discharge (= 82% with PANS survived)

Risk factors for PANS:
presence of hepatic encephalopathy (HE) immediately preop (OR 2.7) and increasing age (OR 1.48)

Risk factors for seizures:
presence of HE immediately preop (OR 3.5) and increasing age (OR 1.36)

No association between PSS location (EH or IH) and post-operative PANS or seizures

Preemptive administration of levetiracetam did not influence the risk of PANS or seizures

Question 9

Wallace VSURG 2018

** prospective, CT, 6 dogs

Gradual attenuation of a congenital EHPSS with a self-retaining polyacrylic acid-silicone device in 6 dogs

Device?
% sx complications?
Serum BA results at 4/8 weeks?
Successful complete attenuation #s in 4 weeks? 8 weeks? partial attenuation?

Answer 9

Polyacrylic acid-silicone radiolucent self-retaining gradual occlusion device – look at device photo

0 complications related to surgery (intra or immediate post-op)

Serum bile acids normal in 5/6 dogs at 4 & 8 wks post-op

Shunt completely attenuated 2/6 dogs at 4 wks and 4/6 dogs at 8 wks, with no acquired shunts

Partial attenuation with mild residual flow of 2 EHPSS

Question 10

Joffe VSURG 2019

Evaluation of different methods of securing cellophane bands for portosystemic shunt attenuation

Which size clips failed less?
Which # of cellophane layers failed more & how more likely?
Difference bw type of clip?

Answer 10

Medium clips failed less often than Med-Lg clips & consistently sustained 100 mmHg w/o failing

3 layer cellophane bands were 4.1 x more likely to fail than 4 layer bands & failed at lower pressures

Failure rates of cellophane band constructs did not differ whether secured with PLLC or with TLC or with 25% vs 50% attenuation

PLLC – polymer locking ligation clip; TLC – titanium ligation clip

Question 11

Freund VSURG 2020

Yay we know her!

Thin film occlusion of an intra-abdominal vein in cats

8 week closure completeness #s?
Histo results at site?
Conclusion?

Answer 11

8 weeks post-op closure complete in 1/6, marked in 2/6, moderate 1/6, and mild in 2/6

Histo examination (3 cats) consistent with chronic, multifocal, granulomatous inflammation with moderate fibrosis & collagen degeneration

Conc: venous occlusion inconsistent and often incomplete 8 weeks after thin film banding of external iliac vein despite moderate – abundant perivascular fibrous tissue

Question 12

Matiasovic VSURG 2020

** Retrospective

Outcomes of dogs treated for EH congenital PSS with thin film banding or ameroid ring constrictor

Post op comps & mortality for TFB? ARC?
Revision surgery for persistent shunting % TFB? ARC?
General long-term outcome score? What about revision group?

Answer 12

Postop complications 15 (28%) dogs with TFB with 9% mortality

Postop complications 8 (35%) dogs with AC with 4% mortality

Revision surgery for persistent shunting performed in 14 (29%) dogs treated initially by TFB & 0 dogs treated by AC

Median long-term outcome scores good in both groups; 9/14 (64%) revision surgeries led to favorable outcomes

Question 13

Otomo VSURG 2020

** Another retrospective, sigh

Long-term clinical outcomes of dogs with single congenital extrahepatic portosystemic shunts attenuated with thin film banding or ameroid ring constrictors

Diff bw TFB and ARC in survival to dc?
% dogs with post-op seizures?
Diff bw TFB and ARC in post-op seizures?

Answer 13

No difference in survival to discharge (95%, 97%)

Postoperative seizures in 10 (8%) dogs;
- prevalence did not differ between dogs with TFB (9/85, 11%) and dogs with ARC (1/38, 2.6%);
(also not different bc pre-op Keppra and w/o)

Conc: Gradual attenuation of a single CEHPSS with either TFB or ARC resulted in similar long-term clinical outcomes and low postoperative morbidity and mortality rates.

Question 14

Valiente JVIM 2020

Complications and outcome of cats with congenital EH PSS treated with thin film: 34 cases (2008-2017)

% comps?
% mortality?
Majority died why?
% post-op seizures? Pre-op anti sz drugs?
BA normal in %?

Answer 14

Complications 11/34 cats (32%)

Deaths related to CEHPSS in 6/34;
4 cats didn’t survive to discharge
Overall mortality rate 17.6%

Persistent seizures cause of death 4/6 (but post-op seizures not associated with surv to dc)

Post-op seizures in 8/34 (24%) cats; all these cats received preop antiepileptic drugs

Serum BA normalized in 25/28, 89%
3 it did not - 1 patent shunt, 2 developed multiple acquired

Question 15

Mullins VSURG 2020
* 2/3 papers for this guy

Prognostic factors for short-term survival of dogs that experience postattenuation seizures after surgical correction of single congenital extrahepatic portosystemic shunts: 93 cases (2005-2018)

% 30 day survival
% with generalized PAS?
Factors (+) associated with short-term survival?
Most euth why?

Answer 15

30 (32%) dogs survived to 30 days

76 (82%) dogs experienced generalized PAS (post-attenuation seizures)

Factors positively associated with short-term survival:
having a history of preoperative seizures and development of focal PAS only

Most nonsurvivors were humanely euthanized because of uncontrolled or recurrent seizures

Extra (not in abs):

Prophylactic treatment with LEV, surgery performed in the second half of the study period, and treatment of PAS with propofol CRI were not associated with short-term survival

• History of pre-operative seizures had 7.6 fold increased odds of survival
• Focal only seizures had 14.4 increased odds of short-term survival

Question 16

Strickland VSURG 2020

** Another retrospective, sigh

Incidence and risk factors for neurological signs after attenuation of a single congenital portosystemic shunt in 50 cats

% EHPSS vs IHPSS?
% with PANS?
% with PANS that died?
Assoc bw PANS or seizures and shunt type? deg of attenuation? age? HE? Use of pre-op Keppra?
What was lower 24 h post-op in cats with PANS?

Answer 16

Congenital portosystemic shunts in 50 cats: 40 extrahepatic (80%) and 10 intrahepatic shunts.

Postattenuation neurological signs in 31 (62%)

5/31 cats with PANS did not survive to discharge (16%)

No association detected between PANS or seizures and the type of CPSS (intrahepatic or extrahepatic), degree of attenuation, age, or the use of periop levetiracetam or hepatic encephalopathy immediately preop

Osmolality at a median 24 hours postop was lower in cats with PANS, odds ratio [Exp(B)] 0.86

Question 17

Carroll VSURG 2020

Feasibility of thoracoscopic attenuation of the azygos vein as a model for portoazygos shunts: a canine cadaveric study

Describe positioning and port placement (who knows, maybe impt?)
What attenuation devices did they try?
What # cases needed port modification?
Median BW?
Success?
Diff in placement of each device?

Answer 17

Cadavers placed in sternal recumbency with left dorsolateral obliquity
3 ports in the right hemithorax at the mid-10th ICS and dorsal third of the 9th and 11th ICS.
Caudal azygos vein isolated
3 devices (coated cellophane, uncoated cellophane, 5-mm ameroid constrictor) placed around one segment in each dog.

Minor port access modifications were required to improve working space and triangulation in 3/10

Median dog weight was 7.7 kg (range, 1.8-11).

All attenuation devices were successfully placed thoracoscopically in all cadavers.

No difference was detected in time required for placement between the ameroid constrictor and coated and uncoated cellophane

Question 18

Carrera JAVMA 2022

Long-term outcome and quality of life of dogs that developed neurologic signs after surgical treatment of a congenital portosystemic shunt: 50 cases (2005-2020)

**NOTE: they only included dogs that surv >/30 days

% that had seizures w PANS?
% w seizure recurrence?
% graded by O to have high QOL?
% surv >6m?
% of dogs w other neuro signs at dc that later resolved?

Answer 18

30/50 (60%) dogs had postattenuation seizures with or without other nonseizure neurologic signs

(20 (40%) had neurologic signs other than seizures)

Seizures reoccurred in 15/30 dogs, 50%, of those that had postattenuation seizures

27/33 (82%) owners graded their dog’s long-term (> 30 days after surgery) quality-of-life as high.

45 (90%) dogs survived > 6 months

Most (29/43 [67%]) neurologic signs (other than seizures) present at the time of hospital discharge resolved

Question 19

Devriendt JVIM 2021
** same author / jc/ year as MEGX

Plasma amino acid profiles in dogs with closed extrahepatic portosystemic shunts are only partially improved 3 months after successful gradual attenuation

BCAA: AAA Ratio change after 4 wk MM?

Ratio change 3 m post-op?

Answer 19

Dogs with portosystemic shunts have an altered blood amino acid profile, with an abnormal branched-chained amino acid (BCAA)-to-aromatic amino acid (AAA) ratio being the most common abnormality

BCAA: AAA was extremely low (0.6) at time of dx and did not improve after 4wks medical mgmt. at time of sx (0.5) despite improved neuro scores

3mo postop BCAA:AAA was significantly higher (1.5) but was still indicative of moderate to severe hepatic dysfunction

Question 20

Devriendt JVIM 2021
** same author / journal / year as BCAA:AAA

Evaluation of serum lidocaine/monoethylglycinexylidide concentration to assess shunt closure in dogs with extrahepatic portosystemic shunts

What is MEGX? What did they do to measure it?
At T15 how did MEGX differ bw dogs w complete attenuation vs not?
MEGX Sn and SP for shunt attenuation?

Answer 20

Got baseline blood sample (T0), gave 1 mg/kg body weight of lidocaine IV. 15 (T15) and 30 min (T30) later, blood collected. Plasma concentrations of lidocaine and its metabolites MEGX and glycylxylidide (GX) were determined - assess its ability to determine liver perfusion after EHPSS closure

At T15, median MEGX concentrations were sig higher in dogs with closed EHPSS compared to diagnosis but were not different in dogs with persistent shunting

Sensitivity to determine shunt closure for MEGX at T15 was 96% and specificity 83%

Question 21

Sunlight VSURG 2021

Protein C and comparative biochemical changes in dogs treated with percutaneous transvenous coil embolization of congenital intrahepatic portosystemic shunts

Post op PC increased in what % dogs, with what % mean inc?

Association bw pre-op PC and post-clinical status?

What mean post-op values were increased in excellent status dogs?

What PC finding was associated with excellent status?

Answer 21

Postoperative PC activity increased in 37/47 (79%) dogs with a mean increase of 39% ± 2%

No association was detected between preoperative PC and ultimate clinical status

Mean postoperative PC (76% ± 1.4%), HCT, MCV, ALB, and BUN were higher in dogs with excellent clinical status

Postoperative PC activity was higher when shunts were completely occluded (96.3% ± 10.9%), which was a finding associated with excellent status

Question 22

/% intra-op comp?

Culp JAVMA 2020

Use of percutaneous transvenous coil embolization in the treatment of intrahepatic portosystemic shunts in four cats

Answer 22

No major intra-op complications

Question 23

Wallace JAVMA 2022

** large retrospective

Dogs ≥ 5 years of age at the time of congenital extrahepatic portosystemic shunt diagnosis have better long-term outcomes with surgical attenuation than with medical management alone

Survival time longer with which group? Hazard ratio?

What 2 things 6-12 months post-diagnosis were more common in MM group?

Periop mortality % for sx group?

Answer 23

Survival time was longer with surgery than medical management (hazard ratio, 4.2; M, 3.4 years; S, 10.9 years)

Continued clinical signs 6-12 months after diagnosis were more common with MM (M, 40% [33/88]; S, 14% [21/155])

Continued medical treatments 6-12 months after diagnosis were more common in the MM group (M, 78% [69/88]; S, 34% [53/155])

Perioperative mortality rate 7%

Question 24

Serrano JVIM 2022

Comparison of diet (hepatic supportive diet, HSD), lactulose, and metronidazole combinations in the control of pre-surgical clinical signs in dogs with congenital extrahepatic portosystemic shunts

T1 (4 weeks) clinical scores decreased in which group(s)?

Answer 24

T1 (4 weeks) clinical scores decreased in the HSD + lactulose, but not in the HSD and HSD + metronidazole groups

Question 25

Solari JAVMA 2022

Percutaneous transvenous coil embolization of congenital intrahepatic portosystemic shunts in small- and toy-breed dogs: 20 cases (2015–2021)

Intra & post-op complication rates? Comps listed for both?
% survival to dc?
CS resolved in what % at what median # days?
1 and 2 year survival rate?

Answer 25

Intra- and postop complication rates were 20% (4/20) and 5% (1/20)
& included hypotension, bradycardia, hypercapnia, ventricular premature contractions, hypothermia, and regurgitation

All dogs (100%) survived to d/c

Clinical signs resolved in 95% (19/20) of the dogs a median of 21 days after the procedure

One- and 2-year survival rates were 92%

Question 26

Devriendt VSURG 2022

** Third one for this lady; diff JC/yr
*** prospective, clinical

Evaluation of different blood tests in dogs with extrahepatic portosystemic shunts to assess shunt closure after surgical treatment

Which single test had highest Sp for determining post-op shunt closure?
Which single test highest Sn for post-op closure?
Best combo tests?
Conclusion?

Answer 26

Fasting ammonia (FA), preprandial, postprandial, and paired serum bile acids (SBA), the lidocaine/monoethylglycylxylidide (L/MEGX) test, and serum hyaluronic acid (SHA)

FA had the highest specificity (100%), whereas SHA and MEGX measured 15 min after lidocaine administration (T15) had the highest sensitivity (96.9% and 96.2%, respectively)

The most promising blood test combinations were SHA (Sn 97%, Sp 82%), combined with the L/MEGX test (MEGX at T15: Sn 100%, Sp 72%)
or the L/MEGX test (MEGX at T15) combined with either FA (Sn 100%, Sp 83%) or postprandial SBA (Sn 100%, Sp 82%)

Both SHA and the L/MEGX test were sensitive tests for determining shunt closure after gradual attenuation of EHPSS (however still need imaging to definitively say)

Question 27

Mullins VSURG 2023

*3/3 paper for this guy

Postattenuation neurologic signs after surgical correction of congenital portosystemic shunts in cats: A narrative review

Reported incidence of PANS?
Reported incidence of post-att seizures?
2 Possible RF for PANS?
Evidence for pre-op keppra?
+ more on back

Answer 27

All provided for knowledge

PANS includes seizures but also milder neurologic signs - blindness, ataxia, abnormal behavior, tremors, and twitching.

Incidence of PANS in studies including a minimum of five cats ranges from 14%-62%

Incidence of specifically postattenuation seizures in studies including a minimum of five cats: 0%-32%

Etiology: unknown, however, several hypotheses have been proposed including CNS disease/derangement, periop hypoglycemia and electrolyte disturbances, and postop portal hypertension.

Possible risk factors: lower grades of intraop postocclusion mesenteric portovenography and osmolality at 24 h postop.

Evidence for use of prophylactic antiepileptics such as levetiracetam to prevent or reduce incidence of PANS in cats is limited and does not support their use.

Because the cause is unknown, treatment is aimed at controlling neurologic signs, preventing progression to more severe signs, and providing general supportive care.

Prognosis for recovery is variable and dependent on severity of neurologic signs.

For cats surviving to discharge, long-term survival is possible but persistence or recurrence of neurologic signs in the long-term is not uncommon.

Question 28

Glenn JSAP 2022

Short- and long-term outcomes of polyethylene band attenuation of congenital extrahepatic portosystemic shunts in dogs: 60 cases (2010-2020)

% post op comps?
Peri-op mortality %?
Persistent shunting in %?
Long term outcomes excellent / good in %? Poor in %?
% not receiving any MM at last f/u?

Answer 28

Post-op complications occurred in 10/60 dogs (17%)

Peri-operative mortality of 6.7%

Persistent shunting in 9/53 dogs (17%) available for follow-up examination

Long term outcomes excellent or good in 82% and poor in 18%

At last f/u 68% on no meds / MM

Question 29

Economu JFMS 2022

Surgical treatment and outcome of intrahepatic shunts in 12 cats

3 Treatments performed?
% with PANS?
% died from PANS?
Short term survival %?
Long term outcome?

Answer 29

Treatment:
3 cats tolerated complete acute suture attenuation,
8 cats underwent partial suture attenuation, 4 of which received complete suture ligation at a second surgery
1 cat underwent partial attenuation with a thin film band

PANS:
6 cats (50%) developed PANS after first surgery
2 cats (17%) died or were euthanized due to severe PANS.

Short term survival: 10/12 (83%)
Excellent outcome in 5/8 (63%), fair in 2/8, poor in 1

Question 30

van Blokland-Post JVIM 2023

** prospective

Prediction of outcome after ligation or thin film banding of extrahepatic shunts, based on plasma albumin concentration and hematologic expression of 8 target genes in 85 dogs

% developed PAS?
Risks for development of PAS?
% dogs with clinical recovery?
% dogs with complete recovery?

Answer 30

5 dogs (6%) developed PAS

Risks: age, WBC, expression of hepatocyte growth factor activator, LysM, putative peptidoglycan-binding domain-containing protein 2

72/85 (85%) dogs had clinical recovery and 51/80 (64%) had complete recovery

Question 31

Bristow JSAP 2019

Health-related quality of life following surgical attenuation of congenital portosystemic shunts versus healthy controls

Median long term health related QOL scores?
Long term PSS clinical sign scores?

Answer 31

Median long-term health-related QOL score excellent for both intrahepatic & extrahepatic shunt cases & similar to control dogs

Long-term PSS clinical sign scores for both intrahepatic and extrahepatic congenital PSS dogs were S worse than those of control group

Question 32

Mullins VSURG 2019

** 1/3 paper for this guy, all VSURG, diff years
*** huge retrospective, 940 dogs

Effect of prophylactic treatment with levetiracetam on the incidence of postattenuation seizures in dogs undergoing surgical management of single congenital extrahepatic portosystemic shunts

Tx groups (3)?
% dogs with PAS?
Incidence of PAS in each group?
Differences bw groups?

Answer 32

3 groups:
- no LEV (LEV-);
- LEV at ≥15 mg/kg q8h for ≥24 hours preoperatively or a 60 mg/kg IV loading dose perioperatively, followed by ≥15 mg/kg q8h postop (LEV1);
- LEV at <15 mg/kg q8h, for <24 hours preoperatively, or continued at <15 mg/kg q8h postop (LEV2).

75 (8.0%) dogs developed PAS

Incidence of PAS 35/523 (6.7%) for LEV negative group, 21/188 (11%) for LEV1 group, and 19/228 (8%) LEV 2 group
–> Differences were not significant in incidence for each group

No differences between groups of dogs that seized with respect to investigated variables were identified

Question 33

Anglin JAVMA 2022

Clinical characteristics of, prognostic factors for, and long-term outcome of dogs with multiple acquired portosystemic shunts: 72 cases (2000-2018)

MST?
Factors significantly associated with dying of MAPSS?
Dogs with what factors less likely to die of MAPSS?

Answer 33

MST 580 days

Factors significantly associated with dying of MAPSS-related versus unrelated: body weight, albumin concentration at the first and last recheck examinations, and cholesterol, total solids, and glucose concentrations at the last recheck examination

Body weight increased risk of 1.082 for every 1 kg increase in weight
Albumin at first recheck (lower albumin = risk of dying)

Dogs not receiving medical management or without signs of depressed mentation at the time of initial presentation were less likely to die of causes related to MAPSSs

Question 34

Tinoco-Najera JSAP 2021

Risk factors for urinary bacterial growth in dogs with congenital portosystemic shunts: 66 cases (1997-2019)

Urinary tract abn in %? Most had what?
Common abnormalities on UA?
% with positive UC?
RF for positive UC?

Answer 34

urinary tract abnormalities (stones 65% and debris 32%) were ID in 75%

abnormalities on urinalysis were pyuria in 14%, bacteriuria 20%, hematuria 40%

24% had positive urine culture

bacteriuria was the only sig risk factor for positive urine culture

Question 35

Earley VRU 2020

Early partial portal venous contrast enhancement in canine CT-Angiography

Was early portal vein enhancement pathognomonic for arterioportal vascular anomalies?

Answer 35

origin of EPoVE (early portal vein enhancement) was ID in 14/24 areas: gastroduodenal vein, cranial mesenteric vein, pancreatic br of splenic vein and splenic vein

EPoVE during late arterial phase is common phenomenon of early portal venous drainage of abdominal organ and should not be interpreted as pathognomonic for arterioportal vasc anomalies, which should be dx on other criteria

Question 36

Zurita JSAP 2023

Jejunal arteriovenous malformation and multiple acquired extrahepatic portosystemic shunts in a juvenile dog, presenting with melena

Pertinent case report info in title

Answer 36

Enterectomy performed

Developed HE and seizures 8 m post-op

Acquired portosystemic shunts may occur in patients with portal vein hypoplasia and jejunal arteriovenous malformations