PSS

Question 1

abnormal communications of the portal and systemic vasculature that allow products of intestinal absorption to bypass the liver and enter directly into systemic circulation

Answer 1

portosystemic shunts

Question 2

T/F

extrahepatic shunts are microvascular

Answer 2

false - macro

Question 3

what is the signalment for extrahepatic shunts

Answer 3

small dogs - YORKIES

Question 4

what veins are most commonly involved in extrahepatic shunts

Answer 4

left gastric v

splenic v

Question 5

in an extrahepatic shunt, veins that should join the portal vein enter where instead

Answer 5

the cd vena cava or the azygous

Question 6

what should normally be the last vessel to enter the cd vena cava

Answer 6

phrenicoabdominal (drains the adrenal)

Question 7

intrahepatic shunt

Answer 7

macrovascular - large dogs like labs, goldens, old english sheepdogs, and ausseis

Question 8

pathophysiology of intrahepatic shunts

Answer 8

patent ductus venosus - shunting vein within the hepatic parenchyma because it did not close at birth

hepatic parenchyma is bypassed

Question 9

when there is no portal vein at all

Answer 9

portal vein atresia

Question 10

what vessels are affected by portal vein atresia

Answer 10

major pre-hepatic vessels

Question 11

what is the most common sign of portal vein atresia

Answer 11

ascites due to hypoproteinemia

Question 12

surgical treatment for portal vein atresia

Answer 12

NONE - medical management only

Question 13

microvascular shunting within the liver

Answer 13

portal triad is too small

portal ein hypoplasia
or
hepatic microvascular dysplasia

Question 14

sign of portal vein hypoplasia

Answer 14

drug sensitivity
post prandial bile acids < 100
protein C acitivty > 70%

Question 15

plasma anticoag factor synthesized in the liver that reflects hepatic synthetic activity and portal bloodflow

Answer 15

protein C

Question 16

shunt fraction on nuclear scintigraphy of PSS and of PVH

Answer 16

PVH - near normal 15%

PSS - >70%

Question 17

macrovascular shunt general signs

Answer 17

poor growth rate
weight loss
anesthetic and tranquilizer intolerance

Question 18

macrovascular shunt nervous system signs

Answer 18

lethargy 
depression
weakness 
pacing 
aggression 
ataxia 
stupor 
coma 
seizures 
head pressing 
blind

Question 19

macrovascular shunt GI signs

Answer 19

anorexia 
vomit 
diarrhea 
pytalism - cats mostly 
pica 
ascites

Question 20

macrovascular shunt urinary signs

Answer 20

pu/pd 
urolithiasis - liver cannot conjugate ammonium properly
ammonium biurate crystals  
cystitis 
urethral obstruction

Question 21

cats with agressiveness, copper eyes, hypersalivation

Answer 21

macrovascular shunt

Question 22

HAV malformation

Answer 22

bruit

Question 23

biochem for macrovascular shunt

Answer 23

low BUN ALB CHOL

high ALT ALP

Question 24

macrovascular protein c

Answer 24

<70%

Question 25

who can get ammonium biurate crystals

Answer 25

dalmatians | and macrovascular shunts

Question 26

noninvasive method of documenting PSS

Answer 26

nuclear scintigraphy -- distinguish from microvascular dysplasia but cannot tell intra vs extrahepatic

Question 27

what is the isotope used in nuclear scintigraphy

Answer 27

tachnetium 99 - given transcolonic or trans-splenic

Question 28

noninvasive dx modality that is 5.5x more likely to correctly determine presence of absence of PSS compared to ultrasonography

Answer 28

CT angiography

Question 29

most common but invasive diagnostic method

Answer 29

portography - mesenteric vein injection not needed if pre op ct angiography is done false negatives

Question 30

preop ALB levels that make risky surgery

Answer 30

<1.5 mg/dl ALB = risky

Question 31

goal of surgery

Answer 31

improve liver function divert blood flow back through portal system without creating portal hypertension severe enough to be life threatening or high enough or long enough to cause acquired shunts to open up

Question 32

what three areas should be checked for the shunt in exploratory

Answer 32

epiploic foramen esophageal hiatus omental bursa

Question 33

ideal surgical mgmt of PSS

Answer 33

complete ligation - complete occlusion without causing signs of portal hypertension possible in only 1/2 cases

Question 34

attenuation

Answer 34

vessels only partially occluded

Question 35

Maximum change in portal pressure between Pre and post ligation

Answer 35

9-10cmh2o

Question 36

occlusion entirely by inflammatory reaction

Answer 36

cellophane banding typically occludes completely in 8-12 days if occluded to <3mm

Question 37

post op - recheck in how many weeks min

Answer 37

4-8