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Farhoodimoghadam M, Reagan KL, Zwingenberger AL. Diagnosis and classification of portosystemic shunts: a machine learning retrospective case-control study. Front Vet Sci 2024; 11:1291318. [PMID: 38638645 PMCID: PMC11024426 DOI: 10.3389/fvets.2024.1291318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 03/21/2024] [Indexed: 04/20/2024] Open
Abstract
Diagnosis of portosystemic shunts (PSS) in dogs often requires multiple diagnostic tests, and available clinicopathologic tests have limitations in sensitivity and specificity. The objective of this study was to train and validate a machine learning model (MLM) that can accurately predict the presence of a PSS utilizing routinely collected demographic data and clinicopathologic features. Dogs diagnosed with PSS or control dogs tested for PSS but had the condition ruled out (non-PSS) were identified. Dogs were included if a complete blood count and serum chemistry panel were available from PSS diagnostic testing. Dogs with a PSS were subcategorized as having a single intrahepatic PSS, a single extrahepatic PSS, or multiple extrahepatic PSS. An extreme gradient boosting (XGboost) MLM was trained with data from 70% of the cases, and MLM performance was determined on the test set, comprising the remaining 30% of the case data. Two MLMs were created. The first was designed to predict the presence of any PSS (PSS MLM), and the second to predict the PSS subcategory (PSS SubCat MLM). The trained PSS MLM had a sensitivity of 94.3% (95% CI 90.1-96.8%) and specificity of 90.5% (95% CI 85.32-94.0%) for dogs in the test set. The area under the receiver operator characteristic curve (AUC) was 0.976 (95% CI; 0.964-0.989). The mean corpuscular hemoglobin, lymphocyte count, and serum globulin concentration were most important in prediction classification. The PSS SubCat MLM had an accuracy of 85.7% in determining the subtype of PSS of dogs in the test set, with variable sensitivity and specificity depending on PSS subtype. These MLMs have a high accuracy for diagnosing PSS; however, the prediction of PSS subclassification is less accurate. The MLMs can be used as a screening tool to increase or decrease the index of suspicion for PSS before confirmatory diagnostics such as advanced imaging are pursued.
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Affiliation(s)
- Makan Farhoodimoghadam
- Department of Computer Science, University of California, Davis, Davis, CA, United States
| | - Krystle L. Reagan
- Department of Veterinary Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
| | - Allison L. Zwingenberger
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA, United States
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Németh K, Sterczer Á, Kiss DS, Lányi RK, Hemző V, Vámos K, Bartha T, Buzás A, Lányi K. Determination of Bile Acids in Canine Biological Samples: Diagnostic Significance. Metabolites 2024; 14:178. [PMID: 38668306 PMCID: PMC11052161 DOI: 10.3390/metabo14040178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 03/19/2024] [Accepted: 03/20/2024] [Indexed: 04/28/2024] Open
Abstract
The comprehensive examination of bile acids is of paramount importance across various fields of health sciences, influencing physiology, microbiology, internal medicine, and pharmacology. While enzymatic reaction-based photometric methods remain fundamental for total BA measurements, there is a burgeoning demand for more sophisticated techniques such as liquid chromatography-tandem mass spectrometry (LC-MS/MS) for comprehensive BA profiling. This evolution reflects a need for nuanced diagnostic assessments in clinical practice. In canines, a BA assessment involves considering factors, such as food composition, transit times, and breed-specific variations. Multiple matrices, including blood, feces, urine, liver tissue, and gallbladder bile, offer insights into BA profiles, yet interpretations remain complex, particularly in fecal analysis due to sampling challenges and breed-specific differences. Despite ongoing efforts, a consensus regarding optimal matrices and diagnostic thresholds remains elusive, highlighting the need for further research. Emphasizing the scarcity of systematic animal studies and underscoring the importance of ap-propriate sampling methodologies, our review advocates for targeted investigations into BA alterations in canine pathology, promising insights into pathomechanisms, early disease detection, and therapeutic avenues.
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Affiliation(s)
- Krisztián Németh
- Department of Physiology and Biochemistry, University of Veterinary Medicine, István u. 2, H-1078 Budapest, Hungary; (K.N.); (D.S.K.); (V.H.); (T.B.)
| | - Ágnes Sterczer
- Department of Internal Medicine, University of Veterinary Medicine, István u. 2, H-1078 Budapest, Hungary;
| | - Dávid Sándor Kiss
- Department of Physiology and Biochemistry, University of Veterinary Medicine, István u. 2, H-1078 Budapest, Hungary; (K.N.); (D.S.K.); (V.H.); (T.B.)
| | - Réka Katalin Lányi
- Faculty of Pharmacy, University of Szeged, Zrínyi u. 9, H-6720 Szeged, Hungary;
| | - Vivien Hemző
- Department of Physiology and Biochemistry, University of Veterinary Medicine, István u. 2, H-1078 Budapest, Hungary; (K.N.); (D.S.K.); (V.H.); (T.B.)
| | - Kriszta Vámos
- Department of Internal Medicine, University of Veterinary Medicine, István u. 2, H-1078 Budapest, Hungary;
| | - Tibor Bartha
- Department of Physiology and Biochemistry, University of Veterinary Medicine, István u. 2, H-1078 Budapest, Hungary; (K.N.); (D.S.K.); (V.H.); (T.B.)
| | - Anna Buzás
- Institute of Food Chain Science, University of Veterinary Medicine, István u. 2, H-1078 Budapest, Hungary; (A.B.); (K.L.)
| | - Katalin Lányi
- Institute of Food Chain Science, University of Veterinary Medicine, István u. 2, H-1078 Budapest, Hungary; (A.B.); (K.L.)
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Devriendt N, Paepe D, Serrano G, de Rooster H. Evaluation of different blood tests in dogs with extrahepatic portosystemic shunts to assess shunt closure after surgical treatment. Vet Surg 2022; 51:1142-1152. [PMID: 35729849 DOI: 10.1111/vsu.13840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 02/13/2022] [Accepted: 05/21/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To determine the sensitivity and specificity of different individual and combined blood tests to assess extrahepatic portosystemic shunt (EHPSS) closure after gradual attenuation of EHPSS in dogs. STUDY DESIGN Clinical prospective study. ANIMALS Twenty client-owned dogs with EHPSS. METHODS Fasting ammonia (FA), preprandial, postprandial, and paired serum bile acids (SBA), the lidocaine/monoethylglycylxylidide (L/MEGX) test, and serum hyaluronic acid (SHA) were performed at diagnosis, and 1, 3, and 6 months postoperatively. Transsplenic portal scintigraphy was performed to determine EHPSS closure 3 months postoperatively. Their sensitivity and specificity in determining shunt closure postoperatively were calculated. RESULTS When assessing a single blood parameter, 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) for determining shunt closure postoperatively. The most promising blood test combinations were SHA (sensitivity 96.9%, specificity 81.8%), combined with the L/MEGX test (MEGX at T15: sensitivity 100%, specificity 72.4%) or the L/MEGX test (MEGX at T15) combined with either FA (sensitivity 100%, specificity 82.8%) or postprandial SBA (sensitivity 100%, specificity 81.5%). CONCLUSION Both SHA and the L/MEGX test were sensitive tests for determining shunt closure after gradual attenuation of EHPSS. Test performances could even be improved by combining these tests with each other or with traditional tests such as FA or postprandial SBA. CLINICAL SIGNIFICANCE Although SHA and the L/MEGX test are sensitive blood tests for determining EHPSS closure, especially when combined with traditional blood tests, imaging is still needed to confirm EHPSS closure.
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Affiliation(s)
- Nausikaa Devriendt
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Dominique Paepe
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Gonçalo Serrano
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Hilde de Rooster
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
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Devriendt N, Serrano G, Stock E, Paepe D, de Rooster H. Diagnostic value of liver function tests and ultrasonography in dogs with suspected congenital portosystemic shunts. Vet Rec 2022; 190:e1381. [PMID: 35102558 DOI: 10.1002/vetr.1381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/07/2021] [Accepted: 12/24/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Diagnosing a congenital portosystemic shunt (cPSS) in dogs can be challenging. The current study aims to report diagnostic performance of fasting ammonia (FA), preprandial, postprandial and paired serum bile acids (SBA) and abdominal ultrasound (aUS) in dogs suspected of having a cPSS. METHODS Medical records of dogs suspected of having a cPSS at initial presentation were retrospectively reviewed. RESULTS In total, 192 dogs suspected of cPSS were included: a cPSS was confirmed in 147 dogs and excluded in 45 dogs. FA had the best combined sensitivity and specificity (77.4 and 93.3%, respectively) to diagnose cPSS. The sensitivity and negative predictive value were 100.0% for paired SBA, making paired SBA the best test to exclude cPSS in this population. Sensitivity and specificity of aUS were 80.8 and 90.0%, respectively. CONCLUSIONS In dogs with clinical signs compatible with cPSS, elevated FA is suggestive of cPSS, whereas normal paired SBA makes the presence of a cPSS unlikely. Although aUS is a useful tool to diagnose cPSS, additional imaging is required to visualize cPSS in almost 20% of cases. Furthermore, the localisation of cPSS can be misdiagnosed, especially in case of extrahepatic cPSS that do not insert into the prehepatic vena cava.
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Affiliation(s)
- Nausikaa Devriendt
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Gonçalo Serrano
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
- Small Animal Clinic Hofheim, Hofheim, Germany
| | - Emmelie Stock
- Department of Medical Imaging of Domestic Animals and Small Animal Orthopaedics, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Dominique Paepe
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Hilde de Rooster
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
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Spillane AM, Haraschak JL, McMichael MA. Resolution of Severe Neurologic Signs Following Intravenous Lipid Emulsion Therapy in a Young Dog With a Portosystemic Shunt: Case Report. Front Vet Sci 2021; 8:798198. [PMID: 34957288 PMCID: PMC8694260 DOI: 10.3389/fvets.2021.798198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 11/09/2021] [Indexed: 11/13/2022] Open
Abstract
A 5-month-old male intact Great Pyrenees was presented for an acute onset of severe neurologic signs (stupor, absent menace, intermittent head turn to the left). The patient's history included possible naproxen ingestion with a maximum ingested dose of 59 mg/kg, exceeding the reported dose of >50 mg/kg known to cause neurologic signs. Blood sampling for baseline bloodwork was performed, and intravenous lipid emulsion (ILE) was subsequently administered, for treatment of the suspected toxicosis. Due to severe and life-threatening neurologic signs, other methods of decontamination were contraindicated and unlikely to be effective; extracorporeal therapy was also unavailable. Complete resolution of neurologic signs occurred 30 min after completion of ILE therapy. At this time, the owners found the missing naproxen tablets after returning home and the bloodwork results returned revealing findings consistent with hepatic encephalopathy. The fasted blood ammonia concentration immediately prior to ILE administration was 702.1 μg/dL (reference interval, RI: 24–36 μg/dL) and decreased to 194.1 μg/dL 24 h later. In the first 24 h, the patient also received three doses of lactulose, N-acetylcysteine, and intravenous fluids. The patient was subsequently diagnosed with a single, large intrahepatic portosystemic shunt via computed tomography and underwent an endovascular coil embolization procedure. Given the rapid and dramatic improvement in severe neurologic signs after ILE therapy alone, it is strongly suspected that this treatment resulted in improvement of hepatic encephalopathy.
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Affiliation(s)
- Amanda M Spillane
- Department of Veterinary Clinical Medicine, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Jenica L Haraschak
- Department of Veterinary Clinical Medicine, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Maureen A McMichael
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL, United States
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Watanabe S, Suzuki T, Tsuchiya T, Kondo Y. Long-term results of splenomegaly after surgery for biliary atresia in the native liver. Asian J Surg 2021; 45:849-853. [PMID: 34848145 DOI: 10.1016/j.asjsur.2021.07.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/05/2021] [Accepted: 07/27/2021] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Biliary atresia (BA) is a rare disorder characterized by obstructive jaundice in infants, shortly after birth. Postoperatively, some patients exhibit portal hypertension and progressive liver fibrosis. Splenomegaly is a symptom of portal hypertension. We aimed to investigate splenomegaly as a marker for complications of portal hypertension and the relationship between splenomegaly and liver fibrosis in the long-term native liver (NL). METHODS Between 1977 and 2018, 71 patients underwent hepaticojejunostomy. We included 54 patients (34 NL group, 20 liver transplant (LT) group) who fulfilled the eligibility criteria. Spleen volume (SV), total bile acids, hyaluronic acid, type IV collagen, and aspartate aminotransferase-to-platelet ratio index (APRi) were measured. Data were analyzed using Student's t-test, regression analysis, and receiver operating characteristic (ROC) curve analysis (P < 0.05). RESULTS Total bile acids, hyaluronic acid, type IV collagen, and APRi increased in NL patients with a large SV at >25 years. SV and type IV collagen were correlated with NL for >25 years (r = 0.79 [P = 0.006], y = 1.1 - [0.03 × type IV collagen] [P = 0.008]). In the ROC curve analysis, the cutoff value for type IV collagen was 165 ng/mL (P = 0.07). CONCLUSIONS We suggest that SV as a prognostic index for End-Stage Liver Disease may be useful in biliary atresia. Long-term follow-up is necessary because the clinical course may be favorable in childhood but worsen during adulthood.
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Affiliation(s)
- Shunsuke Watanabe
- Department of Pediatric Surgery, Fujita Health University Hospital, Aichi, Japan; Department of Pediatric Surgery, Fujita Health University Hospital, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi Prefecture, 470-1192, Japan.
| | - Tatsuya Suzuki
- Department of Pediatric Surgery, Fujita Health University Hospital, Aichi, Japan; Department of Pediatric Surgery, Fujita Health University Hospital, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi Prefecture, 470-1192, Japan.
| | - Tomonori Tsuchiya
- Department of Pediatric Surgery, Fujita Health University Hospital, Aichi, Japan; Department of Pediatric Surgery, Fujita Health University Hospital, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi Prefecture, 470-1192, Japan.
| | - Yasuhiro Kondo
- Department of Pediatric Surgery, Fujita Health University Hospital, Aichi, Japan; Department of Pediatric Surgery, Fujita Health University Hospital, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi Prefecture, 470-1192, Japan.
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Serrano G, Devriendt N, Paepe D, de Rooster H. Serum insulin-like growth factor-1 as a marker of improved liver function and surgical outcome in dogs with congenital extrahepatic portosystemic shunts. Vet J 2021; 274:105716. [PMID: 34252551 DOI: 10.1016/j.tvjl.2021.105716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/19/2021] [Accepted: 07/06/2021] [Indexed: 11/29/2022]
Abstract
Serum insulin-like growth factor-1 concentration (sIGF-1c) is reduced in various hepatopathies in humans and dogs. This work aimed to evaluate sIGF-1c in dogs before and after congenital extrahepatic portosystemic shunt (cEHPSS) attenuation, in relation to surgical outcome (closed vs. persistent shunting). Secondarily, it aimed to assess if sIGF-1c can discriminate between cEHPSS and portal vein hypoplasia (PVH) and finally compare sIGF-1c ratio (postoperative/preoperative sIGF-1c) to pre-prandial serum bile acids (preBA), post-prandial bile acids (postBA), bile acid stimulation test (BAST) and fasting ammonia (FA), regarding surgical outcome. Thirty-nine dogs were included: 15 with closed cEHPSS, 15 with persistent shunting and nine with PVH. Transplenic portal scintigraphy was used to classifiy surgical outcome. There was no significant difference in sIGF-1c between dogs with cEHPSS and those with PVH (P > 0.05). Postoperative sIGF-1c increased in all dogs (P < 0.001 and P = 0.023 for closed and persistent shunting, respectively) and the increase was more pronounced in closed cEHPSS than in persistent shunting (P = 0.006). Using an optimal sIGF-1c ratio cut-off of 2.23, the sensitivity was 93.3% and the specificity was 66.7% for differentiation between surgical outcomes. Serum pre-prandial bile acids, postBA BAST and FA had sensitivities of 80%, 86.7%, 86.7%, 60%; and specificities of 100%, 93.3%, 93.3%, 100%, respectively. There was a greater increase in sIGF-1c after shunt closure than during persistent shunting; nevertheless sIGF-1c ratio was inferior to advanced imaging to assess surgical outcome.
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Affiliation(s)
- G Serrano
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Campus Merelbeke, Salisburylaan 133, 9820 Merelbeke, Belgium.
| | - N Devriendt
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Campus Merelbeke, Salisburylaan 133, 9820 Merelbeke, Belgium
| | - D Paepe
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Campus Merelbeke, Salisburylaan 133, 9820 Merelbeke, Belgium
| | - H de Rooster
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Campus Merelbeke, Salisburylaan 133, 9820 Merelbeke, Belgium
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Helal EM, Sharaf-Eldin M, Abou El Azm AR, Badr Eldin NM, Dawoud MM, Abd-Elsalam S, Ziada DH. Hemodynamic Changes of Hepatic & Renal Vessels in Systemic Bacterial Infection with Fever in HCV Related Cirrhosis. Infect Disord Drug Targets 2021; 20:511-516. [PMID: 31057113 DOI: 10.2174/1871526519666190506102703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 01/25/2019] [Accepted: 04/20/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To study the hemodynamic changes of hepatic & renal vessels in systemic bacterial infection with fever in HCV related cirrhosis with possible complications. METHODS Three groups of patients with systemic bacterial infection with fever were included in the study; group І included 15 patients with decompensated cirrhosis, group ІІ included 15 patients with compensated cirrhosis and group ІІІ included 10 patients without liver affection. Laboratory parameters and Doppler US of hepatic and renal vessels were evaluated during and after subsidence of fever in all patients. RESULTS Forty patients were enrolled in this prospective study. There were 22 male and 18 female patients. We found that the direction of blood flow in the portal and splenic veins was hepatopetal and the veins were non pulsatile in all cases with no change during and after subsidence of infection. There was no significant difference in portal or splenic vein diameters during and after subsidence of infection in the three studied groups. However, the mean values of portal and splenic veins peak velocities were significantly lower during infection in cirrhotic groups. The mean value of hepatic artery resistive index during fever was significantly higher than after fever in cirrhotic groups. Renal resistive and pulsatility indices were significantly higher during fever in cirrhotic groups. CONCLUSION Systemic bacterial infection with fever can affect hepatic haemodynamics leading to aggravation of portal hypertension and increasing the risk of complications as variceal bleeding and hepatic encephalopathy and can also affect renal haemodynamics with increased risk of renal impairment.
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Affiliation(s)
- Eman Mohammed Helal
- Department of Tropical Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Mohamed Sharaf-Eldin
- Department of Tropical Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
| | | | | | | | - Sherief Abd-Elsalam
- Department of Tropical Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Dina Hazem Ziada
- Department of Tropical Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
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Pena-Ramos J, Barker L, Saiz R, Walker DJ, Tappin S, Hare CHZ, Roberts ML, Williams TL, Bexfield N. Resting and postprandial serum bile acid concentrations in dogs with liver disease. J Vet Intern Med 2021; 35:1333-1341. [PMID: 33955592 PMCID: PMC8163115 DOI: 10.1111/jvim.16134] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 04/07/2021] [Accepted: 04/14/2021] [Indexed: 12/11/2022] Open
Abstract
Background Serum bile acids (SBAs) are frequently measured in dogs. However, there is limited data comparing SBAs in different liver diseases diagnosed according to standardized histological criteria. Objectives To compare resting and postprandial SBAs, and determine their sensitivity and specificity, for various liver diseases in dogs. Animals Three hundred and forty‐one client‐owned dogs with suspected liver disease that had a liver biopsy and SBAs measured. Methods Multicenter retrospective study. Cases were classified according to standardized histological criteria. The sensitivity and specificity of resting and postprandial SBAs for the diagnosis of each liver disease, and all liver diseases combined, were calculated. Results The median resting SBAs were highest in dogs with cirrhosis (98.8 μmol/L; range, 6‐135) and congenital circulatory anomalies (CCa; 79.45 μmol/L; 0.3‐705). The highest median postprandial concentrations were found in CCa (126 μmol/L; 0‐726) and chronic hepatitis (CH; 54.3 μmol/L; 0‐260). Using the cut‐off value of 10 μmol/L, the highest sensitivities of resting SBAs were recorded in dogs with CCa (87.5%; 95% confidence interval, 76.8‐94.4) and CH (81.1%; 71.5‐88.6). The sensitivities of postprandial SBAs were the highest in cholangitis (100%; 47.8‐100.0) and CCa (91.1%; 78.8‐97.5). The specificities of resting and postprandial SBAs for all diseases were 49.3% (37.6‐61.1) and 29.7% (15.9‐47.0), respectively. Conclusions and Clinical Importance Postprandial SBAs are more sensitive but less specific than resting SBAs for the diagnosis of liver disease. There were dogs in all categories of liver disease with resting SBAs <10 and >90 μmol/L. Therefore, careful interpretation of both normal and elevated values is required.
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Affiliation(s)
- Jorge Pena-Ramos
- Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Lucy Barker
- Bristol Veterinary School, University of Bristol, Bristol, United Kingdom
| | - Rocío Saiz
- Anderson Moores Veterinary Specialists, Winchester, United Kingdom
| | - David J Walker
- Anderson Moores Veterinary Specialists, Winchester, United Kingdom
| | - Simon Tappin
- Dick White Referrals, Cambridgeshire, United Kingdom
| | - Cassia H Z Hare
- Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
| | | | - Tim L Williams
- Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Nicholas Bexfield
- Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
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Clinical and laboratory outcome after surgical treatment of single congenital extrahepatic portosystemic shunt using ameroid constrictor in 25 dogs. ACTA VET BRNO 2021. [DOI: 10.2754/avb202089040357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The objective of the study was to evaluate the clinical and laboratory outcome after the surgical treatment of a single congenital extrahepatic portosystemic shunt using an ameroid constrictor. Patient medical records were reviewed in retrospect. Data on the signalment, clinical signs, preoperative bile acid stimulation test and ammonia concentration were recorded. The surgical treatment success rate was evaluated by mortality in the perioperative and short-term postoperative period and by the long-term clinical outcome. Bile acid stimulation test and ammonia concentration were also analysed 2–3 days, 4–6 weeks, and 6–8 weeks postoperatively. No patient died in the selected periods. The long-term clinical outcome was excellent in 15 out of 20 patients, good in 3 out of 20 patients and poor in 2 out of 20 patients. Preprandial bile acid concentration was elevated in 96.00%, postprandial bile acid concentration in 100.00% and ammonia concentration in 80.95% of patients preoperatively. A significant decrease was found in postprandial bile acid and ammonia 2–3 days postoperatively and in preprandial bile acid 4–6 weeks postoperatively. A significant decrease in liver function parameters in days post operation indicates a rapid restoration of hepatic function. The surgical treatment of a single extrahepatic portosystemic shunt using an ameroid constrictor is a successful method of treatment for this type of portosystemic shunt, with as much as 75.00% of the patients having an excellent long-term clinical outcome.
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Weiler K, Kleber K, Zielinsky S, Moritz A, Bauer N. Analytical performance and method comparison of a quantitative point-of-care immunoassay for measurement of bile acids in cats and dogs. J Vet Diagn Invest 2021; 33:35-46. [PMID: 33112211 PMCID: PMC7756073 DOI: 10.1177/1040638720968784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Point-of-care analyzers (POCAs) for quantitative assessment of bile acids (BAs) are scarce in veterinary medicine. We evaluated the Fuji Dri-Chem Immuno AU10V analyzer and v-BA test kit (Fujifilm) for detection of feline and canine total serum BA concentration. Results were compared with a 5th-generation assay as reference method and a 3rd-generation assay, both run on a bench-top analyzer. Analytical performance was assessed at 3 different concentration ranges, and with interferences. For method comparison, samples of 60 healthy and diseased cats and 64 dogs were included. Linearity was demonstrated for a BA concentration up to 130 µmol/L in cats (r = 0.99) and 110 µmol/L in dogs (r = 0.99). The analyzer showed high precision near the lower limit of quantification of 2 µmol/L reported by the manufacturer. Intra- and inter-assay coefficients of variation were < 5% for both species and all concentrations. Interferences were observed for bilirubin (800 mg/L) and lipid (4 g/L). There was excellent correlation with the reference method for feline (rs = 0.98) and canine samples (rs = 0.97), with proportional biases of 6.7% and -1.3%, respectively. However, a large bias (44.1%) was noted when the POCA was compared to the 3rd-generation assay. Total observed error was less than total allowable error at the 3 concentrations. The POCA reliably detected feline and canine BA in clinically relevant concentrations.
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Affiliation(s)
- Kristina Weiler
- Department of Veterinary Clinical Sciences, Clinical Pathology and Clinical Pathophysiology, Justus-Liebig-University, Giessen, Germany
| | - Katharina Kleber
- Department of Veterinary Clinical Sciences, Clinical Pathology and Clinical Pathophysiology, Justus-Liebig-University, Giessen, Germany
| | - Sabine Zielinsky
- Department of Veterinary Clinical Sciences, Clinical Pathology and Clinical Pathophysiology, Justus-Liebig-University, Giessen, Germany
| | - Andreas Moritz
- Department of Veterinary Clinical Sciences, Clinical Pathology and Clinical Pathophysiology, Justus-Liebig-University, Giessen, Germany
| | - Natali Bauer
- Department of Veterinary Clinical Sciences, Clinical Pathology and Clinical Pathophysiology, Justus-Liebig-University, Giessen, Germany
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Williams A, Gow A, Kilpatrick S, Tivers M, Lipscomb V, Smith K, Day MO, Jeffery N, Mellanby RJ. Astrocyte lesions in cerebral cortex and cerebellum of dogs with congenital ortosystemic shunting. J Vet Sci 2020; 21:e44. [PMID: 32476318 PMCID: PMC7263922 DOI: 10.4142/jvs.2020.21.e44] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 03/18/2020] [Accepted: 03/23/2020] [Indexed: 01/08/2023] Open
Abstract
Background Congenital portosystemic shunt (cPSS) is one of the most common congenital disorders diagnosed in dogs. Hepatic encephalopathy (HE) is a frequent complication in dogs with a cPSS and is a major cause of morbidity and mortality. Despite HE been a major cause of morbidity in dogs with a cPSS, little is known about the cellular changes that occur in the central nervous system of dogs with a cPSS. Objectives The objective of this study was to characterise the histological changes in the cerebral cortex and cerebellum of dogs with cPSS with particular emphasis on astrocyte morphology. Methods Eight dogs with a confirmed cPSS were included in the study. Results Six dogs had substantial numbers of Alzheimer type II astrocytes and all cases had increased immunoreactivity for glial fibrillary acidic protein in the cerebral cortex, even if there were minimal other morphological changes. Conclusions This study demonstrates that dogs with a cPSS have marked cellular changes in the cerebral cortex and cerebellum. The cellular changes that occur in the cerebral cortex and cerebellum of dogs with spontaneously arising HE are similar to changes which occur in humans with HE, further validating dogs with a cPSS as a good model for human HE.
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Affiliation(s)
- Alun Williams
- Department of Veterinary Medicine, University of Cambridge, Cambridge, CB3 0ES, United Kingdom
| | - Adam Gow
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, The University of Edinburgh, Edinburgh, EH25 9RG, United Kingdom
| | - Scott Kilpatrick
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, The University of Edinburgh, Edinburgh, EH25 9RG, United Kingdom
| | - Mickey Tivers
- Bristol Veterinary School, University of Bristol, Bristol, BS40 5DU, United Kingdom
| | - Vicky Lipscomb
- Department of Clinical Sciences and Services, Royal Veterinary College, London, AL97TA, United Kingdom
| | - Ken Smith
- Department of Pathobiology and Population Sciences, Royal Veterinary College, London, AL97TA, United Kingdom
| | - Michael Oliver Day
- Bristol Veterinary School, University of Bristol, Bristol, BS40 5DU, United Kingdom
| | - Nick Jeffery
- Department of Small Animal Clinical Studies, Texas A&M University, College Station, TX 77843-4474, USA
| | - Richard John Mellanby
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, The University of Edinburgh, Edinburgh, EH25 9RG, United Kingdom.
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Spinillo S, Golini L, Motta L. Brain MRI findings in a dog with late onset epileptic seizure after portosystemic shunt attenuation. VETERINARY RECORD CASE REPORTS 2020. [DOI: 10.1136/vetreccr-2020-001159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Simone Spinillo
- Department of NeurologyNorth West Veterinary SpecialistsRuncornCheshireUK
| | - Lorenzo Golini
- Veterinary Neurology and Neurosurgery ServiceClinica Veterinaria San MarcoVeggianoItaly
| | - Luca Motta
- Department of NeurologyNorth West Veterinary SpecialistsRuncornCheshireUK
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Devriendt N, Serrano G, Paepe D, de Rooster H. Liver function tests in dogs with congenital portosystemic shunts and their potential to determine persistent shunting after surgical attenuation. Vet J 2020; 261:105478. [PMID: 32741493 DOI: 10.1016/j.tvjl.2020.105478] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 05/24/2020] [Accepted: 05/29/2020] [Indexed: 02/03/2023]
Abstract
Portosystemic shunts (PSS) are congenital or acquired vascular anomalies that cause blood to bypass the liver. Liver function tests, such as fasting ammonia, ammonia tolerance test, and (paired) serum bile acids, are reliable for the diagnosis of PSS in dogs. Surgical attenuation is a common treatment for congenital PSS. Following surgical attenuation, it is useful to evaluate shunt closure. In this critical review, the ability of liver function tests to determine the presence and degree of residual shunting following surgical attenuation of canine PSS is discussed. Despite the availability of several liver function tests, a single rapid, simple, cost-effective, sensitive and specific test to evaluate surgical attenuation of PSS is not available.
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Affiliation(s)
- Nausikaa Devriendt
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820 Merelbeke, Belgium.
| | - Gonçalo Serrano
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820 Merelbeke, Belgium
| | - Dominique Paepe
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820 Merelbeke, Belgium
| | - Hilde de Rooster
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, 9820 Merelbeke, Belgium
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15
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Vallarino N, Pil S, Devriendt N, Or M, Vandermeulen E, Serrano G, Paepe D, Bosmans T, de Rooster H. Diagnostic value of blood variables following attenuation of congenital extrahepatic portosystemic shunt in dogs. Vet Rec 2019; 187:e48. [PMID: 31662576 DOI: 10.1136/vr.105296] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 09/06/2019] [Accepted: 10/09/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND The aims of this study were to determine if extrahepatic portosystemic shunt (EHPSS) postoperative closure could be predicted based on preoperative blood analyses and to determine the accuracy of blood variables to evaluate persistence of portosystemic shunting postoperatively (multiple acquired portosystemic shunts (MAPSS) or persistent EHPSS). METHODS Retrospectively, 62 dogs treated surgically for congenital EHPSS that underwent postoperative trans-splenic portal scintigraphy or CT angiography three to six months postoperatively were included. RESULTS None of the studied preoperative blood variables could unambiguously predict surgical outcome. Elevated postoperative fasting venous ammonia (FA) concentration always indicated surgical failure (persistent shunting or MAPSS), but normal FA did not provide any information on the postoperative shunting status. Paired serum bile acids (SBA) were not reliable enough to confirm or exclude postoperative shunting. In the presence of low normal postoperative FA levels, elevated preprandial SBA was more likely in dogs with persistent shunting (sensitivity of 0.79, specificity of 0.83), whereas postprandial SBA below reference limit was more often observed in case of surgical success (sensitivity of 0.93, specificity of 0.67). CONCLUSION Blood variables, and more specifically the combination of FA and SBA, are not a valuable alternative to advanced medical imaging to reliably assess the surgical outcome after EHPSS surgery.
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Affiliation(s)
- Nicolas Vallarino
- Small Animal Department, Universiteit Gent Faculteit Diergeneeskunde, Merelbeke, Belgium
| | - Steven Pil
- Small Animal Department, Universiteit Gent Faculteit Diergeneeskunde, Merelbeke, Belgium
| | - Nausikaa Devriendt
- Small Animal Department, Universiteit Gent Faculteit Diergeneeskunde, Merelbeke, Belgium
| | - Matan Or
- Small Animal Department, Universiteit Gent Faculteit Diergeneeskunde, Merelbeke, Belgium
| | - Eva Vandermeulen
- Department of Medical Imaging of Domestic Animals and Orthopaedics of Small Animals, Universiteit Gent Faculteit Diergeneeskunde, Merelbeke, Belgium
| | - Gonçalo Serrano
- Small Animal Department, Universiteit Gent Faculteit Diergeneeskunde, Merelbeke, Belgium
| | - Dominique Paepe
- Small Animal Department, Universiteit Gent Faculteit Diergeneeskunde, Merelbeke, Belgium
| | - Tim Bosmans
- Small Animal Department, Universiteit Gent Faculteit Diergeneeskunde, Merelbeke, Belgium
| | - Hilde de Rooster
- Small Animal Department, Universiteit Gent Faculteit Diergeneeskunde, Merelbeke, Belgium
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Fernandes R, Driver C, Rose JH, Rusbridge C. MRI findings in two West Highland White Terrier dogs with hepatic encephalopathy secondary to portosystemic shunt. VETERINARY RECORD CASE REPORTS 2019. [DOI: 10.1136/vetreccr-2019-000814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Ricardo Fernandes
- Department of Neurology and NeurosurgeryFitzpatrick referralsGodalmingUK
| | - Colin Driver
- Department of Neurology and NeurosurgeryFitzpatrick referralsGodalmingUK
| | - J H Rose
- Department of Neurology and NeurosurgeryFitzpatrick referralsGodalmingUK
| | - Clare Rusbridge
- Department of Neurology and NeurosurgeryFitzpatrick referralsGodalmingUK
- School of Veterinary MedicineUniversity of SurreyGuildfordUK
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Webster CRL, Center SA, Cullen JM, Penninck DG, Richter KP, Twedt DC, Watson PJ. ACVIM consensus statement on the diagnosis and treatment of chronic hepatitis in dogs. J Vet Intern Med 2019; 33:1173-1200. [PMID: 30844094 PMCID: PMC6524396 DOI: 10.1111/jvim.15467] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 02/14/2019] [Indexed: 12/13/2022] Open
Abstract
This consensus statement on chronic hepatitis (CH) in dogs is based on the expert opinion of 7 specialists with extensive experience in diagnosing, treating, and conducting clinical research in hepatology in dogs. It was generated from expert opinion and information gathered from searching of PubMed for manuscripts on CH, the Veterinary Information Network for abstracts and conference proceeding from annual meetings of the American College of Veterinary Medicine and the European College of Veterinary Medicine, and selected manuscripts from the human literature on CH. The panel recognizes that the diagnosis and treatment of CH in the dog is a complex process that requires integration of clinical presentation with clinical pathology, diagnostic imaging, and hepatic biopsy. Essential to this process is an index of suspicion for CH, knowledge of how to best collect tissue samples, access to a pathologist with experience in assessing hepatic histopathology, knowledge of reasonable medical interventions, and a strategy for monitoring treatment response and complications.
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Affiliation(s)
- Cynthia R. L. Webster
- Department of Clinical SciencesCummings School of Veterinary Medicine at Tufts UniversityGraftonMassachusetts
| | - Sharon A. Center
- Department of Clinical SciencesNew York State College of Veterinary Medicine at Cornell UniversityIthacaNew York
| | - John M. Cullen
- Population Health and PathobiologyNorth Carolina State Veterinary MedicineRaleighNorth Carolina
| | - Dominique G. Penninck
- Department of Clinical SciencesCummings School of Veterinary Medicine at Tufts UniversityGraftonMassachusetts
| | - Keith P. Richter
- Ethos Veterinary Health and Veterinary Specialty Hospital of San DiegoSan DiegoCalifornia
| | - David C. Twedt
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical SciencesColorado State UniversityFort CollinsColorado
| | - Penny J. Watson
- Department of Veterinary MedicineUniversity of CambridgeCambridgeUnited Kingdom
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18
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van Straten G, van Dalen D, Mesu SJ, Rothuizen J, Teske E, Spee B, Favier RP, van Geijlswijk IM. Efficacy of orally administered sodium benzoate and sodium phenylbutyrate in dogs with congenital portosystemic shunts. J Vet Intern Med 2019; 33:1331-1335. [PMID: 30916412 PMCID: PMC6524074 DOI: 10.1111/jvim.15477] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 02/25/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Hyperammonemia can result in hepatic encephalopathy, which in severe cases eventually can lead to coma and death. In dogs, congenital portosystemic shunts (CPSS) are the most common cause for hyperammonemia. Conservative treatment consists of a protein modified diet, nonabsorbable disaccharides, antibiotics, or some combinations of these. Sodium benzoate (SB) and sodium phenylbutyrate (SPB) both are used in the acute and long-term treatment of humans with hyperammonemia caused by urea cycle enzyme deficiencies. Both treatments are believed to lower blood ammonia concentrations by promoting excretion of excess nitrogen via alternative pathways. OBJECTIVES To evaluate the efficacy and safety of PO treatment with SB and SPB on hyperammonemia and clinical signs in CPSS dogs. METHODS Randomized, double-blind, placebo-controlled crossover trial. Concentrations of blood ammonia and bile acids were measured in CPSS dogs before and after a 5-day treatment with SB, SPB, and placebo. A wash-out period of 3 days was used between treatments. A standard questionnaire was developed and distributed to owners to evaluate clinical signs before and after each treatment. RESULTS Blood ammonia concentrations were not influenced by any of the treatments and were comparable to those observed during placebo treatment. In addition, SB and SPB treatment did not result in improvement of clinical signs. Adverse effects during treatment included anorexia, vomiting, and lethargy. CONCLUSIONS AND CLINICAL IMPORTANCE Based on our results, we conclude that SB or SPB are not useful in the conservative treatment of hyperammonemia in dogs with CPSS.
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Affiliation(s)
- Giora van Straten
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary MedicineUtrecht UniversityUtrechtThe Netherlands
| | - Diewke van Dalen
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary MedicineUtrecht UniversityUtrechtThe Netherlands
| | - Sietske J. Mesu
- Pharmacy Department, Faculty of Veterinary MedicineUtrecht UniversityUtrechtThe Netherlands
| | - Jan Rothuizen
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary MedicineUtrecht UniversityUtrechtThe Netherlands
| | - Erik Teske
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary MedicineUtrecht UniversityUtrechtThe Netherlands
| | - Bart Spee
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary MedicineUtrecht UniversityUtrechtThe Netherlands
| | - Robert P. Favier
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary MedicineUtrecht UniversityUtrechtThe Netherlands
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Funes S, Gordon J, Gorman E, Ruaux C. Clinical evaluation of a benchtop dry chemistry analyzer for measurement of ammonium concentrations in canine plasma samples. J Am Vet Med Assoc 2018; 253:61-65. [PMID: 29911944 DOI: 10.2460/javma.253.1.61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the clinical performance of a veterinary benchtop dry chemistry analyzer for measurement of plasma ammonium concentrations in dogs by comparing results with those obtained by a reference standard test method. DESIGN Prospective evaluation study. SAMPLE 32 blood samples from 30 dogs (16 with and 14 without suspected hepatobiliary disease). PROCEDURES Blood samples were collected by jugular venipuncture. A veterinary benchtop dry chemistry analyzer and a reference standard (enzymatic) test method were used to measure ammonium concentrations in plasma collected from heparinized whole blood. Bland-Altman plots were used to assess intermethod agreement. Results were compared by linear regression, and correlation was calculated by the Pearson method. Samples were classified as having high or normal ammonium concentrations on the basis of cutoff data for the relevant test method; results were compared between methods to evaluate diagnostic agreement. RESULTS 31 of 32 (97%) samples were classified correctly with the benchtop analyzer; 1 sample with a high ammonium concentration was classified as having a normal value (ie, false-negative result) by this method. A strong positive correlation (r2 = 0.989) was found between methods, with constant, proportional, negative bias for benchtop analyzer results. The interassay coefficient of variation (ie, precision) for measurement of an internal standard with the benchtop analyzer was 2.74% (n = 20 repetitions). CONCLUSIONS AND CLINICAL RELEVANCE The dry chemistry analyzer used in the study had acceptable clinical performance for detection of high versus normal ammonium concentrations in canine plasma, indicating the method can be used to aid diagnosis in dogs with suspected hepatobiliary disease.
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Devriendt N, Vandermeulen E, Or M, Paepe D, Rooster H. Inaccuracy of serum bile acids to predict closure after surgical attenuation of a portosystemic shunt. VETERINARY RECORD CASE REPORTS 2018. [DOI: 10.1136/vetreccr-2017-000510] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Nausikaa Devriendt
- Small Animal DepartmentFaculty of Veterinary MedicineUniversiteit Gent Faculteit DiergeneeskundeMerelbekeBelgium
| | - Eva Vandermeulen
- Department of Medical Imaging of Domestic AnimalsUniversiteit Gent Faculteit DiergeneeskundeMerelbekeBelgium
| | - Matan Or
- Small Animal DepartmentFaculty of Veterinary MedicineUniversiteit Gent Faculteit DiergeneeskundeMerelbekeBelgium
| | - Dominique Paepe
- Small Animal DepartmentFaculty of Veterinary MedicineUniversiteit Gent Faculteit DiergeneeskundeMerelbekeBelgium
| | - Hilde Rooster
- Small Animal DepartmentFaculty of Veterinary MedicineUniversiteit Gent Faculteit DiergeneeskundeMerelbekeBelgium
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21
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Herstad KMV, Rønning HT, Bakke AM, Moe L, Skancke E. Changes in the faecal bile acid profile in dogs fed dry food vs high content of beef: a pilot study. Acta Vet Scand 2018; 60:29. [PMID: 29751815 PMCID: PMC5948804 DOI: 10.1186/s13028-018-0383-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 05/03/2018] [Indexed: 12/31/2022] Open
Abstract
Background Dogs are fed various diets, which also include components of animal origin. In humans, a high-fat/low-fibre diet is associated with higher faecal levels of bile acids, which can influence intestinal health. It is unknown how an animal-based diet high in fat and low in fibre influences the faecal bile acid levels and intestinal health in dogs. This study investigated the effects of high intake of minced beef on the faecal bile acid profile in healthy, adult, client-owned dogs (n = 8) in a 7-week trial. Dogs were initially adapted to the same commercial dry food. Thereafter, incremental substitution of the dry food by boiled minced beef over 3 weeks resulted in a diet in which 75% of each dog’s total energy requirement was provided as minced beef during week 5. Dogs were subsequently reintroduced to the dry food for the last 2 weeks of the study. The total taurine and glycine-conjugated bile acids, the primary bile acids chenodeoxycholic acid and cholic acid, and the secondary bile acids lithocholic acid, deoxycholic acid (DCA) and ursodeoxycholic acid (UDCA) were analysed, using liquid chromatography–tandem mass spectrometry. Results The faecal quantities of DCA were significantly higher in dogs fed the high minced beef diet. These levels reversed when dogs were reintroduced to the dry food diet. The faecal levels of UDCA and taurine-conjugated bile acids had also increased in response to the beef diet, but this was only significant when compared to the last dry food period. Conclusions These results suggest that an animal-based diet with high-fat/low-fibre content can influence the faecal bile acids levels. The consequences of this for canine colonic health will require further investigation. Electronic supplementary material The online version of this article (10.1186/s13028-018-0383-7) contains supplementary material, which is available to authorized users.
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Or M, Devriendt N, Kitshoff AM, Peremans K, Vandermeulen E, Paepe D, Polis I, Martlé V, de Rooster H. Ammonia concentrations in arterial blood, venous blood, and cerebrospinal fluid of dogs with and without congenital extrahepatic portosystemic shunts. Am J Vet Res 2017; 78:1313-1318. [DOI: 10.2460/ajvr.78.11.1313] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Harris L, Reems M, Dial S. An Unusual Case of Portal Hypertension Secondary to Primary Hypoplasia of the Portal Vein. J Am Anim Hosp Assoc 2017; 53:331-337. [PMID: 28892424 DOI: 10.5326/jaaha-ms-6428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Primary hypoplasia of the portal vein with secondary portal hypertension and acquired portosystemic collateral circulation is infrequently reported in the veterinary literature. Diagnosis of this condition requires documentation of abnormal hepatocellular function, the lack of intrahepatic or extrahepatic macroscopic congenital portosystemic shunts, and liver histopathology demonstrating portal hypoperfusion in the absence of hepatic inflammation or nodular regeneration. Due to a perceived poor prognosis, many patients with this condition are euthanized; however, those that are spared can be medically managed, in some cases for years. This case report describes the diagnosis and management of a patient with primary hypoplasia of the portal vein and secondary portal hypertension that presented with the severe but typical clinical manifestations of ascites and hepatic encephalopathy, normal liver enzyme concentrations, and normal serum bile acid concentrations.
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Affiliation(s)
- Lauren Harris
- From the BluePearl Veterinary Partners, Tampa, Florida (L.H., M.R.); and the Arizona Veterinary Diagnostic Laboratory, College of Agriculture and Life Sciences, University of Arizona, Tucson, Arizona (S.D.)
| | - Miryam Reems
- From the BluePearl Veterinary Partners, Tampa, Florida (L.H., M.R.); and the Arizona Veterinary Diagnostic Laboratory, College of Agriculture and Life Sciences, University of Arizona, Tucson, Arizona (S.D.)
| | - Sharon Dial
- From the BluePearl Veterinary Partners, Tampa, Florida (L.H., M.R.); and the Arizona Veterinary Diagnostic Laboratory, College of Agriculture and Life Sciences, University of Arizona, Tucson, Arizona (S.D.)
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Montagnese S, De Rui M, Angeli P, Amodio P. Reply to: "Tools and tactics for improving diagnosis of hepatic encephalopathy". J Hepatol 2017; 66:1328-1329. [PMID: 28215599 DOI: 10.1016/j.jhep.2017.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 02/09/2017] [Indexed: 12/04/2022]
Affiliation(s)
| | - Michele De Rui
- Department of Medicine, University of Padua, Padua, Italy
| | - Paolo Angeli
- Department of Medicine, University of Padua, Padua, Italy
| | - Piero Amodio
- Department of Medicine, University of Padua, Padua, Italy
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Dirksen K, Burgener IA, Rothuizen J, van den Ingh TSGAM, Penning LC, Spee B, Fieten H. Sensitivity and Specificity of Plasma ALT, ALP, and Bile Acids for Hepatitis in Labrador Retrievers. J Vet Intern Med 2017; 31:1017-1027. [PMID: 28543991 PMCID: PMC5508325 DOI: 10.1111/jvim.14716] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 02/11/2017] [Accepted: 03/16/2017] [Indexed: 12/28/2022] Open
Abstract
Background Biochemical indicators for diagnosing liver disease are plasma alanine aminotransferase activity (ALT), alkaline phosphatase activity (ALP), and bile acid concentration (BA). Objectives To determine the sensitivity and specificity of ALT, ALP, and BA for detecting primary hepatitis (PH) in clinically healthy Labrador retrievers and investigate whether ALT and ALP can discriminate between dogs with PH and nonspecific reactive hepatitis (RH). Animals 191 clinically healthy and 51 clinically ill Labrador retrievers with hepatic histopathology. Methods Retrospective study. Medical records were reviewed for ALT, ALP, preprandial BA, liver histopathology, and hepatic copper concentrations. Results In 64% (122/191) of the clinically healthy Labrador retrievers, hepatic histology revealed inflammatory infiltrates. This frequency might be biased because part of them was included as first‐line relatives of dogs with copper‐associated hepatitis. Sensitivity of ALT, ALP, and BA in this population for detecting acute hepatitis was 45, 15, and 15%, respectively. For chronic hepatitis, sensitivity was 71, 35, and 13%, respectively. Specificity of ALT, ALP, and BA was >90% for AH, CH, and RH. When increased liver enzymes were present, median ALT was significantly higher in PH cases (312 U/L, range 38–1,369) compared to RH cases (91 U/L, range 39–139) (P < .001). There was no difference in ALP between dogs with a PH and a RH (P = .361). Conclusions and Clinical Importance Histopathologic abnormalities in the liver were present in the majority of apparent clinically healthy Labrador retrievers. The sensitivity of ALT, ALP, and BA for detecting acute and chronic hepatitis in this population was low. More sensitive biomarkers are needed for early detection of liver disease in apparent clinically healthy dogs.
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Affiliation(s)
- K Dirksen
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - I A Burgener
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - J Rothuizen
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | | | - L C Penning
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - B Spee
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - H Fieten
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
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Knapp T, Navalòn I, Medda M, Pradelli D, Borgonovo S, Crosta C, Bussadori CM. A multimodality imaging approach for guiding a modified endovascular coil embolization of a single intrahepatic portosystemic shunt in dogs. Res Vet Sci 2015; 103:156-63. [PMID: 26679811 DOI: 10.1016/j.rvsc.2015.09.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 09/25/2015] [Accepted: 09/27/2015] [Indexed: 10/22/2022]
Abstract
Intrahepatic portosystemic shunts (IHPSS) in dogs are aberrant vascular anomalies that connect the portal and the systemic venous vessels. In most of the patients, the surgical approach is unfavourable due to the difficulties in isolating the IHPSS, making the option of a percutaneous transvenous coil embolization (PTCE) one of the safer occlusive procedures. This study describes the treatment of eight dogs with a single IHPSS using a multimodality imaging approach to guide the modified PTCE procedure. This new technique results in a decrease of 71% of the time of the entire procedure with the reduction of 91% in the time required involved the IHPSS identification and in the fluoroscopy exposure time avoiding the need for iodinated contrast agents during the procedure. Moreover, the placement of the catheter before the caval stent ensures its greater stability, enhancing the procedural safety in the phase when the coils are released and avoiding the risk of their dislocation.
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Affiliation(s)
- Teja Knapp
- Clinica Veterinaria Gran Sasso, Via Donatello 26, 20131 Milan, Italy.
| | | | | | - Danitza Pradelli
- Clinica Veterinaria Gran Sasso, Via Donatello 26, 20131 Milan, Italy.
| | - Simone Borgonovo
- Clinica Veterinaria Gran Sasso, Via Donatello 26, 20131 Milan, Italy.
| | - Cristina Crosta
- Clinica Veterinaria Gran Sasso, Via Donatello 26, 20131 Milan, Italy.
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Grobelna AP, Honkavaara J, Restitutti F, Huuskonen V, Sakka SG, Spillmann T. Evaluation of a transcutaneous method to assess canine liver function by indocyanine green plasma disappearance rate in healthy adult Beagle dogs. Vet J 2015; 209:169-73. [PMID: 26831155 DOI: 10.1016/j.tvjl.2015.10.053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 10/23/2015] [Accepted: 10/26/2015] [Indexed: 11/29/2022]
Abstract
A non-invasive, transcutaneous method using near infrared spectroscopy to assess indocyanine green plasma disappearance rate (ICG-PDR) in healthy dogs subjected to different conditions was evaluated in eight healthy purpose-bred Beagles under isoflurane-anaesthesia (Trial 1) and when they had initially recovered from anaesthesia (Trial 2). Plasma ICG concentrations (0, 5, 10, 15, 30 min after rapid ICG injection (0.5 mg/kg) into a peripheral vein were determined by high-performance liquid chromatography in parallel with transcutaneous measurements. ICG clearance (mL/min/kg) and retention rate after 15 min (R15, %) were calculated from plasma concentrations to be 3.09 ± 0.83 (mean ± SD) and 30.6 ± 8.3 in anaesthetised dogs and 3.63 ± 0.88 and 28.1 ± 7.3 in recovering dogs, respectively. ICG-PDR (%/min) and R15 (%) obtained using the transcutaneous method were 7.11 ± 3.18 and 34.6 ± 12.4 (Trial 1) and 7.79 ± 3.33 and 32.3 ± 9.2 (Trial 2). The coefficients of determination (r(2)) for ICG clearance and ICG-PDR were 0.14 (Trial 1) and 0.81 (Trial 2) and 0.47 (Trial 1) and 0.29 (Trial 2) for R15, respectively. The mean bias (lower, upper limit of agreement) for R15 were 5.6 (-12.3, 23.5) (Trial 1) and 3.9 (-12.4, 20.1) (Trial 2). The results suggest good agreement between the two methods in dogs recovering from isoflurane-anaesthesia and the transcutaneous method might be useful in real-time assessment of liver function in conscious dogs.
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Affiliation(s)
- A P Grobelna
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, Helsinki University, PO Box 59 (Viikintie 49), 00014 Helsinki, Finland
| | - J Honkavaara
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, Helsinki University, PO Box 59 (Viikintie 49), 00014 Helsinki, Finland
| | - F Restitutti
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, Helsinki University, PO Box 59 (Viikintie 49), 00014 Helsinki, Finland
| | - V Huuskonen
- UCD Veterinary Hospital, School of Veterinary Medicine, University College Dublin, Belfield, Dublin, Ireland
| | - S G Sakka
- Department of Anesthesiology and Operative Intensive Care Medicine, Cologne-Merheim Medical Center (CMMC),Witten/Herdecke University, Witten, Germany
| | - T Spillmann
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, Helsinki University, PO Box 59 (Viikintie 49), 00014 Helsinki, Finland.
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van Straten G, Spee B, Rothuizen J, van Straten M, Favier RP. Diagnostic value of the rectal ammonia tolerance test, fasting plasma ammonia and fasting plasma bile acids for canine portosystemic shunting. Vet J 2015; 204:282-6. [PMID: 25959128 DOI: 10.1016/j.tvjl.2015.04.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 01/29/2015] [Accepted: 04/10/2015] [Indexed: 11/19/2022]
Abstract
Portosystemic shunting (PSS) often results in hyperammonaemia and, consequently, hepatic encephalopathy. This retrospective study evaluated the sensitivity, specificity, positive and negative predictive values (PPV and NPV, respectively) and other test performance metrics for the ammonia tolerance test (ATT), serum fasting bile acids (FBA), serum fasting ammonia concentration (FA), and combinations of these tests for their association with PSS in dogs. Medical records of 271 dogs suspect for PSS (symptomatic group) and 53 dogs returning for evaluation after surgical closure of a congenital PSS (CPSS post-surgical control group) were analysed. In the symptomatic group, ATT at 40 min (T40), and the FBA had the highest sensitivity (100% and 98%, respectively) and NPV (100% and 96%, respectively) for PSS. The combination of increased FBA and FA had the highest specificity (97%), with a PPV of 97%, and a positive likelihood ratio of 29. In the CPSS post-surgical control group, the specificity and PPV of FA and the combination of increased FBA/FA were both 100%. In purebred populations, the NPV of all tests was 100%. Consequently, PSS would be ruled out in a symptomatic dog with normal FBA or ATT (T40) and would be highly probable when both FBA and FA are increased. Increased FA was conclusive for PSS in dogs evaluated for post-surgical closure of a CPSS. FBA was the most suitable test for screening purposes.
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Affiliation(s)
- G van Straten
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands.
| | - B Spee
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - J Rothuizen
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - M van Straten
- 'Hachaklait', Mutual Society for Veterinary Services, P.O.B. 3039, Caesarea Industrial Park 38900, Israel; Koret School of Veterinary Medicine, Faculty of Agriculture, Hebrew University of Jerusalem, P.O.B. 12, Rechovot 76100, Israel
| | - R P Favier
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
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Seibert RL, Tobias KM, Reed A, Snyder KR. Evaluation of a semiquantitative SNAP test for measurement of bile acids in dogs. PeerJ 2014; 2:e539. [PMID: 25210659 PMCID: PMC4157295 DOI: 10.7717/peerj.539] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 08/04/2014] [Indexed: 11/20/2022] Open
Abstract
Background. Serum bile acids (SBA) are used as a routine screening tool of liver function in dogs. Serum samples are usually shipped to a referral laboratory for quantitative analysis with an enzymatic chemistry analyzer. The canine SNAP Bile Acids Test (SNAP-BAT) provides an immediate, semi-quantitative measurement of bile acid concentrations in-house. With the SNAP-BAT, bile acids concentrations of 5–30 µmol/L are quantified, and results outside of that range are classified as <5 or >30 µmol/L. Agreement of the SNAP-BAT with the enzymatic method has not been extensively investigated. Objectives. The purposes of this prospective clinical study were to assess the precision of the SNAP-BAT and determine agreement of SNAP-BAT with results from an in-house chemistry analyzer. Methods. After verifying intra-assay precision of the SNAP-BAT, a prospective analysis was performed using blood samples collected from 56 dogs suspected to have liver disease. Each sample was analyzed with an enzymatic, in-house chemistry analyzer and the SNAP-BAT. Agreement between the two methods was statistically assessed using the κ index of agreement. Results. Intra-assay variability was minimal. The κ index for agreement between the SNAP-BAT and routine chemistry analyzer was between 0.752 and 0.819, indicating substantial to near perfect agreement. Conclusions. The SNAP-BAT is a highly accurate, semi-quantitative test that yields immediate results, and has very little intra-assay variability, particularly for results >30 µmol/L.
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Affiliation(s)
- Rachel L Seibert
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee , Knoxville, TN , USA
| | - Karen M Tobias
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee , Knoxville, TN , USA
| | - Ann Reed
- Office of Information Technology, University of Tennessee , Knoxville, TN , USA
| | - Karl R Snyder
- Department of Pathology, College of Veterinary Medicine, University of Tennessee , Knoxville, TN , USA
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31
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Thiel C, Steinbach S, Schmidt M, Amort K, Zahn N, Kramer M, Moritz A. Extrahepatic Biliary Atresia in a 4-Week-Old Pug. Vet Surg 2014. [DOI: 10.1111/j.1532-950x.2014.22210.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Cetina Thiel
- Department of Veterinary Clinical Sciences, Clinic for Small Animals, Surgery; Justus-Liebig-University; Giessen Germany
| | - Sarah Steinbach
- Department of Veterinary Clinical Sciences, Clinic for Small Animals, Internal Medicine; Justus-Liebig-University; Giessen Germany
| | - Martin Schmidt
- Department of Veterinary Clinical Sciences, Clinic for Small Animals, Surgery; Justus-Liebig-University; Giessen Germany
| | - Kerstin Amort
- Department of Veterinary Clinical Sciences, Clinic for Small Animals, Surgery; Justus-Liebig-University; Giessen Germany
| | - Nanette Zahn
- Department of Veterinary Clinical Sciences, Clinic for Small Animals, Surgery; Justus-Liebig-University; Giessen Germany
| | - Martin Kramer
- Department of Veterinary Clinical Sciences, Clinic for Small Animals, Surgery; Justus-Liebig-University; Giessen Germany
| | - Andreas Moritz
- Department of Veterinary Clinical Sciences, Clinic for Small Animals, Internal Medicine; Justus-Liebig-University; Giessen Germany
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32
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Tivers MS, Handel I, Gow AG, Lipscomb VJ, Jalan R, Mellanby RJ. Hyperammonemia and systemic inflammatory response syndrome predicts presence of hepatic encephalopathy in dogs with congenital portosystemic shunts. PLoS One 2014; 9:e82303. [PMID: 24392080 PMCID: PMC3879253 DOI: 10.1371/journal.pone.0082303] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 10/22/2013] [Indexed: 12/29/2022] Open
Abstract
Hepatic encephalopathy (HE) is an important cause of morbidity and mortality in patients with liver disease. The pathogenesis of he is incompletely understood although ammonia and inflammatory cytokines have been implicated as key mediators. To facilitate further mechanistic understanding of the pathogenesis of HE, a large number of animal models have been developed which often involve the surgical creation of an anastomosis between the hepatic portal vein and the caudal vena cava. One of the most common congenital abnormalities in dogs is a congenital portosystemic shunt (cpss), which closely mimics these surgical experimental models of HE. Dogs with a cPSS often have clinical signs which mimic clinical signs observed in humans with HE. Our hypothesis is that the pathogenesis of HE in dogs with a cPSS is similar to humans with HE. The aim of the study was to measure a range of clinical, haematological and biochemical parameters, which have been linked to the development of HE in humans, in dogs with a cPSS and a known HE grade. One hundred and twenty dogs with a cPSS were included in the study and multiple regression analysis of clinical, haematological and biochemical variables revealed that plasma ammonia concentrations and systemic inflammatory response syndrome scores predicted the presence of HE. Our findings further support the notion that the pathogenesis of canine and human HE share many similarities and indicate that dogs with cPSS may be an informative spontaneous model of human HE. Further investigations on dogs with cPSS may allow studies on HE to be undertaken without creating surgical models of HE thereby allowing the number of large animals used in animal experimentation to be reduced.
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Affiliation(s)
- Mickey S. Tivers
- Department of Veterinary Clinical Sciences, Royal Veterinary College, Hatfield, Hertfordshire, United Kingdom
| | - Ian Handel
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, The University of Edinburgh, Roslin, Midlothian, United Kingdom
| | - Adam G. Gow
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, The University of Edinburgh, Roslin, Midlothian, United Kingdom
| | - Vicky J. Lipscomb
- Department of Veterinary Clinical Sciences, Royal Veterinary College, Hatfield, Hertfordshire, United Kingdom
| | - Rajiv Jalan
- UCL Institute for Liver and Digestive Health, UCL Medical School, London, United Kingdom
| | - Richard J. Mellanby
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, The University of Edinburgh, Roslin, Midlothian, United Kingdom
- MRC Centre for Inflammation Research, University of Edinburgh, Edinburgh, United Kingdom
- * E-mail:
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33
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O'Leary CA, Parslow A, Malik R, Hunt GB, Hurford RI, Tisdall PLC, Duffy DL. The inheritance of extra-hepatic portosystemic shunts and elevated bile acid concentrations in Maltese dogs. J Small Anim Pract 2013; 55:14-21. [PMID: 24299127 DOI: 10.1111/jsap.12156] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To determine the heritability of extra-hepatic portosystemic shunts and elevated post-prandial serum bile acid concentrations in Maltese dogs. MATERIALS AND METHODS Maltese dogs were recruited and investigated by a variable combination of procedures including dynamic bile acid testing, rectal ammonia tolerance testing, ultrasonography, portal venography, surgical inspection or necropsy. In addition, nine test matings were carried out between affected and affected dogs, and affected and unaffected dogs. RESULTS In 135 variably related Maltese, shunt status could be confirmed in 113, including 19 with an extra-hepatic portosystemic shunt (17 confirmed at surgery, 2 at necropsy). Rectal ammonia tolerance testing results and post-prandial serum bile acid concentrations were retrievable for 50 and 88 dogs, respectively. Pedigree information was available for these 135 and an additional 164 related dogs. Two consecutive test matings were carried out between two affected animals (whose shunts had been attenuated), with 2 of 8 (25%) of offspring having an extra-hepatic portosystemic shunt. Six test matings were carried out between an affected and an unaffected animal, with 2 of 22 (9%) offspring affected. Heritability of extra-hepatic portosystemic shunt was 0·61 calculated using variance components analysis [95% confidence interval (CI) 0·14 to 1·0, P=0·001]. The best fitting model from segregation analysis was a common, partially penetrant, recessive model (allele frequency 0·34, penetrance 0·99, CI 0·09 to 1·0). The heritability of elevated post-prandial serum bile acid (and thus likely portal vein hypoplasia) was 0·81 (CI 0·43 to 1·0, P=0·2) after logarithmic transformation of post-prandial serum bile acid concentrations. CLINICAL SIGNIFICANCE There is strong support for extra-hepatic portosystemic shunts and elevated post-prandial serum bile acid concentrations both being inherited conditions in Maltese.
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Affiliation(s)
- C A O'Leary
- School of Veterinary Science, The University of Queensland, Brisbane, 4072, Australia
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34
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Fukushima K, Kanemoto H, Ohno K, Takahashi M, Fujiwara R, Nishimura R, Tsujimoto H. Computed tomographic morphology and clinical features of extrahepatic portosystemic shunts in 172 dogs in Japan. Vet J 2013; 199:376-81. [PMID: 24512983 DOI: 10.1016/j.tvjl.2013.11.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 09/26/2013] [Accepted: 11/17/2013] [Indexed: 11/18/2022]
Abstract
Canine extrahepatic congenital portosystemic shunts (EH-cPSS) are classified into several anatomical types, depending on the origin and termination of the shunt vessel. The aim of this retrospective study was to determine the proportion and clinical features of each anatomical shunt type in a population of dogs presented to a veterinary teaching hospital in Japan. Dogs diagnosed with EH-cPSS using computed tomographic (CT) portography were included (n=172) and shunts were classified based on previous reports. Clinical data were collected from case records and analysed statistically. The most common anatomical type was the spleno-phrenic shunt (n=64), followed by the spleno-azygos (n=38), right gastric-caval (n=29), spleno-caval (n=21), right gastric-caval with caudal loop (n=9), right gastric-phrenic (n=6), colono-caval (n=3), spleno-phrenic and azygos (n=1), and porto-caval (n=1) shunts. Spleno-phrenic and spleno-azygos shunts were diagnosed more frequently in older dogs than right gastric-caval and spleno-caval shunts (P<0.05). The portal vein/aortic (PV/Ao) ratio was significantly larger in dogs with spleno-phrenic shunts than in dogs with spleno-azygos, right gastric-caval or spleno-caval shunts (P<0.05). The PV/Ao ratio was significantly larger in dogs with spleno-azygos shunts than in dogs with right gastric-caval shunts. Dogs with spleno-phrenic shunts had significantly lower serum alkaline phosphatase activities than those with right gastric-caval or spleno-caval shunts. Dogs with spleno-phrenic shunts had significantly lower fasting ammonia concentrations than those with spleno-caval shunts.
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Affiliation(s)
- K Fukushima
- Department of Veterinary Internal Medicine, Graduate School of Agricultural and Life Sciences, University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo 113-8657, Japan
| | - H Kanemoto
- Department of Veterinary Internal Medicine, Graduate School of Agricultural and Life Sciences, University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo 113-8657, Japan
| | - K Ohno
- Department of Veterinary Internal Medicine, Graduate School of Agricultural and Life Sciences, University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo 113-8657, Japan.
| | - M Takahashi
- Department of Veterinary Internal Medicine, Graduate School of Agricultural and Life Sciences, University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo 113-8657, Japan
| | - R Fujiwara
- Department of Veterinary Surgery, Graduate School of Agricultural and Life Sciences, University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo 113-8657, Japan
| | - R Nishimura
- Department of Veterinary Surgery, Graduate School of Agricultural and Life Sciences, University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo 113-8657, Japan
| | - H Tsujimoto
- Department of Veterinary Internal Medicine, Graduate School of Agricultural and Life Sciences, University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo 113-8657, Japan
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35
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Kim SE, Giglio RF, Reese DJ, Reese SL, Bacon NJ, Ellison GW. COMPARISON OF COMPUTED TOMOGRAPHIC ANGIOGRAPHY AND ULTRASONOGRAPHY FOR THE DETECTION AND CHARACTERIZATION OF PORTOSYSTEMIC SHUNTS IN DOGS. Vet Radiol Ultrasound 2013; 54:569-74. [DOI: 10.1111/vru.12059] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 05/04/2013] [Indexed: 12/01/2022] Open
Affiliation(s)
- Stanley E. Kim
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine; University of Florida; Gainesville; FL; 32610
| | - Robson F. Giglio
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine; University of Florida; Gainesville; FL; 32610
| | - David J. Reese
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine; University of Florida; Gainesville; FL; 32610
| | - Shona L. Reese
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine; University of Florida; Gainesville; FL; 32610
| | - Nicholas J. Bacon
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine; University of Florida; Gainesville; FL; 32610
| | - Gary W. Ellison
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine; University of Florida; Gainesville; FL; 32610
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36
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Liver. CANINE AND FELINE GASTROENTEROLOGY 2013. [PMCID: PMC7161409 DOI: 10.1016/b978-1-4160-3661-6.00061-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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Nanfelt M, Macphail C, Kennedy KC, Eickhoff J. Interlaboratory agreement and handling variability for consistency of results in paired serum bile acid assays. J Am Anim Hosp Assoc 2011; 48:25-30. [PMID: 22186717 DOI: 10.5326/jaaha-ms-5684] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Paired serum bile acid (SBA) samples from 30 dogs with presumptive hepatobiliary disease and 30 apparently healthy dogs were submitted to three diagnostic laboratories to validate agreement between these facilities. Sensitivities and specificities ranged from 50% to 70% and from 74% to 85%, respectively, for all laboratories. The κ index confirmed almost perfect agreement between laboratories. Variation in sample handling and processing by different laboratories should not be considered a primary factor when aberrant SBA values are encountered. Documenting agreement between laboratories is essential as inconsistencies could direct unnecessary medical or surgical intervention when patients are evaluated at different hospitals during the course of their disease.
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Affiliation(s)
- Michelle Nanfelt
- Department of Clinical Sciences, James L. Voss Veterinary Medical Center, Colorado State University, Fort Collins, CO, USA
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38
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van Steenbeek FG, van den Bossche L, Leegwater PAJ, Rothuizen J. Inherited liver shunts in dogs elucidate pathways regulating embryonic development and clinical disorders of the portal vein. Mamm Genome 2011; 23:76-84. [PMID: 22052005 PMCID: PMC3275728 DOI: 10.1007/s00335-011-9364-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Accepted: 10/13/2011] [Indexed: 12/14/2022]
Abstract
Congenital disorders of the hepatic portal vasculature are rare in man but occur frequently in certain dog breeds. In dogs, there are two main subtypes: intrahepatic portosystemic shunts, which are considered to stem from defective closure of the embryonic ductus venosus, and extrahepatic shunts, which connect the splanchnic vascular system with the vena cava or vena azygos. Both subtypes result in nearly complete bypass of the liver by the portal blood flow. In both subtypes the development of the smaller branches of the portal vein tree in the liver is impaired and terminal branches delivering portal blood to the liver lobules are often lacking. The clinical signs are due to poor liver growth, development, and function. Patency of the ductus venosus seems to be a digenic trait in Irish wolfhounds, whereas Cairn terriers with extrahepatic portosystemic shunts display a more complex inheritance. The genes involved in these disorders cannot be identified with the sporadic human cases, but in dogs, the genome-wide study of the extrahepatic form is at an advanced stage. The canine disease may lead to the identification of novel genes and pathways cooperating in growth and development of the hepatic portal vein tree. The same pathways likely regulate the development of the vascular system of regenerating livers during liver diseases such as hepatitis and cirrhosis. Therefore, the identification of these molecular pathways may provide a basis for future proregenerative intervention.
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Affiliation(s)
- Frank G van Steenbeek
- Faculty of Veterinary Medicine, Utrecht University, Yalelaan 104, PO Box 80154, 3508 TD Utrecht, The Netherlands.
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39
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40
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Erb HN. Prior probability (the pretest best guess) affects predictive values of diagnostic tests. Vet Clin Pathol 2011; 40:154-8. [PMID: 21554365 DOI: 10.1111/j.1939-165x.2011.00315.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Authors who publish evaluations of dichotomous (yes/no) diagnostic tests often include the predictive values of their test at a single prior probability (eg, the prevalence of the target disease within the evaluation data set). The objectives of this technical note are to demonstrate why single-probability predictive values are misleading and to show a better way to display positive predictive values (PPV) and negative predictive values (NPV) for a newly evaluated test. Secondly, this technical note will show readers how to calculate predictive values from only sensitivity and specificity for any desired prior probability. As prior probability increases from 0% to 100%, PPV increases from 0% to 100%, but NPV goes in the opposite direction (drops from 100% to 0%). Because prior probabilities vary so greatly across situations, predictive values should be provided in publications for the full range of potential prior probabilities (if provided at all). This is easily done with a 2-curve graph displaying the predictive values (y-axis) against the prior probability (x-axis).
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Affiliation(s)
- Hollis N Erb
- Section of Epidemiology, Department of Population Medicine & Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA.
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41
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Buob S, Johnston AN, Webster CRL. Portal hypertension: pathophysiology, diagnosis, and treatment. J Vet Intern Med 2011; 25:169-86. [PMID: 21382073 DOI: 10.1111/j.1939-1676.2011.00691.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Portal hypertension (PH) is the result of increased vascular resistance in the portal circulation, increased portal venous blood flow, or both. In veterinary medicine, where portal pressure is seldom measured directly, the diagnosis of PH often is inferred from identification of associated complications including multiple acquired portosystemic shunts, ascites, and hepatic encephalopathy. Likewise, treatment of PH primarily is aimed at controlling these complications. The goal of this review is to provide an update on the pathophysiology, diagnosis, and treatment of PH. The review draws from information in the veterinary hepatology literature, reviews, and consensus statements in human hepatology and the literature on experimental models of PH.
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Affiliation(s)
- S Buob
- Department of Clinical Sciences, Tufts Cummings School of Veterinary Medicine, North Grafton, MA, USA
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42
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Silva S, Wyse C, Goodfellow M, Yam P, Preston T, Papasouliotis K, Hall E. Assessment of liver function in dogs using the 13C-galactose breath test. Vet J 2010; 185:152-6. [DOI: 10.1016/j.tvjl.2009.05.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2008] [Revised: 05/20/2009] [Accepted: 05/23/2009] [Indexed: 10/20/2022]
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43
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Ruland K, Fischer A, Hartmann K. Sensitivity and specificity of fasting ammonia and serum bile acids in the diagnosis of portosystemic shunts in dogs and cats. Vet Clin Pathol 2010; 39:57-64. [DOI: 10.1111/j.1939-165x.2009.00178.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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44
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Rothuizen J. Important clinical syndromes associated with liver disease. Vet Clin North Am Small Anim Pract 2010; 39:419-37. [PMID: 19524787 DOI: 10.1016/j.cvsm.2009.02.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Several clinical syndromes can develop in many different liver diseases. They are important to understanding the clinical manifestations of hepatobiliary diseases. The signs, diagnostic procedures, and specific diseases associated with these syndromes are discussed.
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Affiliation(s)
- Jan Rothuizen
- Department of Clinical Sciences of Companion Animals, University Utrecht, Yalelaan 108, P.O. Box 80.154, Utrecht 3508 TD, The Netherlands.
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45
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Proot S, Biourge V, Teske E, Rothuizen J. Soy protein isolate versus meat-based low-protein diet for dogs with congenital portosystemic shunts. J Vet Intern Med 2009; 23:794-800. [PMID: 19496910 DOI: 10.1111/j.1939-1676.2009.0327.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Both presurgical preparation and long-term support of nonoperable dogs with congenital portosystemic shunts (CPSS) require optimal dietary management. Studies suggested that protein source may play an important role, with vegetable and dairy protein sources having better effects on hepatic encephalopathy (HE) than meat proteins. OBJECTIVES Determine whether a low-protein test diet with soy as its main protein source results in better scores than a control diet with the same composition but with poultry as its main protein source in dogs with CPSS. METHODS In a double-blind cross-over study, 16 dogs received each diet for 4 weeks. Dogs in group T first received the test diet and then the control diet, whereas dogs in group C were fed the diets in the opposite order. Different variables (body weight, body condition score, HE score, fecal score, CBC, plasma tests of liver function including NH3, and coagulation tests) were measured at the start of the study and after completion of each diet. RESULTS One-way repeated measures ANOVA was performed. Plasma NH3 was significantly lower after the test diet than after the control diet. The test diet also resulted in significantly higher fibrinogen concentrations and lower prothrombin times. The HE score improved with both diets, with no significant difference between the 2 diets. CONCLUSIONS Both diets achieved a significant improvement in HE score. The influence of the soy-based diet on plasma NH3 concentration and coagulation parameters suggests that such a diet decreases the risk for HE and gives better support of liver function.
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Affiliation(s)
- S Proot
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands.
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van Steenbeek FG, Leegwater PAJ, van Sluijs FJ, Heuven HCM, Rothuizen J. Evidence of inheritance of intrahepatic portosystemic shunts in Irish Wolfhounds. J Vet Intern Med 2009; 23:950-2. [PMID: 19496918 DOI: 10.1111/j.1939-1676.2009.0319.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The etiogenesis of congenital portosystemic shunt in dogs is not understood. In Irish Wolfhounds, intrahepatic portosystemic shunt (IHPSS) is thought to be hereditary, but the mode of inheritance is unknown. OBJECTIVES To document the genetic background and investigate the potential mode of inheritance of IHPSS in Irish Wolfhounds. ANIMALS Three mature, privately owned, affected siblings and their progeny produced in 2 litters. METHODS Prospective, observational study. Two test matings of 1 affected sire with 2 of his affected sisters were used to determine the inheritance pattern. Affection status was determined by measuring venous blood ammonia concentrations, detection of the shunt by ultrasonography and confirmation during surgical attenuation of the intrahepatic shunting vessel. RESULTS In 1 litter of 5 pups all had an IHPSS. In the other litter 5 of 11 pups were affected. Both left- and right-sided shunts occurred in both litters. No sex predisposition was evident among affected dogs. CONCLUSIONS AND CLINICAL IMPORTANCE Our results show that IHPSS in Irish Wolfhounds is a familial disorder that is likely genetic. It is unlikely that the mode of inheritance is monogenic. A digenic, triallelic trait could explain the observed occurrence of IHPSS but other modes of inheritance cannot be excluded.
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Affiliation(s)
- F G van Steenbeek
- Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands.
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Tarantino G, Citro V, Esposito P, Giaquinto S, de Leone A, Milan G, Tripodi FS, Cirillo M, Lobello R. Blood ammonia levels in liver cirrhosis: a clue for the presence of portosystemic collateral veins. BMC Gastroenterol 2009; 9:21. [PMID: 19292923 PMCID: PMC2662872 DOI: 10.1186/1471-230x-9-21] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2008] [Accepted: 03/17/2009] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Portal hypertension leads to the formation of portosystemic collateral veins in liver cirrhosis. The resulting shunting is responsible for the development of portosystemic encephalopathy. Although ammonia plays a certain role in determining portosystemic encephalopathy, the venous ammonia level has not been found to correlate with the presence or severity of this entity. So, it has become partially obsolete. Realizing the need for non-invasive markers mirroring the presence of esophageal varices in order to reduce the number of endoscopy screening, we came back to determine whether there was a correlation between blood ammonia concentrations and the detection of portosystemic collateral veins, also evaluating splenomegaly, hypersplenism (thrombocytopenia) and the severity of liver cirrhosis. METHODS One hundred and fifty three consecutive patients with hepatic cirrhosis of various etiologies were recruited to participate in endoscopic and ultrasonography screening for the presence of portosystemic collaterals mostly esophageal varices, but also portal hypertensive gastropathy and large spontaneous shunts. RESULTS Based on Child-Pugh classification, the median level of blood ammonia was 45 mcM/L in 64 patients belonging to class A, 66 mcM/L in 66 patients of class B and 108 mcM/L in 23 patients of class C respectively (p < 0.001).The grade of esophageal varices was concordant with venous ammonia levels (rho 0.43, p < 0.001). The best area under the curve was given by ammonia concentrations, i, e., 0.78, when comparing areas of ammonia levels, platelet count and spleen longitudinal diameter at ultrasonography. Ammonia levels predicted hepatic decompensation and ascites presence (Odds Ratio 1.018, p < 0.001). CONCLUSION Identifying cirrhotic patients with high blood ammonia concentrations could be clinically useful, as high levels would lead to suspicion of being in presence of collaterals, in clinical practice of esophageal varices, and pinpoint those patients requiring closer follow-up and endoscopic screening.
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Affiliation(s)
- Giovanni Tarantino
- Department of Clinical and Experimental Medicine, Hepatology in Internal Medicine Section, Federico II University Medical School of Naples, Naples, Italy
| | - Vincenzo Citro
- Hepatology Unit of General Medicine, Mauro Scarlato Hospital, Scafati, ASL SA/1, Naples, Italy
| | - Pasquale Esposito
- Department of Gastroenterology and Digestive Endoscopy, Second University of Naples (SUN), Naples, Italy
| | - Sabrina Giaquinto
- Department of Gastroenterology and Digestive Endoscopy, Second University of Naples (SUN), Naples, Italy
| | - Annalisa de Leone
- Department of Gastroenterology and Digestive Endoscopy, Second University of Naples (SUN), Naples, Italy
| | | | | | - Michele Cirillo
- Department of Oncology and Endocrinology, Gastrointestinal Surgery Unit, Federico II University Medical School of Naples, Naples, Italy
| | - Roberto Lobello
- Department of Oncology and Endocrinology, Gastrointestinal Surgery Unit, Federico II University Medical School of Naples, Naples, Italy
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Bridger N, Glanemann B, Neiger R. Comparison of postprandial and ceruletide serum bile acid stimulation in dogs. J Vet Intern Med 2008; 22:873-8. [PMID: 18537882 DOI: 10.1111/j.1939-1676.2008.0114.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Postprandial (PP) serum bile acid (SBA) stimulation is an important test for detecting hepatic dysfunction in dogs. However, this test is influenced by numerous variables, and a standardized approach using an injectable cholecystokinin analog (ceruletide) may be advantageous. HYPOTHESIS Ceruletide SBA stimulation test is more sensitive than PP SBA stimulation in dogs. ANIMALS Animals with portosystemic shunt (PSS) (n = 11) and dogs with upper respiratory disease (URD) (n = 9) were investigated. Healthy dogs (n = 13) and dogs with other diseases (n = 17) served as controls. METHODS All dogs underwent SBA stimulation with food and ceruletide. Stimulation blood samples were drawn at 60/120 minutes and 20/30/40 minutes, respectively. Results were compared statistically, and the sensitivity and specificity were determined with receiver-operating characteristic curves. RESULTS Stimulated SBA were significantly higher in both study groups than in controls. For dogs with PSS, the sensitivity and specificity (>35 micromol/L) were 100% postprandially (120 minutes) and 91 and 100%, respectively, postceruletide (30 minutes). The difference between these values was not statistically significant. For dogs with URD, the sensitivity and specificity (>22 micromol/L) were 44 and 88% postprandially (120 minutes) and 100 and 88% postceruletide (30 minutes). CONCLUSIONS AND CLINICAL IMPORTANCE Ceruletide SBA stimulation circumvents exogenous and endogenous influences associated with PP SBA stimulation. The results indicate that ceruletide SBA stimulation performs as well as PP SBA stimulation in dogs with PSS and is more sensitive for the detection of hepatic dysfunction in dogs with URD.
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Affiliation(s)
- N Bridger
- Small Animal Clinic, Justus-Liebig University Giessen, Frankfurterstr, Giessen, Germany.
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