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Becher A, Acke E, Serrano G, Kiefer I, Alef M, von Bomhard W, Heilmann RM. Evaluation of the Blood Neutrophil-to-Lymphocyte Ratio (NLR) as a Diagnostic and Prognostic Biomarker in Dogs with Portosystemic Shunt. Vet Sci 2024; 11:80. [PMID: 38393098 PMCID: PMC10893402 DOI: 10.3390/vetsci11020080] [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: 01/04/2024] [Revised: 01/29/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024] Open
Abstract
The neutrophil-to-lymphocyte ratio (NLR) can help in assessing inflammatory diseases, sepsis, and chronic hepatic conditions in humans. Dogs with congenital portosystemic shunts (PSSs) have signs of generalized inflammation, and the clinical signs can overlap with other conditions, including hypoadrenocorticism (HOC). Thus, the potential diagnostic and prognostic value of leukocyte ratios as surrogate markers was assessed in a retrospective case-control study including 106 dogs diagnosed with PSSs. The disease control groups were dogs with parenchymal hepatopathy (PH; n = 22) or HOC (n = 31). In the PSS dogs, the blood NLRs were associated with the severity of systemic inflammation but not with the shunt type, hepatoencephalopathy, systemic infection, or hypoglycemia. The baseline NLRs did not differ between the three disease groups, between medically and surgically treated PSS dogs, or between those with successful PSS ligation and dogs experiencing peri-/post-surgical complications. However, dogs requiring two consecutive surgical interventions had significantly higher NLRs, and an NLR of <2.53 distinguished dogs with successful shunt ligation in one surgery from those requiring two consecutive surgeries for PSS closure. The blood NLR might be a useful clinicopathologic variable in PSS, but its value in helping differentiate PSS from HOC cases appears low. Integrating the NLR into a diagnostic algorithm may allow for a prediction of the number of surgical interventions required.
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Affiliation(s)
- Anja Becher
- Department for Small Animals, Veterinary Teaching Hospital, College of Veterinary Medicine, University of Leipzig, 04103 Leipzig, SN, Germany; (A.B.); (E.A.); (I.K.); (M.A.)
| | - Els Acke
- Department for Small Animals, Veterinary Teaching Hospital, College of Veterinary Medicine, University of Leipzig, 04103 Leipzig, SN, Germany; (A.B.); (E.A.); (I.K.); (M.A.)
- IDEXX Vet Med Labor GmbH, 70806 Kornwestheim, BW, Germany
| | - Gonçalo Serrano
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, 9820 Merelbeke, Belgium;
- AniCura Haaglanden Specialist Referral Centre, 2288 EZ Rijswijk, The Netherlands
| | - Ingmar Kiefer
- Department for Small Animals, Veterinary Teaching Hospital, College of Veterinary Medicine, University of Leipzig, 04103 Leipzig, SN, Germany; (A.B.); (E.A.); (I.K.); (M.A.)
| | - Michaele Alef
- Department for Small Animals, Veterinary Teaching Hospital, College of Veterinary Medicine, University of Leipzig, 04103 Leipzig, SN, Germany; (A.B.); (E.A.); (I.K.); (M.A.)
| | - Wolf von Bomhard
- Antech Specialty Center for Veterinary Pathology, 81477 Munich, BY, Germany;
| | - Romy M. Heilmann
- Department for Small Animals, Veterinary Teaching Hospital, College of Veterinary Medicine, University of Leipzig, 04103 Leipzig, SN, Germany; (A.B.); (E.A.); (I.K.); (M.A.)
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Konstantinidis AO, Adamama-Moraitou KK, Patsikas MN, Papazoglou LG. Congenital Portosystemic Shunts in Dogs and Cats: Treatment, Complications and Prognosis. Vet Sci 2023; 10:vetsci10050346. [PMID: 37235429 DOI: 10.3390/vetsci10050346] [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: 03/13/2023] [Revised: 05/02/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023] Open
Abstract
Congenital portosystemic shunts (CPSS) are a common vascular anomaly of the liver in dogs and cats. Clinical signs of CPSS are non-specific and may wax and wane, while laboratory findings can raise the clinical suspicion for CPSS, but they are also not specific. Definitive diagnosis will be established by evaluation of liver function tests and diagnostic imaging. The aim of this article is to review the management, both medical and surgical, complications, and prognosis of CPSS in dogs and cats. Attenuation of the CPSS is the treatment of choice and may be performed by open surgical intervention using ameroid ring constrictors, thin film banding, and partial or complete suture ligation or by percutaneous transvenous coil embolization. There is no strong evidence to recommend one surgical technique over another. Medical treatment strategies include administration of non-absorbable disaccharides (i.e., lactulose), antibiotics, and dietary changes, and are indicated for pre-surgical stabilization or when surgical intervention is not feasible. After CPSS attenuation, short- and long-term post-surgical complications may be seen, such as post-operative seizures and recurrence of clinical signs, respectively. Prognosis after surgical attenuation of CPSS is generally favorable for dogs and fair for cats.
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Affiliation(s)
- Alexandros O Konstantinidis
- Companion Animal Clinic (Medicine Unit), School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54627 Thessaloniki, Greece
| | - Katerina K Adamama-Moraitou
- Companion Animal Clinic (Medicine Unit), School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54627 Thessaloniki, Greece
| | - Michail N Patsikas
- Laboratory of Diagnostic Imaging, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54627 Thessaloniki, Greece
| | - Lysimachos G Papazoglou
- Companion Animal Clinic (Surgery and Obstetrics Unit), School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54627 Thessaloniki, Greece
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Konstantinidis AO, Patsikas MN, Papazoglou LG, Adamama-Moraitou KK. Congenital Portosystemic Shunts in Dogs and Cats: Classification, Pathophysiology, Clinical Presentation and Diagnosis. Vet Sci 2023; 10:vetsci10020160. [PMID: 36851464 PMCID: PMC9961057 DOI: 10.3390/vetsci10020160] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/07/2023] [Accepted: 02/14/2023] [Indexed: 02/19/2023] Open
Abstract
Congenital portosystemic shunts (CPSS) are abnormal vascular communications between the portal and the systemic circulation, bypassing the hepatic parenchyma and resulting in liver hypoplasia and hepatic insufficiency. Such connections develop in utero and persist postnatally. CPSS are among the two most common congenital vascular anomalies of the liver in small animals, along with primary hypoplasia of the portal vein without portal hypertension (PHPV without PH). CPSS can be extrahepatic (ECPSS), most commonly diagnosed in small and toy breed dogs and cats, or intrahepatic (ICPSS), most commonly seen in large breed dogs. Single ECPSS is the most common type encountered in both dogs and cats. Clinical signs of CPSS are non-specific and may wax and wane, while laboratory findings can raise clinical suspicion for CPSS, but they are also not specific. Definitive diagnosis will be established by evaluation of liver function tests, such as determination of fasting plasma ammonia (FA) levels, and pre- and postprandial serum bile acids concentrations, and diagnostic imaging. The purpose of this article is to review the definition, classification, pathogenesis, clinical presentation, and diagnosis of CPSS in dogs and cats, highlighted by the authors' clinical experience.
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Affiliation(s)
- Alexandros O. Konstantinidis
- Companion Animal Clinic (Medicine Unit), School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54627 Thessaloniki, Greece
- Correspondence:
| | - Michail N. Patsikas
- Laboratory of Diagnostic Imaging, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54627 Thessaloniki, Greece
| | - Lysimachos G. Papazoglou
- Companion Animal Clinic (Surgery and Obstetrics Unit), School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54627 Thessaloniki, Greece
| | - Katerina K. Adamama-Moraitou
- Companion Animal Clinic (Medicine Unit), School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54627 Thessaloniki, Greece
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Toom M, Saunders JH, Duchateau L, Serrano G, De Rooster H, Devriendt N, Stock E. Shear wave elastography measurements in dogs treated surgically for congenital extrahepatic portosystemic shunts. Front Vet Sci 2022; 9:991148. [PMID: 36225793 PMCID: PMC9549120 DOI: 10.3389/fvets.2022.991148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 08/31/2022] [Indexed: 11/13/2022] Open
Abstract
Assessing the postoperative surgical success of congenital extrahepatic portosystemic shunt (EHPSS) attenuation can be challenging and involve invasive imaging methods. Elastography is an ultrasound technique that allows qualitative and quantitative estimation of tissue stiffness and has extensively been used in people with liver disease. In recent years, increased interest in this technique has developed in veterinary medicine due to its non-invasive nature, availability, and low cost. The objective of this study was to compare liver stiffness values between dogs with closed EHPSS and those with multiple acquired portosystemic shunts (MAPSS) after gradual surgical attenuation and to assess whether shear wave elastography could be used to determine EHPSS closure. As a secondary objective, measurements obtained from both intercostal and subxiphoidal views were compared. Mean values for the average, median, and maximum two-dimensional shear wave velocities (2D SWV) for the closed EHPSS were 2.88 +/−0.11 m/s; 2.83 +/−0.11 m/s; and 3.75 +/−0.16 m/s, respectively. In the MAPSS dogs, mean values for the average, median, and maximum 2D SWV were 2.77 +/– 0.17 m/s; 2.71 +/– 0.17 m/s; and 3.66 +/−0.24 m/s, respectively. No significant differences in 2D SWV were present between dogs with closed EHPSS and those with MAPSS (P = 0.33; P = 0.33; P = 0.42, respectively). When assessing potential differences between intercostal and subxiphoidal 2D SWV measurements, no effect was observed for the average and median 2D SWV (P = 0.06; P = 0.07, respectively). Yet, a significant difference was identified for the maximum 2D SWV between intercostal 4.00 +/−0.20 m/s and subxiphoidal 3.41 +/−0.17 m/s measurements (P = 0.02). The relevance of this finding is uncertain as many other studies about liver elastography only report mean and not maximum values.
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Affiliation(s)
- Merle Toom
- Department of Morphology, Imaging, Orthopedics, Rehabilitation and Nutrition, Faculty of Veterinary Medicine, Merelbeke, Belgium
- *Correspondence: Merle Toom
| | - Jimmy H. Saunders
- Department of Morphology, Imaging, Orthopedics, Rehabilitation and Nutrition, Faculty of Veterinary Medicine, Merelbeke, Belgium
| | - Luc Duchateau
- Department of Veterinary and Biosciences, Faculty of Veterinary Medicine, Merelbeke, Belgium
| | - Goncalo Serrano
- Department of Small Animals, Faculty of Veterinary Medicine, Merelbeke, Belgium
| | - Hilde De Rooster
- Department of Small Animals, Faculty of Veterinary Medicine, Merelbeke, Belgium
| | - Nausikaa Devriendt
- Department of Small Animals, Faculty of Veterinary Medicine, Merelbeke, Belgium
| | - Emmelie Stock
- Department of Morphology, Imaging, Orthopedics, Rehabilitation and Nutrition, Faculty of Veterinary Medicine, Merelbeke, Belgium
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Carroll KA, Dickson RE, Scharf VF. Feasibility of thoracoscopic attenuation of the azygos vein as a model for portoazygos shunts: A canine cadaveric study. Vet Surg 2020; 50:345-352. [PMID: 33085107 DOI: 10.1111/vsu.13532] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 08/09/2020] [Accepted: 10/02/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To evaluate the feasibility of thoracoscopic placement of three vascular attenuation devices by using the azygos vein as a model for portoazygos (PA) shunts and to describe the approach for thoracoscopic placement of these attenuation devices in small breed dogs. STUDY DESIGN Randomized, prospective, cadaveric study. ANIMALS Cadavers of 10 adult small breed dogs. METHODS Cadavers were placed in sternal recumbency with left dorsolateral obliquity, and three thoracoscopic ports were established in the right hemithorax at the mid-10th intercostal space and dorsal third of the ninth and 11th intercostal spaces. The caudal azygos vein was thoracoscopically isolated along three adjacent segments bordered by four intercostal arteries, beginning just cranial to the first intercostal artery visualized cranial to the diaphragm. Three attenuation devices including coated cellophane, uncoated cellophane, and a 5-mm ameroid constrictor were thoracoscopically placed around one segment in each dog. Minor port access modifications were required to improve working space and triangulation in three dogs. Ability to successfully place the device, time required for placement, endoscopic clip configuration, and complications associated with placement were recorded. RESULTS Median dog weight was 7.7 kg (range, 1.8-11). All attenuation devices were successfully placed thoracoscopically in all cadavers. No difference was detected in time required for placement between the ameroid constrictor and coated and uncoated cellophane (range, 2.3-33.8 minutes, P = .8). CONCLUSION Ameroid constrictors and thin film bands were consistently placed via thoracoscopy around the caudal azygos vein of small breed dogs. CLINICAL SIGNIFICANCE These results justify further investigation of thoracoscopic PA shunt attenuation in affected dogs.
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Affiliation(s)
- Kenneth A Carroll
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Rachel E Dickson
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Valery F Scharf
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
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M. El-Sebaey A, N. Abramov P, M. Abdelhamid F. Clinical Characteristics, Serum Biochemical Changes, and Expression Profile of Serum Cfa-miRNAs in Dogs Confirmed to Have Congenital Portosystemic Shunts Accompanied by Liver Pathologies. Vet Sci 2020; 7:vetsci7020035. [PMID: 32218339 PMCID: PMC7356535 DOI: 10.3390/vetsci7020035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 03/20/2020] [Accepted: 03/23/2020] [Indexed: 12/24/2022] Open
Abstract
Computed tomography angiography (CTA) and biochemical parameters cannot specify liver pathologies in dogs with congenital portosystemic shunts (CPSS) that are easily determined by invasive histopathology. This study aims to assess the possibility of using circulating serum canine familiaris (cfa) microRNAs (miRNAs) as novel non-invasive serum-based fingerprints for liver injuries associated with various morphologies of extrahepatic and intrahepatic portosystemic shunts (EHPSS and IHPSS). Data were obtained from 12 healthy dogs and 84 dogs confirmed to have EHPSS (splenocaval, splenophrenic, splenoazygos, right gastrocaval (RGC), right gastrocaval with caudal loop (RGC-CL)) and IHPSS (right divisional and left divisional) using CTA. Hepatic pathologies were determined by histopathology. Serum expression of miRNAs was assessed by real-time polymerase chain reaction. Based on the nature of liver injuries in each shunt type, cfa-miR-122 was significantly upregulated in all CPSS groups. Meanwhile, serums cfa-miR-34a and 21 were not significantly expressed in splenophrenic or splenoazygos groups, but they were extensively upregulated in splenocaval, RGC, RGC-CL groups and less frequently in right or left divisional groups. Also, serum cfa-miR126 was significantly upregulated in both IHPSS groups but less significantly expressed in RGC, RGC-CL, and splenocaval groups. Overall, estimated cfa-miRNAs could serve as novel biomarkers to mirror the histopathological and molecular events within the liver in each shunt type.
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Affiliation(s)
- Ahmed M. El-Sebaey
- Department of Clinical Pathology, Faculty of Veterinary Medicine, Mansoura University, Mansoura 35516, Egypt;
- Department of Diagnostics of Diseases, Therapy, Obstetrics and Animal Reproduction, Moscow State Academy of Veterinary Medicine and Biotechnology – MVA named K. I. Skryabin, 109472 Moscow, Russia;
- Correspondence: ; Tel.: +7-966-100-4890
| | - Pavel N. Abramov
- Department of Diagnostics of Diseases, Therapy, Obstetrics and Animal Reproduction, Moscow State Academy of Veterinary Medicine and Biotechnology – MVA named K. I. Skryabin, 109472 Moscow, Russia;
| | - Fatma M. Abdelhamid
- Department of Clinical Pathology, Faculty of Veterinary Medicine, Mansoura University, Mansoura 35516, Egypt;
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Serrano G, Charalambous M, Devriendt N, de Rooster H, Mortier F, Paepe D. Treatment of congenital extrahepatic portosystemic shunts in dogs: A systematic review and meta-analysis. J Vet Intern Med 2019; 33:1865-1879. [PMID: 31471995 PMCID: PMC6766526 DOI: 10.1111/jvim.15607] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 08/20/2019] [Indexed: 11/27/2022] Open
Abstract
Background Several options have been proposed for the treatment of congenital extrahepatic portosystemic shunts (cEHPSS) in dogs, but formal comparisons among different treatment options are currently unavailable. A previous evidence‐based review (2012) found low quality of evidence for papers assessing the treatment of cEHPSS in dogs. Objectives To assess the quality of evidence available in the treatment of cEHPSS, summarize the current state of knowledge with respect to outcome after cEHPSS management, and compare different treatment techniques. Animals Not used. Methods A bibliographic search was performed without date or language restrictions. Studies were assessed for quality of evidence (study design, study group sizes, subject enrollment quality, and overall risk of bias) and outcome measures reported (perioperative outcome, clinical outcome, and surgical or interventional outcome), all reported with 95% confidence intervals. A network meta‐analysis was performed. Results Forty‐eight studies were included. Six retrospective studies (grade 4b) compared 2 techniques and 7 were abstracts (grade 5). The quality of evidence was low and risk of bias high. Regarding surgical outcome, statistically significant superiority of ameroid constrictor over thin film band was observed (P = .003). No other comparisons were statistically significant. Conclusions and Clinical Importance The evidence base of choice of treatment of cEHPSS in dogs remains weak despite recent publications on the subject. Ameroid is superior to thin film band in causing EHPSS closure. Blinded randomized studies comparing different treatment modalities, which routinely include postoperative imaging to assess cEHPSS closure and acquired portosystemic shunt development are essential.
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Affiliation(s)
- Gonçalo Serrano
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - Marios Charalambous
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - Nausikaa Devriendt
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - Hilde de Rooster
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - Femke Mortier
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - Dominique Paepe
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
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Specchi S, Rossi F, Weisse C, Morabito S, Petrovitch NP, Drees R, Thierry F, Ricciardi M, Penchome R, Armenise A, Pey P, Paek M, Panopoulos I, Nicoli S, Schwarz T. Canine and feline abdominal arterioportal communications can be classified based on branching patterns in computed tomographic angiography. Vet Radiol Ultrasound 2018; 59:687-696. [DOI: 10.1111/vru.12685] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 07/04/2018] [Accepted: 07/12/2018] [Indexed: 11/26/2022] Open
Affiliation(s)
- Swan Specchi
- Diagnostic Imaging; Istituto Veterinario di Novara; Granozzo con Monticello Novara 28060 Italy
| | | | - Chick Weisse
- Animal Medical Center; New York New York 10065 USA
| | - Simona Morabito
- Diagnostic Imaging; Istituto Veterinario di Novara; Granozzo con Monticello Novara 28060 Italy
| | | | - Randi Drees
- The Royal Veterinary College; Hatfield AL97TA UK
| | - Florence Thierry
- Royal (Dick) School of Veterinary Studies & Roslin Institute; University of Edinburgh; Roslin EH25 9RG UK
| | - Mario Ricciardi
- Ospedale Veterinario; Pingry via delle Medaglie d'Oro 5; Bari 70126 Italy
| | - Rampaipat Penchome
- Diagnostic Imaging Unit; Faculty of Veterinary Science; Small Animal Teaching Hospital; Chulalongkorn University; Bangkok Thailand
| | | | - Pascaline Pey
- École Nationale Vétérinaire d'Alfort; Maisons-Alfort 94799 France
| | - Matthew Paek
- Synergy Veterinary Imaging Partners, Radiology; Maryland 21029 USA
| | - Ioannis Panopoulos
- Diagnostic Imaging; Istituto Veterinario di Novara; Granozzo con Monticello Novara 28060 Italy
- Alphavet Veterinary Clinic; Athens 14564 Greece
| | - Stefano Nicoli
- Diagnostic Imaging; Istituto Veterinario di Novara; Granozzo con Monticello Novara 28060 Italy
- Clinica Veterinaria Roma Sud; Roma 00173 Italy
| | - Tobias Schwarz
- Royal (Dick) School of Veterinary Studies & Roslin Institute; University of Edinburgh; Roslin EH25 9RG UK
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Van den Bossche L, van Steenbeek FG, Weber MF, Spee B, Penning LC, van Sluijs FJ, Zomerdijk F, Groot Koerkamp MJA, Rothuizen J, Burgener IA, Kummeling A. Genome-wide based model predicting recovery from portosystemic shunting after liver shunt attenuation in dogs. J Vet Intern Med 2018; 32:1343-1352. [PMID: 29770973 PMCID: PMC6060332 DOI: 10.1111/jvim.15140] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 02/16/2018] [Accepted: 03/27/2018] [Indexed: 11/28/2022] Open
Abstract
Background In dogs with congenital portosystemic shunt (CPSS), recovery after surgical CPSS attenuation is difficult to predict. Objectives Our aim was to build a model with plasma albumin concentration and mRNA expression levels of hepatic gene products as predictors of recovery from portosystemic shunting after surgery. Animals Seventy‐three client‐owned dogs referred for surgical attenuation of CPSS. Methods A prediction model was constructed using 2 case‐control studies of recovered and nonrecovered dogs after surgical CPSS attenuation. In the 1st study, a dog‐specific gene expression microarray analysis was used to compare mRNA expression in intraoperatively collected liver tissue between 23 recovered and 23 nonrecovered dogs. In the 2nd study, preoperative plasma albumin concentration and the expression of microarray‐selected genes were confirmed by RT‐qPCR in intraoperatively collected liver samples of 31 recovered and 31 nonrecovered dogs, including 35 dogs from the 1st study. Results In the 1st study, 43 genes were differently expressed in recovered and nonrecovered dogs. The mean preoperative plasma albumin concentration in recovered dogs was higher compared to nonrecovered dogs (23 and 19 g/L, respectively; P = .004). The best fitting prediction model in the 2nd study included preoperative plasma albumin concentration and intraoperative DHDH, ERLEC1, and LYSMD2 gene expression levels. Conclusion and Clinical Importance A preclinical model was constructed using preoperative plasma albumin concentration and intraoperative hepatic mRNA expression of 3 genes that were unbiasedly selected from the genome to predict recovery from portosystemic shunting after shunt ligation. Further development is essential for clinical application.
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Affiliation(s)
- Lindsay Van den Bossche
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Frank G van Steenbeek
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | | | - Bart Spee
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Louis C Penning
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Freek J van Sluijs
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Flin Zomerdijk
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Marian J A Groot Koerkamp
- Holstege groep, Princess Maxima Center for Pediatric Oncology, Uppsalalaan 8, 3584 CT Utrecht, The Netherlands
| | - Jan Rothuizen
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Iwan A Burgener
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands.,Department für Kleintiere und Pferde, Veterinärmedizinische Universität Wien, Vienna, Austria
| | - Anne Kummeling
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
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Wallace ML, MacPhail CM, Monnet E. Incidence of Postoperative Neurologic Complications in Pugs Following Portosystemic Shunt Attenuation Surgery. J Am Anim Hosp Assoc 2018; 54:46-49. [DOI: 10.5326/jaaha-ms-6534] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
ABSTRACT
Postoperative seizures occur in 5–12% of dogs following surgical attenuation of congenital extrahepatic portosystemic shunts (CEPSS) and are often refractory to treatment. Because pugs are predisposed to necrotizing meningoencephalitis, they may be at higher risk of developing neurologic complications after CEPSS attenuation. We hypothesized that pugs have a higher prevalence of postoperative neurologic complications and that pugs who died due to neurologic complications would have evidence of encephalitis at necropsy. Records were searched for pugs that had undergone surgical correction of a single extrahepatic CEPSS. Fourteen pugs met the inclusion criteria and were compared with a control group of 30 dogs of varying breeds who also underwent surgical attenuation for a single CEPSS. Four of 14 pugs (28.6%) died or were euthanized within 1 mo after surgery for neurologic complications, compared with only 1 of 30 dogs in the control group (P < .029). No evidence of necrotizing meningoencephalitis was seen on necropsy. Pugs may be at an increased risk of developing fatal neurologic complications following surgical attenuation for CEPSS. Further studies are indicated to investigate reasons for this increased risk, as well as to determine any factors that may indicate which pugs are at higher risk.
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Affiliation(s)
- Mandy L. Wallace
- From the Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, Georgia (M.L.W.); and the Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado (C.M.M., E.M.)
| | - Catriona M. MacPhail
- From the Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, Georgia (M.L.W.); and the Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado (C.M.M., E.M.)
| | - Eric Monnet
- From the Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, Georgia (M.L.W.); and the Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado (C.M.M., E.M.)
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Culp WTN, Zwingenberger AL, Giuffrida MA, Wisner ER, Hunt GB, Steffey MA, Mayhew PD, Marks SL. Prospective evaluation of outcome of dogs with intrahepatic portosystemic shunts treated via percutaneous transvenous coil embolization. Vet Surg 2017; 47:74-85. [PMID: 29064581 DOI: 10.1111/vsu.12732] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 05/04/2017] [Accepted: 06/22/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To report outcome and complications after percutaneous transvenous coil embolization (PTCE) and evaluate the clinical, laboratory, and imaging changes in dogs with intrahepatic portosystemic shunts (IHPSS) pre-PTCE and post-PTCE. STUDY DESIGN Prospective clinical trial. ANIMALS Twenty-five dogs (15 dogs in imaging subgroup) with IHPSS. METHODS Clinical signs, hematologic, and biochemical parameters were recorded before and 3 months after PTCE. All dogs received the same medical treatment and underwent PTCE. In the imaging subgroup, ultrasonography, hepatic portal scintigraphy, and computed tomography-angiography were performed pre-PTCE and post-PTCE. RESULTS All evaluated bloodwork values improved by at least 50% of their initial value, by 3 months post-PTCE. Liver volume increased after PTCE (P = .001), but remained lower than normal in 11/15 dogs. Hepatic arterial fraction decreased after PTCE (P = .029), consistent with increased portal blood flow to the liver. Twenty-four of 25 dogs were available for reevaluation at 3 months, and all abnormal clinical signs had resolved in 22/24 dogs. CONCLUSION PTCE appears promising as a treatment for IHPSS, as clinical signs resolved in most cases, bloodwork abnormalities often normalized, and the procedure was performed safely with minimal complications. PTCE increased hepatic portal perfusion and liver volume in most dogs. These promising results justify a future randomized clinical trial comparing PTCE, other attenuation options, and medical management alone.
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Affiliation(s)
- William T N Culp
- Department of Surgical and Radiological Sciences, University of California-Davis, School of Veterinary Medicine, Davis, California
| | - Allison L Zwingenberger
- Department of Surgical and Radiological Sciences, University of California-Davis, School of Veterinary Medicine, Davis, California
| | - Michelle A Giuffrida
- Department of Surgical and Radiological Sciences, University of California-Davis, School of Veterinary Medicine, Davis, California
| | - Erik R Wisner
- Department of Surgical and Radiological Sciences, University of California-Davis, School of Veterinary Medicine, Davis, California
| | - Geraldine B Hunt
- Department of Surgical and Radiological Sciences, University of California-Davis, School of Veterinary Medicine, Davis, California
| | - Michele A Steffey
- Department of Surgical and Radiological Sciences, University of California-Davis, School of Veterinary Medicine, Davis, California
| | - Philipp D Mayhew
- Department of Surgical and Radiological Sciences, University of California-Davis, School of Veterinary Medicine, Davis, California
| | - Stanley L Marks
- Department of Medicine and Epidemiology, University of California-Davis, School of Veterinary Medicine, Davis, California
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12
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Van den Bossche L, Schoonenberg VAC, Burgener IA, Penning LC, Schrall IM, Kruitwagen HS, van Wolferen ME, Grinwis GCM, Kummeling A, Rothuizen J, van Velzen JF, Stathonikos N, Molenaar MR, Helms BJ, Brouwers JFHM, Spee B, van Steenbeek FG. Aberrant hepatic lipid storage and metabolism in canine portosystemic shunts. PLoS One 2017; 12:e0186491. [PMID: 29049355 PMCID: PMC5648188 DOI: 10.1371/journal.pone.0186491] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 10/02/2017] [Indexed: 02/06/2023] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) is a poorly understood multifactorial pandemic disorder. One of the hallmarks of NAFLD, hepatic steatosis, is a common feature in canine congenital portosystemic shunts. The aim of this study was to gain detailed insight into the pathogenesis of steatosis in this large animal model. Hepatic lipid accumulation, gene-expression analysis and HPLC-MS of neutral lipids and phospholipids in extrahepatic (EHPSS) and intrahepatic portosystemic shunts (IHPSS) was compared to healthy control dogs. Liver organoids of diseased dogs and healthy control dogs were incubated with palmitic- and oleic-acid, and lipid accumulation was quantified using LD540. In histological slides of shunt livers, a 12-fold increase of lipid content was detected compared to the control dogs (EHPSS P<0.01; IHPSS P = 0.042). Involvement of lipid-related genes to steatosis in portosystemic shunting was corroborated using gene-expression profiling. Lipid analysis demonstrated different triglyceride composition and a shift towards short chain and omega-3 fatty acids in shunt versus healthy dogs, with no difference in lipid species composition between shunt types. All organoids showed a similar increase in triacylglycerols after free fatty acids enrichment. This study demonstrates that steatosis is probably secondary to canine portosystemic shunts. Unravelling the pathogenesis of this hepatic steatosis might contribute to a better understanding of steatosis in NAFLD.
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Affiliation(s)
- Lindsay Van den Bossche
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Vivien A. C. Schoonenberg
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Iwan A. Burgener
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Louis C. Penning
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Ingrid M. Schrall
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Hedwig S. Kruitwagen
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Monique E. van Wolferen
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Guy C. M. Grinwis
- Department of Pathobiology, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Anne Kummeling
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Jan Rothuizen
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Jeroen F. van Velzen
- Laboratory for Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Nikolas Stathonikos
- Department of Pathology, University Medical Center, Utrecht, The Netherlands
| | - Martijn R. Molenaar
- Department of Biochemistry and Cell Biology, Faculty of Veterinary Medicine & Institute of Biomembranes, Utrecht, The Netherlands
| | - Bernd J. Helms
- Department of Biochemistry and Cell Biology, Faculty of Veterinary Medicine & Institute of Biomembranes, Utrecht, The Netherlands
| | - Jos F. H. M. Brouwers
- Department of Biochemistry and Cell Biology, Faculty of Veterinary Medicine & Institute of Biomembranes, Utrecht, The Netherlands
| | - Bart Spee
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | - Frank G. van Steenbeek
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
- * E-mail:
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13
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Tivers MS, Lipscomb VJ, Brockman DJ. Treatment of intrahepatic congenital portosystemic shunts in dogs: a systematic review. J Small Anim Pract 2017; 58:485-494. [DOI: 10.1111/jsap.12712] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 05/15/2017] [Accepted: 05/23/2017] [Indexed: 11/28/2022]
Affiliation(s)
- M. S. Tivers
- School of Veterinary Sciences; University of Bristol; Bristol BS40 5DU UK
| | - V. J. Lipscomb
- Department of Clinical Sciences and Services; Royal Veterinary College; Hertfordshire AL9 7TA UK
| | - D. J. Brockman
- Department of Clinical Sciences and Services; Royal Veterinary College; Hertfordshire AL9 7TA UK
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14
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Cook S, Priestnall SL, Blake D, Meeson RL. Angiostrongylus vasorum Causing Severe Granulomatous Hepatitis with Concurrent Multiple Acquired PSS. J Am Anim Hosp Assoc 2016; 51:320-4. [PMID: 26355583 DOI: 10.5326/jaaha-ms-6210] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A 14 mo old female Jack Russell terrier presented with a 12 hr history of vomiting and inappetence. She was subsequently diagnosed with multiple acquired portosystemic shunts during an exploratory celiotomy. Gross and histopathological hepatic abnormalities were consistent with chronic disease, including features suggestive of portal hypertension that was potentially caused by migrating and resident Angiostrongylus vasorum larvae. Fecal analysis and polymerase chain reaction of hepatic tissue confirmed the presence of Angiostrongylus vasorum . The dog recovered clinically following empirical treatment and supportive care. A lack of parasite burden was confirmed 9 wk postdiagnosis; however, serum biochemical analysis at that time was suggestive of ongoing hepatic dysfunction.
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Affiliation(s)
- Simon Cook
- From the Department of Clinical Sciences and Services (S.C., R.M.) and Department of Pathology and Pathogen Biology (S.P., D.B.), The Royal Veterinary College, University of London, Hatfield, United Kingdom (S.C.)
| | - Simon L Priestnall
- From the Department of Clinical Sciences and Services (S.C., R.M.) and Department of Pathology and Pathogen Biology (S.P., D.B.), The Royal Veterinary College, University of London, Hatfield, United Kingdom (S.C.)
| | - Damer Blake
- From the Department of Clinical Sciences and Services (S.C., R.M.) and Department of Pathology and Pathogen Biology (S.P., D.B.), The Royal Veterinary College, University of London, Hatfield, United Kingdom (S.C.)
| | - Richard L Meeson
- From the Department of Clinical Sciences and Services (S.C., R.M.) and Department of Pathology and Pathogen Biology (S.P., D.B.), The Royal Veterinary College, University of London, Hatfield, United Kingdom (S.C.)
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15
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Van den Bossche L, van Steenbeek F. Canine congenital portosystemic shunts: Disconnections dissected. Vet J 2016; 211:14-20. [DOI: 10.1016/j.tvjl.2015.09.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 09/28/2015] [Accepted: 09/29/2015] [Indexed: 10/22/2022]
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16
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Katić N, Katić C, Reifinger M, Dupré G. Haemorrhage after liver biopsy in a dog with portosystemic shunt. VETERINARY RECORD CASE REPORTS 2014. [DOI: 10.1136/vetreccr-2014-000097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Nikola Katić
- Department of Small Animals and HorsesClinic for Small Animal Surgery, Ophthalmology, Dentistry and RehabilitationUniversity of Veterinary Medicine ViennaViennaAustria
| | - Christina Katić
- Department of Small Animals and HorsesClinic for Small Animal Surgery, Ophthalmology, Dentistry and RehabilitationUniversity of Veterinary Medicine ViennaViennaAustria
| | - Martin Reifinger
- Department of Patho‐Biology and ForensicsInstitute for Pathology and ForensicsUniversity of Veterinary Medicine ViennaViennaAustria
| | - Gilles Dupré
- Department of Small Animals and HorsesClinic for Small Animal Surgery, Ophthalmology, Dentistry and RehabilitationUniversity of Veterinary Medicine ViennaViennaAustria
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17
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Hunt GB, Luff J, Daniel L, Zwingenberger A. Does Hepatic Steatosis Have an Impact on the Short Term Hepatic Response After Complete Attenuation of Congenital Extrahepatic Portosystemic Shunts? A Prospective Study of 20 Dogs. Vet Surg 2014; 43:920-5. [DOI: 10.1111/j.1532-950x.2014.12197.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2013] [Accepted: 12/04/2013] [Indexed: 01/22/2023]
Affiliation(s)
- Geraldine B. Hunt
- Departments of Surgical and Radiological Sciences; School of Veterinary Medicine; University of California-Davis; Davis California
| | - Jennifer Luff
- Departments of Pathology, Microbiology and Immunology; School of Veterinary Medicine; University of California-Davis; Davis California
| | - Leticia Daniel
- Departments of Surgical and Radiological Sciences; School of Veterinary Medicine; University of California-Davis; Davis California
| | - Allison Zwingenberger
- Departments of Surgical and Radiological Sciences; School of Veterinary Medicine; University of California-Davis; Davis California
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18
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Swinbourne F, Smith KC, Lipscomb VJ, Tivers MS. Histopathological findings in the livers of cats with a congenital portosystemic shunt before and after surgical attenuation. Vet Rec 2013; 172:362. [DOI: 10.1136/vr.100812] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- F. Swinbourne
- Veterinary Clinical Sciences; Royal Veterinary College; Hawkshead Lane North Mymms Hatfield AL9 7TA UK
| | - K. C. Smith
- Department of Pathology and Infectious Diseases; Royal Veterinary College; Hawkshead Lane North Mymms Hatfield AL9 7TA UK
| | - V. J. Lipscomb
- Veterinary Clinical Sciences; Royal Veterinary College; Hawkshead Lane North Mymms Hatfield AL9 7TA UK
| | - M. S. Tivers
- Veterinary Clinical Sciences; Royal Veterinary College; Hawkshead Lane North Mymms Hatfield AL9 7TA UK
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19
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Hunt GB, Luff JA, Daniel L, Van den Bergh R. Evaluation of hepatic steatosis in dogs with congenital portosystemic shunts using Oil Red O staining. Vet Pathol 2013; 50:1109-15. [PMID: 23528942 DOI: 10.1177/0300985813481609] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The aims of this prospective study were to quantify steatosis in dogs with congenital portosystemic shunts (CPS) using a fat-specific stain, to compare the amount of steatosis in different lobes of the liver, and to evaluate intra- and interobserver variability in lipid point counting. Computer-assisted point counting of lipid droplets was undertaken following Oil Red O staining in 21 dogs with congenital portosystemic shunts and 9 control dogs. Dogs with congenital portosystemic shunts had significantly more small lipid droplets (<6 μ) than control dogs (P = .0013 and .0002, respectively). There was no significant difference in steatosis between liver lobes for either control dogs and CPS dogs. Significant differences were seen between observers for the number of large lipid droplets (>9 μ) and lipogranulomas per tissue point (P = .023 and .01, respectively). In conclusion, computer-assisted counting of lipid droplets following Oil Red O staining of liver biopsy samples allows objective measurement and detection of significant differences between dogs with CPS and normal dogs. This method will allow future evaluation of the relationship between different presentations of CPS (anatomy, age, breed) and lipidosis, as well as the impact of hepatic lipidosis on outcomes following surgical shunt attenuation.
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Affiliation(s)
- G B Hunt
- Department of Veterinary Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, CA 95616, USA.
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20
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Dang HT, Kim SA, Park HK, Shin JW, Park SG, Kim W. Analysis of Oropharyngeal Microbiota between the Patients with Bronchial Asthma and the Non-Asthmatic Persons. ACTA ACUST UNITED AC 2013. [DOI: 10.4167/jbv.2013.43.4.270] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Hien Thanh Dang
- Department of Microbiology, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Song ah Kim
- Department of Microbiology, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Hee Kuk Park
- Department of Microbiology, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Jong Wook Shin
- Division of Pulmonology and Allergology, Department of Internal Medicine, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Sang-Gue Park
- Department of Applied Statistics, Faculty of Business and Economics, Chung-Ang University, Seoul, Korea
| | - Wonyong Kim
- Department of Microbiology, College of Medicine, Chung-Ang University, Seoul, Korea
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21
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Lee KCL, Winstanley A, House JV, Lipscomb V, Lamb C, Gregory S, Jalan R, Mookerjee RP, Brockman DJ. Association between hepatic histopathologic lesions and clinical findings in dogs undergoing surgical attenuation of a congenital portosystemic shunt: 38 cases (2000-2004). J Am Vet Med Assoc 2011; 239:638-45. [PMID: 21879964 DOI: 10.2460/javma.239.5.638] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To review hepatic histopathologic lesions in dogs undergoing surgical attenuation of a congenital portosystemic shunt (CPSS) in relation to clinical findings and tolerance of complete surgical attenuation. DESIGN Retrospective case series. ANIMALS 38 dogs that underwent surgical attenuation of a CPSS. PROCEDURES Hepatic histologic examination findings and medical records of dogs undergoing surgical attenuation of a single CPSS between August 2000 and July 2004 were reviewed. Liver biopsy specimens were obtained from 38 dogs during surgery prior to complete (n = 16) or partial (22) attenuation of a CPSS and from 13 of the same dogs a median of 3 months following surgical attenuation. RESULTS Portal tracts were inadequate for interpretation in 2 liver biopsy specimens. Liver biopsy specimens obtained prior to surgical attenuation of a CPSS had a lack of identifiable portal veins (13/36 dogs), hepatic arteriolar proliferation (25/36), ductular reaction (5/36), steatosis (16/38), and iron accumulation (32/38). Lack of identifiable portal veins on histologic examination was associated with increased hepatic arteriolar proliferation, decreased tolerance to complete surgical CPSS attenuation, and decreased opacification of intrahepatic portal vessels on portovenography. Ductular reaction was always associated with failure to tolerate complete surgical attenuation of a CPSS. Surgical CPSS attenuation resulted in significant clinical, serum biochemical, and portovenographic changes indicative of improved liver function, but only subtle changes in hepatic histologic examination findings. CONCLUSIONS AND CLINICAL RELEVANCE Dogs without identifiable intrahepatic portal veins that had a ductular reaction on hepatic histologic examination were less likely to tolerate complete attenuation of a CPSS.
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Affiliation(s)
- Karla C L Lee
- Department of Veterinary Clinical Sciences, Royal Veterinary College, University of London, Hertfordshire, AL9 7TA, England.
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22
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Tivers MS, Upjohn MM, House AK, Brockman DJ, Lipscomb VJ. Treatment of extrahepatic congenital portosystemic shunts in dogs - what is the evidence base? J Small Anim Pract 2011; 53:3-11. [PMID: 22098116 DOI: 10.1111/j.1748-5827.2011.01144.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A variety of surgical treatments and medical therapies are recommended for dogs with extrahepatic congenital portosystemic shunts (CPSS). The objective of this review was to assess the evidence base for the management of extrahepatic CPSS in dogs. An online bibliographic search was performed in November 2010 to identify articles relating to the question "Which of the treatment options for extrahepatic CPSS in dogs offers the best short- and long-term outcomes?" Articles were assigned a level of evidence based on a modified grading system. Thirty-eight articles were included in the review. Thirty-six articles were classified as grade 4 and two as grade 5. The timings and methods of assessment of short- and long-term outcomes varied widely between studies. One prospective study (grade 4a) showed that surgically treated dogs survived significantly longer than medically treated dogs. Four retrospective studies (grade 4b) compared the outcome of two surgical techniques but there were no statistically significant differences between treatment groups in terms of complications or outcome. The review found that the evidence base for the treatment of extrahepatic CPSS is weak. There is a lack of evidence of short- and long-term outcomes to recommend one treatment over another.
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Affiliation(s)
- M S Tivers
- Department of Veterinary Clinical Sciences, Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire, United Kingdom
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Tivers M, Lipscomb V. Congenital portosystemic shunts in cats: surgical management and prognosis. J Feline Med Surg 2011; 13:185-94. [PMID: 21338943 DOI: 10.1016/j.jfms.2011.01.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PRACTICAL RELEVANCE Although the surgical management of feline congenital portosystemic shunts (CPSSs) is normally performed at specialist centres, a good knowledge of treatment options and prognosis is important for the general practitioner when advising clients. CLINICAL CHALLENGES A variety of surgical techniques are described for the correction of CPSSs in cats. Choosing between the different techniques is a challenge, given the limited availability of evidence supporting one technique over another. In addition, postoperative complications, and in particular neurological complications, are seen more frequently in the cat than the dog and thus postoperative monitoring and treatment is critically important in feline patients. AUDIENCE This article summarises current evidence in surgical management and is aimed at practising veterinarians, postgraduate students and specialists alike. EQUIPMENT Surgical management of CPSSs typically requires advanced surgical and critical care facilities. The precise nature will depend to some extent on the technique employed. EVIDENCE BASE The evidence base for decision making in the surgical management of CPSSs is relatively sparse. In reviewing the evidence that is available, as well as the areas in which information is still lacking, this article may hopefully serve as a stimulus for further investigation into this condition.
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Affiliation(s)
- Michael Tivers
- Department of Veterinary Clinical Sciences, Royal Veterinay College, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire AL9 7TA, UK.
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24
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Owens SL, Parnell NK. What is the evidence? Portosystemic shunt in a dog. J Am Vet Med Assoc 2011; 238:859-61. [PMID: 21453171 DOI: 10.2460/javma.238.7.859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Scott L Owens
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Purdue University, West Lafayette, IN 47907, USA.
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25
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Greenhalgh SN, Dunning MD, McKinley TJ, Goodfellow MR, Kelman KR, Freitag T, O'Neill EJ, Hall EJ, Watson PJ, Jeffery ND. Comparison of survival after surgical or medical treatment in dogs with a congenital portosystemic shunt. J Am Vet Med Assoc 2010; 236:1215-20. [PMID: 20513200 DOI: 10.2460/javma.236.11.1215] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare survival of dogs with a congenital portosystemic shunt (CPSS) that received medical or surgical treatment. DESIGN Prospective cohort study. ANIMALS 126 client-owned dogs with a single CPSS. PROCEDURES Dogs were examined at 1 of 3 referral clinics, and a single CPSS was diagnosed in each. Dogs received medical or surgical treatment without regard to signalment, clinical signs, or results of hematologic or biochemical analysis. Survival data were analyzed via a Cox regression model. RESULTS During a median follow-up period of 579 days, 18 of 126 dogs died as a result of CPSS. Dogs treated via surgical intervention survived significantly longer than did those treated medically. Hazard ratio for medical versus surgical treatment of CPSS (for the treatment-only model) was 2.9 (95% confidence interval, 1.1 to 7.2). Age at CPSS diagnosis did not affect survival. CONCLUSIONS AND CLINICAL RELEVANCE Both medical and surgical treatment can be used to achieve long-term survival of dogs with CPSS, although results of statistical analysis supported the widely held belief that surgery is preferable to medical treatment. However, the study population consisted of dogs at referral clinics, which suggested that efficacy of medical treatment may have been underestimated. Although surgical intervention was associated with a better chance of long-term survival, medical management provided an acceptable first-line option. Age at examination did not affect survival, which implied that early surgical intervention was not essential. Dogs with CPSS that do not achieve acceptable resolution with medical treatment can subsequently be treated surgically.
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Affiliation(s)
- Stephen N Greenhalgh
- Department of Veterinary Medicine, Veterinary School, University of Cambridge, Cambridge, CB3 0ES, England
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Low WW, Uhl JM, Kass PH, Ruby AL, Westropp JL. Evaluation of trends in urolith composition and characteristics of dogs with urolithiasis: 25,499 cases (1985–2006). J Am Vet Med Assoc 2010; 236:193-200. [DOI: 10.2460/javma.236.2.193] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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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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