Hepatic encephalomyelopathy in a calf with congenital portosystemic shunt (CPSS)

Spongiform encephalomyelopathy in a calf with a congenital portosystemic shunt

A 3-month-old Holstein heifer calf was presented because of an abnormal gait. Further examination revealed cranial nerve deficits, including a severely delayed corneal reflex. The calf was not ataxic and maintained an appetite, but was considerably stunted for her age. A postmortem examination resulted in a diagnosis of a congenital portosystemic shunt.

Evaluation of mid- and long-term efficacy of shunt limiting for hepatic myelopathy after transjugular intrahepatic portosystemic shunt

BACKGROUND

Hepatic myelopathy (HM) is a rare condition caused by severe liver dysfunction, and may be secondary to transjugular intrahepatic portosystemic shunt (TIPS). This study aimed to evaluate the mid- and long-term clinical efficacy of TIPS reduction (TIPSR) for treatment of HM secondary to TIPS.

METHODS

Patients who underwent TIPS (n=1325) for severe portal hypertension between August 2002 and August 2013 at the Affiliated Beijing Millennium Monument Hospital, Capital Medical University (Beijing, China) were reviewed. During follow-up, 22 patients were diagnosed with HM, and 12 underwent TIPSR. Patients were evaluated using the Barthel index (daily activities), the Lovette's Six Classification (lower extremity muscle strength), and the Fugl-Meyer assessment (FMA; lower extremity activity). Hepatic encephalopathy grade was used to assess the severity of clinical symptoms.

RESULTS

TIPSR did not affect portal vein pressure (31.6±6.2 vs. 33.3±7.9mmHg, P=0.55). Blood ammonia levels were 77.9±17.9mmol/L before TIPSR and 77.9±14.8, 73.5±21.5, 59.5±14.5, and 52.0±16.5mmol/L at 1, 3, 6, and 12months (P<0.05 for 6 and 12months vs. baseline). The Barthel index was improved 6months after TIPSR (42.1±10.5 vs. 45.0±8.8, P<0.05), while FMA was improved 3months after TIPSR only (24.6±3.2 vs. 25.5±3.2, P<0.05). Lovette's Six Classification was improved 12months after TIPSR (2.1±0.7 vs. 2.8±0.9, P<0.05). After TIPS, hepatic encephalopathy grade was I (n=3), II (n=6), III (n=2), or IV (n=1), and was I (n=8), II (n=1), or III (n=1) at 6months.

CONCLUSION

TIPSR can improve the mid- and long-term symptoms of HM secondary to TIPS.

Bovine congenital erythropoietic protoporphyria in a crossbred limousin heifer in Ireland

An unusual case of an 11-month-old, black Limousin-cross heifer, with an 8-month history of episodic seizures and photosensitisation, was referred by a veterinary practitioner to the Farm Animal Section of the UCD Veterinary Hospital, School of Veterinary Medicine, University College Dublin, Ireland, in August 2014. Following an investigation, a diagnosis of Bovine Congenital Erythropoietic Protoporphyria (BCEPP) was made. To the authors’ knowledge this is the first report of such a case in Ireland. BCEPP should be considered as a differential diagnosis in young animals displaying periodic seizures and/or photosensitisation.

Congenital portosystemic shunts and hepatic encephalopathy in goat kids in California

Between 1999 and 2012, 11 cases of congenital portosystemic shunts (cPSS) resulting in hepatic encephalopathy were diagnosed in goat kids necropsied at the California Animal Health and Food Safety Laboratory System and at the Department of Pathology, Immunology & Microbiology, School of Veterinary Medicine, University of California–Davis. Affected animals included 6 females and 5 males of various breeds including Boer (5/11), Nigerian Dwarf (1/11), Saanen (1/11), Toggenburg (1/11), and mixed-breed (3/11) aged between 1.5 months and 11 months, submitted live (2/11) or dead (9/11) for necropsy. The most frequent clinical signs in these goats were ataxia, blindness, tremors, head bobbing, head pressing, seizures, circling, weakness, and ill thrift. Bile acids were measured in 2 animals, and were elevated in both cases (134 and 209 µmol/l, reference interval = 0–50 µmol/l). Necropsy findings were poor to fair body condition. Grossly, the livers of 4 animals were subjectively small. Microscopic lesions included portal spaces with increased numbers of arteriolar profiles and hypoplastic or absent portal veins, diffuse atrophy of the hepatic parenchyma with the presence of small hepatocytes and, in some cases, multifocal hepatocellular macrovesicular vacuolation. In the brain and spinal cord of all animals, there was bilateral and symmetric spongy degeneration affecting the cerebrum, mesencephalon, cerebellum, brainstem, and cervical spinal cord. In all cases, the brain lesions were consistent with hepatic encephalopathy. Congenital portosystemic shunts should be considered in the differential diagnosis of young goats with a history of ill thrift, and nonspecific neurological signs.

Ultrasonography of the spleen, liver, gallbladder, caudal vena cava and portal vein in healthy calves from birth to 104 days of age

Background

Many of the ultrasonographic abdominal findings of adult cattle probably also apply to calves. However, significant changes associated with ruminal growth and transition from a milk to a roughage diet occur in young calves during the first few months, and it can be expected that ultrasonographic features of organs adjacent to the rumen such as spleen and liver also undergo significant changes. These have not been investigated to date and therefore the goal of this study was to describe ultrasonographic findings of the spleen, liver, gallbladder, caudal vena cava and portal vein in six healthy calves from birth to 104 days of age. Standing calves were examined ultrasonographically six times at three-week intervals starting on the first or second day of life using a 5.0-MHz transducer and techniques described previously.

Results

The spleen was imaged on the left at the 5th to 12th intercostal spaces. The dorsal and ventral visible limits ran from cranioventral to caudodorsal because of superimposition of the lungs. The size of the spleen was largest at the 7th and 8th intercostal spaces and the maximum thickness was measured at the 9th to 12th intercostal spaces. The liver was seen in all calves on the right and could be imaged at the 5th to 12th intercostal spaces and the area caudal to the last rib. Similar to the spleen, the dorsal visible margin of the liver ran parallel to the ventral border of the lungs. The visible size of the liver was largest at the 8th to 11th intercostal spaces and the maximum thickness was measured at the 8th and 9th intercostal spaces. The parenchymal pattern consisted of numerous fine echoes homogeneously distributed over the entire organ. The gallbladder was most commonly seen at the 9th intercostal space and was circular, oval or pear-shaped on ultrasonograms. It extended beyond the ventral border of the liver depending on the amount of bile. The caudal vena cava was triangular in cross section but sometimes had a round or oval profile and was always seen in at least one intercostal space. The maximum circumference was measured at the 10th and 11th intercostal spaces. The portal vein was circular or oval in cross section and was characterised by stellate ramifications branching into the liver parenchyma. The portal vein could always be imaged at the 7th to 11th intercostal spaces and its mean diameter at the 9th to 11th intercostal spaces ranged from 1.2 cm to 1.8 cm.

Conclusions

The ultrasonographic findings of the spleen, liver, gallbladder, caudal vena cava and portal vein in six healthy Holstein-Friesian calves from birth to 104 days of age serve as reference values for the examination of these anatomical structures in diseased calves.