Congenital extrahepatic portosystemic deviation of gastric vein with azygos in a bitch

Background: Portosystemic shunt (PSS), an alteration commonly found in toy dogs, is caused by an anastomosis between the systemic and portal circulation, interfering with the metabolism of several toxins. It can be of congenital or acquired origin and is classified as intra- or extrahepatic. Clinical signs include the gastrointestinal tract, nervous system, and urinary system according to the fraction of the shunt. It is diagnosed by several imaging tests and exploratory laparotomy. Therapy involves drug therapy and/or surgical correction of the anomalous vessels. Thus, the aim is to present an unusual case of extrahepatic cPSS originating from the left gastric vein and insertion into the azygos vein. Case: A 2-year-old female toy poodle, spayed, weighing 2.7 kg was treated with a history of recurrent cystitis and neurological signs such as focal seizures, ataxia, tremors, blindness, lethargy, head pressing, and compulsive gait. Complementary tests revealed normochromic microcytic anemia, neutrophilia-induced leukocytosis, monocytosis, and lymphopenia. Biochemical analysis revealed hypoproteinemia due to hypoglobulinemia, an increase in alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, and gamma-glutamyl transferase, and a decrease in urea. In the urinalysis, ammonium biurate crystals were detected, and Doppler ultrasound revealed microhepathy and the presence of an anomalous gastrosplenic vein inserted into the azygos vein, a finding compatible with the congenital extrahepatic PSS. Abdominal tomography confirmed vascular deviation with a sinuous path originating from the left gastric and splenic veins, inserting into the azygos vein, measuring approximately 5.95 cm in length. Cranial tomography revealed changes consistent with hepatic encephalopathy. Drug therapy was performed with hydration, liver chow, lactulose, probiotics, metronidazole, S-adenosyl-L-methionine, and ursodeoxycholic acid, and after 15 days, surgery was performed to place a 3.5 mm ameroid constrictor ring for gradual occlusion of the anomalous vessel. The animal recovered well, and a control abdominal ultrasound was repeated 30 days after the procedure, noting that the constrictor had not yet fully occluded the deviation. Doppler imaging revealed a favorable evolution with an increase in the diameter of the portal vein in the hepatopetal direction. The patient was followed-up for a year and had a normal and healthy life. Discussion: Extrahepatic PSS is frequently diagnosed in purebred and toy dogs, commonly occurring between the portal vein and one of its tributaries, with a lower frequency of anomalous vessels between the azygos veins, as in the present report. The patient's age and clinical signs were compatible with the disease, in addition to ammonia biurate crystals and hematological and biochemical alterations. The neurological clinical signs observed were compatible with hepatic encephalopathy secondary to congenital PSS. The imaging examinations facilitated the identification of the extrahepatic vascular anomaly, with the tomography being more accurate and helping in proper surgical planning. Clinical treatment should be performed for presurgical stabilization, and occlusion can be performed by placing cellophane bands or an ameroid constrictor, which is the technique of choice for congenital PSS, as it allows for slow constriction to avoid acute portal hypertension, as in this case, emphasizing that anesthesia in animals with portosystemic shunts must be performed with care.

Anestesia para correção de shunt portossistêmico com anel de ameróide em cão / Anesthesia for the correction of portosystemic shunt with an ameroid ring in a dog

O shunt ou desvio portossistêmico (DPS) é uma conexão anormal entre a circulação portal e sistêmica, que desvia o fluxo sanguíneo do fígado em variados graus. Nesse contexto, uma anestesia de qualidade e segura faz toda diferença na recuperação do paciente. Com isso, o presente trabalho teve o objetivo de relatar a técnica anestésica utilizada para o tratamento cirúrgico de um caso de shunt portossistêmico congênito em um cão da raça Yorkshire Terrier, fêmea, de quatro anos, pesando aproximadamente quatro quilos, que apresentava sintomas neurológicos decorrentes de encefalopatia hepática, devido à DPS. Para a medicação pré-anestésica (MPA), foi utilizado o cloridrato de remifentanila (2mg), na taxa de 10µg/Kg/h. Propofol (1%) foi utilizado para indução anestésica, na dose de 1mg/Kg/min, e para anestesia periglótica foi usado cloridrato de lidocaína (2%), no volume de 0,1mL/Kg. Quanto à manutenção anestésica, foi utilizado isoflurano (100%), em um vaporizador universal, citrato de maropitant (1%) em infusão contínua, na taxa de 30µg/Kg/h, cloridrato de remifentanila (2%), na mesma taxa utilizada na MPA, cetamina (10%), na taxa de 0,6mg/Kg/h, e brometo de rocurônio (10mg/mL), na dose de 0,15mg/Kg. Antes do início da cirurgia, foi realizado um bloqueio intraperitoneal com cloridrato de ropivacaína (0,4mg/Kg) diluída em 0,4mL/Kg, na dose de 0,1mL/Kg. Durante todo o procedimento cirúrgico, não houveram intercorrências nem alterações nos parâmetros fisiológicos. Dessa forma, pôde-se observar a eficácia da técnica anestésica utilizada para correção de shunt portossistêmico em um cão apresentando sintomatologia neurológica.

Shunt or portosystemic deviation (DPS) is an abnormal connection between portal and systemic circulation that diverts blood flow from the liver to varying degrees. In this context, quality and safe anesthesia makes all the difference in the patient's recovery. Thus, the present study aims to report the anesthetic technique used for the surgical treatment of a case of congenital portosystemic shunt in a four-year-old Yorkshire Terrier dog, weighing approximately four kilograms, which presented neurological symptoms resulting from of hepatic encephalopathy due to DPS. For pre-anesthetic medication (MPA), remifentanil hydrochloride (2mg) was used at a rate of 10µg/Kg/h. Propofol (1%) was used for anesthetic induction at a dose of 1mg/kg/min and for periglotic anesthesia lidocaine hydrochloride (2%) in a volume of 0.1mL/kg was used. As for anesthetic maintenance, isoflurane (100%) in a universal vaporizer, maropitant citrate (1%) in continuous infusion, at the rate of 30µg/Kg/h, remifentanil hydrochloride (2%), at the same rate used in MPA, ketamine (10%) at a rate of 0.6mg/kg/h and rocuronium bromide (10mg/mL), at a dose of 0.15mg/kg. Before the start of surgery, an intraperitoneal block was performed with ropivacaine hydrochloride (0.4mg/kg) diluted in 0.4mL/kg, in the dose of 0.1mL/kg. Throughout the surgical procedure, there were no complications or changes in physiological parameters. Thus, it was possible to observe the effectiveness of the anesthetic technique used to correct portosystemic shunt in a dog presenting neurological symptoms.

Anestesia para correção de shunt portossistêmico com anel de ameróide em cão / Anesthesia for the correction of portosystemic shunt with an ameroid ring in a dog

O shunt ou desvio portossistêmico (DPS) é uma conexão anormal entre a circulação portal e sistêmica, que desvia o fluxo sanguíneo do fígado em variados graus. Nesse contexto, uma anestesia de qualidade e segura faz toda diferença na recuperação do paciente. Com isso, o presente trabalho teve o objetivo de relatar a técnica anestésica utilizada para o tratamento cirúrgico de um caso de shunt portossistêmico congênito em um cão da raça Yorkshire Terrier, fêmea, de quatro anos, pesando aproximadamente quatro quilos, que apresentava sintomas neurológicos decorrentes de encefalopatia hepática, devido à DPS. Para a medicação pré-anestésica (MPA), foi utilizado o cloridrato de remifentanila (2mg), na taxa de 10µg/Kg/h. Propofol (1%) foi utilizado para indução anestésica, na dose de 1mg/Kg/min, e para anestesia periglótica foi usado cloridrato de lidocaína (2%), no volume de 0,1mL/Kg. Quanto à manutenção anestésica, foi utilizado isoflurano (100%), em um vaporizador universal, citrato de maropitant (1%) em infusão contínua, na taxa de 30µg/Kg/h, cloridrato de remifentanila (2%), na mesma taxa utilizada na MPA, cetamina (10%), na taxa de 0,6mg/Kg/h, e brometo de rocurônio (10mg/mL), na dose de 0,15mg/Kg. Antes do início da cirurgia, foi realizado um bloqueio intraperitoneal com cloridrato de ropivacaína (0,4mg/Kg) diluída em 0,4mL/Kg, na dose de 0,1mL/Kg. Durante todo o procedimento cirúrgico, não houveram intercorrências nem alterações nos parâmetros fisiológicos. Dessa forma, pôde-se observar a eficácia da técnica anestésica utilizada para correção de shunt portossistêmico em um cão apresentando sintomatologia neurológica.(AU)

Shunt or portosystemic deviation (DPS) is an abnormal connection between portal and systemic circulation that diverts blood flow from the liver to varying degrees. In this context, quality and safe anesthesia makes all the difference in the patient's recovery. Thus, the present study aims to report the anesthetic technique used for the surgical treatment of a case of congenital portosystemic shunt in a four-year-old Yorkshire Terrier dog, weighing approximately four kilograms, which presented neurological symptoms resulting from of hepatic encephalopathy due to DPS. For pre-anesthetic medication (MPA), remifentanil hydrochloride (2mg) was used at a rate of 10µg/Kg/h. Propofol (1%) was used for anesthetic induction at a dose of 1mg/kg/min and for periglotic anesthesia lidocaine hydrochloride (2%) in a volume of 0.1mL/kg was used. As for anesthetic maintenance, isoflurane (100%) in a universal vaporizer, maropitant citrate (1%) in continuous infusion, at the rate of 30µg/Kg/h, remifentanil hydrochloride (2%), at the same rate used in MPA, ketamine (10%) at a rate of 0.6mg/kg/h and rocuronium bromide (10mg/mL), at a dose of 0.15mg/kg. Before the start of surgery, an intraperitoneal block was performed with ropivacaine hydrochloride (0.4mg/kg) diluted in 0.4mL/kg, in the dose of 0.1mL/kg. Throughout the surgical procedure, there were no complications or changes in physiological parameters. Thus, it was possible to observe the effectiveness of the anesthetic technique used to correct portosystemic shunt in a dog presenting neurological symptoms.(AU)

Abordagem transcirúrgica e acompanhamento pós-operatório de um canino com um shunt esplênico-azigos / Transurgical approach and postoperative follow-up of a canine with a splenic-azygos shunt

Background: The most frequent hepatic circulatory abnormality in dogs is the portosystemic shunt, characterized by an atypical deviation of the hepatic blood flow, that causes the blood that should be drained by the liver through the portal vein to be diverted to another systemic vein, as a result of the presence of the anomalous vessel. This diversion leads to reduced hepatic blood flow and, consequently, organ dysfunction, along with the accumulation of many toxins in the circulation, for instance, ammonia and short-chain fatty acids. The main objective of this paper is to Report the clinical case of a canine female diagnosed with an extrahepatic portosystemic shunt and submitted to surgical treatment using an ameroid constrictor ring in the obstruction of the anomalous vessel. Case: A canine Shih-Tzu, at the age of 1 year and 8 months, was brought to the Veterinary Hospital presenting a history of emesis and smaller body structure than other animals from the same litter. The animal had been diagnosed with portosystemic shunt at age 1 month, by means of complementary biochemistry, ultrasonography and computed tomography examinations. The latter identified the anomalous vessel, which originated from the left gastric vein and was inserted into the azygos vein in the portohepatic region. During the surgical intervention, after median pre-retro-umbilical celiotomy, a calibrous vessel was identified, coming out of the junction of two splenic veins and a gastric vein that penetrated the diaphragm and connected to the azygos vein in the thorax before flowing into the vena cava

Abordagem transcirúrgica e acompanhamento pós-operatório de um canino com um shunt esplênico-azigos / Transurgical approach and postoperative follow-up of a canine with a splenic-azygos shunt

Background: The most frequent hepatic circulatory abnormality in dogs is the portosystemic shunt, characterized by an atypical deviation of the hepatic blood flow, that causes the blood that should be drained by the liver through the portal vein to be diverted to another systemic vein, as a result of the presence of the anomalous vessel. This diversion leads to reduced hepatic blood flow and, consequently, organ dysfunction, along with the accumulation of many toxins in the circulation, for instance, ammonia and short-chain fatty acids. The main objective of this paper is to Report the clinical case of a canine female diagnosed with an extrahepatic portosystemic shunt and submitted to surgical treatment using an ameroid constrictor ring in the obstruction of the anomalous vessel. Case: A canine Shih-Tzu, at the age of 1 year and 8 months, was brought to the Veterinary Hospital presenting a history of emesis and smaller body structure than other animals from the same litter. The animal had been diagnosed with portosystemic shunt at age 1 month, by means of complementary biochemistry, ultrasonography and computed tomography examinations. The latter identified the anomalous vessel, which originated from the left gastric vein and was inserted into the azygos vein in the portohepatic region. During the surgical intervention, after median pre-retro-umbilical celiotomy, a calibrous vessel was identified, coming out of the junction of two splenic veins and a gastric vein that penetrated the diaphragm and connected to the azygos vein in the thorax before flowing into the vena cava…(AU)

Abordagem clínico-cirúrgica de desvio portossistêmico congênito em pequenos animais: quais as novidades? / Clinical and surgical approach of congenital portosystemic shunt in small animals: are there new informations?

Foi realizada uma revisão sobre a fisiopatogenia, sinais clínicos, diagnóstico e principais tratamentos e técnicas para o desvio portossistêmico em pequenos animais. As fontes pesquisadas foram: CAB, MEDILINE por um período retrospectivo de 20 anos e acervos da Biblioteca da Faculdade de Medicina Veterinária e Zootecnia (FMVZ) da Universidade de São Paulo (USP). O desvio portossistêmico congênito (DPSC) é uma das anormalidades vasculares mais comuns em cães, as raças de pequeno porte apresentam maior incidência. Os DPSCs em cães e gatos são comunicações vasculares que ocorrem do sistema venoso portal para o sistema venoso sistêmico, ou seja, fazem uma via secundária. Há dois tipos de DPSCs, intra-hepático e extra-hepático, observados com frequência em raças de grande porte e miniaturas, respectivamente. O diagnóstico é baseado no histórico de animais jovens com retardo de crescimento, letargia, convulsão ou distúrbio de comportamento principalmente após alimentação, retorno demorado de anestesia ou sedação, crise de encefalopatia hepática, em raças predispostas. A confirmação do vaso anômalo é realizada pela ultrassonografia com doppler, angiografia por tomografia computadorizada ou por ressonância magnética.(AU)

It was performed a review of pathophysiology, clinical signs, diagnostic and main treatments and techniques for portosystemic shunts in small animals. The researched Sources were: a 20 years retrospective research of CAB, MEDILINE and collection of Faculty of MedicineVeterinary and Animal Science (FMVZ) of the Universidade de São Paulo (USP). Congenital portossystemic shunts (CPSS) are one of the vascular abnormalities more common in dogs. Small breeds are the most affected. The CPSS in dogs and cats, are vascular communications between portal venous system and systemic venous system, in other words, a secondary via. There are two types of CPSS, the intrahepatic and extrahepatic shunts, observed in large and small breeds, respectively. The diagnosis is based on clinical findings of young dogs referring delayed development, lethargy, convulsions, behavior disturbances mainly after food ingestion, poor recovery after anesthesia or sedation, hepatic encephalopathy crisis observed breeds with predisposition. Definitive diagnosis of CPSS is done by abdominal doppler ultrasonography, computed tomography angiography or magnetic resonance. Medical management can alleviate signs of hepatic encephalopathy. However, long term treatment is questionable because blood circulation is still bypassing liver to systemic circulation, leading to disturbance of hepatotropic factors distribution to the liver, resulting in liver atrophy. The only definitive treatment is the surgical one. The ideal technique is the progressive attenuation of anomalous vessel and avoid acute portal hypertension. Within the described techniques for surgical treatment, the use of ameroid constrictor represents the safest way of vessel closure. On the other way, some CPS patients can suffer severe perioperative complications. So they need specific clinical and surgical approaches associated to precise image diagnostic to correct localization of the anomalous vessel and surgical success.(AU)

Abordagem clínico-cirúrgica de desvio portossistêmico congênito em pequenos animais: quais as novidades? / Clinical and surgical approach of congenital portosystemic shunt in small animals: are there new informations?

Foi realizada uma revisão sobre a fisiopatogenia, sinais clínicos, diagnóstico e principais tratamentos e técnicas para o desvio portossistêmico em pequenos animais. As fontes pesquisadas foram: CAB, MEDILINE por um período retrospectivo de 20 anos e acervos da Biblioteca da Faculdade de Medicina Veterinária e Zootecnia (FMVZ) da Universidade de São Paulo (USP). O desvio portossistêmico congênito (DPSC) é uma das anormalidades vasculares mais comuns em cães, as raças de pequeno porte apresentam maior incidência. Os DPSCs em cães e gatos são comunicações vasculares que ocorrem do sistema venoso portal para o sistema venoso sistêmico, ou seja, fazem uma via secundária. Há dois tipos de DPSCs, intra-hepático e extra-hepático, observados com frequência em raças de grande porte e miniaturas, respectivamente. O diagnóstico é baseado no histórico de animais jovens com retardo de crescimento, letargia, convulsão ou distúrbio de comportamento principalmente após alimentação, retorno demorado de anestesia ou sedação, crise de encefalopatia hepática, em raças predispostas. A confirmação do vaso anômalo é realizada pela ultrassonografia com doppler, angiografia por tomografia computadorizada ou por ressonância magnética.

It was performed a review of pathophysiology, clinical signs, diagnostic and main treatments and techniques for portosystemic shunts in small animals. The researched Sources were: a 20 years retrospective research of CAB, MEDILINE and collection of Faculty of MedicineVeterinary and Animal Science (FMVZ) of the Universidade de São Paulo (USP). Congenital portossystemic shunts (CPSS) are one of the vascular abnormalities more common in dogs. Small breeds are the most affected. The CPSS in dogs and cats, are vascular communications between portal venous system and systemic venous system, in other words, a secondary via. There are two types of CPSS, the intrahepatic and extrahepatic shunts, observed in large and small breeds, respectively. The diagnosis is based on clinical findings of young dogs referring delayed development, lethargy, convulsions, behavior disturbances mainly after food ingestion, poor recovery after anesthesia or sedation, hepatic encephalopathy crisis observed breeds with predisposition. Definitive diagnosis of CPSS is done by abdominal doppler ultrasonography, computed tomography angiography or magnetic resonance. Medical management can alleviate signs of hepatic encephalopathy. However, long term treatment is questionable because blood circulation is still bypassing liver to systemic circulation, leading to disturbance of hepatotropic factors distribution to the liver, resulting in liver atrophy. The only definitive treatment is the surgical one. The ideal technique is the progressive attenuation of anomalous vessel and avoid acute portal hypertension. Within the described techniques for surgical treatment, the use of ameroid constrictor represents the safest way of vessel closure. On the other way, some CPS patients can suffer severe perioperative complications. So they need specific clinical and surgical approaches associated to precise image diagnostic to correct localization of the anomalous vessel and surgical success.

Ultrasonography and portography in the diagnosis of shunt portoazigos in a dog: case report / Ultrassonografia e portografia no diagnóstico de shunt portoázigos em um cão: relato de caso

Portosystemic shunt (PSS) is an anomalous vascular connection between the portal venous system and the systemic circulation. These deviations connect the main portal vein (PV) or some portal branches to the vena cava (VC) or, less commonly, to the azygos vein (AV). The purpose of this case report was to describe the diagnosis of PSS in a dog classified as porto-azygos. This diagnosis is considered uncommon compared to other portosystemic shunts using ultrasonography and portography. The subject was a male dog, Yorkshire, 8 months old, presented neurological signs characterized by head press, ataxia, tremors and episodes of temporary blindness and deafness. Ultrasonographic examination revealed a dilated and curved anomalous vessel with approximately 0.6cm of diameter and turbulent flow seen through pulsed and color Doppler, and segmental dilation of the azygos vein. The portography revealed enhancement by iodinated contrast in the jejunal vein, the portal vein and an anomalous vessel flowing towards the azygos vein in the craniodorsal region of the abdomen. The PSS was surgically corrected with an ameroid constrictor. Ultrasonography and portography were effective at detecting and characterizing the portoazygos shunt despite some limitations.(AU)

Shunt portossistêmico (SPS) é uma comunicação vascular anômala entre o sistema venoso portal e a circulação sistêmica. Esses desvios comunicam a VP ou alguma de suas tributárias à veia cava ou, menos comumente, à veia ázigos (VA). O objetivo do presente estudo foi descrever o diagnóstico, por meio de ultrassonografia e portografia, de um caso de shunt extra-hepático em cão, classificado como portoázigos e considerado incomum quando comparado aos demais tipos de desvio portossistêmico. Um cão, macho, raça Yorkshire, oito meses de idade, chegou ao Hospital Veterinário da Universidade Federal de Minas Gerais apresentando sinais neurológicos, caracterizados por andar apoiando a cabeça na parede, ataxia, tremores, episódios de cegueira e surdez. Ao exame ultrassonográfico, observou-se vaso anômalo calibroso e tortuoso de aproximadamente 0,6cm de diâmetro e fluxo turbulento ao Doppler pulsado e colorido, bem como dilatação segmentar da VA. A portografia revelou realce de contraste iodado em veia jejunal, porta e vaso anômalo (shunt) seguindo em direção à VA em região dorsal do abdômen. Foi realizada a correção cirúrgica do SPS por meio de anel ameroide. A ultrassonografia e a portografia foram eficientes na detecção e caracterização do shunt portoázigos, mesmo que com algumas limitações.(AU)

Ultrasonography and portography in the diagnosis of shunt portoazigos in a dog: case report / Ultrassonografia e portografia no diagnóstico de shunt portoázigos em um cão: relato de caso

Portosystemic shunt (PSS) is an anomalous vascular connection between the portal venous system and the systemic circulation. These deviations connect the main portal vein (PV) or some portal branches to the vena cava (VC) or, less commonly, to the azygos vein (AV). The purpose of this case report was to describe the diagnosis of PSS in a dog classified as porto-azygos. This diagnosis is considered uncommon compared to other portosystemic shunts using ultrasonography and portography. The subject was a male dog, Yorkshire, 8 months old, presented neurological signs characterized by head press, ataxia, tremors and episodes of temporary blindness and deafness. Ultrasonographic examination revealed a dilated and curved anomalous vessel with approximately 0.6cm of diameter and turbulent flow seen through pulsed and color Doppler, and segmental dilation of the azygos vein. The portography revealed enhancement by iodinated contrast in the jejunal vein, the portal vein and an anomalous vessel flowing towards the azygos vein in the craniodorsal region of the abdomen. The PSS was surgically corrected with an ameroid constrictor. Ultrasonography and portography were effective at detecting and characterizing the portoazygos shunt despite some limitations.(AU)

Shunt portossistêmico (SPS) é uma comunicação vascular anômala entre o sistema venoso portal e a circulação sistêmica. Esses desvios comunicam a VP ou alguma de suas tributárias à veia cava ou, menos comumente, à veia ázigos (VA). O objetivo do presente estudo foi descrever o diagnóstico, por meio de ultrassonografia e portografia, de um caso de shunt extra-hepático em cão, classificado como portoázigos e considerado incomum quando comparado aos demais tipos de desvio portossistêmico. Um cão, macho, raça Yorkshire, oito meses de idade, chegou ao Hospital Veterinário da Universidade Federal de Minas Gerais apresentando sinais neurológicos, caracterizados por andar apoiando a cabeça na parede, ataxia, tremores, episódios de cegueira e surdez. Ao exame ultrassonográfico, observou-se vaso anômalo calibroso e tortuoso de aproximadamente 0,6cm de diâmetro e fluxo turbulento ao Doppler pulsado e colorido, bem como dilatação segmentar da VA. A portografia revelou realce de contraste iodado em veia jejunal, porta e vaso anômalo (shunt) seguindo em direção à VA em região dorsal do abdômen. Foi realizada a correção cirúrgica do SPS por meio de anel ameroide. A ultrassonografia e a portografia foram eficientes na detecção e caracterização do shunt portoázigos, mesmo que com algumas limitações.(AU)

Congenital extrahepatic portosystemic deviation in a mixed-breed dog

Background: Portosystemic deviation (PSD) is a congenital or acquired vascular anomaly that allows an abnormal bloodflow from the portal vein directly to the systemic circulation. This liver by-pass avoids hepatic metabolism of severaltoxins. Congenital PSDs are usually solitary and extra-hepatic, with a high incidence in pure-breed dogs. Acquired PSDsare usually multiple and occur as a consequence of portal hypertension. Surgery is the definitive treatment. Cliniciansand surgeons may present difficulties in the propaedeutic of animals with PSD. This paper aims at reporting a successfulsurgical treatment of a solitary extra-hepatic congenital PSD in a mixed-breed dog.Case: A 7-month-old mixed-breed dog, female, spayed, weighing 8 kg, was presented with a history of sudden syncopeafter feeding. Complementary exams revealed normocytic hypochromic anaemia, hypoalbuminemia and increased alanineaminotransferase and alkaline phosphatase. Abdominal ultrasound revealed an anomalous vessel inserted in the caudalcava vein, compatible with a congenital extra-hepatic PSD. Computed tomography revealed the anomalous vessel, with1,1 cm of diameter, originated from the cranial mesenteric vein and it inserted in the cranial margin of the caudal cavavein. A medical support was started with hydration, metronidazole, lactulose, probiotic and Hepatic diet. After 15 days thedog was submitted to surgery and a 5 mm ameroid constrictor ring was placed to gradually close the anomalous vessel.The dog recovered well and an abdominal ultrasound was repeated after 30 days, showing the ameroid constrictor ringring in the left cranial abdominal region, occluding the PSD close to its insertion in the caudal cava vein...

Congenital extrahepatic portosystemic deviation in a mixed-breed dog

Background: Portosystemic deviation (PSD) is a congenital or acquired vascular anomaly that allows an abnormal bloodflow from the portal vein directly to the systemic circulation. This liver by-pass avoids hepatic metabolism of severaltoxins. Congenital PSDs are usually solitary and extra-hepatic, with a high incidence in pure-breed dogs. Acquired PSDsare usually multiple and occur as a consequence of portal hypertension. Surgery is the definitive treatment. Cliniciansand surgeons may present difficulties in the propaedeutic of animals with PSD. This paper aims at reporting a successfulsurgical treatment of a solitary extra-hepatic congenital PSD in a mixed-breed dog.Case: A 7-month-old mixed-breed dog, female, spayed, weighing 8 kg, was presented with a history of sudden syncopeafter feeding. Complementary exams revealed normocytic hypochromic anaemia, hypoalbuminemia and increased alanineaminotransferase and alkaline phosphatase. Abdominal ultrasound revealed an anomalous vessel inserted in the caudalcava vein, compatible with a congenital extra-hepatic PSD. Computed tomography revealed the anomalous vessel, with1,1 cm of diameter, originated from the cranial mesenteric vein and it inserted in the cranial margin of the caudal cavavein. A medical support was started with hydration, metronidazole, lactulose, probiotic and Hepatic diet. After 15 days thedog was submitted to surgery and a 5 mm ameroid constrictor ring was placed to gradually close the anomalous vessel.The dog recovered well and an abdominal ultrasound was repeated after 30 days, showing the ameroid constrictor ringring in the left cranial abdominal region, occluding the PSD close to its insertion in the caudal cava vein...(AU)

Encefalopatía en gato causada por condicíon simultánea de "shunt" portosistémico y peritonitis infecciosa felina (PIF) no efusiva - reporte de caso / Encefalopathy in cat caused by simultaneous afection of portosystemic "shunt" and non effusive feline infectious peritonitis (FIP) - case report / Encefalopatia em gato causada por afecção simultânea de "shunt" portossistêmico e peritonite infecciosa felina (PIF) não efusiva - relato de caso

Encefalopatías en gatos pueden presentar varias causas, entre ellas, trastornos hepáticos, renales y enfermedades infecciosas. Apesar de diferentes etiologías, es posible que estas encefalopatías ocurran simultáneamente y exacerban los síntomas del animal afectado. La investigación de todas las causas posibles, de acuerdo con la evolución de la situación del animal, es de gran importancia. El objetivo de este trabajo es presentar un caso de encefalopatía en gato de dos fuentes distintas de forma simultánea, encefalopatía hepática por "shunt" portosistémico e causada por la infección del virus de la peritonitis infecciosa felina no efusiva.(AU)

Encefalopthies in felines may be presented by several causes, among them, hepatic affections, renal affections and infectious diseases. Despite the differentiated etiologies, its possible this encefalopathies occurs in simultaneous form and exacerbate the sintomatology of the stricken animal. The investigation of all the possible causes, according to the evolution of the animal situation, is very important. The aim of this paper is to report a case of a cat presenting encefalophaty by two different origins simultaneously, hepatic encefalophaty by portosystemic "shunt" and caused by non-effusive feline infectious peritonitis virus infection.(AU)

Encefalopatias em felinos podem se apresentar por várias causas, dentre elas, distúrbios metabólicos e doenças infecciosas. Apesar de etiologias diferenciadas, é possível que essas encefalopatias ocorram de forma simultânea e exacerbam a sintomatologia do animal acometido. A investigação de todas as possíveis causas, de acordo com a evolução do quadro do animal, é de grande importância. O objetivo deste trabalho é relatar um caso de gato apresentando encefalopatia de duas origens diferentes em simultaneidade, encefalopatia hepática por "shunt" portossistêmico e causada por infecção por vírus da peritonite infecciosa felina não efusiva.

Encefalopatía en gato causada por condicíon simultánea de "shunt" portosistémico y peritonitis infecciosa felina (PIF) no efusiva - reporte de caso / Encefalopathy in cat caused by simultaneous afection of portosystemic "shunt" and non effusive feline infectious peritonitis (FIP) - case report / Encefalopatia em gato causada por afecção simultânea de "shunt" portossistêmico e peritonite infecciosa felina (PIF) não efusiva - relato de caso

Encefalopatías en gatos pueden presentar varias causas, entre ellas, trastornos hepáticos, renales y enfermedades infecciosas. Apesar de diferentes etiologías, es posible que estas encefalopatías ocurran simultáneamente y exacerban los síntomas del animal afectado. La investigación de todas las causas posibles, de acuerdo con la evolución de la situación del animal, es de gran importancia. El objetivo de este trabajo es presentar un caso de encefalopatía en gato de dos fuentes distintas de forma simultánea, encefalopatía hepática por "shunt" portosistémico e causada por la infección del virus de la peritonitis infecciosa felina no efusiva.

Encefalopthies in felines may be presented by several causes, among them, hepatic affections, renal affections and infectious diseases. Despite the differentiated etiologies, its possible this encefalopathies occurs in simultaneous form and exacerbate the sintomatology of the stricken animal. The investigation of all the possible causes, according to the evolution of the animal situation, is very important. The aim of this paper is to report a case of a cat presenting encefalophaty by two different origins simultaneously, hepatic encefalophaty by portosystemic "shunt" and caused by non-effusive feline infectious peritonitis virus infection.

Encefalopatias em felinos podem se apresentar por várias causas, dentre elas, distúrbios metabólicos e doenças infecciosas. Apesar de etiologias diferenciadas, é possível que essas encefalopatias ocorram de forma simultânea e exacerbam a sintomatologia do animal acometido. A investigação de todas as possíveis causas, de acordo com a evolução do quadro do animal, é de grande importância. O objetivo deste trabalho é relatar um caso de gato apresentando encefalopatia de duas origens diferentes em simultaneidade, encefalopatia hepática por "shunt" portossistêmico e causada por infecção por vírus da peritonite infecciosa felina não efusiva.

Avaliação do metabolismo proteico e aminoacídico de cães com shunt portossistêmico

ERNANDES, M.C. Avaliação do metabolismo proteico e aminoacídico de cães com shunt portossistêmico. 2018. 63 f. Tese de Doutorado (Doutorado em Ciências) Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, São Paulo, 2018. No desvio portossistêmico, o sangue proveniente do trato gastrintestinal não é direcionado ao fígado para ser metabolizado e sim desviado para a circulação sistêmica. O acúmulo dessas substâncias tóxicas associado às alterações funcionais do órgão pode resultar em encefalopatia hepática. O manejo nutricional é o ponto chave para o sucesso da terapia. Dessa forma, o presente estudo objetivou avaliar os efeitos do emprego de um alimento hipoproteico nas concentrações séricas aminoacídicas de cães com desvio portossistêmico. Foram incluídos nove cães com diagnóstico de desvio portossistêmico (Shunt) e nove cães saudáveis (Controle). Os animais foram avaliados no dia um (T0) e após 60 dias (T60) de ingestão de uma dieta hipoproteica comercial. Nos dois momentos foram coletadas amostras de sangue para realização de hemograma, leucograma, bioquímica sérica, determinação dos aminoácidos séricos e amônia. A análise estatística dos resultados referentes aos hemogramas e exames bioquímicos foi baseada em um modelo misto que considerou efeito fixos de grupo, tempo e interação e, para os aminoácidos somente efeitos fixos de grupo (p<0,05). Os animais do grupo controle apresentaram maiores valores de proteína total (p<0,0001), ureia (p<0,0001), creatinina (p=0,0163), albumina (p<0,0001) e colesterol (p=0,0012) quando comparado ao grupo Shunt que apresentou maiores valores de hematócrito (p=0,0213), ALT e FA (p=0,0253 e p=0,0004, respectivamente), amônia em jejum (p=0,0083) e amônia pós-prandial (p=0,0036). Em relação aos aminoácidos séricos, o grupo Shunt apresentou valores maiores quando comparados ao grupo Controle nas concentrações dos aminoácidos fenilalanina (p=0,0054), glutamato (p=0,0066), serina (p=0,0054) e tirosina (p=0,0106), já o aminoácido sérico alanina (p=0,0280), a razão de Fischer (p=0,0093) e a razão da concentração sérica de aminoácidos de cadeia ramificada e tirosina (p=0,0243) foram maiores no grupo Controle. Concluiu- se que o manejo dietético foi eficiente em prevenir a progressão da doença e controlar os sinais clínicos, sem promover aumento nas concentrações séricas dos aminoácidos de cadeia ramificada.

ERNANDES, M.C. Evaluation of amino acid and protein metabolism in dogs with portosystemic shunt. 2018. 63 f. Tese de Doutorado (Doutorado em Ciências) Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, São Paulo, 2018. In the portosystemic shunt, the blood coming from the gastrointestinal tract is not directed to the liver to be metabolized but rather diverted to the systemic circulation. The accumulation of these toxic substances associated with functional alterations of the organ can result in hepatic encephalopathy. Nutritional management is the key to successful therapy. Thus, the present study aimed to evaluate the effects of the use of a hypoproteic food on the protein and amino acid profile of dogs with portosystemic shunt. For this, nine dogs with a diagnosis of portosystemic shunt (Shunt) and nine healthy dogs (Control) were included. The dogs were evaluated on day one (T0) and after 60 days (T60) feeding a commercial hypoprotein diet. Blood samples were collected for hemogram, leukogram, serum biochemistry, determination of serum amino acids and ammonia. For the analysis of hemograms and biochemistry, a mixed model was used considering group fixed effects, time and interaction, and for amino acids only group fixed effects (p<0.05). The results showed that the animals in the Control group presented higher values of total protein (p<0.0001), urea (p<0.0001), creatinine (p=0.0163), albumin (p<0.0001) and cholesterol (p=0.0012) when compared to the Shunt group that presented higher values of hematocrit (p=0.0213), ALT and FA (p=0.0253 and p=0.0004, respectively), fasting ammonia (p=0.0083) and postprandial ammonia (p=0.0036). Serum amino acids (p=0.0054), glutamate (p=0.0066), serine (p=0.0054) and tyrosine (p=0.0054) were higher in the Shunt group than in the Control group (0.0106). The Fischer ratio (p=0.0093) and the ratio of serum concentration of branched-chain amino acids and tyrosine (p=0.0243) were higher for the Control group. In conclusion, that dietary management was efficient in preventing disease progression and controlling clinical signs without increasing branched-chain amino acids.

Hepatopatia crônica associada ao acúmulo de cobre em um cão da raça American Pitbull Terrier / Chronic Liver Disease Associated to Copper Accumulation in an American Pitbull Terrier

Background: The liver plays a variety of essential biochemical functions such as the metabolism of carbohydrates, proteins, lipids and vitamins, the maintenance of blood glucose and bile acids synthesis. Hepatic insufficiency occurs when 70 to 80% of the functional liver mass is committed the liver is unable to metabolize substances on the circulation. In some cases, chronic liver disease may be associated with copper accumulation, which may occur by increased dietary intake, faults in hepatic copper metabolism or liver diseases that cause colestase. The purpose of this paper is to report a case of chronic liver disease associated with copper accumulation in a 8-month-old American Pit Bull Terrier. Case: An American Pitbull Terrier was referred to the Veterinary Teaching Hospital of the Federal University of Rio Grande do Sul with a history of abdominal distension, decreased appetite, vomiting, diarrhea, weight loss and exhaustion. On physical examination the animal presented ascites and dehydration and laboratory tests were suggestive of active liver disease. Supportive care was provided. The patient was prescribed ranitidine (2 mg/kg) VO BID for 7 days, metoclopramide (0.3 mg/kg) VO BID also for 7 days and furosemide (1 mg/kg) PO BID until further instructions while awaiting for test results. The next appointment was scheduled for ten days later but the owner came back for consultation only 60 days after the first visit. The patient had then a history of abdominal distension, dullness and polydipsia. During physical examination, it was possible to notice pale mucous membranes, dehydration, cachexia, hypothermia and ascites. The animal was then hospitalized for additional tests, abdominocentesis, support treatment and further observation. Laboratory findings showed liver failure. The patient died after two days. Necropsy revealed macroscopic alterations compatible with liver cirrhosis. On microscopic examination, it was observed marked diffuse proliferation of fibrous connective tissue and epithelial cells of the bile ducts, besides moderate multifocal histiocytic infiltrate with granular intracytoplasmic brownish pigment. Copper determination on hepatic fragment was performed. The examination found 1320 mg/g on dry weight of copper in the body. The necropsy report was liver cirrhosis associated with copper accumulation. Discussion: Liver disease associated with copper accumulation has been reported in West Highland Terriers, Skye Terriers and Bedlington Terriers. There are not, however, reports of this disease in American Pitbull Terriers. Laboratory findings of this case are consistent with liver failure, also reported by previous studies. Based on laboratory findings supportive care was established since the patient was in an irreversible condition. A biopsy was not performed, despite being the definitive diagnostic method for cirrhosis, since the patient had alterations in the coagulation tests, preventing the procedure. The acquired portosystemic shunt observed on necropsy was due to increased intrahepatic resistance, caused by fibrosis and is a common finding in cases of cirrhosis. The copper concentration found in the liver was three times greater than the value considered normal for the canine species. However, it was not possible to determine whether the copper accumulation was the cirrhosis' cause or consequence. Chronic liver disease is common in veterinary care, but it is often difficult to identify the cause of injury. The copper accumulation should be considered as a liver failure cause in same breeds as predisposed but yet unreported, especially in young patients.

Avaliação morfométrica e hemodinâmica comparativa dos vasos envolvidos no shunt portossistêmico congênito em cães / Morphometric and haemodynamic evaluation of the vessels associated with the congenital portosystemic shunting in dogs

The morphometry and haemodynamic aspects of portal vein were studied in 20 normal dogs with less than 120 days of age and in 14 dogs presenting portosystemic shunting with ages between 90 and 360 days. In the control group the hepatic margins were seen 1.50cm to 3.00cm caudal to the costal margin. Collected data indicated that the mean diameter of portal vein (VP), caudal vena cava (VCC) and abdominal aorta (AO) measured respectively, 0.38cm, 0.37cm and 0.41cm. The VP/VCC and VP/AO mean ratios were respectively, 1.10 and 0.94. The average of VP, VCC and AO areas were respectively, 0.12cm², 0.11cm² and 0.14cm². The haemodynamic of portal vein was studied by ultrasound Doppler and the mean velocity of portal blood flow (VMFSP) measured was 17.76cm/s. It was verified that portal blood flow (FSP) average was 83.11ml/min/kg and the congestion index (IC) average was 0.006. In the group of animals presenting portosystemic shunting, the hepatic margins were seen 1.00cm to 2.00cm cranial to the costal margin. The morphometry of VP, VCC and AO presented a mean diameter of 0.40cm, 0.74cm and 0.56cm, respectively. The VP/VCC and VP/AO mean ratios were respectively, 0.54 and 0.69. The average of VP, VCC and AO areas were respectively, 0.14cm², 0.31cm² and 0.25cm². The haemodynamic study demonstrated that the VMFSP measured was 22.29cm/s and the IC average was 0.006.(AU)

Foram realizados o estudo morfométrico e o estudo hemodinâmico da veia porta em vinte cães clinicamente normais, de idade igual e inferior a 120 dias e em quatorze cães portadores de shunt portossistêmico, de idades entre 90 e 360 dias. Nos cães do grupo controle, as margens hepáticas apresentaram-se entre 1,50cm e 3,00cm caudalmente à margem costal. Os diâmetros médios da veia porta (VP), veia cava caudal (VCC) e aorta abdominal (AO) obtidas foram respectivamente, 0,38cm, 0,37cm e 0,41cm. As proporções entre os diâmetros médios VP/VCC e VP/AO apresentaram médias de 1,10 e 0,94, respectivamente. As médias das áreas da VP, VCC e AO resultaram respectivamente em 0,12cm² , 0,11cm² e 0,14cm². No estudo hemodinâmico da VP destes animais, utilizando-se o ultrassom Doppler, a velocidade média de fluxo sangüíneo portal (VMFSP) mediu 17,76cm/s. A média de fluxo sangüíneo portal (FSP) resultou em 83,11ml/min/kg. O índice de congestão (IC) apresentou média de 0,006. Para o grupo de cães portadores de shunt portossistêmico, o fígado apresentou redução de seu volume, sendo as margens hepáticas visibilizadas entre 1,00cm e 2,00cm cranialmente à margem costal. No estudo morfométrico, as médias dos diâmetros médios obtidos de VP, VCC e AO resultaram respectivamente em 0,40cm, 0,74cm e 0,56cm. As proporções entre os diâmetros médios VP/VCC e VP/AO resultaram respectivamente em 0,54 e 0,69. As médias das áreas de VP, VCC e AO resultaram respectivamente em 0,14cm², 0,31cm² e 0,25cm². Ao ultrassom Doppler a VMFSP mediu 22,29cm/s e a média do IC da VP obtido foi de 0,006.(AU)

Venous drainage from the tail of the pancreas to the lienal vein and its relationship with the distal splenorenal shunt selectivity / Drenagem venosa da cauda do pâncreas para a veia lienal e sua relação com a seletividade da anastomose esplenorrenal

PURPOSE: To identify the veins draining from the pancreatic tail to the lienal vein and its possible relationship with the loss of the distal splenorenal shunt selectivity. METHODS: Thirty eight human blocks including stomach, duodenum, spleen, colon and pancreas, removed from fresh corpses, were studied with the replenish and corrosion technique, using vinilic resin and posterior corrosion of the organic tissue with commercial hydrochloric acid, in order to study the lienal vein and its tributaries. RESULTS: The number of veins flowing directly to the splenic vein varied from seven to twenty two (14.52 ± 3.53). Pancreatic branches of the pancreatic tail flowing to the segmentary veins of the spleen were found in 25 of the anatomical pieces studied (65.79 percent). These branches varied from one to four, predominating one branch (60 percent) and two branches (24 percent). CONCLUSIONS: In 65.79 percent of the anatomical pieces studied, the veins of the pancreatic tail flowed in segmentary branches of the splenic vein. These branches could be responsible for the loss of distal splenorenal shunt selectivity. The complete disconnection of the pancreatic tail could increase the selectivity in this procedure.(AU)

OBJETIVO: Identificar as veias da cauda do pâncreas afluentes da veia lienal e a possível relação destes ramos com a perda de seletividade da derivação esplenorrenal distal. MÉTODOS: Foram estudadas 38 peças humanas, retiradas de cadáveres, contendo estômago, duodeno, baço, cólon e pâncreas, utilizando-se a técnica de repleção vascular com resina vinílica e posterior corrosão do tecido orgânico com o objetivo de se estudar o molde vascular da veia lienal e seus afluentes. RESULTADOS: O número de veias afluindo diretamente para a veia esplênica variou de sete a vinte dois (MA 14.52±3.53). Ramos pancreáticos da cauda do pâncreas afluindo para as veias segmentares do baço estavam presentes em 25 das peças estudadas (65,79 por cento). Estes ramos variaram de um a quatro, predominando um ramo (60 por cento) e dois ramos (24 por cento). CONCLUSÕES: Em 65,79 por cento das peças veias da cauda do pâncreas desembocavam em ramos segmentares da veia esplênica. Estes ramos poderiam ser responsáveis pela perda de seletividade da derivação esplenorrenal distal e a esqueletização completa da cauda do pâncreas poderia aumentar a seletividade neste procedimento.(AU)

A new experimental model for acute hepatic failure in rats / Novo modelo experimental em ratos para insuficiência hepática aguda

PURPOSE: To develop a reliable surgical model of acute hepatic failure and hyperammonemia in rats that avoids porto-systemic shunt and bile duct ligation, applicable to hepatic encephalopathy research. METHODS: The pedicles of right lateral and caudate lobes were exposed and clamped. One hour later, the animal was reopened, clamps were released and anterior subtotal hepatectomy (resection of median and left lateral lobes) was performed, comprising 75 percent of liver removal. Four hours after hepatectomy, blood samples and liver tissues were collected from ALF and control groups. RESULTS: Differences between ALF and control groups were significant for ALT, AST, total and direct bilirubin, sodium, potassium, alkaline phosphatasis, gamma-glutamyltransferase and most important, ammonia. Histologically, significant differences were noticed between groups. CONCLUSION: The model is useful for the study of specific aspects of ALF and the development of new therapeutic approaches.(AU)

OBJETIVO: Desenvolver um modelo cirúrgico de IHA e hiperamonemia em ratos, que evita o shunt porto-sistêmico e a ligadura do ducto biliar, que seja aplicável à pesquisa de encefalopatia hepática. MÉTODOS: Após anestesia geral e laparotomia mediana, os pedículos dos lobos laterais direito e caudado foram isolados e clampeados. Após 1 hora, o animal foi reaberto, os clampes retirados e foi realizada hepatectomia anterior subtotal (ressecção dos lobos médio e lateral esquerdo), compreendendo a remoção de 75 por cento do parênquima. Quatro horas após a hepatectomia, amostras de sangue e tecido hepático foram coletadas nos grupos IHA e controle. RESULTADOS: Diferenças entre os grupos IHA e controle foram significativas para ALT, AST, bilirrubina total e direta, sódio, potássio, fosfatase alcalina, gama glutamiltransferase e principalmente amônia. Histologicamente, diferenças significativas foram observadas entre os grupos. CONCLUSÃO: O modelo é útil para o estudo de aspectos específicos da IHA e o desenvolvimento de novas abordagens terapêuticas.(AU)

Dopplervelocimetric evaluation of portal vein as a diagnostic tool for portosystemic shunt diagnosis in dogs

The objective of this research was to verify if the study of portal hemodynamic parameters through duplex Doppler ultrasonography (DUS) is able to help to detect portosystemic shunt (PSS) and the shunted vessel origin. It was detected PSS in 20 dogs by abdominal DUS and confirmed at surgery or necropsy from March of 2004 until March 2007. Main ultrasonographic findings were: identification of a tortuous vessel shunting portal flow being: portocaval shunt (16/20 or 80%), esplenocaval shunt (2/20 or 10%), gastrocaval shunt (1/20 or 5%), portoazigo shunt (1/20 or 5%); 2) elevated portal flow velocity before shunt (17/20 or 81%), 3) lower portal flow velocity after shunt (17/20 or 81%), 4) turbulence in the caudal vena cava (10/20 or 47,5%) and 5) reduced liver size (15/20 or 71%). The others ultrasonographic findings associated with clinical records were similar to that described in literature. With this work we could conclude that hemodynamic assessment of portal vein with DUS may be a useful tool for PSS diagnosis and to detect the shunted vessel origin.

O objetivo desta pesquisa foi verificar se o estudo dos parâmetros hemodinâmicos, por meio da ultrassonografia duplex Doppler (USD), é capaz de auxiliar na detecção do desvio portossistêmico (DPS) e na origem do vaso desviado. Por meio da USD abdominal, foram detectados, no período de março de 2004 a março de 2007, casos de DPS em 20 cães, os quais foram confirmados pela cirurgia ou necropsia. Os principais achados ultrassonográficos foram: 1) identificação de um vaso tortuoso, desviando o fluxo portal, sendo: desvio portocaval (16/20 ou 80%), desvio esplenocaval (2/20 ou 10%), desvio gastrocaval (1/20 ou 5%), desvio portoázigos (1/20 ou 5%); 2) velocidade de fluxo portal elevada antes do desvio (17/20 ou 81%); 3) velocidade de fluxo portal diminuída após o desvio (17/20 ou 81%); 4) fluxo turbulento na veia cava caudal (10/20 ou 47,5%); e 5) fígado de tamanho diminuído (15/20 ou 71%). Os outros achados ultrassonográficos associados com dados clínicos foram semelhantes aos descritos na literatura. Com este trabalho, pode-se concluir que a avaliação hemodinâmica da veia portal com USD pode ser uma ferramenta diagnóstica útil na detecção do DPS e na origem do vaso desviado.

Dopplervelocimetric evaluation of portal vein as a diagnostic tool for portosystemic shunt diagnosis in dogs

The objective of this research was to verify if the study of portal hemodynamic parameters through duplex Doppler ultrasonography (DUS) is able to help to detect portosystemic shunt (PSS) and the shunted vessel origin. It was detected PSS in 20 dogs by abdominal DUS and confirmed at surgery or necropsy from March of 2004 until March 2007. Main ultrasonographic findings were: identification of a tortuous vessel shunting portal flow being: portocaval shunt (16/20 or 80%), esplenocaval shunt (2/20 or 10%), gastrocaval shunt (1/20 or 5%), portoazigo shunt (1/20 or 5%); 2) elevated portal flow velocity before shunt (17/20 or 81%), 3) lower portal flow velocity after shunt (17/20 or 81%), 4) turbulence in the caudal vena cava (10/20 or 47,5%) and 5) reduced liver size (15/20 or 71%). The others ultrasonographic findings associated with clinical records were similar to that described in literature. With this work we could conclude that hemodynamic assessment of portal vein with DUS may be a useful tool for PSS diagnosis and to detect the shunted vessel origin.

O objetivo desta pesquisa foi verificar se o estudo dos parâmetros hemodinâmicos, por meio da ultrassonografia duplex Doppler (USD), é capaz de auxiliar na detecção do desvio portossistêmico (DPS) e na origem do vaso desviado. Por meio da USD abdominal, foram detectados, no período de março de 2004 a março de 2007, casos de DPS em 20 cães, os quais foram confirmados pela cirurgia ou necropsia. Os principais achados ultrassonográficos foram: 1) identificação de um vaso tortuoso, desviando o fluxo portal, sendo: desvio portocaval (16/20 ou 80%), desvio esplenocaval (2/20 ou 10%), desvio gastrocaval (1/20 ou 5%), desvio portoázigos (1/20 ou 5%); 2) velocidade de fluxo portal elevada antes do desvio (17/20 ou 81%); 3) velocidade de fluxo portal diminuída após o desvio (17/20 ou 81%); 4) fluxo turbulento na veia cava caudal (10/20 ou 47,5%); e 5) fígado de tamanho diminuído (15/20 ou 71%). Os outros achados ultrassonográficos associados com dados clínicos foram semelhantes aos descritos na literatura. Com este trabalho, pode-se concluir que a avaliação hemodinâmica da veia portal com USD pode ser uma ferramenta diagnóstica útil na detecção do DPS e na origem do vaso desviado.