Confirmed-porto-phrenic could be harder to diagnosed....

Insertion site of congenital extrahepatic portosystemic shunts influences clinicopathological findings in dogs

Yinthe Demeulemeester, Hilde de Rooster, Gonçalo Serrano, Emmelie Stock, Nausikaa Devriendt

Background
Congenital extrahepatic portosystemic shunts (EHPSS) allow portal blood to bypass the liver, leading to systemic circulation of toxic metabolites and resulting in various clinical signs. Different anatomical types of EHPSS exist, categorized by their insertion site into portoazygos (PA), portocaval (PC), and portophrenic (PP) shunts. This study aimed to assess whether the insertion site of EHPSS influences clinical presentation, hematologic and biochemical abnormalities, and diagnostic imaging findings in affected dogs.

Methods
A retrospective analysis was performed on 104 dogs diagnosed with EHPSS. Cases were categorized based on shunt insertion site (15 PA, 70 PC, 19 PP), and clinical signs, blood test results, and imaging findings were compared. Standardized clinical scores were used to assess severity, and statistical analyses determined differences between shunt types.

Results
Dogs with PC shunts were diagnosed at a significantly younger age and had more severe clinical signs, including neurological symptoms, compared to those with PP shunts. PC shunt cases also exhibited lower body condition scores, more pronounced microcytosis and monocytosis, lower urea and creatinine levels, and higher preprandial bile acid and fasted ammonia concentrations compared to PP shunt cases. No significant differences in body weight were observed between groups. Imaging findings did not reveal significant differences in kidney size or portal vein-to-aorta ratios, though PP shunts were more challenging to diagnose with ultrasonography.

Limitations
The retrospective nature of the study, variations in laboratory reference ranges, and differences in imaging techniques among patients may have introduced variability. Owner-reported clinical signs and non-standardized ultrasound assessments could also affect data consistency. Additionally, factors beyond insertion site, such as vessel diameter and blood flow dynamics, may influence clinical severity.

Conclusions
The insertion site of EHPSS significantly impacts clinical presentation and laboratory abnormalities in dogs. PC shunts are associated with earlier diagnosis, more severe clinical signs, and greater biochemical abnormalities compared to PP shunts. In older dogs with subtle signs, clinicians should consider PP shunts, which may be more difficult to detect with ultrasound. Computed tomography angiography may be beneficial for diagnosing these cases.

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