AUTHOR
Clinician's Brief
_title_
No results found.
Content continues after advertisement
This is a filled error message
Account sign in.
To access full articles on www.cliniciansbrief.com, please sign in below.
This quiz reviews clinical signs, diagnostic testing, medical and surgical options, and complications associated with congenital portosystemic shunts (PSS).
Which of the following signs are most frequently found in young dogs presenting with congenital portosystemic vascular anomaly (PSVA)? Choose 2 answers.
Abnormal mentation
GI signs
Lethargy
Poor hair coat
Polyuria/polydipsia (PU/PD)
Stunted growth
Weight loss
The most common presentation of canine congenital PSVA is a young dog with abnormal mentation and/or stunted growth. More subtle signs, including GI signs, lethargy, PU/PD, weight loss, and poor hair coat, are becoming increasingly appreciated in older dogs. Generally, other clinical signs are related to the nervous and urinary systems.
From: Top 5 Liver Conditions in Dogs by Craig B. Webb, PhD, DVM, DACVIM (Small Animal), Colorado State University
The most common presentation of canine congenital PSVA is a young dog with abnormal mentation and/or stunted growth. More subtle signs, including GI signs, lethargy, PU/PD, weight loss, and poor hair coat, are becoming increasingly appreciated in older dogs. Generally, other clinical signs are related to the nervous and urinary systems.
From: Top 5 Liver Conditions in Dogs by Craig B. Webb, PhD, DVM, DACVIM (Small Animal), Colorado State University
A patient is suspected of having a congenital portosystemic shunt (PSS).
Which of the following findings is likely to be abnormal on serum chemistry profile?
Total bile acids
Blood glucose
Blood urea nitrogen (BUN)
Ammonia
All of the above
Liver function test results are generally nonspecific; however, dogs with PSS will typically be found to have elevated bile acids, hypoglycemia, and hyperammonemia, along with decreased BUN levels.
Bile acid levels will be elevated in animals with congenital or acquired PSS as well as in those with bile stasis or reduced hepatic function.
Hypoglycemia most commonly occurs in patients with acute fulminant hepatic failure, small-breed dogs with congenital PSS, or patients in end-stage hepatic failure.
Decreased BUN is common in dogs with congenital PSS.
Hyperammonemia can occur in patients with congenital or acquired PSS and when there is >75% reduction in functional hepatic mass.
From: Diagnosing Liver Disease by Nick Bexfield, BVetMed, PhD, DSAM, DECVIM (Small Animal), FSB, MRCVS, University of Nottingham
Liver function test results are generally nonspecific; however, dogs with PSS will typically be found to have elevated bile acids, hypoglycemia, and hyperammonemia, along with decreased BUN levels.
Bile acid levels will be elevated in animals with congenital or acquired PSS as well as in those with bile stasis or reduced hepatic function.
Hypoglycemia most commonly occurs in patients with acute fulminant hepatic failure, small-breed dogs with congenital PSS, or patients in end-stage hepatic failure.
Decreased BUN is common in dogs with congenital PSS.
Hyperammonemia can occur in patients with congenital or acquired PSS and when there is >75% reduction in functional hepatic mass.
From: Diagnosing Liver Disease by Nick Bexfield, BVetMed, PhD, DSAM, DECVIM (Small Animal), FSB, MRCVS, University of Nottingham
Liver function test results are generally nonspecific; however, dogs with PSS will typically be found to have elevated bile acids, hypoglycemia, and hyperammonemia, along with decreased BUN levels.
Bile acid levels will be elevated in animals with congenital or acquired PSS as well as in those with bile stasis or reduced hepatic function.
Hypoglycemia most commonly occurs in patients with acute fulminant hepatic failure, small-breed dogs with congenital PSS, or patients in end-stage hepatic failure.
Decreased BUN is common in dogs with congenital PSS.
Hyperammonemia can occur in patients with congenital or acquired PSS and when there is >75% reduction in functional hepatic mass.
From: Diagnosing Liver Disease by Nick Bexfield, BVetMed, PhD, DSAM, DECVIM (Small Animal), FSB, MRCVS, University of Nottingham
Liver function test results are generally nonspecific; however, dogs with PSS will typically be found to have elevated bile acids, hypoglycemia, and hyperammonemia, along with decreased BUN levels.
Bile acid levels will be elevated in animals with congenital or acquired PSS as well as in those with bile stasis or reduced hepatic function.
Hypoglycemia most commonly occurs in patients with acute fulminant hepatic failure, small-breed dogs with congenital PSS, or patients in end-stage hepatic failure.
Decreased BUN is common in dogs with congenital PSS.
Hyperammonemia can occur in patients with congenital or acquired PSS and when there is >75% reduction in functional hepatic mass.
From: Diagnosing Liver Disease by Nick Bexfield, BVetMed, PhD, DSAM, DECVIM (Small Animal), FSB, MRCVS, University of Nottingham
Liver function test results are generally nonspecific; however, dogs with PSS will typically be found to have elevated bile acids, hypoglycemia, and hyperammonemia, along with decreased BUN levels.
Bile acid levels will be elevated in animals with congenital or acquired PSS as well as in those with bile stasis or reduced hepatic function.
Hypoglycemia most commonly occurs in patients with acute fulminant hepatic failure, small-breed dogs with congenital PSS, or patients in end-stage hepatic failure.
Decreased BUN is common in dogs with congenital PSS.
Hyperammonemia can occur in patients with congenital or acquired PSS and when there is >75% reduction in functional hepatic mass.
From: Diagnosing Liver Disease by Nick Bexfield, BVetMed, PhD, DSAM, DECVIM (Small Animal), FSB, MRCVS, University of Nottingham
Based on results of serum chemistry testing, the index of suspicion for congenital PSS in a 6-month-old female Yorkshire terrier is increasing. Total serum bile acids (TSBA) testing is ordered to help confirm the diagnosis.
Which of the following statements regarding TSBA testing is false?
Patients should be fasted prior to testing.
Fasting TSBA finding of >8 μmol/L has a sensitivity of 89% for detecting PSS.
Postprandial and fasting TSBA testing share the same diagnostic value.
SBA testing cannot discriminate between other causes of hepatobiliary disease.
TSBA testing cannot predict the degree of shunting present.
Postprandial TSBA testing has greater diagnostic value as compared with fasting TSBA testing.1 Patients should be fasted 12 hours before TSBA testing so a baseline sample can be obtained. Postprandial TSBA values should be obtained 2 hours after the dog has been fed a small meal (≈2 teaspoons of canned maintenance diet for dogs <10 lb to up to 2 tablespoons for larger dogs). For PSS detection, a fasting TSBA value of >8 μmol/L has a sensitivity of 89% and specificity of 68%. A postprandial TSBA value of >30 μmol/L has a sensitivity approaching 100% for vascular disease.1 The high sensitivity of postprandial TSBA testing makes it a useful screening test in patients with PSS.
TSBA testing is generally useful in the diagnosis of various hepatobiliary dysfunctions associated with reduced hepatic mass or hepatoportal perfusion abnormalities (eg, congenital PSS, multiple acquired PSS, primary hypoplasia of the portal vein with or without portal hypertension, hepatic arteriovenous fistula). Two limitations of TSBA testing for PSS are the test’s inability to discriminate between various causes of hepatobiliary disease and predict the degree of shunting present.
From: Diagnostic Utility of Bile Acid Determination in Dogs by Cynthia RL Webster, DVM, DACVIM (Small Animal), and Johanna C. Cooper, DVM, Tufts University
Postprandial TSBA testing has greater diagnostic value as compared with fasting TSBA testing.1 Patients should be fasted 12 hours before TSBA testing so a baseline sample can be obtained. Postprandial TSBA values should be obtained 2 hours after the dog has been fed a small meal (≈2 teaspoons of canned maintenance diet for dogs <10 lb to up to 2 tablespoons for larger dogs). For PSS detection, a fasting TSBA value of >8 μmol/L has a sensitivity of 89% and specificity of 68%. A postprandial TSBA value of >30 μmol/L has a sensitivity approaching 100% for vascular disease.1 The high sensitivity of postprandial TSBA testing makes it a useful screening test in patients with PSS.
TSBA testing is generally useful in the diagnosis of various hepatobiliary dysfunctions associated with reduced hepatic mass or hepatoportal perfusion abnormalities (eg, congenital PSS, multiple acquired PSS, primary hypoplasia of the portal vein with or without portal hypertension, hepatic arteriovenous fistula). Two limitations of TSBA testing for PSS are the test’s inability to discriminate between various causes of hepatobiliary disease and predict the degree of shunting present.
From: Diagnostic Utility of Bile Acid Determination in Dogs by Cynthia RL Webster, DVM, DACVIM (Small Animal), and Johanna C. Cooper, DVM, Tufts University
Postprandial TSBA testing has greater diagnostic value as compared with fasting TSBA testing.1 Patients should be fasted 12 hours before TSBA testing so a baseline sample can be obtained. Postprandial TSBA values should be obtained 2 hours after the dog has been fed a small meal (≈2 teaspoons of canned maintenance diet for dogs <10 lb to up to 2 tablespoons for larger dogs). For PSS detection, a fasting TSBA value of >8 μmol/L has a sensitivity of 89% and specificity of 68%. A postprandial TSBA value of >30 μmol/L has a sensitivity approaching 100% for vascular disease.1 The high sensitivity of postprandial TSBA testing makes it a useful screening test in patients with PSS.
TSBA testing is generally useful in the diagnosis of various hepatobiliary dysfunctions associated with reduced hepatic mass or hepatoportal perfusion abnormalities (eg, congenital PSS, multiple acquired PSS, primary hypoplasia of the portal vein with or without portal hypertension, hepatic arteriovenous fistula). Two limitations of TSBA testing for PSS are the test’s inability to discriminate between various causes of hepatobiliary disease and predict the degree of shunting present.
From: Diagnostic Utility of Bile Acid Determination in Dogs by Cynthia RL Webster, DVM, DACVIM (Small Animal), and Johanna C. Cooper, DVM, Tufts University
Postprandial TSBA testing has greater diagnostic value as compared with fasting TSBA testing.1 Patients should be fasted 12 hours before TSBA testing so a baseline sample can be obtained. Postprandial TSBA values should be obtained 2 hours after the dog has been fed a small meal (≈2 teaspoons of canned maintenance diet for dogs <10 lb to up to 2 tablespoons for larger dogs). For PSS detection, a fasting TSBA value of >8 μmol/L has a sensitivity of 89% and specificity of 68%. A postprandial TSBA value of >30 μmol/L has a sensitivity approaching 100% for vascular disease.1 The high sensitivity of postprandial TSBA testing makes it a useful screening test in patients with PSS.
TSBA testing is generally useful in the diagnosis of various hepatobiliary dysfunctions associated with reduced hepatic mass or hepatoportal perfusion abnormalities (eg, congenital PSS, multiple acquired PSS, primary hypoplasia of the portal vein with or without portal hypertension, hepatic arteriovenous fistula). Two limitations of TSBA testing for PSS are the test’s inability to discriminate between various causes of hepatobiliary disease and predict the degree of shunting present.
From: Diagnostic Utility of Bile Acid Determination in Dogs by Cynthia RL Webster, DVM, DACVIM (Small Animal), and Johanna C. Cooper, DVM, Tufts University
Postprandial TSBA testing has greater diagnostic value as compared with fasting TSBA testing.1 Patients should be fasted 12 hours before TSBA testing so a baseline sample can be obtained. Postprandial TSBA values should be obtained 2 hours after the dog has been fed a small meal (≈2 teaspoons of canned maintenance diet for dogs <10 lb to up to 2 tablespoons for larger dogs). For PSS detection, a fasting TSBA value of >8 μmol/L has a sensitivity of 89% and specificity of 68%. A postprandial TSBA value of >30 μmol/L has a sensitivity approaching 100% for vascular disease.1 The high sensitivity of postprandial TSBA testing makes it a useful screening test in patients with PSS.
TSBA testing is generally useful in the diagnosis of various hepatobiliary dysfunctions associated with reduced hepatic mass or hepatoportal perfusion abnormalities (eg, congenital PSS, multiple acquired PSS, primary hypoplasia of the portal vein with or without portal hypertension, hepatic arteriovenous fistula). Two limitations of TSBA testing for PSS are the test’s inability to discriminate between various causes of hepatobiliary disease and predict the degree of shunting present.
From: Diagnostic Utility of Bile Acid Determination in Dogs by Cynthia RL Webster, DVM, DACVIM (Small Animal), and Johanna C. Cooper, DVM, Tufts University
Dogs with congenital PSS often present with clinical signs secondary to hyperammonemia, including hepatic encephalopathy, lower urinary tract signs, and GI signs.
Which of the following might be a component of medical management in patients with congenital PSS?
Antibiotic therapy
Diet containing plant-, dairy-, or soy-derived proteins
H2-receptor blockers or proton pump inhibitors
Lactulose
All of the above
The goal of medical management of congenital PSS in dogs is to control clinical signs. In dogs with hepatic encephalopathy, treatment is targeted at increasing protein tolerance by administering lactulose and/or antibiotics (eg, metronidazole, neomycin). Protein intake should be optimized by providing adequate protein and calories to avoid muscle catabolism. Diets containing high-quality protein from plant, dairy, or soy sources and those with high-fiber content are preferred.
Any GI ulceration or bleeding should be addressed with administration of H2-receptor blockers or proton pump inhibitors. In general, precipitating factors, including GI bleeding, metabolic alkalosis, overuse of sedatives and analgesics, concurrent infections, azotemia, and constipation, should be controlled.
From: Congenital Hepatobiliary Diseases in Dogs & Cats by Faith Buckley, DVM, Veterinary Referral Center of New Hampshire, Concord, and Cynthia RL Webster, DVM, DACVIM (Small Animal), Tufts University
The goal of medical management of congenital PSS in dogs is to control clinical signs. In dogs with hepatic encephalopathy, treatment is targeted at increasing protein tolerance by administering lactulose and/or antibiotics (eg, metronidazole, neomycin). Protein intake should be optimized by providing adequate protein and calories to avoid muscle catabolism. Diets containing high-quality protein from plant, dairy, or soy sources and those with high-fiber content are preferred.
Any GI ulceration or bleeding should be addressed with administration of H2-receptor blockers or proton pump inhibitors. In general, precipitating factors, including GI bleeding, metabolic alkalosis, overuse of sedatives and analgesics, concurrent infections, azotemia, and constipation, should be controlled.
From: Congenital Hepatobiliary Diseases in Dogs & Cats by Faith Buckley, DVM, Veterinary Referral Center of New Hampshire, Concord, and Cynthia RL Webster, DVM, DACVIM (Small Animal), Tufts University
The goal of medical management of congenital PSS in dogs is to control clinical signs. In dogs with hepatic encephalopathy, treatment is targeted at increasing protein tolerance by administering lactulose and/or antibiotics (eg, metronidazole, neomycin). Protein intake should be optimized by providing adequate protein and calories to avoid muscle catabolism. Diets containing high-quality protein from plant, dairy, or soy sources and those with high-fiber content are preferred.
Any GI ulceration or bleeding should be addressed with administration of H2-receptor blockers or proton pump inhibitors. In general, precipitating factors, including GI bleeding, metabolic alkalosis, overuse of sedatives and analgesics, concurrent infections, azotemia, and constipation, should be controlled.
From: Congenital Hepatobiliary Diseases in Dogs & Cats by Faith Buckley, DVM, Veterinary Referral Center of New Hampshire, Concord, and Cynthia RL Webster, DVM, DACVIM (Small Animal), Tufts University
The goal of medical management of congenital PSS in dogs is to control clinical signs. In dogs with hepatic encephalopathy, treatment is targeted at increasing protein tolerance by administering lactulose and/or antibiotics (eg, metronidazole, neomycin). Protein intake should be optimized by providing adequate protein and calories to avoid muscle catabolism. Diets containing high-quality protein from plant, dairy, or soy sources and those with high-fiber content are preferred.
Any GI ulceration or bleeding should be addressed with administration of H2-receptor blockers or proton pump inhibitors. In general, precipitating factors, including GI bleeding, metabolic alkalosis, overuse of sedatives and analgesics, concurrent infections, azotemia, and constipation, should be controlled.
From: Congenital Hepatobiliary Diseases in Dogs & Cats by Faith Buckley, DVM, Veterinary Referral Center of New Hampshire, Concord, and Cynthia RL Webster, DVM, DACVIM (Small Animal), Tufts University
The goal of medical management of congenital PSS in dogs is to control clinical signs. In dogs with hepatic encephalopathy, treatment is targeted at increasing protein tolerance by administering lactulose and/or antibiotics (eg, metronidazole, neomycin). Protein intake should be optimized by providing adequate protein and calories to avoid muscle catabolism. Diets containing high-quality protein from plant, dairy, or soy sources and those with high-fiber content are preferred.
Any GI ulceration or bleeding should be addressed with administration of H2-receptor blockers or proton pump inhibitors. In general, precipitating factors, including GI bleeding, metabolic alkalosis, overuse of sedatives and analgesics, concurrent infections, azotemia, and constipation, should be controlled.
From: Congenital Hepatobiliary Diseases in Dogs & Cats by Faith Buckley, DVM, Veterinary Referral Center of New Hampshire, Concord, and Cynthia RL Webster, DVM, DACVIM (Small Animal), Tufts University
Which of the following statements regarding use of interventional radiology (IR) to address congenital intrahepatic PSS is false?
IR has a lower perioperative mortality rate than that of open surgery.
IR has a higher complication rate than that of open surgery.
IR has better outcomes than those associated with medical management.
IR is becoming increasingly available to clients.
IR is less invasive than open surgery.
Although still fairly new to veterinary medicine, minimally invasive surgery through the use of IR techniques is gaining popularity. The goal of IR is to reduce perioperative mortality and complication rates, as compared with rates associated with open surgery. A recent study of intrahepatic PSS in dogs found that the perioperative mortality rate associated with IR techniques was approximately 3% and all other complications were minor.2
Most IR techniques are approached through small incisions or via catheterization, making them less invasive than open surgery. Attenuation of intrahepatic PSS via IR techniques, like open surgical approaches, offers superior outcomes compared with those occurring with medical management. Because facilities with fluoroscopic capabilities and advanced training courses for veterinarians are becoming more common, IR treatment is becoming increasingly accessible for patients with intrahepatic PSS, as well as patients with many other conditions.
From: Interventional Radiology: A Trend in Veterinary Medicine by Chick Weisse, DVM, DACVS, Animal Medical Center, New York, New York
Although still fairly new to veterinary medicine, minimally invasive surgery through the use of IR techniques is gaining popularity. The goal of IR is to reduce perioperative mortality and complication rates, as compared with rates associated with open surgery. A recent study of intrahepatic PSS in dogs found that the perioperative mortality rate associated with IR techniques was approximately 3% and all other complications were minor.2
Most IR techniques are approached through small incisions or via catheterization, making them less invasive than open surgery. Attenuation of intrahepatic PSS via IR techniques, like open surgical approaches, offers superior outcomes compared with those occurring with medical management. Because facilities with fluoroscopic capabilities and advanced training courses for veterinarians are becoming more common, IR treatment is becoming increasingly accessible for patients with intrahepatic PSS, as well as patients with many other conditions.
From: Interventional Radiology: A Trend in Veterinary Medicine by Chick Weisse, DVM, DACVS, Animal Medical Center, New York, New York
Although still fairly new to veterinary medicine, minimally invasive surgery through the use of IR techniques is gaining popularity. The goal of IR is to reduce perioperative mortality and complication rates, as compared with rates associated with open surgery. A recent study of intrahepatic PSS in dogs found that the perioperative mortality rate associated with IR techniques was approximately 3% and all other complications were minor.2
Most IR techniques are approached through small incisions or via catheterization, making them less invasive than open surgery. Attenuation of intrahepatic PSS via IR techniques, like open surgical approaches, offers superior outcomes compared with those occurring with medical management. Because facilities with fluoroscopic capabilities and advanced training courses for veterinarians are becoming more common, IR treatment is becoming increasingly accessible for patients with intrahepatic PSS, as well as patients with many other conditions.
From: Interventional Radiology: A Trend in Veterinary Medicine by Chick Weisse, DVM, DACVS, Animal Medical Center, New York, New York
Although still fairly new to veterinary medicine, minimally invasive surgery through the use of IR techniques is gaining popularity. The goal of IR is to reduce perioperative mortality and complication rates, as compared with rates associated with open surgery. A recent study of intrahepatic PSS in dogs found that the perioperative mortality rate associated with IR techniques was approximately 3% and all other complications were minor.2
Most IR techniques are approached through small incisions or via catheterization, making them less invasive than open surgery. Attenuation of intrahepatic PSS via IR techniques, like open surgical approaches, offers superior outcomes compared with those occurring with medical management. Because facilities with fluoroscopic capabilities and advanced training courses for veterinarians are becoming more common, IR treatment is becoming increasingly accessible for patients with intrahepatic PSS, as well as patients with many other conditions.
From: Interventional Radiology: A Trend in Veterinary Medicine by Chick Weisse, DVM, DACVS, Animal Medical Center, New York, New York
Although still fairly new to veterinary medicine, minimally invasive surgery through the use of IR techniques is gaining popularity. The goal of IR is to reduce perioperative mortality and complication rates, as compared with rates associated with open surgery. A recent study of intrahepatic PSS in dogs found that the perioperative mortality rate associated with IR techniques was approximately 3% and all other complications were minor.2
Most IR techniques are approached through small incisions or via catheterization, making them less invasive than open surgery. Attenuation of intrahepatic PSS via IR techniques, like open surgical approaches, offers superior outcomes compared with those occurring with medical management. Because facilities with fluoroscopic capabilities and advanced training courses for veterinarians are becoming more common, IR treatment is becoming increasingly accessible for patients with intrahepatic PSS, as well as patients with many other conditions.
From: Interventional Radiology: A Trend in Veterinary Medicine by Chick Weisse, DVM, DACVS, Animal Medical Center, New York, New York
A 6-year-old, 10-kg castrated miniature schnauzer was presented for stranguria and hematuria. Diagnostic testing revealed an anomalous hepatic vessel and urinary calculi on ultrasonography, abnormal TSBA, and ammonium biurate crystaluria. Transplenic portal scintigraphy demonstrated portosystemic shunting. A diagnosis of a congenital extrahepatic PSS was made.
Following medical management of concurrent Escherichia coli urinary tract infection and mild hepatic encephalopathy, the shunt was surgically attenuated with placement of an ameroid constrictor. Cystotomy was also performed and multiple small bladder stones removed. The perioperative period was uneventful.
What approximate incidence of postligation neurological syndrome (PLNS) occurs in dogs following attenuation of congenital PSS?
0%
6%
10%
18%
25%
PLNS encompasses a constellation of neurologic signs, ranging from twitches, tremors, and ataxia to life-threatening seizures. The incidence of PLNS after attenuation of congenital PSS is ≈6%, with refractory seizures being less common (3.5%).3 Older age at time of attenuation may increase occurrence of PLNS.
A recent study has suggested that initiating levetiracetam treatment at 20 mg/kg PO q8h 1 or 2 days before surgery can lower the incidence of severe PLNS.3 The miniature schnauzer in this case was treated preoperatively with levetiracetam and was clinically normal 3 weeks before surgery; antiseizure and hepatic encephalopathy medications were tapered over the following month.
From: Stranguria & Hematuria in a Mature Dog by Cynthia RL Webster, DVM, DACVIM (Small Animal), Tufts University
PLNS encompasses a constellation of neurologic signs, ranging from twitches, tremors, and ataxia to life-threatening seizures. The incidence of PLNS after attenuation of congenital PSS is ≈6%, with refractory seizures being less common (3.5%).3 Older age at time of attenuation may increase occurrence of PLNS.
A recent study has suggested that initiating levetiracetam treatment at 20 mg/kg PO q8h 1 or 2 days before surgery can lower the incidence of severe PLNS.3 The miniature schnauzer in this case was treated preoperatively with levetiracetam and was clinically normal 3 weeks before surgery; antiseizure and hepatic encephalopathy medications were tapered over the following month.
From: Stranguria & Hematuria in a Mature Dog by Cynthia RL Webster, DVM, DACVIM (Small Animal), Tufts University
PLNS encompasses a constellation of neurologic signs, ranging from twitches, tremors, and ataxia to life-threatening seizures. The incidence of PLNS after attenuation of congenital PSS is ≈6%, with refractory seizures being less common (3.5%).3 Older age at time of attenuation may increase occurrence of PLNS.
A recent study has suggested that initiating levetiracetam treatment at 20 mg/kg PO q8h 1 or 2 days before surgery can lower the incidence of severe PLNS.3 The miniature schnauzer in this case was treated preoperatively with levetiracetam and was clinically normal 3 weeks before surgery; antiseizure and hepatic encephalopathy medications were tapered over the following month.
From: Stranguria & Hematuria in a Mature Dog by Cynthia RL Webster, DVM, DACVIM (Small Animal), Tufts University
PLNS encompasses a constellation of neurologic signs, ranging from twitches, tremors, and ataxia to life-threatening seizures. The incidence of PLNS after attenuation of congenital PSS is ≈6%, with refractory seizures being less common (3.5%).3 Older age at time of attenuation may increase occurrence of PLNS.
A recent study has suggested that initiating levetiracetam treatment at 20 mg/kg PO q8h 1 or 2 days before surgery can lower the incidence of severe PLNS.3 The miniature schnauzer in this case was treated preoperatively with levetiracetam and was clinically normal 3 weeks before surgery; antiseizure and hepatic encephalopathy medications were tapered over the following month.
From: Stranguria & Hematuria in a Mature Dog by Cynthia RL Webster, DVM, DACVIM (Small Animal), Tufts University
PLNS encompasses a constellation of neurologic signs, ranging from twitches, tremors, and ataxia to life-threatening seizures. The incidence of PLNS after attenuation of congenital PSS is ≈6%, with refractory seizures being less common (3.5%).3 Older age at time of attenuation may increase occurrence of PLNS.
A recent study has suggested that initiating levetiracetam treatment at 20 mg/kg PO q8h 1 or 2 days before surgery can lower the incidence of severe PLNS.3 The miniature schnauzer in this case was treated preoperatively with levetiracetam and was clinically normal 3 weeks before surgery; antiseizure and hepatic encephalopathy medications were tapered over the following month.
From: Stranguria & Hematuria in a Mature Dog by Cynthia RL Webster, DVM, DACVIM (Small Animal), Tufts University
Quiz: Congenital Portosystemic Shunts
Final scoreReferences and Author Information
Author Information
For global readers, a calculator to convert laboratory values, dosages, and other measurements to SI units can be found here.
All Clinician's Brief content is reviewed for accuracy at the time of publication. Previously published content may not reflect recent developments in research and practice.
Material from Clinician's Brief may not be reproduced, distributed, or used in whole or in part without prior permission of Educational Concepts, LLC. For questions or inquiries please contact us.
*2007-2017 PERQ and Essential Media Studies
© 2023 Educational Concepts, L.L.C. dba Brief Media ™ All Rights Reserved. Terms & Conditions | DMCA Copyright | Privacy Policy | Acceptable Use Policy
