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Eric Lindquist DMV , DABVP (Canine & Feline Practice)

Global Sonographic Parameters In Portosystemic Shunts In 38 Dogs & Cats E Lindquist , D Casey, J Frank. Eric Lindquist DMV , DABVP (Canine & Feline Practice) Director: Sound-Eklin New Jersey Mobile Associates Founder: SonoPath.com. To Shunt Or Not To Shunt? That Is The Question.

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Eric Lindquist DMV , DABVP (Canine & Feline Practice)

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  1. Global Sonographic Parameters In Portosystemic Shunts In 38 Dogs & CatsE Lindquist, D Casey, J Frank Eric Lindquist DMV , DABVP (Canine & Feline Practice) Director: Sound-Eklin New Jersey Mobile Associates Founder: SonoPath.com

  2. To Shunt Or Not To Shunt? That Is The Question. To Shunt Not To Shunt PV/CVC ≥0.75 and PV/AO ≥ 0.8. D‘Anjou et. al. Vet rad and US Vol 45, No 5 2004 102 pqtients

  3. Study Premise: • Attempt to stabilize a reliable global and precise sonographic criteria to diagnose or rule out the presence of portosystemic shunting

  4. Study Design: Retrospective 5 Sonographers, Trained By 1 Single Evaluator Experienced in Dx Of PSS • 33 Dogs & Cats with EHPSS • 5 Dogs With Intrahepatic Shunts • Age Range: 2 mo- 12 yr • 19/38 Sx Confirmed • Bile Acids: 93-473 umol/L • US Evaluation of Bladder, Kidneys, Liver Size, PV:CVC and PV:AO Ratios

  5. Parameter 1: The Bladder Normal: No Calculi Or Sediment Calculi Or Sediment 24/33 (73%) EHPSS Cases. 2/5 IHPSS(40%). 68% overall.

  6. Parameter 2: The Kidneys Normal: No Renal Calculi Renal Calculi 32/33 (97%) Of EHPSS Cases. 3/5 for IHPSS(60%). 92% overall

  7. Parameter 3: Renomegaly EHPSS 29/33. 88% IHPSS 2/5. 40% 82 % Overall

  8. Parameter 3: Liver Size Normal: Subjectively Normal Liver Size Microhepatica 33/33 EHPSS. 5/5 IHPSS. 100% Of Cases Overall

  9. Parameters 4 & 5: Normal Portal Hilus; PV:CVC, PV:AO RatiosNormals: PV/CVC ≥0.75 and PV/AO ≥ 0.8. D‘Anjou et. al. Vet Rad US Vol. 45, No 5, 2004. 102 Patients

  10. Intrahepatic Shunt Parameters • Bladder Sand/Stones: 2/5 • Renal Calculi: 3/5 • Renomegaly: 2/5 • Microhepatica: 5/5 • PV:CVC Ratio: 1:1 • PV:AO Ratio: 1:1 • CVC:AO Ratio: 1:1

  11. Types Of Extrahepatic Shunts: 9 Gastrocaval (Looping), 18 Splenocaval (Short), 6 Splenoazygos (Long minimally curved)

  12. Caval Shunts:Increased Vena Cava Volume Gastrocaval Splenocaval

  13. Scanning Target: Excessive Vena Caval Volume For Gastrocaval & Splenocaval Shunts

  14. Caval EHPSS: 9 Gastrocaval & 18Splenocaval Shunt Ratios (NormalsPV/CVC ≥0.75 and PV/AO ≥ 0.8.) Gastrocaval: PV/CVC: 0.4-0.67 PV/AO: 0.4-0.71 Splenocaval: PV/CVC: 0.28-0.75 PV/AO: 0.4-0.78

  15. Azygos EHPSS Shunt Parameters Azygos Shunt Bypasses The Cava Normal CVC:AO Ratio

  16. 6 Azygos Shunts: Normal Vena Cava Volume: Ratios: PV/CVC:0.4-0.63 PV/AO: 0.4-0.68 PV Pre/Post Shunt Differential Double Aorta

  17. PV/CVC Ratio 38 cases

  18. PV/AO Ratio 38 Cases

  19. Study Flaws • Published Controls • Non blinded • Urolithiasis is a non specific finding • Microhepatica & renomegaly are subjective parameters • Caval probe pressure creates a variable • Small number of cases (38)

  20. Conclusions In this population of 38 dogs and cats, the presence of : • Urinary bladder sand/calculi, • Renal mineralization • Renomegaly • Microhepatica were reliable, non exclusive, positive predictive factors for the presence of PSS , but do not distinguish IHPSS from EHPSS. • Subnormal PV/CVC and PV/AO ratios (0.7 8 or less) are highly reliable indicators of the presence of EHPSS.

  21. Any Questions? Questions? Eric.Lindquist@ SonoPath.com

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