Stan's Liver Shunt diagnosis
Stan's successful operation a year ago has given him a better quality of life
Puppy needed our help
Stan (Blue) a six-month-old puppy was a happy bouncy lad. Apart from an irritation in his eyes as the lashes rubbed occasionally, a constant need to urinate, and not carrying much body weight, he appeared full of life.
On the 23rd of March his liver was scanned at Langford Veterinary Hospital. The result showed he had an Intra-hepatic portosystemic shunt, (IHPSS). The operation would take place when Scan had reach maturity.
Diagnosis: intra-hepatic portosystemic shunt (IHPSS)
Stan has an intra-hepatic portosystemic shunt; this is where an abnormal blood vessel(s) allows blood from the gut (i.e. from the portal vein) to bypass the liver. Due to this, the body accumulates toxins that normally would be eliminated by the liver. These toxins can cause neurological signs (hepatic encephalopathy), vomiting, diarrhoea, bladder stones, problems urinating, and reduced growth.
Shortly after Stan’s first birthday
an appointment was made for a
pre-operation scan.
The result showed that his liver had not deteriorated. The Veterinary Surgeon called to explain Stan’s option for his future health. He could remain on medical management, which could shorten his life but avoid the perilous operation, or the transvenous coil embolisms could have a better long-term survival rate, though surgery had complication. On the 24th of October surgery was successful, Stan recovered exceptionally well from the anaesthetic, and in fact went home a day early.
Ed Friend - Veterinary Surgeon
The owner decided to go ahead with coil embolization of Stan’s intrahepatic porto-systemic shunt (IHPSS) and he was admitted here on 23.10.22.
Surgery
Stan underwent coil embolisation of his IHPSS on 24.10.22; this was using interventional radiology techniques from a left jugular incision. The shunt was central divisional, and these are always difficult to access, however 5 coils were placed and these led to increased back flow of contrast on subsequent angiograms into vessels feeding into the shunt; a good result for this type of shunt. The incision in his neck was closed with intradermal 3/0 monocryl and so there are no sutures to remove.
Possible complications
He has recovered well. The main complication now would be ongoing shunting, either through the congenital shunt, or through multiple acquired shunts in future (which can sometimes develop in a matter of months).
Now three weeks since the operation, he has shown signs of improvement. For a month perhaps longer he is walked on lead, so that there’s no sudden excitement accumulating in a rush of blood through his arteries.
21st December
On the 21st December Bloods and Bile Acid tests were taken, showing good results of improvement.
19th February
As of the 19th February Stan has not taken Lactulose for a full week, and all good so far. He is gaining weight slowly and enjoying energetic walks.
Video: Stan playing with his new friend Nala he met in the park.
Stan is booked in to have his third operation
Update August 2023
In October 2022 he had first emergency eye operation, the second, was to lessen his Liver Shunt condition. Stan has made a miraculous recovery from major surgery, he is not cured but the bypasses have enabled him to have a better quality of life.
Eye Operation 17th October 2023
Now his final eye operation, is due 17th October 2023 to have meticulous surgery to both his eyes for Entropion, Ectropion and cherry eye. The invasive, detailed, possibly three hour surgery on both his eyes will be expensive. We are expecting an Invoice of up to £3000. The outcome? Stan will have clear vision, no more irritation and no more drops! For the first in his young life he will be free of discomfort.
He is now medication free!
He is now on a normal kibble diet. He has a teaspoon of manuka honey with lactose free milk with his breakfast and homeopathic milk thistle added to his dinner.
