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| Diagnostic Features of Portosystemic Shunts |
| Blood Chemistry | *High levels of liver enzymes, serum bile acids, blood ammonia. * Low levels of blood urea nitrogen,glucose, cholesterol |
| Hematology | Mild, nonregenerative anemia microcytosis |
| Urinalysis | Low specific gravity, ammonium blurate crystals |
| Radiography | Small liver |
| Ultrasonography | Small liver, poorly defined intrahepatic portal vessels, large anomalous intrahepatic vessel |
| Contrast Radiography | Shunting of contrast agent directly into caudal vena cava or azygous vein |
| Portal Scintigraphy | Radioactivity bypasses liver directly to the heart |
| Hepatic Biopsy | Hepatocyte atrophy, small or absent portal blood vessels, microvascular dysplasia |
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Indications for Medical Management of Portosystemic Shunts |
| All acquired shunts |
| All dogs with microvascular dysplasia |
| For 2-4 weeks pre - and postoperatively for surgical correction |
| Dogs with partially ligated shunts that continue to show clinical signs |
| Dogs with intrahepatic and extrahepatic shunts that are not amenable to surgery |
| Dogs in which surgery is not undertaken because of financial costs or owner refusal to accept high risk of perioperative mortality. |
| Dietary Recommendations for Dogs with Portosystemic Shunts |
| Reduced intake of high quality, highly digestible protein |
| Bulk of energy in form of fat and complex carbohydrates (e.g., starch) |
| Soluble fiber (e.g., lactulose) to reduce production and absorption of neurotoxins |
| Insoluble fiber (e.g., bran) to avoid Constipation |
| Zinc to improve detoxification of ammonia |