5+ 6. shunts Flashcards
left divisional shunt
left:
left medial lobe
left lateral lobe
central:
right medial and quadrate
right:
right lateral lobe and caudate process of caudate lobe
right divisional shunt
left:
left medial lobe
left lateral lobe
central:
right medial and quadrate
right:
right lateral lobe and caudate process of caudate lobe
central divisional shunt
left:
left medial lobe
left lateral lobe
central:
right medial and quadrate
right:
right lateral lobe and caudate process of caudate lobe
— ligament connect liver to diaphragm
right and Left triangular ligament
— ligament connect liver to foramen vena cava
coronary ligament
— ligament attaches to liver to the diaphragm and body wall
falciform
— attaches caudate lobe of liver to cranial pole of — kidney
hepatorenal ligament
Right
blood supply for hepatic artery is from
aorta - celiac - hepatic- hepatic branches
hepatic artery brings — % of blood flow to liver
20-25
* at low BP can increase to 60% to supply O2 to liver
aorta-celiac-hepatic-branches of hepatic
blood supply to portal vein in dogs vs cats
both:
- cranial and caudal mesenteric veins
- gastrosplenic veins
Dogs only: gastroduodenal vein!
portal vein supply —% of blood flow to liver
75-80
dogs have gastroduodenal vein
what does liver do
- Metabolism of lipids, carbs, proteins, vitamins
- hemostasis- coag factor
- protein production
- immunologic functions
- detox
PT and PTT for shunt pts
may be longer, but clinical bleeding not normal
- may resolve 6 weeks post sx
what bloodwork for shunts in dogs
- low albumin, globulin, cholestrol, glucose
- normal or elevated liver enzymes
- low BUN/creat
- low coags= high PT, PTT
- high ammonia (liver incharge of ammonia to urea)= low urea
(ABC glucose)
cats: low Creat, BUN
slight increase ALT,ALP
most common cause of intrahepatic shunt
patent ductus venosus (between aorta and liver)
most single extrahepatic shunts are
- congenital
- young small/toy breeds
- DSH, persians, himalayans
- from gastric or splenic veins
most single extrahepatic shunts are from the
from gastric or splenic veins
what happens to portal vein with single extrahepatic shunt
becomes smaller
usually form gastric or splenic veins in small toy breed dogs
intraheptic shunts usually occur in
large breed
congenital- most common patent ductus venosus
what happens to portal vein with intrahepatic shunt
dilated/ turbulent
multiple extrahepatic shunts occur 2nd to
portal hypertension
- older dogs- end stage liver disease
- young animals- congenital hepatopathy or arteriovenous fistula
poor prognosis
what does portal vein look like in multiple extrahepatic shunts
older dogs- end stage liver disease → portal HTN
young dogs- congenital heptaopathy or AV fistula
what causes ascites with extrahepatic shunts
low albumin
( made in liver- decreased blood flow to liver= less albumin= less oncontic pressure = fluid leave vessels into tissues)
shunts in cats might have — eyes
copper colored iris
what are some clinical signs of pt with shunt
- Central nervous signs: drooling, aggression, head pressing, seizures, ataxia
- GI signs- GI bleed (dogs), vomiting, diarrhea
- Urinary signs- hematuria, dysuria, stones (ammonium biurate)
- cats- copper colored iris
- small stature
- Cryptorchid/ retained baby teeth
- large kidneys
what type of urinary stones with hepatic shunts
ammonium biurate
good bloodwork test for hepatic shunt in cats
biles acids
- both pre and post bile acids will be ↑
medical treatment for shunts
low protein diet
lactulose
antibiotics
seizure control- benzo, pheno, keppra
GI ulcer treatment: antiacids
hepatoprotective: Vit E, milk thistle
why give lactulose to shunt pts
- can be given by enema
- ammonia- ammonium
- increase fecal transit times so bacteria move through faster= less time for toxins to effect pt
why give antibiotics to shunt pt
trying to kill off bacteria that create urea
- ampicillin, amoxicillin, neomysin, metro
how to measure portal pressure during shunt repair
water manometer
pressure transducer
what happens to BP when you tie off shunt
it will drop- blood will backflow into GI tract
post op care for shunt repair
- IV fluids
- Prevent hypothermia, hypoglycemia
- Monitor blood pressure
- Monitor for portal hypertension
- Development of ascites
- Monitor for seizures
- Abdominal discomfort
how to treat post op seizures from shunt repair
- mannitol
- IV midazolam, diazepam or propofol
- pheno
- fix electrolyte, acid/base, ammonia, BG
- postassium bromide
