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surgery > PSS > Flashcards

PSS Flashcards

1
Q

abnormal communications of the portal and systemic vasculature that allow products of intestinal absorption to bypass the liver and enter directly into systemic circulation

A

portosystemic shunts

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2
Q

T/F

extrahepatic shunts are microvascular

A

false - macro

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3
Q

what is the signalment for extrahepatic shunts

A

small dogs - YORKIES

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4
Q

what veins are most commonly involved in extrahepatic shunts

A

left gastric v

splenic v

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5
Q

in an extrahepatic shunt, veins that should join the portal vein enter where instead

A

the cd vena cava or the azygous

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6
Q

what should normally be the last vessel to enter the cd vena cava

A

phrenicoabdominal (drains the adrenal)

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7
Q

intrahepatic shunt

A

macrovascular - large dogs like labs, goldens, old english sheepdogs, and ausseis

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8
Q

pathophysiology of intrahepatic shunts

A

patent ductus venosus - shunting vein within the hepatic parenchyma because it did not close at birth

hepatic parenchyma is bypassed

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9
Q

when there is no portal vein at all

A

portal vein atresia

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10
Q

what vessels are affected by portal vein atresia

A

major pre-hepatic vessels

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11
Q

what is the most common sign of portal vein atresia

A

ascites due to hypoproteinemia

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12
Q

surgical treatment for portal vein atresia

A

NONE - medical management only

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13
Q

microvascular shunting within the liver

A

portal triad is too small

portal ein hypoplasia
or
hepatic microvascular dysplasia

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14
Q

sign of portal vein hypoplasia

A

drug sensitivity
post prandial bile acids < 100
protein C acitivty > 70%

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15
Q

plasma anticoag factor synthesized in the liver that reflects hepatic synthetic activity and portal bloodflow

A

protein C

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16
Q

shunt fraction on nuclear scintigraphy of PSS and of PVH

A

PVH - near normal 15%

PSS - >70%

17
Q

macrovascular shunt general signs

A

poor growth rate
weight loss
anesthetic and tranquilizer intolerance

18
Q

macrovascular shunt nervous system signs

A 
lethargy 
depression
weakness 
pacing 
aggression 
ataxia 
stupor 
coma 
seizures 
head pressing 
blind
19
Q

macrovascular shunt GI signs

A 
anorexia 
vomit 
diarrhea 
pytalism - cats mostly 
pica 
ascites
20
Q

macrovascular shunt urinary signs

A 
pu/pd 
urolithiasis - liver cannot conjugate ammonium properly
ammonium biurate crystals  
cystitis 
urethral obstruction
21
Q

cats with agressiveness, copper eyes, hypersalivation

A

macrovascular shunt

22
Q

HAV malformation

A

bruit

23
Q

biochem for macrovascular shunt

A

low BUN ALB CHOL

high ALT ALP

24
Q

macrovascular protein c

A

<70%

25
Q

who can get ammonium biurate crystals

A

dalmatians

and macrovascular shunts

26
Q

noninvasive method of documenting PSS

A

nuclear scintigraphy – distinguish from microvascular dysplasia but cannot tell intra vs extrahepatic

27
Q

what is the isotope used in nuclear scintigraphy

A

tachnetium 99 - given transcolonic or trans-splenic

28
Q

noninvasive dx modality that is 5.5x more likely to correctly determine presence of absence of PSS compared to ultrasonography

A

CT angiography

29
Q

most common but invasive diagnostic method

A

portography - mesenteric vein injection

not needed if pre op ct angiography is done
false negatives

30
Q

preop ALB levels that make risky surgery

A

<1.5 mg/dl ALB = risky

31
Q

goal of surgery

A

improve liver function

divert blood flow back through portal system without creating portal hypertension severe enough to be life threatening or high enough or long enough to cause acquired shunts to open up

32
Q

what three areas should be checked for the shunt in exploratory

A

epiploic foramen
esophageal hiatus
omental bursa

33
Q

ideal surgical mgmt of PSS

A

complete ligation - complete occlusion without causing signs of portal hypertension
possible in only 1/2 cases

34
Q

attenuation

A

vessels only partially occluded

35
Q

Maximum change in portal pressure between Pre and post ligation

A

9-10cmh2o

36
Q

occlusion entirely by inflammatory reaction

A

cellophane banding

typically occludes completely in 8-12 days if occluded to <3mm

37
Q

post op - recheck in how many weeks min

A

4-8

surgery (18 decks)

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