PSS- Exam 2

Question 1

What is PSS?

Answer 1

Abnormal communications of the portal/systemic vasculature allowing products of intestinal absorption to bypass liver and enter directly into systemic circulation

Question 2

Which two organs are NOT drained by the portal vein?

Answer 2

Kidney and adrenal gland

Question 3

What is the signalment for a intraheptaic macrovascular shunt?

Answer 3

Large breed dogs- labs, goldens, australian shepherd, OES

Question 4

What is the main cause of a intraheptic macrovascular shunt?

Answer 4

Patent ductus venosus

Question 5

Which patients typically have extrahepatic macrovascular shunts?

Answer 5

Small dogs and cats- YORKIE, shih tzu, maltese, poodle, schnauzer, dachshund, pugs

Question 6

What are the most common veins involved with extrahepatic macrovascular shunts?

Answer 6

L gastric vein and splenic vein

Question 7

What should be the last vein that enters the portal vein?

Answer 7

Phrenicoabdominal vein

Question 8

What are the protein C levels for micro vs. macrovascular shunts?

Answer 8

Micro: > 70%
Macro: < 70%

Question 9

What shunt is secondary to diseases that cause portal hypertension?

Answer 9

Multiple extrahepatic PSS

Spaghetti vessels develop around the kidney

Question 10

Cats with this phenotypic trait are more predisposed to develop PSS

Answer 10

Copper colored irises

Question 11

What is a PE finding in patients with PSS?

Answer 11

Ascites- hypoproteinemic (poor prognosis)

Question 12

What is bruit?

Answer 12

Murmur in the abdomen

Question 13

What is seen on UA in a patient with PSS?

Answer 13

Ammonium biurate crystals

If there is a non-dalmatian patient with these crystals, put PSS to top of your ddx

Question 14

What is a diagnostic method that distinguishes microvascular from macrovascular shunts?

Answer 14

Nuclear scintigraphy

Question 15

What is the agent used with nuclear scintigraphy?

Answer 15

Technetinum 99

Question 16

What is the gold standard dx test that distinguishes intrahepatic from extrahepatic shunt?

Answer 16

CT angiography

Question 17

What are the three main systems affected in a patient with PSS?

Answer 17

Nervous system
Gastrointestinal system
Urinary system

Question 18

What kind of diet should a patient with PSS be put on to medically manage?

Answer 18

Low protein diet

Question 19

What is portal vein atresia?

Answer 19

No development of portal vein at all

Question 20

T/F: When portal vein atresia is diagnosed, you should consider sx therapy for treatment of choice

Answer 20

FALSE

There is no vein there so nothing surgically can be done- medical management only

Question 21

What is seen as a consequence of portal vein atresia?

Answer 21

Portal hypertension

Question 22

What is portal vein hypoplasia?

Answer 22

Hepatic microvascular dysplasia- portal triads are abnormal and too small
Microvascular shunting within the liver

Question 23

What is Protein C

Answer 23

Anticoagulant factor synthesized in the liver

Question 24

What are the normal nuclear scintigraphy levels vs. a patient with PSS?

Answer 24

Normal: ~15%
PSS: > 70%

Question 25

What will you notice on rads in a patient with PSS?

Answer 25

Small liver and big kidney

Question 26

What is a pre-op consideration that should be evaluated- indicates how the liver will handle the new blood flow

Answer 26

Albumin < 1.5 mg/dL is much riskier sx

Question 27

What are the three areas to evaluate in an abdominal exploratory when dealing with PSS?

Answer 27

Epiploic foramen Omental bursa Esophageal hiatus

Question 28

What pressure is good enough to perform ligation?

Answer 28

9-10 cmH2O

Question 29

What are some methods of gradual occlusion for PSS tx

Answer 29

Ameroid constrictor- rapid closure and kinking Cellophane band- occlusion by inflammatory rxn Thrombogenic coils Hydraulic occluders Intrapetic shunts

Question 30

What are some acute post-op complications?

Answer 30

``` Portal hypertension Portal vein thormbosis Hypoglycemia Seizures Hemorrhage Electrolyte distrubances ```

Question 31

What is the prognosis of a patient with pss?

Answer 31

Good to excellent