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SA Sx > PSS- Exam 2 > Flashcards

PSS- Exam 2 Flashcards

1
Q

What is PSS?

A

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

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2
Q

Which two organs are NOT drained by the portal vein?

A

Kidney and adrenal gland

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3
Q

What is the signalment for a intraheptaic macrovascular shunt?

A

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

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4
Q

What is the main cause of a intraheptic macrovascular shunt?

A

Patent ductus venosus

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5
Q

Which patients typically have extrahepatic macrovascular shunts?

A

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

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6
Q

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

A

L gastric vein and splenic vein

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7
Q

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

A

Phrenicoabdominal vein

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8
Q

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

A

Micro: > 70%
Macro: < 70%

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9
Q

What shunt is secondary to diseases that cause portal hypertension?

A

Multiple extrahepatic PSS

Spaghetti vessels develop around the kidney

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10
Q

Cats with this phenotypic trait are more predisposed to develop PSS

A

Copper colored irises

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11
Q

What is a PE finding in patients with PSS?

A

Ascites- hypoproteinemic (poor prognosis)

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12
Q

What is bruit?

A

Murmur in the abdomen

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13
Q

What is seen on UA in a patient with PSS?

A

Ammonium biurate crystals

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

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14
Q

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

A

Nuclear scintigraphy

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15
Q

What is the agent used with nuclear scintigraphy?

A

Technetinum 99

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16
Q

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

A

CT angiography

17
Q

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

A

Nervous system
Gastrointestinal system
Urinary system

18
Q

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

A

Low protein diet

19
Q

What is portal vein atresia?

A

No development of portal vein at all

20
Q

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

A

FALSE

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

21
Q

What is seen as a consequence of portal vein atresia?

A

Portal hypertension

22
Q

What is portal vein hypoplasia?

A

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

23
Q

What is Protein C

A

Anticoagulant factor synthesized in the liver

24
Q

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

A

Normal: ~15%
PSS: > 70%

25
Q

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

A

Small liver and big kidney

26
Q

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

A

Albumin < 1.5 mg/dL is much riskier sx

27
Q

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

A

Epiploic foramen
Omental bursa
Esophageal hiatus

28
Q

What pressure is good enough to perform ligation?

A

9-10 cmH2O

29
Q

What are some methods of gradual occlusion for PSS tx

A

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

30
Q

What are some acute post-op complications?

A 
Portal hypertension
Portal vein thormbosis
Hypoglycemia
Seizures
Hemorrhage
Electrolyte distrubances
31
Q

What is the prognosis of a patient with pss?

A

Good to excellent

SA Sx (22 decks)

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