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As Olivia continues to improve, surgery is scheduled for the following week at a referral hospital. Olivia does well during surgery and an ameroid ring is placed on the shunt vessel and a liver biopsy (this should always be done in case of concurrent liver disease such as microvascular dysplasia) is obtained. A cystotomy is also performed and the uroliths are removed. Olivia recovers well from surgery and is sent home with owner instructions to feed her a protein-restricted diet as before and continue the lactulose and neomycin. The uroliths are later confirmed to be ammonium urate, and hepatic histologic examination shows mild hepatic fibrosis and atrophy likely due to decreased blood flow but is otherwise unremarkable.
What is your long-term plan for Olivia now that she has had surgery for her PSS?
a) Olivia should continue the medications and protein-restricted diet lifelong.
b) Olivia should be reevaluated two weeks later and, if she is doing well clinically, the medications and protein-restricted diet can be discontinued and she can begin eating her regular dog food again.
c) In addition to her postoperative recheck in 10 days to check her serum chemistry profile results, Olivia should have a repeat pre- and post-prandial bile acid assay six to eight weeks after surgery.
d) A recheck serum chemistry profile should be performed two weeks after surgery. If the results are normal, then the medications and low-protein diet can be discontinued.
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