Olivia continues to do well clinically, and her serum chemistry profile results are improved two weeks after surgery. At eight weeks, you perform a repeat bile acid assay and these are the results:
Bile acid assay
Pre-prandial = 45 µmol/L (normal < 13 µmol/L)
Post-prandial = 72 µmol/L (normal < 25 µmol/L)
These results indicate that Olivia's liver function has improved but not normalized. You recommend that the owner stop the lactulose and neomycin and continue the protein-restricted diet. If Olivia continues to do well, you recommend another bile acid assay in six weeks, but if the owner sees any recurrence of Olivia's clinical signs before then, the owner should bring Olivia in sooner.
Unfortunately, the owner doesn't return until three months later, but she reports that Olivia has continued to do well. She is active and drinking a normal amount of water and has not had any elimination problems or neurologic signs and she is still eating the protein-restricted diet.
Olivia's bile acid assay results at this visit are normal. You tell the owner that Olivia no longer needs to eat a protein-restricted diet and can be fed a high-quality commercial adult dog food. The owner will still need to watch for changes in Olivia's clinical signs, but you are optimistic that she will have a good long-term outcome.
Good job on this case!
1. Center SA, Randolph JF, Warner KL, et al. Long-term survival of dogs (n = 597) with congenital or acquired portosystemic shunting: 1980-2010 (abst). J Vet Intern Med 2012;26(3):781.
2. Fryer KJ, Levine JM, Peycke LE, et al. Incidence of postoperative seizures with and without levetiracetam pretreatment in dogs undergoing portosystemic shunt attenuation. J Vet Intern Med 2011;25(6):1379-1384.
1. Center SA, Randolph JF, Sapa KC, et al. Best predictors of portosystemic shunting in 568 dogs: Post feeding serum bile acids and protein C (abst). J Vet Intern Med 2012;25(3):705.
2. Gow A. Pathophysiology of hepatic encephalopathy in companion animals: new information, in Proceedings. Am Coll Vet Intern Med, 2012.
3. Balkman CE, Center SA, Randolph JF, et al. Evaluation of urine sulfated and nonsulfated bile acids as a diagnostic test for liver disease in dogs. J Am Vet Med Assoc 2003;222(10):1368-1375.
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