You would never know by looking at him, but Nacho was recently diagnosed with a life-threatening condition for which he showed no signs whatsoever! When Nacho turned one, his owners wished to have him neutered. He was an active and happy pup, and as expected, his exam was completely normal. As part of routine diagnostics done prior to any surgical procedure here at West Hills, Nacho had blood work performed. Results showed a single value related to liver health was slightly elevated. You might argue that a slight elevation of a sole value on a blood panel is likely insignificant, but at West Hills we are committed to practicing the highest standard of care for our pets. Therefore, Nacho’s veterinarian, Dr. Sikalas, recommended further testing to ensure it was safe for him to undergo anesthesia and surgery.
An additional blood test (called bile acids) was performed and Nacho’s results returned abnormal. When this occurs in a young small breed dog, a likely possibility is a congenital abnormality associated with the liver called a portosystemic shunt (PSS). In dogs and cats, blood carrying toxins, such as ammonia, from the digestive tract is first transported to the liver through the portal vein. The liver removes all the harmful substances before returning the detoxified blood to the general circulation.
In pets with a PSS, there are one or more abnormal vessels that bypass the liver, allowing those harmful substances to the rest of the body before detoxification occurs. Pets with this condition often times suffer from a smaller liver with impaired function, and can have stunted growth or abnormal neurologic behavior, particularly after eating. They may also have problems metabolizing medications, especially anesthetic drugs, and this can be fatal for some pets.
Surgery is frequently recommended for dogs with PSS and consists of an abdominal exploration to identify the abnormal “shunting” vessel and a procedure to redirect blood flow back to the liver. Nacho underwent surgery with our ACVS Board Certified Veterinary Surgeon, Dr. Marc Hirshenson, who identified an abnormal vessel consistent with a PSS. Dr. Hirshenson placed a small device called an occluder on the vessel. This allows for gradual closure of the vessel and redirection of blood flow to the liver.
Nacho handled surgery like a champ and recovered without any complications. At home, Nacho continues to thrive. More importantly, his most recent bloodwork showed normal liver values! Congratulations Nacho!