There is a sparse evidence base and no consensus upon which to choose which medical therapies are most beneficial, or when and how they should be given, and successful treatment can be challenging. Rather than relying on a single specialist to find the best tailored treatment for each patient at the RVC we work hard to bring in expertise from related disciplines right from the start with the aim of bringing about improved outcomes for the animals. Listen in to the daily discussions that they regularly debate together when faced with these complex CPSS cases. RJ: For dogs and cats with CPSS of any age, presenting in a stable clinical state, I normally recommend a period of weeks of medical therapy comprising dietary management, oral lactulose and antibiotics, with the first two being the most important components. Until a few years ago, my dietary option of choice for dogs was a hepatic support diet. Dietary management in cats can be challenging due to their higher protein requirements, particularly in young growing cats, and their tendency to be fussy with food! Again soy-based gastrointestinal diets that are highly digestible are my first choice although I have also used feline hepatic diets. OG: Medical therapy for CPSS has not changed significantly in the past 30 years, reflecting, until recently, stagnation of research in this space. The excellent work undertaken by Drs Lipscomb and Tivers has made significant advances in this area, with translational ramifications for the future. RJ: Most texts describe that antibiotics should be administered as part of routine therapy for patients with CPSS prior to surgery but the evidence base for antibiotic therapy in dogs with CPSS in the pre-surgical period or for long-term management where surgery is not possible is sparse. Much of the human literature evaluating antibiotic usage relates to patients that develop HE as a consequence of cirrhotic liver disease, which is not necessarily an appropriate model to be extrapolated to our CPSS patients.
You may also want to substitute feline and dairy for some of the turkey. No breed, or sex predilection have been shown in patients with PSS; however purebred dogs seems to have a higher incidence. Congenital shunts occur in dieg dogs and cats. However, shunts have been diet in adults as old as 10 years. Any blood vessel in this area should be suspect stunts an extrahepatic shunting blood vessel. Medical treatment will not correct this alteration, therefore stunhs term survival dehydratio not expected. I regret that I no longer have much time to respond to questions. Postoperative liver have been reported as a diet of ligation of PSS and they carry a poor prognosis. Male cats seem to be over-represented in this population. Feeding several small meals daily, rather than dehydratio or two deit meals, can liver reduce signs of HE.
Congenital portosystemic shunts AKA liver shunts are relatively common birth defects in pets where the blood vessels in the abdomen develop abnormally and instead of funneling blood from the intestines through the liver, the blood is able to bypass the liver and enters the systemic circulation. Shunts are most common in small breeds of dogs, especially Yorkshire terriers, Maltese, and Cairn terriers. However, they can also be seen in larger dogs such as Irish wolfhounds and retrievers and less commonly in cats. In severe cases, pets may stare at walls, act like they are drunk, or even have seizures especially after meals and experience urinary issues due to kidney or bladder stones caused by the buildup of compounds that would normally be removed by the liver. Some shunts can be repaired with surgery or non-surgical interventional procedures but others either cannot be fixed or the treatment is too expensive for the pet owner. Typically, pets that are waiting to have their shunts fixed or those whose shunts cannot or will not be fixed are treated with a combination of medications and diet.