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Ultrasonographic Diagnosis of Portosystemic Shunts
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Portosystemic shunts (PSSs) occur both in dogs and cats with a great variety of different morphologies. These shunts allow the passage of blood from the portal system to the systemic circulation bypassing the liver. Liver atrophy is the main consequence, since the portal vein is responsible for 80% of hepatic blood flow and provides 50% of oxygen for this organ. Clinical signs normally associated with the presence of PPS are related to the entry of toxins, such as ammonia, into the blood stream and include gastrointestinal, central nervous and urinary effects. Besides this, affected animals tend to have a stunted growth. The detection and morphological characterization of the shunt(s) by imaging influences the therapeutic action and aids surgery, if indicated.
Before addressing the diagnostic tests, PSS classification should be reviewed since it has recently been updated. Three categories of hepatic vascular pathology are suggested: first, intrahepatic and extrahepatic shunts, second, primary portal vein hypoplasia with or without portal hypertension and, third, flow disturbances. The second category is the most confusing because it includes all the conditions that can and cannot cause portal hypertension. The clearest example of hypoplasia without hypertension is hepatic microvascular dysplasia and primary portal vein hypoplasia with hypertension (in cases of fibrosis or veno-occlusive disease). […]
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