Page 1619 - Cote clinical veterinary advisor dogs and cats 4th

816 Pregnancy

• Address severe hypoglycemia, if present Drug Interactions and protein C level. May also require repeat
(p. 552). Caution when using drugs that require hepatic • Dogs diagnosed late in life (>5 years) and
advanced imaging
VetBooks.ir described medical treatment, use anticon- medications without signs of HE can have excellent surgi-
metabolism and for sedative or analgesic
• If seizues continue despite previously
vulsant therapy (p. 903).
cal outcomes, but survival may be similar
Possible Complications
• If present, address urinary obstruction (p. 1009)
with surgical versus medical management.
or infection (p. 232) secondary to urolithiasis. Varies (life-threatening to minor): postopera- APSS due to underlying hepatopathy:
• If suspected, address gastrointestinal ulcers tive complications can occur hours to weeks • Depends on specific diagnosis, severity, and
(p. 380). after surgery and include seizures, failure potential for medical intervention, but often
to adequately occlude shunt, portal venous poor if associated with cirrhosis
Chronic Treatment hypertension, failure of liver portal vasculature
Congenital PSS: to handle redirected blood flow, hypothermia, PEARLS & CONSIDERATIONS
• Best option is usually surgical correction to hypoglycemia, ascites, and infection.
reduce shunting blood flow; surgery is more Comments
difficult for intrahepatic than extrahepatic Recommended Monitoring • Consider PSS as a differential diagnosis for
shunts. Referral to a veterinary surgeon is • Monitor closely for seizures or evidence of young dogs and cats having intermittent
strongly reccomended. portal hypertension in the postoperative central neurologic problems; periods of
○ Goal is to achieve normal life expectancy period. Over the next weeks to months after suspected blindness; unexplained ptyalism;
and wellness without need for dietary or shunt ligation, watch for resolution of clinical poor growth; prolonged effects of anesthesia,
medical interventions. signs, recheck serum biochemical profiles, sedatives, or drugs metabolized by the liver;
○ Medical stabalization usually is indicated reassess TSBA (may not normalize if HMD vague gastrointestinal upsets or poor appetite;
for a period of weeks to months before present or shunt ligation incomplete), reassess failure to train or behavior swings (including
surgery. protein C (reversion to normal), resolution aggression); and in any non-Dalmation,
○ Ameroid occluder: slow occlusion over of ammonium urate crystalluria. Often, non-bulldog patient with ammonium urate
several days to weeks; may not always dietary restrictions and medications can be crystalluria or urolithiasis.
completely close or may close too quickly withdrawn. • Perioperative mortality rate with surgery
○ Cellophane banding: partial immediate • Monitoring patients with APSS as for for intrahepatic shunts is higher than that
ligation followed by slow occlusive peri- cirrhosis and HE or for specific cause of with extrahepatic PSS. IR-assisted place-
venular fibrosis with thrombosis occurring hepatopathy. ment of intravascular coils shows promise
over period of weeks for intrahepatic and extrahepatic shunt
○ Direct ligation (silk ligature): attenuated PROGNOSIS & OUTCOME correction, but it requires specific expertise
shunted flow; best to measure portal and is not foolproof.
venous pressure before and after attenu- Congenital PSS:
ation (largely replaced by other techniques) • Although serious complications are possible Prevention
○ Intrahepatic PSS: coil placements by around the time of surgical correction (more Do not breed affected dogs.
interventional radiology (IR) technique so for intrahepatic shunt), surgery can offer
(percutaneous transvenous coil emboli- an excellent long-term prognosis. Technician Tips
zation) is used to create occlusive clot; • Partial PSS ligation can have good results • Patients should be fasted for 12 hours before
multiple attempts may be needed. based on degree of attenuation of shunted bile acid testing or abdominal imaging
• If surgery is not an option (e.g., costs, referral blood flow. Patients with incomplete shunt studies.
distance), medical treatment can be sustained. correction (or concurrent HMD) often
Some animals do well for many years with benefit from chronic dietary and medical SUGGESTED READING
medical management alone. management. Greenhalgh SN, et al: Long-term survival and quality
APSS: • Progressive occlusion of shunt flow can occur of life in dogs with clinical signs associated with
• Surgery is contraindicated for APSS (excep- over many months after surgery (depending a congenital portosystemic shunt after surgical or
tion: resectable arterioportal malformation) on techinique used). medical treatment. J Am Vet Med Assoc 245:527-
• Medical management of HE and complica- • Extent of closure for ameroid occluders and 533, 2014.
tions: as for congenital PSS cellophane banding is not specifically known AUTHOR: Mark E. Hitt, DVM, MS, DACVIM
• Address underlying hepatopathy or cirrhosis but can be reflected in bile acid test results EDITOR: Keith P. Richter, DVM, MSEL, DACVIM
(pp. 174, 452, and 458).

Pregnancy Client Education
Sheet

Epidemiology
BASIC INFORMATION days from ovulation (54-60 days from the
first day of diestrus and 57-72 days from SPECIES, AGE, SEX
Definition breeding). Canine and feline: postpubertal intact female
• The period of gestational development in • Queen: gestational length is 64 days (usually > 6 months old)
the uterus, beginning at conception and from the LH surge. Cats are induced
continuing through parturition ovulators, and the LH surge corresponds GENETICS, BREED PREDISPOSITION
• Bitch: gestational length is 65 days from to 24 hours after the first breeding Fertility (pregnancy rate) and fecundity (litter
the luteinizing hormone (LH) surge or 63 date. size) are heritable traits. Mixed breeds and

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