Page 1137 - Small Animal Clinical Nutrition 5th Edition

Hepatobiliary Disease 1183

Progress Notes
VetBooks.ir The food was changed to a commercial dry veterinary therapeu-
a
tic product (Prescription Diet k/d Canine ) that contained re-
duced levels of high quality and easily digested protein while pro-
viding a good source of non-protein calories (14.5% dry matter
[DM] protein, 19.0% DM fat, 61.1% DM digestible carbohy-
drate). DER was calculated to be 1.2 x RER for an estimated
optimal body weight of 10 kg (DER = 440 kcal [1.84 MJ]). The
food was to be offered in at least three separate meals throughout
b
the day. Additional therapy consisted of oral lactulose syrup (10
ml, three times daily).
Three weeks later, the dog had gained 1.2 kg body weight.The
owners reported a marked decrease in the number of vomiting
episodes and periods of lethargy and depression. No new physi-
cal findings were noted.The hypoproteinemia,hypoalbuminemia
and ammonium biurate crystalluria persisted. Results of clotting
studies done before surgery were normal. During surgery, an
anastomotic vessel was easily visualized at the level of the right
kidney. This vessel was partially ligated. The dog was released
from the hospital five days later with instructions for the owners
Figure 1. A three-and-one-half-year-old, neutered female miniature
to continue feeding the veterinary therapeutic food and adminis- schnauzer with chief complaints of intermittent vomiting, depression
tering lactulose, as described before surgery. and lethargy with weight loss and poor body condition.
The dog was reassessed one month later. Body weight had
increased to 8.6 kg, the BCS was 2/5 and the owners reported no
episodes of malaise or vomiting. The serum urea nitrogen, total
protein and albumin concentrations were normal, and ammoni-
um biurate crystals were absent from the urine.The liver size was
increased radiographically. Because of the apparent return of nor-
mal hepatic function and size, the owners were instructed to
change the food to a regular adult maintenance product (25%
DM protein, 15.4% DM fat, 53.3% DM digestible carbohydrate)
and discontinue the lactulose. The food dosage was continued at
1.2 x RER (440 kcal [1.84 MJ]).
Five months later the dog was examined again. Body weight
was 10 kg with a BCS of 3/5.The owners reported that the high-
er protein food had not precipitated any clinical signs. No
changes in foods or feeding methods were recommended.

Endnotes
Figure 2. A lateral radiograph showing the results of an injection of
a. Hill’s Pet Nutrition, Inc., Topeka, KS, USA.
positive-contrast medium into the mesenteric vein. A large vascular
b. Cholac. Alra Laboratories, Gurnee, IL, USA. shunt is communicating from the portal vasculature to the caudal
vena cava.
Bibliography
Center SA. Hepatic vascular diseases. In: Guilford WG, Center SA, Strombeck DR, et al, eds. Strombeck’s Small Animal
Gastroenterology, 3rd ed. Philadelphia, PA: WB Saunders Co, 1996; 802-846.
Laflamme DP, Allen SW, Huber TL. Apparent dietary protein requirement of dogs with portosystemic shunt. American Journal
of Veterinary Research 1993; 554: 719-723.