![]() It was decided to proceed with surgical attenuation, and under the care of our Anaesthesia Team, a ventral midline coeliotomy was performed. Three weeks later, George returned for reassessment with the Soft Tissue Service, and the owners reported a marked difference in his behaviour and demeanour following commencement of medical treatment. (GD: gastroduodenal vein, PV: portal vein, CVC: caudal vena cava). ![]() A large and tortuous vessel arising from the right gastric vein and entering the caudal vena cava just caudal the porta hepatis. He recovered over the following 48 hours and CT angiography was performed by the Imaging Service which revealed the presence of a single extrahepatic PSS (gastro-caval).įigure 1. Medical management with intravenous fluids and antibiotics, lactulose, initially via enemas, and then orally, was commenced. Hepatic encephalopathy due to portosystemic shunt, or other congenital vascular liver disease was suspected and he was transferred to the Internal Medicine Service. Routine haematology and serum biochemistry revealed hyperammonaemia, elevated bile acids, mild elevations in hepatic parametres, panhypoproteinemia and anaemia. These signs were consistent with a diffuse forebrain disease. On presentation, he was obtunded, circling to the left hand side, with head pressing and an absent menace bilaterally. He then developed a corneal ulcer affecting his right eye, which required a corneal graft procedure one week before referral. Even though he was only three months old, George had been quite unlucky, and had lost his left ear, which was bitten off by his mother shortly after birth. ![]() ![]() George was initially referred to the Neurology Service at SCVS, for investigation of acute onset forebrain signs, including dullness, head pressing and ataxia. One such case that recently benefited from our multi-disciplinary approach was George, a three month old Pug. Many cases at SCVS require the input of multiple specialists, and we are very lucky to be able to call upon the expertise and experience of 21 Veterinary Specialists in eight disciplines, in addition to an experienced nursing team. Written by Tony Ryan, MVB, CertSAS, DipECVS, MRCVS. ![]()
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