Four month history of occasional episodes of ataxia, ptyalism, pacing. Recently circling, head pressing, and vomiting. Seems to be always hungry.
PE: BCS 3/9, unkempt/fuzzy haircoat, peripheral blindness, pacing room and clinging to wall.
Labwork (fasted): TP 4.5, Alb 2.5, ALP 144, ALT 155, GGT 3, Bili 0.4, Cre 0.3, Cho 51, Amy 266 CBC – HCT 39%, Hgb 12.0 UA – USG 1.030pH 6, 1+ bilirubin, WBC 4-10/hpf, rods 26-50/hpf Negative Accuplex Bile Acids: Pre 299.2, Post-meal – 90.7
gastrocaval vs gastroazygos shunt
The liver was subnormal in size. Parenchymal echogenicity was naturally coarse and hypoechoic to the spleen. The extrahepatic vascularity was abnormal in this patient with a large, tortuous extrahepatic shunt that was deriving just caudal from the pyloric outflow decoursing ventrally and then dorsally. It appeared to enter into the vena cava. The pattern of this type of shunt would be consistent with gastrocaval shunt. The termination appears to likely vena cava; however, I cannot rule out an azygos determination.
A moderate amount of bladder debris and a trace amount of sand was noted.
The kidneys were both swollen. There was some loss of corticomedullary definition. The kidneys were mildly enlarged. The left kidney measured 5.5 cm. The right kidney measured 6.0 cm.
Extrahepatic portosystemic shunt is noted. This is consistent with gastric shunt, potential gastrocaval or gastroazygos.
CT evaluation for surgical planning is indicated. Cystotomy and bladder lavage may also be appropriate, yet the amount of sand at the time of sonogram was minimal.
portosystemic shunt
