Puppy not growing - suspected liver shunt

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Puppy not growing - suspected liver shunt

Postby countrygirl » Tue Jul 19, 2011 3:58 pm

Hi,

I'm new to the forum but have been reading some of the topics posted and it seems a really friendly and supportive group. I'm lucky enough to share my home with a 4 month mini schnauzer called Rufus who is the most laid back sweetest puppy anyone could wish for. The concern we have is that Rufus just hasn't been growing as he should, he was always little and the smallest in the litter but not by much, so not the obvious runt.

He was 1kg at 2 months, 1.35kg at 3 months and now 2.05kg at 4 months. I know he should be much bigger by now, closer to 3-4kg but I wondered if anyone else had had such a small mini? He came from a 1st time breeder and the mum and dad were their pets so I met them twice in their home and were both a healthy size.

The vet told me at 3 months that they were very concerned about his slow growth, suspected a liver shunt and told me not to expect him to have a long life which just devastated me. At the time he was vomiting quite often at night and slept for about 22 hours a day but doesn't have any of the neurological symtoms such as seizures. She recommended lots of small meals a day and changing to a low protein diet so he's fed 5 meals of a 50/50 mix of blended puppy food and rice, supplemented with chicken. His whole personality has changed 100% since he's been on the new diet and obviously has much more energy as he is now awake most of the day and so much more playful and cheeky. He also stopped vomiting straight away and, interestingly, I ran out of his mix the other day and gave him pure puppy food for 2 meals and he vomited that night so he just can't seem to be able to digest the puppy food (purina pro plan puppy sensitive).

I'm so glad that he's much better on the new diet but will have the bile acid tests soon just to see if it is a liver shunt or not and then consider if surgery is the right answer. Has anyone else had similar problems and any advice?

Thanks x
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Re: Puppy not growing - suspected liver shunt

Postby Caramomo » Tue Jul 19, 2011 4:03 pm

Hi and welcome to the forum. I have no experience of this but it must have been so hard to hear his susspected diagnosis and resulting prognosis. I do wonder though if it is worth you looking at a barf diet if he has problems on kibble. It is a raw meat diet supplemented with raw bones (yes they are safe raw, its cooked bones that cause the problems), a bit of veg, and some oils with yogurt/cream cheese added when he is older. Have a look at the barf section and see if it is something you would like to consider.
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Re: Puppy not growing - suspected liver shunt

Postby countrygirl » Tue Jul 19, 2011 4:16 pm

Thanks, i've been recommended to keep him on a low protein diet as a liver shunt means the liver can't process the toxins released by the stomach when digesting food (particularly protein) so the toxins build up in the body and sometimes the brain. I don't think a raw meat diet would be the right course in this instance.
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Re: Puppy not growing - suspected liver shunt

Postby Tulip » Tue Jul 19, 2011 4:25 pm

Welcome.

I'm so sorry about your little Rufus. :(
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Re: Puppy not growing - suspected liver shunt

Postby BBG » Tue Jul 19, 2011 5:28 pm

Sorry to hear about Rufus. You're quite right about low protein diet if a liver shunt is suspected as the liver can't filter toxins from the blood properly.

Depending on where the shunt is it may be treatable.

Also I think you need to let the breeder know if you haven't already.
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Re: Puppy not growing - suspected liver shunt

Postby Snazy » Tue Jul 19, 2011 5:57 pm

No point letting the breeder know until there is a definite diagnosis of the problem.

I agree with you about avoidinng the barf diet at this time, while he needs to be on a low protein diet. Has he shown no signs at all apart from low growth and low energy levels? Has he had his urine checked for crystals as these can also form in a liver shunt dog.


For those who don't know what a liver shunt is..... This article draws on a client FAQ sheet given by the author to owners of affected dogs referred to Bristol Veterinary School.

What causes a shunt ?

This is a congenital problem, but although a patient is born with the PSS, signs usually only begin to develop weeks or even months after weaning, as the protein content of the diet increases. It is likely an inherited condition and breeding from affected animals is not recommended.

What does a PSS do to the animal?

A PSS can have a number of consequences:

1.Toxins [including ammonia (NH3)] produced by bacterial fermentation of protein in the intestines are not filtered by the liver and affect the brain. Variable neurological signs of ‘hepatic encephalopathy’ may occur e.g. restlessness, intermittent blindness, aimless wandering, head pressing, disorientation, increased thirst and even fits (seizures) and coma in severe cases.

2. Nutrients are not metabolised by the liver, which remains small. This can lead to stunting of the animal.

3. If the liver fails to produce adequate blood proteins, fluid may accumulate in the abdomen (‘ascites’) giving a pot-bellied appearance.

4. Sometimes the abnormal liver function leads to formation of stones in the kidneys and/or bladder and signs of blood in the urine or even obstruction.

5. Occasionally bacteria escape from the gut and, having evaded the liver, enter the circulation causing periods of ill health and raised temperature.

Where is the shunt ?

There are many anatomical variations on a theme, but in general there are two main types:

1.Intra-hepatic – the vein draining the intestine passes through the liver without dividing. This arises most frequently from failure of a vessel normally only present in the foetus to close. It is most commonly seen in giant breed dogs, and is a surgical challenge to correct.

2.Extra-hepatic – the shunt completely bypasses the liver and enters the general circulation directly via one of several possible routes; porto-caval is the most common type. Extra-hepatic shunts are more amenable to surgical correction.





What is the ideal treatment ?

In an ideal world the PSS is tied off (ligated) surgically, and this can be curative. The success rate varies between 50 and 85% depending on the type of shunt and surgical expertise. At Bristol Vet School, we can also now attempt to treat intra-hepatic shunts by placing an occluding coil via a venous catheter. There is still a risk with this new procedure but even riskier open surgery is not required

In some cases, ligation is not possible, for either medical or financial reasons. These patients are managed medically to control the signs of hepatic encephalopathy. Medical treatment merely reduces the production of toxins and does not correct the shunt.

What can go wrong ?

The aim of surgery is to completely close the shunt. Regrettably it is not always that straightforward:

The shunt may be impossible to find
There may be inadequate veins going to the liver (or even none) so that complete closure of the PSS causes excessive back-pressure on the intestines. In mild cases this may cause temporary accumulation of fluid (ascites). In severe cases it can lead to death of the patient, and so the surgery has to be reversed.
There is a risk of serious haemorrhage, especially with intra-hepatic shunts, which may have to be dissected free of surrounding liver tissue. Placement of a coil by venous access is less risky but not widely available.

If the shunt is found but complete closure is not possible, a partial ligation may be performed. Alternatively a sterile cellophane band placed around the shunt, in order to cause scarring and gradual closure to allow time for the vessels to the liver to regrow.

What is medical management ?

The aim is to reduce intestinal production and absorption of toxins such as ammonia, and so reduce signs of hepatic encephalopathy. Medical treatment is indicated for:

For short-term stabilisation of patients before surgery
Patients where ligation of the shunt fails because of a lack of normal vessels going to the liver to cope with the revised blood flow
Patients where surgery is declined for whatever reason.

There are three lines of treatment

1.Dietary management

A restricted protein diet with carbohydrates as the main energy source should be fed. Veterinary diets such as RCW Hepatic Support or Hill’s l/d are suitable. Alternatively a home-prepared diet consisting of equal parts of boiled rice, pasta or potatoes with low-fat cottage cheese may be fed. IIf blood proteins are low, protein should not be restricted severely, and other methods must be used.

2. Lactulose

This synthetic sugar is a laxative that helps remove the intestinal contents rapidly before significant fermentation occurs. It also decreases the absorption of ammonia. The effect is quite variable, and the dose has to be tailored until the patient produces 2-3 soft motions per day.

3.Oral antibiotics

These help reduce the number of ammonia producing bacteria in the gut lumen.

Treatment is tailored by trial and error to each individual patient until signs of hepatic encephalopathy are controlled. Mild cases may do well on dietary management alone, whilst severe cases may require all three medications.

NB. Cases of PSS must be referred by their vet to other centres offering surgery (including Bristol Veterinary School); owners cannot make arrangements directly
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Conformation indicates what the animal appears to be
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Re: Puppy not growing - suspected liver shunt

Postby countrygirl » Tue Jul 19, 2011 7:17 pm

Thanks so much for all this information. Apart from the slow growth and lack of energy he has a quiet temperament and before changing his diet he could have a very vacant expression sometimes which I know are other signs of a shunt. He has a very small frame and always had a pot belly after eating which is partly why he's on a little and often diet.

I did contact the breeder as the vet asked if I could find out what weight his litter mates were at 3 months. She was upset to hear that he might have a problem and was helpful in contacting the other owners. When he was 1.35kg his litter mates were all 2-2.5kg. I'll let her know when i find out for sure what's up with him, but she's not a professional breeder and wasn't planning to breed again soon.
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Re: Puppy not growing - suspected liver shunt

Postby Suzie » Tue Jul 19, 2011 8:14 pm

So sorry to read all this, please keep us posted on his progress. Rufus looks adorable.
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Re: Puppy not growing - suspected liver shunt

Postby frazers mam » Tue Jul 19, 2011 8:19 pm

Hi,
Rufus you are one bonny pup sending you healing hugs, hope you get better soon little man.
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Re: Puppy not growing - suspected liver shunt

Postby hula-hoop » Tue Jul 19, 2011 9:41 pm

Welcome to the forum. Sorry to hear about poor little Rufus. I dont have any experience in this area, but you have certainly come to the right place for support and advice from schnauzer experts on here. Hope things go okay for you both and that things can be done to help little Rufus. Would love to hear how you get on. (dogrun)
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Re: Puppy not growing - suspected liver shunt

Postby BeeBee » Tue Jul 19, 2011 10:11 pm

Poor little chap, that's a tough start for you all, hope he gets sorted soon & grows up to be a big strong boy. Never nice to have animals unwell but especially little tiddlers.
All the best to you & Rufus.
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Re: Puppy not growing - suspected liver shunt

Postby karen_schnauzer » Tue Jul 19, 2011 10:22 pm

Hi countrygirl, 1st off im so sorry to hear about your pup. Is he insured? from what iv read this condition is best sorted out early and if operated on the pups can go on to lead happy and normal lives. Recently i have learnt of another pup with an extra-hepatic shunt. He was normal weight at 8 weeks etc but at 11 weeks started to show strange behaviour (spaced out after meals, pressing head agents surfaces and vomiting) he was refferd to a specilist vet and after bile tests and ultrasounds a shunt was diagnosed. He is now booked in for an op in a weeks time (he will be 3 months) which will be fully covered by insurance.

The vets have explained that although this is a congenital defect it can be a dormant gene up to 5 generations back so it isn’t necessarily from the parents. Makes a bit of a pickle with regards to breeding with so many minis sharing common ancestors!
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Re: Puppy not growing - suspected liver shunt

Postby countrygirl » Tue Jul 19, 2011 10:29 pm

He is insured but my vet doesn't think it will be covered as he had to have some tests at 9 weeks for intestinal gas (he was vomiting a lot the first week I had him) and a shunt would be classed as a pre-existing condition.
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Re: Puppy not growing - suspected liver shunt

Postby Guinevere » Tue Jul 19, 2011 10:59 pm

Hi there.
Sorry to hear about little Rufus. Please let us know how he gets on
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Re: Puppy not growing - suspected liver shunt

Postby summer46 » Wed Jul 20, 2011 9:49 am

Awww poor baby and what a worrying time for you all.

I hope it will all get sorted out for you.
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