Diagnosis And Treatment Of Porto-systemic Shunts In The Cat

Porto-Systemic Shunts(PSS)is a kind of hepatobiliary system disease,which refers to the abnormal vascular connection between the portal vein system and the posterior vena cava,so that some blood flows directly into the posterior vena cava without pouring into the liver through the portal vein.There is no definite report on the incidence rate,the cure rate is high,but the clinical diagnosis is not easy,and the longterm prognosis is poor.Early diagnosis can significantly improve the prognosis.This article preliminarily summarize the basic information such as breed,age and sex in 27 cats with PSS,then analyzed retrospectively the clinical examination,laboratory examination,imaging examination,treatment methods and results in 22 cats with PSS,so as to master the diagnosis and treatment of PSS cats and provide reference for clinical PET doctors.The incidence rate of PSS cats is 0.05% in China,55.6%(15/27)PSS cats were concentrated in young cats under 1 year old,the incidence rate of female cats(59.3%)is greater than that of male cats(40.7%).Most of the affected cats are Chinese domestic cats(44.4%)and British Shorthairs(37.0%).Garfield cats(11.1%),American Shorthairs(3.7%)and Muppets(3.7%)can be used as potential domestic cat breeds.86.4%(19/22)PSS cats usually show different degree hepatic encephalopathy,including excessive salivation,drowsiness,ataxia,visual impairment,seizures and coma.Most of these symptoms occur intermittently and worsen after eating.Compared with the normal value,MCH,MCV,HCT and HGB of PSS cats decreased,which were0.3-1 pg,0.3-3.4 f L,2.4-8.8 %,0.1-1.9 g/dL respectively,and RDW increased by 0.7-2.8 %;blood biochemical examination showed that GLU,CREA and UREA decreased,which were 0.07-0.13 mmol/L,2-43 μmol/L and 0.1-3mmol/L respectively;ALT,ALKP,Preprandial bile acid and blood ammonia increased,which were 7-114 U/L,13-134 U/L,23.1-171.4 μmol/L and 20-397 μmol/L;The results of ultrasound examination showed that 90.1% PSS cats detected abnormal shunt vessels and portal vein blood flow,40.9% urinary calculi and 13.6% small liver volume.The diagnostic rate of abdominal ultrasound was 90.1%(20/22);7 cats with PSS were examined by CT and angiography,and the diagnostic rate was 100%.The treatment of PSS cats is mainly conservative medical treatment combined with surgical treatment.The principle of conservative treatment is to strengthen nursing,anti-bacterial and anti-inflammatory,and control seizures.Long-term feeding of low protein diet such as liver prescription diet;oral lactulose 1-3 m L/time,amoxicillin 12.5-25 mg/kg/time and metronidazole 10 mg/kg/time twice a day;at the same time,antiepileptic drugs such as enphobarbital 2-4 mg/kg/time and levetiracetam 10-30mg/kg/time were taken orally twice a day.Surgical treatment uses CT and threedimensional reconstruction technology to determine the shunt type and surgical pathway,the way was performed by ameroid constrictor to block the shunt vessels,and the success rate was 87.5%(7/8).