Kirin: Liver Shunt Surgery
| Education > Patient Stories | 13th April 2019 |
4 months ago, a kind act by rescuer Benji and Purely Adoptions got a very sick puppy off the streets. Treatment and surgery by Dr Dennis Choi and Dr Nathalee Prakash provided the best chance for a long healthy life. Top it all off, and Victor changed Kirin’s future by giving him the best home any street dog could ask for!
When Kirin was found in a car workshop, he was very weak and showing signs of respiratory distress.
PORTOSYSTEMIC OR LIVER SHUNT
Our liver plays a role in most of the metabolic processes in the body. Normally, blood from the abdominal organs flows to the liver via the portal vein. The blood brings the liver nutrients and is cleansed of toxins and impurities. In a puppy like Kirin, a portosystemic or liver shunt is an abnormal blood vessel that diverts blood around the liver instead of into it. The liver is deprived of necessary nutrients and fails to grow normally. Congenital shunts can be extrahepatic (outside the liver) or intrahepatic (inside the liver).
With Purely Adoption’s support, a rescuer took Kirin to Mount Pleasant Vet Centre (Mandai) for treatment.
CLINICAL SIGNS AND DIAGNOSIS OF LIVER SHUNTS
Common clinical signs include stunted growth, poor muscle development, mental dullness, reduced appetite, vomiting, diarrhoea, blood in urine. Hepatic insufficiency combined with toxin build-up can result in hepatic encephalopathy – affecting the brain and causing neurological signs such as ataxia, seizures, head pressing and behavioural changes.
MEDICAL MANAGEMENT BY DR NATHALEE PRAKASH BEFORE SURGERY
Kirin was referred to Mount Pleasant (Gelenggang) for a full diagnostic work-up including blood work, urinalysis, liver function tests, ultrasound and CT scan with contrast to confirm and locate the portosystemic shunts. Before surgery could be performed, Kirin was managed by veterinary specialist Dr Nathalee Prakash. The aim was to reduce the amount of toxins produced and improve Kirin’s health to decrease the risk of anaesthesia and surgery. Kirin was placed on an appropriate hepatic diet, antibiotics to reduce intestinal bacterial overgrowth, and lactulose to encourage rapid transit of faecal matter and bacteria through the intestinal tract.
LIVER SHUNT SURGERY BY DR DENNIS CHOI
Once Kirin’s condition is stable for general anaesthesia, surgeon Dr Dennis Choi performed a challenging procedure to close the shunt. The abdominal cavity is opened and the liver shunt identified. An ameroid ring constrictor is then carefully placed around the shunt, allowing it to close progressively over time and restore normal blood flow to the liver. Gradual occlusion is important to prevent excessively high portal system pressure, called portal hypertension, which can result in death.
Dr Dennis Choi assisted by Dr Korn
After locating the shunt, Dr Dennis Choi prepares to place the ameroid ring constrictor around it. Over the next few weeks, the casein absorbs fluids from the body and swells inwards, gradually compressing the shunt to restore normal blood flow to the liver.
Kirin was hospitalised for a few days and closely monitored.
Kirin at his post-surgery review with Dr Korn, Victor, Dr Dennis Choi, Dr Gloria Lee. Surgical site healing very well.
POST SURGERY CARE
It takes time for liver cells to regenerate and regain normal function as the shunt slowly closes in the weeks following ameroid constrictor placement. A month and half after surgery, Kirin is a healthy 19kg, playful and active. Kirin will continue on a hepatic diet and medications while returning for regular blood tests to monitor his recovery.
When Kirin was found in a car workshop, he was very weak and showing signs of respiratory distress.
PORTOSYSTEMIC OR LIVER SHUNT
Our liver plays a role in most of the metabolic processes in the body. Normally, blood from the abdominal organs flows to the liver via the portal vein. The blood brings the liver nutrients and is cleansed of toxins and impurities. In a puppy like Kirin, a portosystemic or liver shunt is an abnormal blood vessel that diverts blood around the liver instead of into it. The liver is deprived of necessary nutrients and fails to grow normally. Congenital shunts can be extrahepatic (outside the liver) or intrahepatic (inside the liver).
With Purely Adoption’s support, a rescuer took Kirin to Mount Pleasant Vet Centre (Mandai) for treatment.
CLINICAL SIGNS AND DIAGNOSIS OF LIVER SHUNTS
Common clinical signs include stunted growth, poor muscle development, mental dullness, reduced appetite, vomiting, diarrhoea, blood in urine. Hepatic insufficiency combined with toxin build-up can result in hepatic encephalopathy – affecting the brain and causing neurological signs such as ataxia, seizures, head pressing and behavioural changes.
MEDICAL MANAGEMENT BY DR NATHALEE PRAKASH BEFORE SURGERY
Kirin was referred to Mount Pleasant (Gelenggang) for a full diagnostic work-up including blood work, urinalysis, liver function tests, ultrasound and CT scan with contrast to confirm and locate the portosystemic shunts. Before surgery could be performed, Kirin was managed by veterinary specialist Dr Nathalee Prakash. The aim was to reduce the amount of toxins produced and improve Kirin’s health to decrease the risk of anaesthesia and surgery. Kirin was placed on an appropriate hepatic diet, antibiotics to reduce intestinal bacterial overgrowth, and lactulose to encourage rapid transit of faecal matter and bacteria through the intestinal tract.
LIVER SHUNT SURGERY BY DR DENNIS CHOI
Once Kirin’s condition is stable for general anaesthesia, surgeon Dr Dennis Choi performed a challenging procedure to close the shunt. The abdominal cavity is opened and the liver shunt identified. An ameroid ring constrictor is then carefully placed around the shunt, allowing it to close progressively over time and restore normal blood flow to the liver. Gradual occlusion is important to prevent excessively high portal system pressure, called portal hypertension, which can result in death.
Dr Dennis Choi assisted by Dr Korn
After locating the shunt, Dr Dennis Choi prepares to place the ameroid ring constrictor around it. Over the next few weeks, the casein absorbs fluids from the body and swells inwards, gradually compressing the shunt to restore normal blood flow to the liver.
Kirin was hospitalised for a few days and closely monitored.
Kirin at his post-surgery review with Dr Korn, Victor, Dr Dennis Choi, Dr Gloria Lee. Surgical site healing very well.
POST SURGERY CARE
It takes time for liver cells to regenerate and regain normal function as the shunt slowly closes in the weeks following ameroid constrictor placement. A month and half after surgery, Kirin is a healthy 19kg, playful and active. Kirin will continue on a hepatic diet and medications while returning for regular blood tests to monitor his recovery.