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Konstantinidis AO, Patsikas MN, Papazoglou LG, Adamama-Moraitou KK. Congenital Portosystemic Shunts in Dogs and Cats: Classification, Pathophysiology, Clinical Presentation and Diagnosis. Vet Sci 2023; 10:vetsci10020160. [PMID: 36851464 PMCID: PMC9961057 DOI: 10.3390/vetsci10020160] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/07/2023] [Accepted: 02/14/2023] [Indexed: 02/19/2023] Open
Abstract
Congenital portosystemic shunts (CPSS) are abnormal vascular communications between the portal and the systemic circulation, bypassing the hepatic parenchyma and resulting in liver hypoplasia and hepatic insufficiency. Such connections develop in utero and persist postnatally. CPSS are among the two most common congenital vascular anomalies of the liver in small animals, along with primary hypoplasia of the portal vein without portal hypertension (PHPV without PH). CPSS can be extrahepatic (ECPSS), most commonly diagnosed in small and toy breed dogs and cats, or intrahepatic (ICPSS), most commonly seen in large breed dogs. Single ECPSS is the most common type encountered in both dogs and cats. Clinical signs of CPSS are non-specific and may wax and wane, while laboratory findings can raise clinical suspicion for CPSS, but they are also not specific. Definitive diagnosis will be established by evaluation of liver function tests, such as determination of fasting plasma ammonia (FA) levels, and pre- and postprandial serum bile acids concentrations, and diagnostic imaging. The purpose of this article is to review the definition, classification, pathogenesis, clinical presentation, and diagnosis of CPSS in dogs and cats, highlighted by the authors' clinical experience.
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Affiliation(s)
- Alexandros O. Konstantinidis
- Companion Animal Clinic (Medicine Unit), School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54627 Thessaloniki, Greece
- Correspondence:
| | - Michail N. Patsikas
- Laboratory of Diagnostic Imaging, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54627 Thessaloniki, Greece
| | - Lysimachos G. Papazoglou
- Companion Animal Clinic (Surgery and Obstetrics Unit), School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54627 Thessaloniki, Greece
| | - Katerina K. Adamama-Moraitou
- Companion Animal Clinic (Medicine Unit), School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54627 Thessaloniki, Greece
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Serrano G, Devriendt N, de Rooster H, Paepe D. Comparison of diet, lactulose, and metronidazole combinations in the control of pre-surgical clinical signs in dogs with congenital extrahepatic portosystemic shunts. J Vet Intern Med 2022; 36:1258-1266. [PMID: 35633289 PMCID: PMC9308425 DOI: 10.1111/jvim.16464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 05/10/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Hepatic supportive diet (HSD), lactulose, and antimicrobials are medical treatments for dogs with congenital extrahepatic portosystemic shunts (cEHPSS). The relative contribution of these treatment components is currently unknown. OBJECTIVES To determine which treatment combinations are most efficacious in pre-surgical control of clinical signs of cEHPSS in dogs. ANIMALS Thirty-six dogs with untreated cEHPSS. METHODS Three-arm randomized clinical trial. At inclusion (T0), dogs were divided into 3 groups: HSD (n = 12), HSD + lactulose (n = 12), or HSD + metronidazole (n = 12) and received the randomized treatment for 4 weeks (T1) followed by combined treatment of HSD + lactulose + metronidazole for 2 weeks or until cEHPSS attenuation (T2). Clinical score as well as fasting ammonia (FA) and C-reactive protein (CRP) concentrations were compared among groups and time points. RESULTS Thirty-four dogs were evaluated. Thirty-four dogs reached T1 and 29 dogs T2. At T1, clinical scores decreased in the HSD + lactulose (n = 11; P = .001), but not in the HSD (n = 8; P = .96) and HSD + metronidazole (n = 10; P = .06) groups. Adding metronidazole to HSD + lactulose (n = 11) did not result in further clinical score improvement (T2; P = 1.000). Moderate and weak correlation between clinical score and FA and clinical score and CRP was present (ρ = .35, P < .001; ρ = .27, P = .01, respectively) with FA decreasing over time on medical treatment (P = .001). CONCLUSIONS AND CLINICAL IMPORTANCE Combined HSD + lactulose seems sufficient for pre-surgical cEHPSS stabilization unlike sole HSD or HSD + metronidazole. Medical treatment of cEHPSS clinical signs decreases FA.
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Affiliation(s)
- Goncalo Serrano
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - Nausikaa Devriendt
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - Hilde de Rooster
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - Dominique Paepe
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
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Wallace ML, Grimes JA, Edwards L, Lux CN, Tam C, Dickerson VM, Carroll KA, Scharf VF, Colberg V, Kudej RK, Otomo A, Singh A, Miller A, Regier PJ, Curcillo C, Holt DE, Ogden JA, Arai S, Upchurch DA, Eicher L, Howard J, Hardie RJ, Zellner EM, Milovancev M, Bennett B, Heape N, Matz BM, Schmiedt CW. Dogs ≥ five years of age at the time of congenital extrahepatic portosystemic shunt diagnosis have better long-term outcomes with surgical attenuation than with medical management alone. J Am Vet Med Assoc 2022; 260:758-764. [PMID: 35201999 DOI: 10.2460/javma.21.09.0417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To determine the outcome in dogs diagnosed with congenital extrahepatic portosystemic shunts (EHPSS) at ≥ 5 years of age treated with medical management only (M) or with surgical attenuation (S). The hypothesis was that dogs undergoing surgical attenuation would have a longer survival time than dogs undergoing medical management only. ANIMALS 351 dogs definitively diagnosed with EHPSS at ≥ 5 years of age. PROCEDURES Medical records from 2009 to 2019 at 16 veterinary teaching hospitals were evaluated. Data collected included signalment, clinical signs at diagnosis, clinicopathologic data, surgical and medical treatments, shunt morphology, clinical signs and medical treatments at 6 to 12 months after diagnosis, and survival time. RESULTS 351 dogs (M, 119 [33.9%]; S, 232 [66.1%]) were included in the study. Survival time was longer with surgery than medical management (hazard ratio, 4.2; M, 3.4 years; S, 10.9 years). Continued clinical signs at 6 to 12 months after diagnosis were more common with medical management (M, 40% [33/88]; S, 14% [21/155]). Continued medical treatments at 6 to 12 months after diagnosis were more common in the medical management group (M, 78% [69/88]; S, 34% [53/155]). Perioperative mortality rate was 7.3%. CLINICAL RELEVANCE Dogs diagnosed at ≥ 5 years of age with EHPSS have significantly better survival times and fewer clinical signs with surgical attenuation, compared with medical management. Older dogs have similar surgical mortality rates to dogs of all ages after surgical EHPSS attenuation.
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Affiliation(s)
- Mandy L Wallace
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA
| | - Janet A Grimes
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA
| | - Lauren Edwards
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine University of Tennessee, Knoxville, TN
| | - Cassie N Lux
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine University of Tennessee, Knoxville, TN
| | - Candace Tam
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX
| | - Vanna M Dickerson
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX
| | - Kenneth A Carroll
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC
| | - Valery F Scharf
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC
| | - Valerie Colberg
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA
| | - Raymond K Kudej
- Department of Clinical Sciences, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA
| | - Aki Otomo
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - Ameet Singh
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - Annellie Miller
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL
| | - Penny J Regier
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL
| | - Chiara Curcillo
- Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
| | - David E Holt
- Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jessica A Ogden
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN
| | - Shiori Arai
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, Saint Paul, MN
| | - David A Upchurch
- Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, KS
| | - Logan Eicher
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH
| | - James Howard
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH
| | - Robert J Hardie
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin, Madison, WI
| | - Eric M Zellner
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, IA
| | - Milan Milovancev
- Department of Clinical Sciences, Carlson College of Veterinary Medicine, Oregon State University, Corvallis, OR
| | - Barbara Bennett
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL
| | - Natalie Heape
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL
| | - Brad M Matz
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL
| | - Chad W Schmiedt
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA
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Covin MA, Steiner JM. Measurement and clinical applications of C-reactive protein in gastrointestinal diseases of dogs. Vet Clin Pathol 2022; 50 Suppl 1:29-36. [PMID: 35014071 PMCID: PMC9303876 DOI: 10.1111/vcp.13100] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 10/12/2021] [Accepted: 11/14/2021] [Indexed: 12/11/2022]
Abstract
C-reactive protein (CRP) is a positive acute-phase protein, serum concentrations of which increase nonspecifically in response to inflammatory processes of the dog. As such, it can aid in the identification of inflammatory disease and, maybe more importantly, the objective monitoring of disease progression. In dogs, CRP is frequently used to evaluate dogs with gastrointestinal diseases, such as chronic inflammatory enteropathies (also termed idiopathic inflammatory bowel disease), acute pancreatitis, canine parvovirus infection, hepatic disease, acute abdomen, and protein-losing enteropathy. The diversity of the assays available to measure CRP in dogs is nearly as numerous as the diseases in which serum concentrations of this protein are increased. Assay methodologies include laser nephelometric immunoassays, enzyme-linked immunosorbent assays, immunoturbidimetric assays, and time-resolved immunofluorometric assays. While many of these assays are acceptable for clinical use in the dog, the same assay and analyzer should be used to measure a patient's CRP concentration longitudinally. By looking at the uses of CRP in human gastroenterology, including reducing the duration of antibiotic therapy, the veterinary profession can gain insight into novel ways in which serum CRP concentration measurements might be applied in veterinary medicine in the future.
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Affiliation(s)
- Marshal A Covin
- Gastrointestinal Laboratory, Department of Small Animal Clinical Sciences, Texas A&M University, College Station, TX, USA
| | - Joerg M Steiner
- Gastrointestinal Laboratory, Department of Small Animal Clinical Sciences, Texas A&M University, College Station, TX, USA
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Asakawa M, Fukuzawa M, Asakawa MG, Flanders JA. Preoperative serum C-reactive protein concentration can be used to detect gallbladder rupture in dogs with gallbladder mucocele. Am J Vet Res 2022; 83:23-32. [PMID: 34757924 DOI: 10.2460/ajvr.21.09.0141] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To determine whether serum C-reactive protein (CRP) concentration could be used to detect gallbladder rupture (GBR) prior to surgery in dogs undergoing cholecystectomy for treatment of gallbladder mucocele (GBM). ANIMALS 45 dogs that underwent cholecystectomy because of GBM at a companion animal referral hospital from 2017 to 2020. PROCEDURES Electronic medical records were reviewed, and dogs were included if serum CRP concentration had been measured within 24 hours prior to cholecystectomy. Dogs were grouped as to whether the gallbladder was found to be ruptured or intact during surgery. Accuracy of using preoperative CRP concentration to predict GBR was compared with accuracy of abdominal ultrasonography and other preoperative blood tests. RESULTS GBR was present in 15 dogs at the time of surgery. Median preoperative CRP concentration was significantly higher in dogs with GBR (15.1 mg/dL; interquartile range, 7.4 to 16.8 mg/dL) than in dogs with an intact gallbladder (2.65 mg/dL; interquartile range, 0.97 to 13.4 mg/dL). Sensitivity, specificity, and accuracy of using preoperative CRP concentration to predict GBR were 100%, 67%, and 78%, respectively. CLINICAL RELEVANCE Measurement of preoperative CRP concentration provided excellent sensitivity and moderate specificity for detection of GBR in dogs undergoing cholecystectomy because of GBM. Accuracy of using preoperative CRP concentration for detection of GBR was not superior to the accuracy of preoperative abdominal ultrasonography. However, when CRP concentration was combined with results of ultrasonography, the sensitivity, specificity, and accuracy for detection of GBR were 100%, 93%, and 96%, respectively.
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Affiliation(s)
- Makoto Asakawa
- 1Veterinary Specialists Emergency Center, Saitama Prefecture, Japan
| | - Mayuko Fukuzawa
- 1Veterinary Specialists Emergency Center, Saitama Prefecture, Japan
| | | | - James A Flanders
- 2Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY
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Cognitive Impairement in Non-Cirrhotic Portal Hypertension: Highlights on Physiopathology, Diagnosis and Management. J Clin Med 2021; 11:jcm11010101. [PMID: 35011842 PMCID: PMC8745274 DOI: 10.3390/jcm11010101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 12/19/2021] [Accepted: 12/21/2021] [Indexed: 11/18/2022] Open
Abstract
Hepatic encephalopathy (HE) is one of the most frequent complications of cirrhosis. Several studies and case reports have shown that cognitive impairment may also be a tangible complication of portal hypertension secondary to chronic portal vein thrombosis and to porto-sinusoidal vascular disease (PSVD). In these conditions, representing the main causes of non-cirrhotic portal hypertension (NCPH) in the Western world, both overt and minimal/covert HE occurs in a non-neglectable proportion of patients, even lower than in cirrhosis, and it is mainly sustained by the presence of large porto-systemic shunt. In these patients, the liver function is usually preserved or only mildly altered, and the development of porto-systemic shunt is either spontaneous or iatrogenically frequent; HE is an example of type-B HE. To date, in the absence of strong evidence and large cooperative studies, for the diagnosis and the management of HE in NCPH, the same approach used for HE occurring in cirrhosis is applied. The aim of this paper is to provide an overview of type B hepatic encephalopathy, focusing on its pathophysiology, diagnostic tools and management in patients affected by porto-sinusoidal vascular disease and chronic portal vein thrombosis.
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Devriendt N, Paepe D, Serrano G, Vandenabeele S, Stock E, Van Acker L, de Rooster H. Plasma amino acid profiles in dogs with closed extrahepatic portosystemic shunts are only partially improved 3 months after successful gradual attenuation. J Vet Intern Med 2021; 35:1347-1354. [PMID: 33949730 PMCID: PMC8162604 DOI: 10.1111/jvim.16135] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 04/07/2021] [Accepted: 04/14/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Dogs with portosystemic shunts have an altered blood amino acid profile, with an abnormal branched-chained amino acid (BCAA)-to-aromatic amino acid (AAA) ratio being the most common abnormality. Different liver diseases have distinctive amino acid profiles. OBJECTIVES Determine the changes in plasma amino acid profiles in dogs with extrahepatic portosystemic shunts (EHPSS) from diagnosis to complete closure. ANIMALS Ten client-owned dogs with EHPSS closed after surgical attenuation. METHODS Prospective cohort study. Medical treatment was instituted in dogs diagnosed with EHPSS. At least 4 weeks later, gradual surgical attenuation was performed. Three months postoperatively, EHPSS closure was confirmed by transsplenic portal scintigraphy. Clinical signs were scored and blood was taken before institution of medical treatment, at time of surgery, and 3 months postoperatively. At the end of the study, the plasma amino acid profiles were analyzed in batch. RESULTS The median BCAA-to-AAA ratio was extremely low (0.6) at time of diagnosis and remained low (0.5) at time of surgery, despite the fact that median neurological score significantly improved from 22 to 2 after starting medical treatment (P = .04). Three months after surgical attenuation, a significantly higher BCAA-to-AAA ratio (1.5) was observed (P < .001). CONCLUSIONS AND CLINICAL IMPORTANCE Medical treatment does not improve the BCAA-to-AAA ratio in dogs with EHPSS, despite substantial clinical improvement. Although the ratio significantly increased after EHPSS closure, it was still indicative of moderate to severe hepatic dysfunction in all dogs.
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Affiliation(s)
- Nausikaa Devriendt
- Small Animal Department, Faculty of Veterinary MedicineGhent UniversityMerelbekeBelgium
| | - Dominique Paepe
- Small Animal Department, Faculty of Veterinary MedicineGhent UniversityMerelbekeBelgium
| | - Gonçalo Serrano
- Small Animal Department, Faculty of Veterinary MedicineGhent UniversityMerelbekeBelgium
| | - Sophie Vandenabeele
- Small Animal Department, Faculty of Veterinary MedicineGhent UniversityMerelbekeBelgium
| | - Emmelie Stock
- Department of Medical Imaging of Domestic Animals and Small Animal Orthopaedics, Faculty of Veterinary MedicineGhent UniversityMerelbekeBelgium
| | - Lisa Van Acker
- Small Animal Department, Faculty of Veterinary MedicineGhent UniversityMerelbekeBelgium
| | - Hilde de Rooster
- Small Animal Department, Faculty of Veterinary MedicineGhent UniversityMerelbekeBelgium
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Favier RP, de Graaf E, Corbee RJ, Kummeling A. Outcome of non-surgical dietary treatment with or without lactulose in dogs with congenital portosystemic shunts. Vet Q 2021; 40:108-114. [PMID: 32194008 PMCID: PMC7170303 DOI: 10.1080/01652176.2020.1745928] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background Congenital portosystemic shunts (CPSS) are vascular anomalies, allowing portal blood to bypass the hepatic parenchyma, thereby accumulating toxic substances such as ammonia in the systemic circulation resulting in hepatic encephalopathy. Aim To evaluate the outcome of non-surgically treated dogs with a CPSS. Methods Case records of 78 dogs with a single congenital CPSS confirmed by ultrasound and/or computed tomography between September 2003 and February 2015 were reviewed. Median age at diagnosis of CPSS in dogs was 10.8 months (range 2–133 months). Non-surgical treatment was started as an adjusted diet (a diet restricted in protein) with or without lactulose. Owners were contacted by telephone to determine survival time and presumed cause of death, if applicable. In addition, a questionnaire was used to retrospectively assess quality of life (QoL) and CPSS scores in 37 dogs before and during non-surgical treatment. Differences between Kaplan–Meier curves were tested by a Log rank test. Results Overall estimated median survival time (EMST) was 38.5 months (range 1 day − 91 months; 78 dogs). No significant differences between EMSTs were found between dogs with extra- (n = 48) or intrahepatic (n = 29) shunts, nor between treatment with only an adjusted diet, or an adjusted diet combined with lactulose. During non-surgical treatment, significant improvement in perceived QoL and CPSS scores were found (P < 0.01). Conclusion Our study demonstrated that an overall median EMST of 3.2 years was reached and that owners retrospectively perceived that non-surgical treatment resulted in an improved QoL and clinical performance, irrespective of intrahepatic or extrahepatic CPSS location.
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Affiliation(s)
- Robert P Favier
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands
| | - Eline de Graaf
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands
| | - Ronald J Corbee
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands
| | - Anne Kummeling
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands
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Devriendt N, Serrano G, Croubels S, Stock E, Vandermeulen E, Paepe D, von Luckner J, de Rooster H. Evaluation of serum lidocaine/monoethylglycylxylidide concentration to assess shunt closure in dogs with extrahepatic portosystemic shunts. J Vet Intern Med 2021; 35:261-268. [PMID: 33432666 PMCID: PMC7848304 DOI: 10.1111/jvim.16030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 12/21/2020] [Accepted: 12/21/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Liver function tests do not always normalize despite successful attenuation of extrahepatic portosystemic shunts (EHPSS). OBJECTIVES Assess the lidocaine/monoethylglycylxylidide (MEGX) test to determine liver perfusion after EHPSS closure. ANIMALS Twenty dogs with EHPSS. METHODS A prospective cohort study was performed and all dogs were tested at diagnosis, 1, 3, and 6 months postoperatively. After collecting a baseline blood sample (T0), 1 mg/kg body weight of lidocaine was injected intravenously. Fifteen (T15) and 30 minutes (T30) later, blood was collected. Plasma concentrations of lidocaine and its metabolites MEGX and glycylxylidide (GX) were determined, using a high-performance liquid chromatography with electrospray ionization tandem mass spectrometry method. Three months postoperatively, transsplenic portal scintigraphy was performed to determine EHPSS closure. RESULTS At T15, median MEGX concentrations were higher in dogs with closed EHPSS compared to diagnosis (33.73 ng/mL [21.11-66.44 ng/mL] vs 13.74 ng/mL [7.25-21.93 ng/mL]; P < .001), but were not different (12.28 ng/mL [10.62-23.17 ng/mL] vs 13.74 ng/mL [7.25-21.93 ng/mL]) in dogs with persistent shunting. Sensitivity to determine shunt closure for MEGX at T15 was 96.2% (95% confidence interval [CI]: 78.4-99.8) and specificity 82.8% (95% CI: 63.5-93.5). CONCLUSIONS AND CLINICAL IMPORTANCE The lidocaine/MEGX test is a promising, rapid, and noninvasive blood test that seems helpful to differentiate dogs with closed EHPSS and dogs with persistent shunting after gradual attenuation.
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Affiliation(s)
- Nausikaa Devriendt
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Gonçalo Serrano
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Siska Croubels
- Laboratory of Pharmacology and Toxicology, Department of Pharmacology, Toxicology and Biochemistry, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Emmelie Stock
- Department of Medical Imaging of Domestic Animals and Small Animal Orthopaedics, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Eva Vandermeulen
- Department of Medical Imaging of Domestic Animals and Small Animal Orthopaedics, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Dominique Paepe
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | | | - Hilde de Rooster
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
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Williams A, Gow A, Kilpatrick S, Tivers M, Lipscomb V, Smith K, Day MO, Jeffery N, Mellanby RJ. Astrocyte lesions in cerebral cortex and cerebellum of dogs with congenital ortosystemic shunting. J Vet Sci 2020; 21:e44. [PMID: 32476318 PMCID: PMC7263922 DOI: 10.4142/jvs.2020.21.e44] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 03/18/2020] [Accepted: 03/23/2020] [Indexed: 01/08/2023] Open
Abstract
Background Congenital portosystemic shunt (cPSS) is one of the most common congenital disorders diagnosed in dogs. Hepatic encephalopathy (HE) is a frequent complication in dogs with a cPSS and is a major cause of morbidity and mortality. Despite HE been a major cause of morbidity in dogs with a cPSS, little is known about the cellular changes that occur in the central nervous system of dogs with a cPSS. Objectives The objective of this study was to characterise the histological changes in the cerebral cortex and cerebellum of dogs with cPSS with particular emphasis on astrocyte morphology. Methods Eight dogs with a confirmed cPSS were included in the study. Results Six dogs had substantial numbers of Alzheimer type II astrocytes and all cases had increased immunoreactivity for glial fibrillary acidic protein in the cerebral cortex, even if there were minimal other morphological changes. Conclusions This study demonstrates that dogs with a cPSS have marked cellular changes in the cerebral cortex and cerebellum. The cellular changes that occur in the cerebral cortex and cerebellum of dogs with spontaneously arising HE are similar to changes which occur in humans with HE, further validating dogs with a cPSS as a good model for human HE.
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Affiliation(s)
- Alun Williams
- Department of Veterinary Medicine, University of Cambridge, Cambridge, CB3 0ES, United Kingdom
| | - Adam Gow
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, The University of Edinburgh, Edinburgh, EH25 9RG, United Kingdom
| | - Scott Kilpatrick
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, The University of Edinburgh, Edinburgh, EH25 9RG, United Kingdom
| | - Mickey Tivers
- Bristol Veterinary School, University of Bristol, Bristol, BS40 5DU, United Kingdom
| | - Vicky Lipscomb
- Department of Clinical Sciences and Services, Royal Veterinary College, London, AL97TA, United Kingdom
| | - Ken Smith
- Department of Pathobiology and Population Sciences, Royal Veterinary College, London, AL97TA, United Kingdom
| | - Michael Oliver Day
- Bristol Veterinary School, University of Bristol, Bristol, BS40 5DU, United Kingdom
| | - Nick Jeffery
- Department of Small Animal Clinical Studies, Texas A&M University, College Station, TX 77843-4474, USA
| | - Richard John Mellanby
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, The University of Edinburgh, Edinburgh, EH25 9RG, United Kingdom.
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Ferreira MDF, Mellanby RJ, Gow AG. Serum melatonin in dogs with congenital portosystemic shunting, with and without hepatic encephalopathy. Vet Rec 2020; 187:e23. [PMID: 31974269 DOI: 10.1136/vr.105245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 10/16/2019] [Accepted: 12/31/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND Melatonin is a hormone produced and secreted primarily by the pineal gland and mainly metabolised in the liver. Increased melatonin concentrations have been reported in human cirrhosis and hepatic encephalopathy (HE), a syndrome of neurological dysfunction. The pathogenesis of canine HE is incompletely understood. Melatonin has been hypothesised as a contributor to the development of HE. The aim of this study was to investigate whether serum melatonin concentrations are increased in canine congenital portosystemic shunting (cPSS), with and without HE. METHODS Medical records were retrospectively reviewed, for which archived (-80°C) serum samples were available. A canine competitive ELISA was used to measure melatonin in two cohorts: dogs with a final diagnosis of cPSS (n=23) with and without clinical signs of HE, and healthy dogs (n=15). RESULTS Melatonin concentrations were not significantly different (P=0.81) between healthy controls (median 27.2 pg/mL, range 19.8-161.5 pg/mL) and dogs with cPSS (median 25.7 pg/mL, range 18.5-244.9 pg/mL). Serum melatonin did not differ between cPSS patients with and without clinical signs of HE (P>0.99). No correlation was found between serum melatonin and blood ammonia (Spearman rank correlation coefficient, rs =-0.41, P=0.08). CONCLUSION Serum melatonin is not increased in canine cPSS with and without HE. We found no evidence that altered melatonin metabolism plays a role in the pathogenesis of cPSS-associated HE.
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Affiliation(s)
- Marisa da Fonseca Ferreira
- Hospital for Small Animals, The Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Roslin, Midlothian, UK
| | - Richard John Mellanby
- Hospital for Small Animals, The Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Roslin, Midlothian, UK
| | - Adam George Gow
- Hospital for Small Animals, The Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Roslin, Midlothian, UK
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12
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Spontaneous gall bladder infarction in a dog with a congenital extrahepatic portosystemic shunt. VETERINARY RECORD CASE REPORTS 2018. [DOI: 10.1136/vetreccr-2017-000557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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13
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Raghu C, Ekena J, Cullen JM, Webb CB, Trepanier LA. Evaluation of potential serum biomarkers of hepatic fibrosis and necroinflammatory activity in dogs with liver disease. J Vet Intern Med 2018; 32:1009-1018. [PMID: 29485210 PMCID: PMC5980386 DOI: 10.1111/jvim.15064] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 01/08/2018] [Accepted: 01/16/2018] [Indexed: 02/06/2023] Open
Abstract
Background Serum interleukin 6 (IL‐6), chemokine ligand 2 (CCL2), C‐reactive protein (CRP), and the ratio of aspartate transaminase to alanine transaminase (AST:ALT) have been correlated with fibrosis and necroinflammatory activity in humans with various hepatopathies. Hypothesis/Objectives To determine whether increases in serum IL‐6, CCL2, CRP, or AST:ALT were associated with moderate to severe fibrosis or necroinflammatory activity in dogs with various hepatopathies. Animals Forty‐four client‐owned dogs with clinical evidence of liver disease and 10 healthy purpose‐bred dogs, all undergoing liver biopsies by laparoscopy or laparotomy. Methods Measurement of serum IL‐6, CCL2, CRP, AST, and ALT before scheduled liver biopsy and evaluation of liver histopathology using the METAVIR scoring system used in human medicine, blinded to clinical presentation. Results Median serum IL‐6 was approximately twice as high in dogs with high fibrosis scores (15.5 pg/mL; range, 1.4 to 235 pg/mL) compared to dogs with low fibrosis scores (7.6 pg/mL; range, 1.4 to 148.1 pg/mL), with marginal significance (P = .05). Median serum CCL2 was significantly higher in dogs with active necroinflammation (444 pg/mL; range, 144 to 896 pg/mL) compared to dogs without detectable necroinflammation (326 pg/mL; range, 59 to 1692 pg/mL; P = .008), but with considerable overlap between groups. Neither serum CRP nor AST:ALT ratios were significantly different based on fibrosis or necroinflammatory scores. Conclusions and Clinical Importance Because of substantial variability among dogs, single measurements of IL‐6 and CCL2 have limited diagnostic utility for identifying fibrosis or necroinflammation, respectively, in dogs with various chronic liver diseases. The value of these biomarkers should be explored further in monitoring response to treatment in individual dogs with chronic hepatopathies.
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Affiliation(s)
- Chantel Raghu
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin
| | - Joanne Ekena
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin
| | - John M Cullen
- Department of Public Health and Pathobiology, North Carolina State University, College of Veterinary Medicine, Raleigh, North Carolina
| | - Craig B Webb
- Department of Clinical Sciences, Colorado State University, College of Veterinary Medicine and Biomedical Sciences, Fort Collins, Colorado
| | - Lauren A Trepanier
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin
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14
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Abstract
This article reviews hepatic encephalopathy (HE) in companion animals. Clinical signs and categories of hepatic disease likely to cause HE are discussed. Ammonia has a key role in pathogenesis and current concepts in body ammonia metabolism are reviewed. Inflammation and manganese accumulation are also thought to be important in pathogenesis. Treatment of HE in acute and chronic cases is discussed along with the rationale for current treatment recommendations. Potential avenues for new treatments and human treatments, which may be transferable to companion animals, are reviewed.
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Affiliation(s)
- Adam G Gow
- Hospital for Small Animals, Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Easter Bush, Edinburgh EH25 9RG, Scotland.
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15
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Craig SM, Fry JK, Rodrigues Hoffmann A, Manino P, Heilmann RM, Suchodolski JS, Steiner JM, Hottinger HA, Hunter SL, Lidbury JA. Serum C-reactive protein and S100A12 concentrations in dogs with hepatic disease. J Small Anim Pract 2016; 57:459-64. [PMID: 27271454 DOI: 10.1111/jsap.12504] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 03/03/2016] [Accepted: 03/04/2016] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To describe serum C-reactive protein and S100A12 concentrations in dogs with hepatic disease and to determine whether there is a relationship between the concentration of either and the severity of hepatic necroinflammation. METHODS Serum C-reactive protein and S100A12 concentrations were measured in 46 dogs undergoing hepatic biopsy. Dogs were divided into three groups: congenital portosystemic shunts, chronic hepatitis and hepatic neoplasia. The histological severity of hepatic necroinflammation was scored. RESULTS C-reactive protein and S100A12 concentrations were greater than the upper limit of the reference intervals in 39 and 26% of dogs, respectively. There was no association of disease group with C-reactive protein (P=0·1733) or S100A12 (P=0·1513) concentrations. There was a positive correlation between serum C-reactive protein concentration and hepatic necroinflammatory activity (rs =0·428, P=0·006). CLINICAL SIGNIFICANCE Increased serum C-reactive protein and S100A12 concentrations were observed in a subpopulation of dogs with various types of hepatic diseases, suggesting acute-phase inflammation and activation of phagocytic cells, respectively. Dogs with higher hepatic necroinflammatory activity scores tended to have higher serum C-reactive protein concentrations. Further studies are needed to confirm this finding in a larger group of dogs.
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Affiliation(s)
- S M Craig
- Gulf Coast Veterinary Specialists, Houston, Texas, 77027, USA
| | - J K Fry
- Gulf Coast Veterinary Specialists, Houston, Texas, 77027, USA
| | - A Rodrigues Hoffmann
- Department of Pathobiology, College of Veterinary Medicine & Biomedical Sciences, College Station, Texas, 77843-4474, USA
| | - P Manino
- Gulf Coast Veterinary Specialists, Houston, Texas, 77027, USA
| | - R M Heilmann
- Gastrointestinal Laboratory, Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, College Station, Texas, 77843-4474, USA
| | - J S Suchodolski
- Gastrointestinal Laboratory, Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, College Station, Texas, 77843-4474, USA
| | - J M Steiner
- Gastrointestinal Laboratory, Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, College Station, Texas, 77843-4474, USA
| | - H A Hottinger
- Gulf Coast Veterinary Specialists, Houston, Texas, 77027, USA
| | - S L Hunter
- Gulf Coast Veterinary Specialists, Houston, Texas, 77027, USA
| | - J A Lidbury
- Gastrointestinal Laboratory, Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, College Station, Texas, 77843-4474, USA
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16
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Lidbury JA, Cook AK, Steiner JM. Hepatic encephalopathy in dogs and cats. J Vet Emerg Crit Care (San Antonio) 2016; 26:471-87. [PMID: 27060899 DOI: 10.1111/vec.12473] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 11/04/2014] [Accepted: 11/07/2014] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To comparatively review the pathogenesis, clinical presentation, diagnosis, and management of hepatic encephalopathy (HE) in dogs and cats. DATA SOURCES The Medline database was searched for articles related to HE in people, dogs, and cats. Articles published within the last 5 years were given special importance. HUMAN DATA SYNTHESIS The pathogenesis of HE is complex and incompletely understood, but ammonia appears to play a central role. Hyperammonemia leads to accumulation of glutamine in astrocytes, with subsequent astrocyte swelling and neurological dysfunction. The development of HE in patients with hepatic cirrhosis is a poor prognostic indicator. The fermentable disaccharide lactulose and the antimicrobial rifaximin are US Food and Drug Administration approved treatments for human HE. Severe protein restriction is no longer recommended for patients with this condition. VETERINARY DATA SYNTHESIS HE is often associated with portosystemic shunting in dogs and cats. Ammonia plays a central role in the pathogenesis of HE in dogs and cats, but other factors such as manganese and endogenous benzodiazepines may also contribute. Recently, a soy protein-based diet was found to be beneficial in treating canine HE. Severe dietary protein restriction is likely to be detrimental in affected animals. There have been no clinical trials of drugs routinely used in the management HE in veterinary medicine, but lactulose and antimicrobials such as metronidazole are well-established treatments. CONCLUSIONS HE is a potentially life-threatening condition that is probably underdiagnosed in companion animals. Although various treatment recommendations have been proposed, there is a lack of evidence in the veterinary literature regarding optimal strategies for the management of this condition. As our understanding of the pathogenesis of HE in dogs and cats evolves, novel diagnostic tests and therapeutic agents may become available.
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Affiliation(s)
- Jonathan A Lidbury
- Department of Veterinary Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, 77843
| | - Audrey K Cook
- Department of Veterinary Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, 77843
| | - Jörg M Steiner
- Department of Veterinary Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, 77843
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17
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Gow AG, Frowde PE, Elwood CM, Burton CA, Powell RM, Tappin SW, Foale RD, Duncan A, Mellanby RJ. Surgical attenuation of spontaneous congenital portosystemic shunts in dogs resolves hepatic encephalopathy but not hypermanganesemia. Metab Brain Dis 2015; 30:1285-9. [PMID: 25936718 DOI: 10.1007/s11011-015-9676-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 04/23/2015] [Indexed: 12/26/2022]
Abstract
Hypermanganesemia is commonly recognized in human patients with hepatic insufficiency and portosystemic shunting. Since manganese is neurotoxic, increases in brain manganese concentrations have been implicated in the development of hepatic encephalopathy although a direct causative role has yet to be demonstrated. Evaluate manganese concentrations in dogs with a naturally occurring congenital shunt before and after attenuation as well as longitudinally following the changes in hepatic encephalopathy grade. Our study demonstrated that attenuation of the shunt resolved encephalopathy, significantly reduced postprandial bile acids, yet a hypermanganasemic state persisted. This study demonstrates that resolution of hepatic encephalopathy can occur without the correction of hypermanganesemia, indicating that increased manganese concentrations alone do not play a causative role in encephalopathy. Our study further demonstrates the value of the canine congenital portosystemic shunt as a naturally occurring spontaneous model of human hepatic encephalopathy.
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Affiliation(s)
- Adam G Gow
- Division of Veterinary Clinical Studies, Easter Bush Veterinary Centre, Royal (Dick) School of Veterinary Studies, The Roslin Institute, The University of Edinburgh, Hospital for Small Animals, Roslin, Midlothian, EH25 9RG, UK,
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18
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Lidbury JA, Ivanek R, Suchodolski JS, Steiner JM. Putative precipitating factors for hepatic encephalopathy in dogs: 118 cases (1991–2014). J Am Vet Med Assoc 2015; 247:176-83. [DOI: 10.2460/javma.247.2.176] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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19
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Lipopolysaccharide and toll-like receptor 4 in dogs with congenital portosystemic shunts. Vet J 2015; 206:404-13. [PMID: 26383860 DOI: 10.1016/j.tvjl.2015.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 05/19/2015] [Accepted: 07/01/2015] [Indexed: 12/12/2022]
Abstract
Surgical attenuation of a congenital portosystemic shunt (CPSS) results in increased portal vein perfusion, liver growth and clinical improvement. Portal lipopolysaccharide (LPS) is implicated in liver regeneration via toll-like receptor (TLR) 4 mediated cytokine activation. The aim of this study was to investigate factors associated with LPS in dogs with CPSS. Plasma LPS concentrations were measured in the peripheral and portal blood using a limulus amoebocyte lysate (LAL) assay. LPS concentration was significantly greater in the portal blood compared to peripheral blood in dogs with CPSS (P = 0.046) and control dogs (P = 0.002). LPS concentrations in the peripheral (P = 0.012) and portal (P = 0.005) blood of dogs with CPSS were significantly greater than those of control dogs. The relative mRNA expression of cytokines and TLRs was measured in liver biopsies from dogs with CPSS using quantitative PCR. TLR4 expression significantly increased following partial CPSS attenuation (P = 0.020). TLR4 expression was significantly greater in dogs that tolerated complete CPSS attenuation (P = 0.011) and those with good portal blood flow on pre-attenuation (P = 0.004) and post-attenuation (P = 0.015) portovenography. Serum interleukin (IL)-6 concentration was measured using a canine specific ELISA and significantly increased 24 h following CPSS attenuation (P < 0.001). Portal LPS was increased in dogs with CPSS, consistent with decreased hepatic clearance. TLR4 mRNA expression was significantly associated with portal blood flow and increased following surgery. These findings support the concept that portal LPS delivery is important in the hepatic response to surgical attenuation. Serum IL-6 significantly increased following surgery, consistent with LPS stimulation via TLR4, although this increase might be non-specific.
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20
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Thieman Mankin KM. Current Concepts in Congenital Portosystemic Shunts. Vet Clin North Am Small Anim Pract 2015; 45:477-87. [DOI: 10.1016/j.cvsm.2015.01.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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21
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Greenhalgh SN, Reeve JA, Johnstone T, Goodfellow MR, Dunning MD, O'Neill EJ, Hall EJ, Watson PJ, Jeffery ND. Long-term survival and quality of life in dogs with clinical signs associated with a congenital portosystemic shunt after surgical or medical treatment. J Am Vet Med Assoc 2015; 245:527-33. [PMID: 25148094 DOI: 10.2460/javma.245.5.527] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare long-term survival and quality of life data in dogs with clinical signs associated with a congenital portosystemic shunt (CPSS) that underwent medical or surgical treatment. DESIGN Prospective cohort study. ANIMALS 124 client-owned dogs with CPSS. PROCEDURES Dogs received medical or surgical treatment without regard to signalment, clinical signs, or clinicopathologic results. Survival data were analyzed with a Cox regression model. Quality of life information, obtained from owner questionnaires, included frequency of CPSS-associated clinical signs (from which a clinical score was derived), whether owners considered their dog normal, and (for surgically treated dogs) any ongoing medical treatment for CPSS. A Mann-Whitney U test was used to compare mean clinical score data between surgically and medically managed dogs during predetermined follow-up intervals. RESULTS 97 dogs underwent surgical treatment; 27 were managed medically. Median follow-up time for all dogs was 1,936 days. Forty-five dogs (24 medically managed and 21 surgically managed) died or were euthanized during the follow-up period. Survival rate was significantly improved in dogs that underwent surgical treatment (hazard ratio, 8.11; 95% CI, 4.20 to 15.66) than in those treated medically for CPSS. Neither age at diagnosis nor shunt type affected survival rate. Frequency of clinical signs was lower in surgically versus medically managed dogs for all follow-up intervals, with a significant difference between groups at 4 to 7 years after study entry. CONCLUSIONS AND CLINICAL RELEVANCE Surgical treatment of CPSS in dogs resulted in significantly improved survival rate and lower frequency of ongoing clinical signs, compared with medical management. Age at diagnosis did not affect survival rate and should not influence treatment choice.
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Affiliation(s)
- Stephen N Greenhalgh
- Department of Veterinary Medicine, University of Cambridge, Cambridge, CB3 0ES, England
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22
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Tivers MS, Handel I, Gow AG, Lipscomb VJ, Jalan R, Mellanby RJ. Attenuation of congenital portosystemic shunt reduces inflammation in dogs. PLoS One 2015; 10:e0117557. [PMID: 25658922 PMCID: PMC4320035 DOI: 10.1371/journal.pone.0117557] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 12/29/2014] [Indexed: 12/15/2022] Open
Abstract
Liver disease is a major cause of morbidity and mortality. One of the most significant complications in patients with liver disease is the development of neurological disturbances, termed hepatic encephalopathy. The pathogenesis of hepatic encephalopathy is incompletely understood, which has resulted in the development of a wide range of experimental models. Congenital portosystemic shunt is one of the most common congenital disorders diagnosed in client owned dogs. Our recent studies have demonstrated that the pathophysiology of canine hepatic encephalopathy is very similar to human hepatic encephalopathy, which provides strong support for the use of dogs with a congenital portosystemic shunt as a naturally occurring model of human hepatic encephalopathy. Specifically, we have demonstrated an important role for ammonia and inflammation in the development of hepatic encephalopathy in dogs with a congenital portosystemic shunt. Despite the apparent importance of inflammation in driving hepatic encephalopathy in dogs, it is unclear whether inflammation resolves following the successful treatment of liver disease. We hypothesized that haematological and biochemical evidence of inflammation, as gauged by neutrophil, lymphocyte and monocyte concentrations together with C-reactive protein concentrations, would decrease following successful treatment of congenital portosystemic shunts in dogs. One hundred and forty dogs with a congenital portosystemic shunt were enrolled into the study. We found that the proportion of dogs with a monocyte concentration above the reference range was significantly greater in dogs with hepatic encephalopathy at time of initial diagnosis. Importantly, neutrophil and monocyte concentrations significantly decreased following surgical congenital portosystemic shunt attenuation. We also found a significant decrease in C-reactive protein concentrations following surgical attenuation of congenital portosystemic shunts. Our study demonstrates that haematological and biochemical indices of inflammation reduce following successful treatment of the underlying liver disorder.
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Affiliation(s)
- Michael S. Tivers
- Department of Veterinary Clinical Sciences, Royal Veterinary College, Hatfield, Hertfordshire, United Kingdom
- * E-mail:
| | - Ian Handel
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, The University of Edinburgh, Roslin, Midlothian, United Kingdom
| | - Adam G. Gow
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, The University of Edinburgh, Roslin, Midlothian, United Kingdom
| | - Victoria J. Lipscomb
- Department of Veterinary Clinical Sciences, Royal Veterinary College, Hatfield, Hertfordshire, United Kingdom
| | - Rajiv Jalan
- UCL Institute for Liver and Digestive Health, UCL Medical School, London, United Kingdom
| | - Richard J. Mellanby
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, The University of Edinburgh, Roslin, Midlothian, United Kingdom
- MRC Centre for Inflammation Research, University of Edinburgh, Edinburgh, United Kingdom
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23
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Kuleš J, Mrljak V, Barić Rafaj R, Selanec J, Burchmore R, Eckersall PD. Identification of serum biomarkers in dogs naturally infected with Babesia canis canis using a proteomic approach. BMC Vet Res 2014; 10:111. [PMID: 24885808 PMCID: PMC4045879 DOI: 10.1186/1746-6148-10-111] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 04/07/2014] [Indexed: 11/30/2022] Open
Abstract
Background Canine babesiosis is a tick-borne disease that is caused by the haemoprotozoan parasites of the genus Babesia. There are limited data on serum proteomics in dogs, and none of the effect of babesiosis on the serum proteome. The aim of this study was to identify the potential serum biomarkers of babesiosis using proteomic techniques in order to increase our understanding about disease pathogenesis. Results Serum samples were collected from 25 dogs of various breeds and sex with naturally occurring babesiosis caused by B. canis canis. Blood was collected on the day of admission (day 0), and subsequently on the 1st and 6th day of treatment. Two-dimensional electrophoresis (2DE) of pooled serum samples of dogs with naturally occurring babesiosis (day 0, day 1 and day 6) and healthy dogs were run in triplicate. 2DE image analysis showed 64 differentially expressed spots with p ≤ 0.05 and 49 spots with fold change ≥2. Six selected spots were excised manually and subjected to trypsin digest prior to identification by electrospray ionisation mass spectrometry on an Amazon ion trap tandem mass spectrometry (MS/MS). Mass spectrometry data was processed using Data Analysis software and the automated Matrix Science Mascot Daemon server. Protein identifications were assigned using the Mascot search engine to interrogate protein sequences in the NCBI Genbank database. A number of differentially expressed serum proteins involved in inflammation mediated acute phase response, complement and coagulation cascades, apolipoproteins and vitamin D metabolism pathway were identified in dogs with babesiosis. Conclusions Our findings confirmed two dominant pathogenic mechanisms of babesiosis, haemolysis and acute phase response. These results may provide possible serum biomarker candidates for clinical monitoring of babesiosis and this study could serve as the basis for further proteomic investigations in canine babesiosis.
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Affiliation(s)
| | | | | | | | | | - Peter D Eckersall
- Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
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24
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Kilpatrick S, Gow AG, Foale RD, Tappin SW, Carruthers H, Reed N, Yool DA, Woods S, Marques AI, Jalan R, Mellanby RJ. Plasma cytokine concentrations in dogs with a congenital portosystemic shunt. Vet J 2014; 200:197-9. [PMID: 24518641 DOI: 10.1016/j.tvjl.2014.01.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 01/09/2014] [Accepted: 01/11/2014] [Indexed: 12/12/2022]
Abstract
Congenital portosystemic shunts (cPSS) are a well-recognised vascular anomaly in dogs. Recent studies have shown an association between inflammation and hepatic encephalopathy (HE), which is a common clinical syndrome in dogs with a cPSS. Pro-inflammatory cytokines such as interleukin (IL)-6 and tumour necrosis factor (TNF)-α are frequently increased in the plasma of human patients with liver disease and have been implicated in the development of HE. In the current study, plasma concentrations of IL-2, IL-6, IL-8 and TNF-α were measured using a multiplex electrochemiluminescence immunoassay in 36 dogs with a cPSS and compared to 25 healthy dogs. There were no significant differences in plasma IL-2, IL-8 and TNF-α concentrations between the two groups; however, plasma concentrations of IL-6 were significantly higher in dogs with a cPSS compared to healthy dogs (P=0.02).
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Affiliation(s)
- Scott Kilpatrick
- Royal (Dick) School of Veterinary Studies, Division of Veterinary Clinical Sciences, Hospital for Small Animals, The University of Edinburgh, Midlothian EH25 9RG, United Kingdom
| | - Adam G Gow
- Royal (Dick) School of Veterinary Studies, Division of Veterinary Clinical Sciences, Hospital for Small Animals, The University of Edinburgh, Midlothian EH25 9RG, United Kingdom; Roslin Institute, Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Midlothian EH25 9RG, United Kingdom
| | - Rob D Foale
- Dick White Referrals, Station Farm, London Road, Six Mile Bottom, Cambridgeshire CB8 0UH, United Kingdom
| | - Simon W Tappin
- Dick White Referrals, Station Farm, London Road, Six Mile Bottom, Cambridgeshire CB8 0UH, United Kingdom
| | | | - Nicola Reed
- Royal (Dick) School of Veterinary Studies, Division of Veterinary Clinical Sciences, Hospital for Small Animals, The University of Edinburgh, Midlothian EH25 9RG, United Kingdom
| | - Donald A Yool
- Royal (Dick) School of Veterinary Studies, Division of Veterinary Clinical Sciences, Hospital for Small Animals, The University of Edinburgh, Midlothian EH25 9RG, United Kingdom
| | - Samantha Woods
- Royal (Dick) School of Veterinary Studies, Division of Veterinary Clinical Sciences, Hospital for Small Animals, The University of Edinburgh, Midlothian EH25 9RG, United Kingdom
| | - Ana I Marques
- Royal (Dick) School of Veterinary Studies, Division of Veterinary Clinical Sciences, Hospital for Small Animals, The University of Edinburgh, Midlothian EH25 9RG, United Kingdom
| | - Rajiv Jalan
- UCL Institute of Hepatology, Royal Free Hospital, Upper Third Floor, UCL Medical School, Pond Street, London NW3 2QG, United Kingdom
| | - Richard J Mellanby
- Royal (Dick) School of Veterinary Studies, Division of Veterinary Clinical Sciences, Hospital for Small Animals, The University of Edinburgh, Midlothian EH25 9RG, United Kingdom; Roslin Institute, Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Midlothian EH25 9RG, United Kingdom.
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25
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Tivers MS, Handel I, Gow AG, Lipscomb VJ, Jalan R, Mellanby RJ. Hyperammonemia and systemic inflammatory response syndrome predicts presence of hepatic encephalopathy in dogs with congenital portosystemic shunts. PLoS One 2014; 9:e82303. [PMID: 24392080 PMCID: PMC3879253 DOI: 10.1371/journal.pone.0082303] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 10/22/2013] [Indexed: 12/29/2022] Open
Abstract
Hepatic encephalopathy (HE) is an important cause of morbidity and mortality in patients with liver disease. The pathogenesis of he is incompletely understood although ammonia and inflammatory cytokines have been implicated as key mediators. To facilitate further mechanistic understanding of the pathogenesis of HE, a large number of animal models have been developed which often involve the surgical creation of an anastomosis between the hepatic portal vein and the caudal vena cava. One of the most common congenital abnormalities in dogs is a congenital portosystemic shunt (cpss), which closely mimics these surgical experimental models of HE. Dogs with a cPSS often have clinical signs which mimic clinical signs observed in humans with HE. Our hypothesis is that the pathogenesis of HE in dogs with a cPSS is similar to humans with HE. The aim of the study was to measure a range of clinical, haematological and biochemical parameters, which have been linked to the development of HE in humans, in dogs with a cPSS and a known HE grade. One hundred and twenty dogs with a cPSS were included in the study and multiple regression analysis of clinical, haematological and biochemical variables revealed that plasma ammonia concentrations and systemic inflammatory response syndrome scores predicted the presence of HE. Our findings further support the notion that the pathogenesis of canine and human HE share many similarities and indicate that dogs with cPSS may be an informative spontaneous model of human HE. Further investigations on dogs with cPSS may allow studies on HE to be undertaken without creating surgical models of HE thereby allowing the number of large animals used in animal experimentation to be reduced.
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Affiliation(s)
- Mickey S. Tivers
- Department of Veterinary Clinical Sciences, Royal Veterinary College, Hatfield, Hertfordshire, United Kingdom
| | - Ian Handel
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, The University of Edinburgh, Roslin, Midlothian, United Kingdom
| | - Adam G. Gow
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, The University of Edinburgh, Roslin, Midlothian, United Kingdom
| | - Vicky J. Lipscomb
- Department of Veterinary Clinical Sciences, Royal Veterinary College, Hatfield, Hertfordshire, United Kingdom
| | - Rajiv Jalan
- UCL Institute for Liver and Digestive Health, UCL Medical School, London, United Kingdom
| | - Richard J. Mellanby
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, The University of Edinburgh, Roslin, Midlothian, United Kingdom
- MRC Centre for Inflammation Research, University of Edinburgh, Edinburgh, United Kingdom
- * E-mail:
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26
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Crawford K, Warman SM, Marques AI, Yool DA, Eckersall PD, McCulloch E, Lynn K, Mellanby RJ, Gow AG. Serum haptoglobin concentrations in dogs with liver disease. Vet Rec 2013; 173:579. [DOI: 10.1136/vr.101306] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- K. Crawford
- Northwest Surgeons; Delamere House, Ashville Point Sutton Weaver Cheshire WA7 3FW UK
- Department of Clinical Veterinary Science; University of Bristol; Langford House Langford Bristol BS40 5DU UK
| | - S. M. Warman
- Department of Clinical Veterinary Science; University of Bristol; Langford House Langford Bristol BS40 5DU UK
| | - A. I. Marques
- Division of Veterinary Clinical Studies; Royal (Dick) School of Veterinary Studies; The Roslin Institute; The University of Edinburgh; Hospital for Small Animals; Easter Bush Veterinary Centre Roslin Midlothian EH25 9RG UK
| | - D. A. Yool
- Division of Veterinary Clinical Studies; Royal (Dick) School of Veterinary Studies; The Roslin Institute; The University of Edinburgh; Hospital for Small Animals; Easter Bush Veterinary Centre Roslin Midlothian EH25 9RG UK
| | - P. D. Eckersall
- Division of Animal Production & Public Health; Faculty of Veterinary Medicine; Institute of Comparative Medicine; University of Glasgow; Bearsden Road Glasgow G61 1QH UK
| | - E. McCulloch
- ReactivLab Ltd; Garscube Estate, Bearsden Rd Glasgow G61 1QH UK
| | - K. Lynn
- ReactivLab Ltd; Garscube Estate, Bearsden Rd Glasgow G61 1QH UK
| | - R. J. Mellanby
- Division of Veterinary Clinical Studies; Royal (Dick) School of Veterinary Studies; The Roslin Institute; The University of Edinburgh; Hospital for Small Animals; Easter Bush Veterinary Centre Roslin Midlothian EH25 9RG UK
| | - A. G. Gow
- Division of Veterinary Clinical Studies; Royal (Dick) School of Veterinary Studies; The Roslin Institute; The University of Edinburgh; Hospital for Small Animals; Easter Bush Veterinary Centre Roslin Midlothian EH25 9RG UK
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27
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Kelley D, Lester C, DeLaforcade A, Webster C. Thromboelastographic Evaluation of Dogs with Congenital Portosystemic Shunts. J Vet Intern Med 2013; 27:1262-7. [DOI: 10.1111/jvim.12130] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Revised: 05/03/2013] [Accepted: 05/21/2013] [Indexed: 11/28/2022] Open
Affiliation(s)
- D. Kelley
- Department of Clinical Sciences; Tufts Cummings School of Veterinary Medicine; Grafton MA
| | - C. Lester
- Department of Clinical Sciences; Tufts Cummings School of Veterinary Medicine; Grafton MA
| | - A. DeLaforcade
- Department of Clinical Sciences; Tufts Cummings School of Veterinary Medicine; Grafton MA
| | - C.R.L. Webster
- Department of Clinical Sciences; Tufts Cummings School of Veterinary Medicine; Grafton MA
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