Clinical Cases

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Just a fussy eater?

Miss Marple is a 8 year old, tiny pug (5kg) from Germany. She was initially fed a normal diet. However, her preference was to eat  apples and vegetables. Only on rare occasions would she eat dog biscuits or boiled chicken. Regardless of her diet she failed to gain weight.IMG_1789

Due to her size, her weird eating habits and her very thin coat, full bloods were run on several occasions throughout her life. The results always came back normal.

In 2010 Miss Marple travelled to New Zealand and started a new life. In quarantine she would only eat boiled potatoes, apple and strawberry yoghurt. After a dental in 2011, it took Miss Marple approximately one week to fully recover from the anaesthetic. Full bloods were run again. Biochemistry was all normal but an elevated white blood cell count was identified.

A year later, Miss Marple started drinking more, and became less active. She was reluctant to exercise and seemed restless during the night. At times she appeared to be disoriented, in pain and unresponsive to her name.

Further veterinary examinations failed to identify any specific health issues. No neurological deficits were detected, urine analysis and X-rays were normal. Bloods were taken for a full biochemistry, pancreas and thyroid check but remained without significant findings apart from a markedly elevated white blood cell count. Miss Marple never vomited or had diarrhoea, but would still refuse to eat normal dog food.

A list of differential diagnoses included: Cystitis, Stomatitis, Encephalitis, Chiari-like syndrome, Pancreatitis, Hypothyroidism, Liver shunt.

With a bile acid study result of 182 fasting and 685 after fatty food (reference range 0-30) it looked very suspicious that Miss Marple was suffering from a liver shunt.

An extrahepatic liver shunt was confirmed by ultrasound examination through a veterinary specialist. An extrahepatic liver shunt can be managed medically or surgically and in Miss Marple`s case she was treated medically. She was immediately put on Hills L/D (liver diet), lactulose and daily antibiotics and responded very well. Miss Marple is still able to eat fruit and vegetables.

A liver shunt is a congenital or an acquired condition. It is a additional blood vessel, which makes the blood bypass the liver by the body’s circulatory system. The liver never has the chance in developing or functioning properly. Therefore toxins accumulate in the bloodstream. Liver shunts are found in dogs and cats, in toy breeds but also in large dog breeds. Acquired shunts are usually multiple and congenital shunts are solitary. We need to differentiate between intra- or extra hepatic shunts. The symptoms vary a lot and  usually appear by at least 6 months of age. Failure to gain weight, vomiting, diarrhoea, excessive thirst or urination, blindness, seizures, depression, bladder stones, long anesthetic recovery and death are all symptoms of a liver shunt. Treatment options are to  either close the shunt surgically (amoroid constrictor or cellophane taping) or manage the symptoms medically.

The photo shows Miss Marple with her friend Rübe – a normal size adult pug.

Note: I, as Miss Marple’s Owner, think there is always a reason in life why things happen the way they do. Miss Marple has found me to be rehomed with as she is now in the best hands to deal with her medical condition. I find it quite astonishing that she managed the liver shunt herself by only eating the things which didn’t make her feel ill over all that time. We hope to have her around for many more years, as she is and always will be our precious little princess


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