한국임상수의학회지 (Journal of Veterinary Clinics)

  • 제20권4호
  • /
  • Pages.508-515
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  • 2003
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  • 1598-298X(pISSN)
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  • 2384-0749(eISSN)
한국임상수의학회 (The Korean Society of Veterinary Clinics)
권호 표지

개의 단순 간내성 간문맥전신단락증의 영상진단학 및 치료 1예

Radiographic and Ultrasonographic Diagnosis of Single Intrahepatic Portosystemic Shunt in a Dog

  • 전혜영 (서울대학교 수의과대학) ;
  • 장동우 (서울대학교 수의과대학)
  • 발행 : 2003.12.01
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초록

A 4-month-old 5.7 kg male Golden retriever with history of seizure, depression, lethargy and anorexia was referred to Veterinary Medical Teaching Hospital, Chungbuk National University. Hematologic examination revealed microcytosis and nonregenerative anemia. Serum chemical values showed increased serum ammonia (423 $\mu$mol/L), ALP (1101 U/L), r-GTP (13.9 U/L) and CPK (1454 U/L), and decreased total protein (4.9 g/dl) and BUN (1.6 mg/dl). Microhepatia was shown in survey abdominal radiographs. Color doppler ultrasonographic examination revealed dilated tortuous vein with turbulent flow within liver parenchyma. Intraoperative jejunoportography and intraoperative ultrasonography confirmed the location and size of single intrahepatic shunt vessel in the left medial liver lobe. Also, the anomalous vessel entering the caudal vena cava was identified beneath the diaphragm. The shunting vessel was ligated with using an Ameroid constrictor. General conditions, hematologic and serum chemical values resolved gradually after surgery. One month after surgery abdominal radiograph showed normal gastric axis and it was consistent whit the normal size liver. Normal echogenecity of liver and enlargement of portal vein were shown in ultrasonography. It is assumed that survey radiography and ultrasonography are useful for diagnosis of single intrahepatic shunt in a dog and especially jejunoportography vein portography and intraoperative ultrasonography are suitable for confirmation of the anatomic location and size of the shunting vessels.

키워드

참고문헌

  1. Birchard SJ, Biller DS, Johnson SE. Differentiation of intrahepatic versus extrahepatic portosystemic shunts in dogs using positive-contrast portography. J Am Anim Hosp Assoc 1989; 25: 13-17
  2. Boothe HW, et al. Multiple extrahepatic shunts in dogs: 30 cases (1981-1993). J Am Vet Med Assoc 1996; 208: 1849
  3. Butterworth J, et al. Selective alterations of cerebral spinal fluid amino acids in dogs with congenital portosystemic shunts. Metab Brain Dis 1997. 12: 299
  4. Center SA, Baldwin BH, Lahunta A, Dietze AE, Tennant BC. Evaluation of serum bile acid concentrations for the diagnosis of portosystemic venous anomalies in the dog and cat. J Am Vet Med Assoc 1985; 186: 1090-1094
  5. Center SA. Hepatic vascular diseases, In: Small animal gastroenterology. 3rd ed. Philadelphia: WB Saunders. 1996: 802-846
  6. Center SA, Magne ML. Historical, Physical examination and clinicopathologic features of portosystemic vascular anomalies in the dog and cat. Semin Vet Med Surg Small Anim 1990; 5: 23
  7. Daniel GB, et al. Per rectal portal scintigraphy using 99mtechnetium pertechnetate to diagnose portosystemic shunts in dogs and cats. J Vet Intern Med 1991; 5: 23 https://doi.org/10.1111/j.1939-1676.1991.tb00926.x
  8. Fossum TW. Surgery of the liver, In: Fossum TW, ed. Small animal surgery. St Louis: CV Mosby Co 1997: 367-388
  9. Griffiths GL, Lumsden JH, Valli VEO. Hematologic and biochemical changes in dogs with portosystemic shunts. J Am Anim Hosp Assoc 1981; 17: 705-710
  10. Havig M, Tobias KM. Outcome of ameroid constrictor ligation of single congenital extrahepatic poitosystemic shunts in cats. J Am Vet Med Assoc 2002; 220: 337 https://doi.org/10.2460/javma.2002.220.337
  11. Hunt GB, Hughes J. Outcomes after extrahepatic porto-systemic shunt ligation in 49 dogs. Aust Vet J 1999; 77: 303 https://doi.org/10.1111/j.1751-0813.1999.tb10268.x
  12. Koblik PD, Hornof WJ, Breznock EM. Use of quantitative hepatic scintigraphy to evaluate spontaneous portosystemic shunts in 12 dogs. Vet RadioI 1983; 24: 232-236 https://doi.org/10.1111/j.1740-8261.1983.tb00721.x
  13. Kyles AE, Gregory CR. Jackson J, Ilkiw JE. Pascow PJ. Adin C, Samii V, Herrgesell E. Evaluation of a portocaval venograft and Ameroid ring for the occlusion of intrahepatic portocaval shunts in dogs. Vet Surg 2001; 30:161-169 https://doi.org/10.1053/jvet.2001.20333
  14. Laflamme DP, Mahaffey EA, Allen SW, Twedt DC, Presse KW, Huber TL. Microcytosis and iron status in dogs with surgically induced portosystemic shunts. J Vet Intern Med 1994; 8: 212-216 https://doi.org/10.1111/j.1939-1676.1994.tb03218.x
  15. Lamb CR. Ultrasonographic diagnosis of congenital porto-systemic shunts in dogs: Results of prospective study. Vet Radiol Ultrasound 1996; 37: 281 https://doi.org/10.1111/j.1740-8261.1996.tb01231.x
  16. Laurence D, Bellah JR, Diaz R. Results of surgical management of portosystemic shunts in dogs: 20 cases (1985-1990). J Am Vet Med Assoc 1992; 201 : 1750-1753
  17. Maddison JE. Hepatic encephalopathy. Current concepts of the pathogenesis. J Vet Intern Med 1992; 6: 341 https://doi.org/10.1111/j.1939-1676.1992.tb00367.x
  18. Martin RA, Payne JT. Seminars in Veterinary Medicine and Surgery (Small Animal) 1990; 5: 134
  19. Matushek KJ, Bjorling D, Mathews K. Generalized motor seizures after portosystemic shunt ligation in dogs: Five cases (1981-1988). J Am Vet Med Assoc 1990; 196: 2014-2017
  20. Meyer DJ. Liver function tests in dogs with portosystemic shunts: Measurement of serum bile acid concentration. J Am Vet Med Assoc 1986; 188: 168-169
  21. Murphy ST, Ellison GW, Long M, et al. A comparison of the ameroid constrictor versus ligation in the surgical management of single extrahepatic portosystemic shunt. J Am Anim Hosp Assoc 2001; 37: 390-396
  22. Porster van Hijfte MA, et al. Per rectal portal scintigraphy in the diagnosis and management of feline congenital portosystemic shunts. J Small Anim Pract 1996; 37: 7 https://doi.org/10.1111/j.1748-5827.1996.tb01925.x
  23. Roudebush P, et al. Hepatobiliary disease, In Hand MS, et al (eds). Small Animal Clinical Nutrition. Mark Morris Institute, Topeka, Kan, 2000: 811
  24. Schunk CM. Feline ponosystemic shunts. Semin Vet Med Surg Small Anim 1997; 12: 45
  25. Sleight DR, Thomford NR. Anatomical Record 1970; 166:153 https://doi.org/10.1002/ar.1091660204
  26. Swalec KM. Portosystemic shunts. In Bojrab MJ, et al (eds). Disease Mechanisms in Small Animal Surgery. Lea & Febiger, Philadelphia, 1993: 298
  27. Tiemessen I, et al. Ultrasonography in the diagnosis of congenital portosystemic shunts in dogs. Vet Q 1995; 17: 50
  28. Tobias KMS, et al. Surgical approaches to single extrahepatic portosystemic shunts. Compend Contin Educ Pract Vet 1998; 20: 593
  29. Tobias KMS, Rawlings CA. Surgical techniques for extravascular occlusion of intrahepatic shunts. Compend Contin Educ Pract Vet 1996; 18: 745
  30. Vogt JC, Krahwinkel DJ, Bright RM, Daniel GB, Toal RL, Rohrbach B. Gradual occlusion of extrahepatic portosystemic shuns in dogs and cats using the Ameroid constiictor. Vet Surg 1996; 25: 495-502 https://doi.org/10.1111/j.1532-950X.1996.tb01449.x
  31. Vulgamott JC. Portosystemic shuns. Vet Clin North Am Small Anim Pract 1985; 15: 229-242
  32. Watson PJ, Herrtage ME. Medical management of congenital portosystemic shunts in 27 dogs-a retrospective study. J small Anim Pract 1998; 39: 62 https://doi.org/10.1111/j.1748-5827.1998.tb03595.x
  33. White RN, Burton CA, McEvoy FJ. Surgical treatment of intrahepatic portosystemic shunts in 45 dogs. Veterinary Record 1998; 142: 358-365 https://doi.org/10.1136/vr.142.14.358
  34. Whiting PG, Peterson SL. Portosystemic shunts, In: Textbook of small animal surgery, 2nd ed. Philadelphia: WB Saunders. 1993: 660-677
  35. 연성찬, 남치주. 미생숙견에서 Portosystemic shunt (PSS) 의 증례. 서울대 수의대논문집 1998; 23: 55-62
  36. 정성목, 이충호, 양정환, 김완희, 최민철, 윤정희, 이주명, 권오경, 남치주. Ameroid Constrictor를 이용한 개에서의 단순 간외성 간문맥전신단락증의 치료. J Vet Clin 2001; 18(4): 442-447