From episodes 151 and 152 on the Surgery Feed, with Prof Karen Tobias.
So you have your ‘usual suspect’ dog breed for a PSS, and you do a bile acid stim test. But the results come back a bit ‘meh.’ Like 60-something - not normal, but not 100+, as you’d expect for a shunt.
Professor Tobias (yes, THE Tobias!) shared these pearls in our discussion about shunt surgery:
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Those 'kinda-maybe-but-not-quite' bile acid results are often due to a condition called congenital portal vein hypoplasia.
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It’s a non-pathological syndrome where a patient has an underdeveloped portal system, but not an actual shunt.
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Affected patients will always have high-ish bile acids.
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It affects mostly the same breeds that are likely to have shunts, so the small fluffies.
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Prof Karen reckons that two thirds of ‘normal’ Yorkies in the US have it. (She’s likely exaggerating, but you get the point!)
“I would say that the vast majority of our small breed shunt dogs also have that condition, so they'll never have totally normal bile acids. They will never have totally normal ALT.”
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