The Case: Claude, one-year-old Chihuahua, brought to AERC’s Emergency Service in the middle of the night. His mom reports he was squatting to urinate, only producing a few drops or no urine at all, and then he would cry out in pain. (CLUE ONE)
Claude’s Treatment
During his initial exam, our team immediately noticed Clause had a very large, painful bladder (CLUE TWO).
X-rays showed a very large bladder, but no clear cause for why he couldn’t urinate. (CLUE THREE).
Claude was given pain medication and a urinary catheter to allow him to urinate freely while our team began a medical investigation to solve the case!
The Ultrasound
X-rays showed no signs of stones, masses, or other structural changes that could explain Claude’s symptoms. Dr. Nevins, our board-certified veterinary radiologist, performed and interpreted an ultrasound of Claude’s entire urinary tract.
Dr. Nevins discovered bladder stones, the cause of Claude’s inability to urinate. The stones had previously lodged in his urethra, causing an obstruction. When the urinary catheter was placed, the stones had flushed back into the bladder (CLUE FOUR).
But Wait…There’s More!
The bladder stones weren’t all the ultrasound revealed. Dr. Nevins made another discovery…
*CRACK* (That’s the sound of the ultrasound – and Dr. Nevins – cracking the case!)
JINKIES! A liver shunt!
So…What’s a Liver Shunt?
In a healthy pet, the blood from the organs in the abdomen is first filtered through the liver before returning to the heart. With a portosystemic shunt (PSS), an extra vessel takes that blood and bypasses the liver. This can cause low blood sugar and build-up of toxins in the body which can severely affect the brain. PSS is a congenital abnormality, meaning Claude was born with this.
Symptoms of a liver shunt include slow or poor growth, lethargy, weight loss, anorexia, diarrhea, vomiting, increased thirst, abnormal mentation, seizures, or head-pressing.
Since a PSS causes abnormal filtering and metabolism, pets are more prone to develop a special type of bladder stone called a urate stone. These stones caused Claude’s urinary obstruction. Since urate stones are made up of ammonia and uric acid, they cannot be seen on x-rays like most bladder stones (which is why they weren’t visible on Claude’s x-rays).
What Does This Mean for Claude?
With this official diagnosis, our team was able to determine the best next steps for Claude. Surgery was needed to close the shunt vessel and remove the bladder stones. However; the surgery couldn’t be performed immediately. For best results, Claude would need to be on medications for a few weeks to help reduce the amount of toxins in his body and stabilize his metabolism.
Once Claude was eating and urinate well without the catheter, he was able to go home. With the plan in place, he waited a few weeks before returning for surgery. Dr. Meyers, one of our board-certified veterinary surgeons, removed the bladder stones and then used a special device called an ameroid constrictor to slowly close the shunt vessel over a period of several weeks. This constrictor is used to prevent the shunt vessel from closing to quickly and causing serious damage to the liver and other organs.
Claude did great during surgery and was able to go home the next day! Case closed.
Update
Claude’s surgery was four months ago, and he is doing great! He has had several recheck appointments to monitor his liver enzymes, blood sugar, and proteins. His mom says he is a happy, spunky boy who has been enjoying the summer sunshine! Soon, he’ll be finished with his medications and prescription diet and go on to live a normal, wonderful life!
Our “Fur-tunately: Stories of Animal Survival” series feature real pets treated by our team at Animal Emergency & Referral Center of Minnesota. All images and information have been shared with the owner’s permission.
