# Testing Puppies for Liver Shunt



## Ladysmom (Oct 19, 2004)

To be sure that you are buying a healthy puppy, you should NEVER buy a puppy from a breeder who does not test the pups for liver shunt. NEVER buy a puppy without seeing the results of it's SERUM BILE ACID TEST. You should get a copy of the test results when you buy your puppy. This test should be done between 9 and 12 weeks, ideally at 10 weeks of age. There should be 2 sets of results. The 12 hour "fasting" result, and then the second result that is done 2 hours after the puppy has eaten. Both readings should be under 25, and it is normal for the second reading to be a little higher than the first, but still below 25. 

Many breeders will try to tell you that "I don't need to test, I have never had a puppy with liver shunt in my lines", or "My dogs are healthy". These are just excuses, and not very good ones at that! No breeder can tell by looking at their dogs. Just because the parents of your puppy do not actually have Liver Shunt, it does not mean that they are not carries of this deadly disease, and it is possible that they can produce a puppy with it. It can pop up in any line of yorkies, at any time. There is no guarantee that your pup will be free of the HEREDITARY form of this disease, unless you have a blood test. 

AVOID A BREEDER IF THEY DO NOT TEST THEIR PUPPIES.



I can not think of a single reason that an ethical breeder would not do this test. It does not cost that much money for each test, and the peace of mind just knowing that your pups are healthy, and free of the hereditary form of this disease is well worth any amount of money spent. 


I ADMIT THAT I DO NOT KNOW EVERYTHING THAT THERE IS TO KNOW ABOUT YORKIES, BUT I DO KNOW RIGHT FROM WRONG.....







The following information on this page was taken from Dr. Karen Tobias, DVM, MS, Diplomate ACVS. Dr. Tobias' Email - [email protected]



What is a Liver Shunt? 
A Liver Shunt is a blood vessel that carries blood around the liver, instead of through it. In some animals a liver shunt is a birth defect, known as "congenital portosystemic shunt". In others, there are multiple small shunts, known as "acquired porotsystemic shunts", and they form because of severe liver disease such as cirrhosis.
Toxins, especially ammonia, build up in the blood stream and the dog has seizures due to increased ammonia levels. The liver is usually smaller than normal and will have decreased liver function. Secondary liver infection can occur but this plays a minimal role in the liver shunt syndrome. It is the bypassing of the blood thru the liver that is the major problem. 
The symptoms of liver shunt can start to appear at almost any age. Dogs with a liver shunt are usually very thin dogs that pick at food. They not only have a poor appetite but they can become lethargic, dizzy, and stagger. They may try to climb out of their pen, climb higher on you, and cry and throw their head far back after eating, and they may go into convulsions. 

Many breeders feel that it is an inherited disease and that the only way to eliminate that disease is to cull those dogs that are affected and producing this disease from their breeding program. SO FAR, IT HAS NOT BEEN PROVEN THAT THIS IS INDEED A HEREDITARY DISEASE, but it will probably be proven with the DNA studies that are being done right now. If a puppy has a test score that says it is free of liver shunt, it will never develop the hereditary type, but ANY YORKIE can develop an acquired liver shunt due to poor diet, high protein diet, stress, and other factors.

Before you buy a puppy, you should INSIST on seeing BILE ACID fasting/feeding test results that a good breeder has had done at the age of 9 to 12 weeks of age. The readings should be BELOW 25. I would hesitate to buy a pup without this test, and with a test result that is over the 25 limit.

There are studies being done at this very moment, and they are on the verge of finding the DNA marker that will be able to test both sire and dam BEFORE they are bred, and this should go a long way in terminating this horrible disease.

Many toy breeds are affected, but yorkies, in the United States, have almost a 36 times greater risk of developing shunts than all other breeds combined!

The other breeds where liver shunt is a problem are: Schnauzers, Cairn Terriers, Maltese, Dachshunds, Cocker Spaniels, Jack Russel Terriers, Shih-Tzu, Lhasa-Apso, and Poodles.

Liver shunt Acquired vs. Congenital
Acquired shunts can form with severe liver disease or other conditions that cause high blood pressure in the liver. Shunts usually connect the portal vein, which normally carries blood from the intestines to the liver, to the caudal vena cava, which carries blood from the legs and kidneys to the heart. If blood pressure in the portal vein gets too high- maybe from scar tissue or severe swelling in the liver- shunts will form to carry the blood somewhere else. If there was a toxin in the food that caused severe liver swelling and scar tissue formation, then that could cause shunts to form. However, most dogs are very sick with the liver disease before they form acquired shunts and most continue to have health problems afterwards.
In other words, if their liver is so damaged that they form shunts (like people with alcoholism and cirrhosis), it usually remains damaged. Some shunts may get smaller as the liver swelling goes down. Many veterinarians only guess that a shunt is there based on blood work changes. We have seen several older dogs that have congenital shunts that are fine unless they get another illness; then the problem of the shunt shows up. Once the other illness resolves, the shunt may not cause noticeable problems (at least, the owners may not detect them). 

There is a big debate as to whether liver shunts are hereditary. A disease is likely to be hereditary if it occurs more commonly in one breed than others, if it occurs in a family of dogs, or if it or a closely related disease is proven hereditary in other breeds or species. 

To date, liver shunts are considered to be hereditary in Irish Wolfhounds, Cocker Spaniels, Maltese, and Yorkshire Terriers, and are probably hereditary in several other breeds. The affected dog should be castrated or spayed and, because of the mode of inheritance is not known, it is best to avoid breeding the parents of the affected dog.

Do all dogs with shunts have high bile acid results?
Dogs with shunts will almost always have high bile acids 2 hours after eating, and at least 95% of dogs will have high bile acids after a 12 hours fast. For the most accurate test results, samples are taken after a 12 hour fast, and then repeated 2 hours after feeding. This is done for several reasons. Some dogs normally release bile acids in the middle of the night, and therefore would have a higher fasting result. Other dogs may have fat in their blood after eating, which could interfere with the results. If only one sample can be obtained, it is best to take it 2 hours after feeding.

Do all dogs with high bile acids have shunts?
Bile acids can be increased with any liver disease. Bile acids can also be mildly increased in normal dogs, particularly in some breeds (such as the Maltese) where chemicals that naturally occur in their blood interfere with the test. Most dogs with liver shunts have after feeding results of well over 100 (normal is 15-20). If the bile acids are only slightly increased, the vet may want to re run the test in 3 to 4 weeks.



Treatment 
This disease usually goes hand in hand with a kidney disorder and it seems that a special diet can sometimes keep it under control with some dogs for a time. Surgery sometimes works depending on where the "shunt" is, and how large it is. Ameroid constrictor surgery is now being done on some LS victims, with a very high success rate. If your dog has been diagnosed with high bile acids, I would advise you to contact Dr. Karen Tobias for a referral.



For more information on this subject, please refer to:

Dr. Karen Tobias, DVM, MS, Diplomate ACVS
Professor, Small Animal Surgery
University of Tennessee College of Veterinary Medicine
Regent, American College of Veterinary Surgeons
President, Society of Veterinary Soft Tissue Surgery
University of Tennessee College of Veterinary Medicine

University Phone (865)974-8387
FAX (865) 974-5554
Dr. Tobias' Email - [email protected]


http://www.vet.utk.edu/clinical/sacs/shunt/faq.shtml


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## Sisses Momma (Dec 29, 2004)

Thanks again Marj for a great article!! As I have said before, we have already started a "Sisse" fund just in case...... :new_Eyecrazy:


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## Furbaby's Mommie (Jul 10, 2004)

Thanks for the article Marj. Very informative.


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## Tavish (Feb 5, 2005)

I'm not sure if this posting was meant to be just for owners of Yorkies, or if it is recommending the tests be done for both Maltese _and_ Yorkies, but there is data available that suggests Maltese tend to have scores higher than the "normal" levels associated with bile acid level readings. As such, in the Maltese breed, it is not recommended that you rely completely on bile acids results to determine the possibility of a liver shunt.


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## jmm (Nov 23, 2004)

I have the study on Maltese. They hypothesized the cause of the elevated bile acids as a chemical in Maltese that isn't present in other breeds. Nobody actually knows if this is the case, if we have a lot of MVD, or what. Other vets have hypothesized that there is a high rate of asymptomatic MVD in the breed. 

So, bile acids is a good starting point with Maltese along with a chemistry panel. From there, ammonia tolerance testing can be done and, depending on the numbers, scintigraphy. On a bitch sold as pet, a liver biopsy can be take at the time of spay. 

Most vets use 25 or 30 as the upper end of normal for bile acids in a Maltese. 

According to Dr. Sharon Center at Cornell, elevated bile acids are not normal for Maltese, but in some dogs they could potentially not be an indicator of disease.


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## k/c mom (Oct 9, 2004)

> _Originally posted by JMM_@Apr 16 2005, 10:04 PM
> *I have the study on Maltese. They hypothesized the cause of the elevated bile acids as a chemical in Maltese that isn't present in other breeds. Nobody actually knows if this is the case, if we have a lot of MVD, or what. Other vets have hypothesized that there is a high rate of asymptomatic MVD in the breed.
> 
> So, bile acids is a good starting point with Maltese along with a chemistry panel. From there, ammonia tolerance testing can be done and, depending on the numbers, scintigraphy. On a bitch sold as pet, a liver biopsy can be take at the time of spay.
> ...


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Jackie, are all of those tests necessary no matter what or does one proceed with more and more testing if the early results are suspicious?


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## jmm (Nov 23, 2004)

If the bile acids results are suspiciously elevated or the dog has elevated liver enzymes, further testing (ammonia tolerance, scintigraphy, ultrasound depending on the elevation) are recommended. No decent vet is going to recommend surgery or something drastic for a dog with slightly elevated bile acids but otherwise normal indications of liver function and no problems. Bile acids 100+ post prandial definately need to be looked in to in any breed of dog. This may be indicative of a liver shunt which can actually go unnoticed for years before causing problems because the liver has shrunk so much. 

I think the fact that Maltese tend to have elevated bile acids has been thrown around as normal too much. I use to think it was normal until I spoke with liver specialists and found out they actually didn't know why. There is a more expensive way to measure bile acids which can be done for Maltese, but very few places have the ability to do it...


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## Tavish (Feb 5, 2005)

Have you looked into the studies done in Australia? I remember reading about one that showed bile acid levels in healthy maltese much higher than the 25 most look for. The post results ranged from 20 to over 100, and many of the pre results were high as well. After further testing none were found to have liver shunts. Of course, this isn't to say that if you have a reading over 25 you shouldn't investigate further, however it is interesting to note that there is no other breed which seems to fluctuate as widely in results as the Maltese when it comes to bile acids.


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## jmm (Nov 23, 2004)

> _Originally posted by Tavish_@Apr 16 2005, 10:42 PM
> *Have you looked into the studies done in Australia? I remember reading about one that showed bile acid levels in healthy maltese much higher than the 25 most look for. The post results ranged from 20 to over 100, and many of the pre results were high as well. After further testing none were found to have liver shunts. Of course, this isn't to say that if you have a reading over 25 you shouldn't investigate further, however it is interesting to note that there is no other breed which seems to fluctuate as widely in results as the Maltese when it comes to bile acids.
> <div align="right">index.php?act=findpost&pid=53392*


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I have the 1995 Tisdall study. They only biopsied a total of 9 dogs...so who knows about the rest. MVD was only published on by Sharon Center in 1995 and in the Tisdall article, they briefly mention the possibility. They did not do scintigraphy on the other dogs, only ammonia tolerance tests... According to Sharon Center, we still don't know enough.


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## Tavish (Feb 5, 2005)

Nine is a pretty small number. The studies done in Australia included over 100 Maltese.


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## jmm (Nov 23, 2004)

> _Originally posted by Tavish_@Apr 18 2005, 12:12 AM
> *Nine is a pretty small number. The studies done in Australia included over 100 Maltese.
> <div align="right">index.php?act=findpost&pid=53645*


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This is the same study. They did bile acids on over 100 but only biopsied 9.


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## kodie (Aug 24, 2004)

> _Originally posted by JMM_@Apr 16 2005, 09:26 PM
> *No decent vet is going to recommend surgery or something drastic for a dog with slightly elevated bile acids but otherwise normal indications of liver function and no problems.*


its funny you said that because thats how i felt when the first place i took kodie wanted to do EXPLORATORY SURGERY on him without further testing. This makes me so MAD. I am glad i listened to myself and went somewhere else. 

Not to talk bad about vet offices but red bank in NJ is the place that wanted to just cut kodie open.


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## jmm (Nov 23, 2004)

I pulled out the study...

200 Malts had bile acids
106 with elevated bile acids had ammonia tolerance testing
11 had biopsies

"A large proportion of healthy Maltese of all age groups had increased PPSBA concentrations compared with mixed-breed dogs. It is unclear why this should be so. Recognition and investigation of this phenomenom is important because of its potential to confound the clinicopathological evaluation of sick Maltese dogs" (Tisdall, et al 1995:125)

Sorry I got the biopsy number mixed up with another number...but 11/200 still is rather insignificant IMO. 

So, bile acids are a starting point, but not the end all and be all of testing.


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