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She is not eating. she has liver disease n is on nausea n…

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She is not eating...

She is not eating. she has liver disease n is on nausea n liver n milk thistle meds n still will not eat.

Veterinarian's Assistant: I'll do all I can to help. Hopefully it didn't make a mess. Did the dog eat anything unusual?

No. we have been giving her milk with muscle milk to get proteins in her trying natural foods/ people foods

Veterinarian's Assistant: OK. The Expert will know what to do. What is the dog's name and age?

Cinnamon will be 8 on the 12th this month

Veterinarian's Assistant: Is there anything else important you think the Veterinarian should know about the dog?

The vet said her liver was small er tan normal. she has lost weight.she has hard time pooping

Submitted: 6 months ago.Category: Dog Veterinary
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Answered in 1 hour by:
1/3/2018
Dog Veterinarian: Dr. Kara, Veterinarian replied 6 months ago
Dr. Kara
Dr. Kara, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 18,825
Experience: Over 20 years of experience as a veterinarian.
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Hello, I'm Dr. Kara. I have over 20 years of experience as a veterinarian and I'd like to help. Please give me a moment to review your concerns.

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Dog Veterinarian: Dr. Kara, Veterinarian replied 6 months ago

I'm sorry to hear that Cinnamon has been tentatively diagnosed with a small liver and is not eating, losing weight, having a hard time passing stools, and nauseous despite the use of milk thistle and medication for nausea.

Has anyone mentioned the possibility of a portosystemic liver shunt?

This would be my primary concern in a dog with a small liver.

If she has a shunt the good news is that Cinnamon has grown to adulthood, so she must have some part of her liver that has been working. Puppies that are diagnosed young tend to be the most severely affected and thus have the most symptoms.

There are different types of shunts. There can be one abnormal vessel out side the liver that interferes with proper liver development as then the blood supply bypasses the liver. That causes the liver to never develop normally. Or there can be several vessels causing most of the blood to bypass the liver in or outside of the liver. Or there can be multiple tiny blood vessels within the liver which are abnormal.

If the shunt is a single one out side of the liver and can be successfully occluded without raising blood pressure within the liver then surgery is the way to go.

If the shunt is involving multiple small vessels within the liver or if when the shunt is occluded blood pressure within the liver rises then medical/diet therapy is the way to go.

Is your pup of normal size for her breed?

How was this diagnosed? (what made you seek veterinary care for this problem?) The fewer the symptoms the better the patient tends to do in the long run.

If she had some symptoms, a small liver, and an elevated bile acids test then the next step would be imaging studies to identify what type of shunt is present and come up with a plan for treatment.

Really prognosis will depend upon whether they can successfully tie off her shunt.

If so prognosis is very good.

If not then even if they can partially tie it off that will help.

Otherwise medical therapy/diet is the only way to control symptoms, and some dogs do very well on medical therapy alone.

Starting now she'll need a low protein diet (Hills L/d diet, Royal Canin Veterinary Hepatic Formula), antibiotics to control gut flora (which are always abnormal in an animal with a shunt) as well as a medication called lactulose which absorbs some of the toxins produced because the liver isn't normal. Lactulose also helps regulate stool softness. I also recommend a supplement that includes the active ingredient in milk thistle (silymarin) as well as s-adenosyl methionine. A product called Denamarin has both active ingredients and has been tested numerous times to make sure it is effective. These supplements help the liver heal and actually take over some of the liver's function so it is less stressed.

Low doses of an appetite stimulant called mirtazapine may be helpful to get her eating.

I understand that you are trying to stop further weight loss but foods high in protein can worsen her disease and symptoms. I recommend stopping the muscle milk.

If she isn't eating prescription foods for liver disease then perhaps a homemade diet would get her eating.

If you find that she will not eat the prescription diets for liver disease and you need to feed a homemade diet all of the time I recommend consulting with a veterinary nutritionist to design a diet for her. There are recipes available but a recent study found that none were balanced appropriately.
Here is a link to help you find one in your area:
http://www.acvn.org/directory/
Another option is a company called BalanceIt. They sell trace mineral and vitamin supplements to add to homemade diets to make them balanced and will help you formulate a diet for her. Here's a link to their website:
https://secure.balanceit.com/

If they are suspecting a liver shunt highly I recommend letting them try and diagnose it with imaging studies and if it's single shunt try treating it with tying it off.

If it's multiple vessels then give her a try with medical therapy.

You won't know until you try.

I'll give you a link which discusses the different shunts as well as surgery and medical treatment which I hope will be helpful for you:

http://www.acvim.org/websites/acvim/index.php?p=193

And here's another that is a little more about medical treatment:

http://www.michvet.com/Client%20Education%20Handouts/Internal%20Medicine%20handouts/Portosystemic%20Shunts.pdf

This isn't something that can be done at a general practice clinic, the imaging studies require specialized equipment and so does the surgery.

I hope I've addressed your concerns, please let me know if you have any further concerns.

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