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PART II
SOFT TISSUE
CASE BASED EXAMINATION
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FOUR MINUTES
A nine month old entire male West Highland White Terrier is presented with a
history of depression, polyuria, polydipsia and intermittent vomiting.
On clinical examination you find a quiet, underweight dog with mild ascites.
Blood results are shown on the slide.
1. Based on this information give FOUR differential diagnoses.
4pts
2. What is a possible cause of the mild ascites?
1pt
3. List THREE causes of reduced blood urea nitrogen (BUN)
3pts
8pt
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FOUR MINUTES
The dog underwent ultrasonography. A congenital portosystemic shunt was
identified. A urine sample was obtained by cystocentesis.
1. List TWO abnormalities that could be found on urinalysis in this patient.
2pts
2. Briefly explain how EACH of these abnormalities occur with portosystemic
shunts
4pts
The patient underwent three weeks of medical management. Surgical
correction was considered in this patient, but melena was reported at
admission.
The slide shows the results of haematology and coagulation screen.
3. What is your interpretation of the haematology results?
1pt
4. What is the likely cause of the abnormalities in PT and APTT in this
patient?
1pt
5. Based on the laboratory results shown on the slide what would be your
next step prior to surgery?
2pts
10pt
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FOUR MINUTES
There is no image for this slide.
A whole blood transfusion was performed prior to surgery.
6. List THREE KEY steps when ADMINISTERING the blood?
3pts
After the transfusion the dog was pre-medicated and anaesthetised for
surgery.
7. List TWO effects of acepromazine which CONTRAINDICATE its use in this
patient. BE SPECIFIC.
2pts
8. List TWO reasons why halothane should be avoided in patients with
HEPATIC dysfunction.
2pts
7pt
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FOUR MINUTES
An exploratory coeliotomy was performed. Portovenograms were undertaken
with digital subtraction. Both images are shown on the slide.
Image 1 shows the portovenogram before temporary occlusion
Image 2 shows the portovenogram after temporary occlusion
1. Name structures A, B and C on Image 1.
3pts
2. List the TWO clinically significant radiographic findings of Image 2
2pts
3. According to Lee et al (2006) what grade would you assign to the
portovenograms in Images 1 and 2?
2pts
7pt
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FOUR MINUTES
An intraoperative view is shown on the slide. A cellophane band has been
placed around the shunt.
4. List THREE other techniques that can be used to achieve PARTIAL occlusion
of an extrahepatic portosystemic shunt.
3pts
5. What combination of cellophane band and ligaclips has been reported to be
the most secure configuration?
2pts
6. When using cellophane banding, what is the difference in postoperative
clinical grade between dogs with no attenuation versus dogs with partial
attenuation?
1pt
6pt
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FOUR MINUTES
There is no image for this slide
The cellophane band was placed around the shunt with no attenuation and a
liver biopsy was obtained. The patient was recovered from anaesthesia.
7. List TWO most likely short–term complications in THIS case. 2pts
The liver histopathology revealed arteriolar hyperplasia, moderate fibrosis,
biliary hyperplasia and evidence of lipidosis.
8. How does the severity of liver histopathological changes correlate with
long-term survival in dogs with congenital extrahepatic shunts?
1pt
9. List THREE imaging techniques to objectively evaluate long-term clinical
outcome in this patient.
3pts
10. In addition to bile acids and ammonia, what other serum parameter has
been suggested as a potential biomarker when assessing post-operative
progress of PSS patients?
1pt
7pt
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