A congenital portosystemic shunt in a 16 week old kitten: a medical illustrator's perspective

Abstract

A 16 week old, male, domestic-shorthaired kitten presented to the Cornell University Hospital for Animals Internal Medicine Service for further evaluation of tremors, hind limb weakness, ptyalism post-meals, chronic hematuria, and elevated post-prandial bile acids. The kitten presented with mild bilateral renomegaly and intermittent dull mentation. Bloodwork showed a low BUN and creatinine, increased phosphate and bile acids, and decreased magnesium, globulin, and protein C. Ultrasound evaluations showed a congenital extrahepatic portosystemic shunt and cystic calculus. An exploratory laparotomy revealed an anomalous blood vessel connecting the portal vein to the caudal vena cava. An intraoperative portogram showed no portal blood flow to the liver. Liver biopsy revealed portal arteriolization and mild lipid vacuolar change in hepatocytes. The kitten has been managed well on lactulose, metronidazole, and protein-restricted diet. The author uses this clinical case to discuss the creation of a veterinary medical illustration and the importance of illustration to the veterinary profession.