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===Diagnostic Imaging===
===Diagnostic Imaging===
*Abdominal radiographs shows microhepatica and often renomegaly. Renomegally may relate to altered splanchnic blood flow or o increased metabolic activity of the kidney due to hyperammonaemia. These findings in a young dog is highly suggestive of [[Portosystemic Shunt]]
*Abdominal radiographs shows microhepatica and often renomegaly. Renomegally may relate to altered splanchnic blood flow or o increased metabolic activity of the kidney due to hyperammonaemia. These findings in a young dog is highly suggestive of [[Portosystemic Shunt]].
*Confirmation of a [[Portosystemic Shunt]] requires visualisation of the shunting blood vessel. This may be done with either ultrasonography or contrast portography or at surgery.
==Treatment==
==Treatment==
*Enemas to decrease the amount of bacteria in the colon
===Surgical management===
*Ampicillin PO to reduce the amount of bacteria in intestines and hence decrease the production of ammonia
*Surgical ligation of shunt is recommended in cases of [[Portosystemic Shunt]].
===Medical management===
*Enemas to decrease the amount of bacteria in the colon.
*Oral antibiotics such as ampicillin, neomycin or metronidazole can be given initially reduce the amount of bacteria in intestines and hence decrease the production of ammonia.
*Lactulose PO
*Lactulose PO
**This is metabolised by colonic bacteria are responsible for producing acids, thereby decreasing the pH in the colon. Ammonia is converted into ammonium ions which cannot be absorbed and is therefore lost in the faeces. Lactulose also causes water to be drawn into the colonic lumen, causing diarrhoea, thereby more faeces and bacteria are washed out.
**This is a synthetic disaccharide which is metabolised by the colonic bacteria, acidifying the colon. Ammonia is converted into ammonium ions which cannot be absorbed, hence trapped in the colon and excreted in the faeces. Lactulose also acts as a osmotic laxative, allowing more faeces and bacteria to be washed out.
*High carbohydrate, low protein (2g/kg/day) and low fat diet is recommended.
*A high carbohydrate, low protein (2g/kg/day) and low fat diet is recommended.
**The aim is to provide adequate nutrients and energy to support hepatic tissue repair, reduce the metabolic load on the liver and minimise the development of hepatic encephalopathy
==Prognosis==
==Prognosis==