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Vetdle Archive

Archive Case #92: Canine Portosystemic Shunt

Dog veterinary case - Hard - June 3, 2026

Clinical Clues

  1. A young small breed dog is presented for poor growth and intermittent episodes of staring and disorientation after meals.
  2. The owner says the dog sometimes presses its head and then improves again by the next day.
  3. Body size is smaller than expected for age and breed.
  4. Bloodwork reveals low urea and low albumin, and ammonium biurate crystals are present in the urine.
  5. Bile acid testing is markedly abnormal.
  6. Abnormal blood flow bypassing the liver can cause hepatic encephalopathy and stunted growth in young dogs.

Diagnosis

Canine Portosystemic Shunt

This case is most consistent with Canine Portosystemic Shunt because the dog has postprandial neurologic signs, poor growth, and biochemical evidence of reduced hepatic processing. The most important clues are the bile acid result and ammonium biurate crystals, which make primary brain disease less likely.

Learning review

Review the case evidence

Use the paired clues to explain how the evidence in this dog case supports the provided diagnosis, Canine Portosystemic Shunt, then compare your reasoning with the case explanation.

Evidence checkpoints

Clues 1-2

  1. Clue 1: A young small breed dog is presented for poor growth and intermittent episodes of staring and disorientation after meals.
  2. Clue 2: The owner says the dog sometimes presses its head and then improves again by the next day.

Clues 3-4

  1. Clue 3: Body size is smaller than expected for age and breed.
  2. Clue 4: Bloodwork reveals low urea and low albumin, and ammonium biurate crystals are present in the urine.

Clues 5-6

  1. Clue 5: Bile acid testing is markedly abnormal.
  2. Clue 6: Abnormal blood flow bypassing the liver can cause hepatic encephalopathy and stunted growth in young dogs.

Self-review prompts

  1. After clues 1-2, what evidence from this dog case shaped your initial interpretation?
  2. When you compare clues 3-4 with clues 1-2, what changed in your reasoning about Canine Portosystemic Shunt?
  3. How do clues 5-6 align with the case explanation for Canine Portosystemic Shunt?

Educational Use

Vetdle archive cases are educational veterinary games for diagnostic reasoning practice. They do not provide veterinary advice, diagnosis, treatment, or professional medical guidance.