In this BoardsCast episode, we finish Tobias Chapter 96 — Hepatic Vascular Anomalies with the nightmare every shunt surgeon fears:
The shunt was fixed… and the problems weren’t.
This episode explains why shunt attenuation is not a “cure switch.” It’s a forced physiologic reset — and the complications that follow (especially PANS and portal hypertension) are usually adaptation problems, not surgical mistakes.
You’ll learn:
- Why attenuation is a pressure + adaptation event, not a simple plumbing repair
- What the liver looks like pre-op: underperfused, hypoplastic, low resistance — and why redirecting flow can spike sinusoidal pressure
- Why the danger zone exists: surgery takes an hour, hepatic hypertrophy takes weeks to months
- PANS (post-attenuation neurologic signs): why seizures/blindness/agitation peak at 48–80 hours and how to treat it (CRIs like propofol; Keppra)
- Portal hypertension warning signs, plus the intra-op pressure ranges that define the danger zone (normal ~8–13 cm H₂O; high-risk rises beyond ~17–24 cm H₂O)
- Long-term outcomes: why some dogs improve clinically even if bile acids stay high (MVD or collateral formation) — treat the patient, not the number
Key takeaway: Surgery ends. Physiology begins.
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