Have you ever had a puppy that just presents with lethargy, exercise intolerance and sleeps all the time?
This is normal for my teenage daughters, but not so for a young Lhasa apso that presented to my surgery. Physical exam was unremarkable, but the dog was so sleepy we administered IV fluids to perk it up.
Routine biochemistry revealed a low blood urea nitrogen (BUN), and a urine sample demonstrated the presence of urate crystals.
This triggered a request for a bile acid stimulation test, which showed markedly abnormal elevation postprandial levels.
Our diagnosis of hepatic portosystemic shunt was confirmed at Davies Veterinary Specialists and luckily this was shown to be extra hepatic. So, after some very smart surgery, the dog went on to live an energetic life.