Liver shunt?

Hello vets! My kitten is acting weirder than usual. She was given to me by the previous owners because they were going to separate. She is 6 months old but tiny for her age. She came to us a couple of weeks ago and was happy, bouncing and playing with my other cats right away (they have met before) and had a healthy appetite. In the middle of the night she vomited and after that she was feeling sort of weak, wouldn’t eat and she drooled a lot. She didn’t want to cuddle (which is unusual for her) and she was not interested in her toys. After that it’s been like this sometimes. One second she is fine and the next she is drooling and acting apathetic for a few hours. She hasn’t vomited anymore since that night but we are concerned about her. She is under evaluation by our vet, and they think it might be liver shunt. We have an appointment for an ultrasound in two days. But today she is acting worse than ever. She is drooling so much that her front legs are completely wet and she sleeps more than she has before. And her drool smells really bad. What are the success rates of surgery vs no surgery? Her blood test came back better than expected. Is that normal for a liver shunt? 

Hello - it is not usually possible to diagnose liver shunts from looking at routine blood tests;  the higher blood liver enzymes that we see with most liver diseases in cats, can be completely absent in this relatively unusual condition.  There are some specialised, targetted tests that can be useful eg blood ammonia, or bile acids taken before and after eating.  Ultrasonography is another way to diagnose but clear, definitive diagnosis can require more complex imaging methods eg CT.  It is important when going for tests to first ask how useful they are ikely to be, in terms of how likely they are to answer your question.  Shunts can be congenital (from birth) or acquired (in concurrence with other disease).  Acquired shunts are complicated and carry a poorer prognosis, where as in my experience, perhaps half of congenital (present from bith) shunts can be treated surgically with a positive outllok.  When your vet is ready to talk about statistics and how they relate to your individual cat, good questions include:  how many cats presenting like this would still have a good quality of life 2 / ⁵ / 10 years later?  What outcomes would you expect long term?  Would additional medical management be required?  Are the outcomes from a referral surgeon better than a normal vet?  What level of input is required from you, both financially and in terms of time? Once your vets have managed to gather all the information they can specific to this case, they should be ready to answer your questions.  Wishing you and your little one all the best on this journey.