It’s a fully-booked surgery day in your first job as a new grad veterinarian in a busy general practice, with four spays, two neuters, and several dentals on the schedule. As you perform pre-surgical exams on your patients for the day, you notice that one of your spay patients, a Maltese puppy, is extra-tiny and a bit on the skinny side (BCS 3/9).
The remainder of her physical exam is normal, but preanesthetic blood work reveals multiple liver enzyme elevations. You also note mild hypoglycemia and hypoalbuminemia, along with microcytic anemia. Your mind immediately jumps to the possibility of a portosystemic shunt (PSS).