My senior cat's liver enzymes are high. Should she get an ultrasound?

Hi there and thank you for using Petco Pet Education Center, formerly Petcoach to address your concern. The further testing may help with determining what the primary cause is so that treatment can be administered that will help with the condition. However, if you do not want to put Kai through a major surgery or chemotherapy, the further diagnostics that have been recommended would then be more for your own knowledge so you know what the cause is. You could also keep Kai comfortable and start her on liver supplements without doing the further diagnostics and hope for the best. If you are determined to find out what the problem is, then I would proceed with the recommended testing that the veterinarian discussed with you. I hope this helps guide you in the right direction. Please let me know if you have any other questions or concerns and I would be more than happy to help you further. Please take the time to mark this question as helpful or not as it helps us to improve on the quality of our answers to other pet owners. Thank you kindly!

Hello and thank you very much for your question. Because the liver enzymes are increasing, even with liver protectant medications on board, I now believe it is time to perhaps consider a liver biopsy. It is possible that when the original ultrasound was performed, there was a liver specific disease that was not detectable on the ultrasound. So at the very least, I would repeat the ultrasound, as well as try to get a liver biopsy. Make certain that your general practitioner feels confident with this procedure. If they are not, please have them refer you to an internal medicine specialist. Thanks a lot for your question. I hope you find the answer.

Although we can not prescribe treatment via an online method (illegal with our veterinary licenses), what i can tell you is that an ultrasound can not assess liver function. Ultrasound is just an image so it can tell you size and texture changes to organs and evaluate for masses, fluid, etc. Also the good appetite and energy level are not typical with liver failure. Your cat has elevated liver enzymes and total bilirubin but this does not always mean liver failure. I would try to get better clarification from your vet about what was seen on the ultrasound and were the other organs normal (pancreas, GI tract, etc.). More common causes of these bloodwork changes would include liver/biliary infection, pancreatitis, and underlying GI disease associated with the above. Cancer and certain infectious diseases such as FIP can as well. So options would include additional testing to search for a cause (such as pancreatitis testing, liver aspirates, etc.) and/or symptomatic treatment can be attempted for pancreatitis, liver infection, etc. I hope this helps and thank you for using Petco Pet Education Center, formerly Petcoach!

It is unlikely that diet alone is the cause of significant decrease to liver function. I would agree that Royal Canin and Hill's are not very different in terms of dietary quality. I feel that starting on a liver diet at this point based on one blood test is very premature and that further diagnostics are likely warranted. Some possible causes of increased liver values including endocrine conditions, liver shunts, hepatitis, bile duct / gall bladder issues, liver / gall bladder tumors, or fatty liver disease. Depending on the nature and magnitude of the elevation, it may be insignificant as well if Maki's findings were not coupled with any clinical signs of illness. Some additional diagnostic testing to look into things more would be additional more specific blood work, radiographs, and ultrasound. Rather than dietary change, there are more target liver supplements. One that comes to mind is called Denamarin. There is a feline formulation available that would work fine. Hope this helps.

Hello and thank you for contacting Petco Pet Education Center, formerly Petcoach. Liver enlargement means that the liver is bigger than it should be. It could be because of liver inflammation due to infection (bacterial or viral) or toxins ingestion. In young cats like Arya liver tumors are very uncommon, but enlargement of one liver lobe could be caused by a liver abscess or a cyst. The best way to assess liver size is ultrasound scan and/or x-ray. Blood test tells about liver function. In other words, it tells if the liver, ,despite being enlarged or diseased, is still able to maintain its function. Blood test also can assess the extent of liver damage. It is hard to say anything about the prognosis without knowing why the liver is enlarged and what are the blood results. In general, liver have huge capacity to recover from any insult, but again it really depends what has happened.

Without a full history and physical exam report it is difficult to know why they are recommending an ultrasound which is usually used to track changes in size or texture of internal organs, fluid build up and/or tumor growth. I recommend you contact your vets office and speak to the particular vet involved in order to get a better understanding of exactly what they are trying to identify or rule out and this will allow you to make a more informed decision as to the risks and benefits of anesthesia for an older cat with evidence of kidney issues. A full assessment of the entire blood work and any other current symptoms would be needed to discuss in any more detail and your vet should release these to you for a second opinion should you not feel the situation is adequately explained when you speak to them directly

Hello, I am sorry to hear about Ginger. Based on the recheck liver values I would be concerned that Ginger has a problem in her biliary system, such as a GB mucocele or potentially a biliary duct obstruction. I would recommend rechecking the ultrasound to look for either of these developments. One thing that is interesting is that the other values are improving. Did your vet have any concerns about the blood sample when he ran/submitted the bloodwork. If there is a large amount of hemolysis (or breakdown of red blood cells) secondary to a traumatic blood draw or mishandling of the blood tube, this can lead to a false elevation of bilirubin. Although this value seems quite high to be due solely to sample error, I wonder if it may be contributing somewhat. If Ginger has a repeat ultrasound it might also be wise to recheck her total bilirubin level. Hope this helps, good luck!