My senior cat's liver enzymes are rising on Denamarin. What's next?

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!

Hi, yes in cats even small changes in liver enzymes can be significant and are worthy further investigations. An ultrasound will have a look at the liver structure and biliary tree and will definitely provide more useful information.

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 your interesting question. The first thing I would do is schedule another blood work up appointment to look at the liver enzymes in about two weeks after the first sample was taken. If the liver enzymes, specifically ALT, are still elevated, then there is some evidence that there’s been hepatocellular or liver disease or damage. I understand the veterinarian not wanting to test for Cushing’s disease, especially with the age and the lack of symptoms. But if the enzymes are still elevated, I would ask the vet if it would be worthwhile to start a liver protectant daily medication such as Denamarin. This medication given daily could potential he slow the damage to the liver cells and you may never exhibit clinical signs for the remainder of life and this medication has very little side effects. The other thing that you could possibly do if the liver enzymes are elevated used to start a liver protectant diet which is usually a prescription diet that is dispensed that your veterinary clinic. Again, these are two fairly easy, noninvasive ways to protect your pets liver from whatever is causing the cellular damage. I hope I’ve given you some information that helps. Have a great day.

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!

Hello. There are many underlying causes for high liver values, some more serious than others. The beauty of our livers is it is the only organ that can heal & regenerate once an insult is removed. I am not sure what your veterinarian hoped to accomplish keeping Lucy over night, but if she is otherwise feeling well, use of the Denamarin & prudent monitoring of the liver values is a good start. It would be helpful to obtain a bile acid assay & abdominal ultrasound to try & get as much information as possible about the liver, but the Denamarin can protect the liver from further oxidative injury. It will not help much if this is cancer, or an active hepatitis or infection, but it has helped to bring the enzyme levels down in some patients. Once you can obtain more detailed information about the liver can you determine how absolutely serious this might be. Stay in contact with your vet & try to follow their recommendations as closely as possible. Hopefully, Lucy will do very well. Thanks for using Petco Pet Education Center, formerly Petcoach.

Likely not but it depends on the reason for the liver enzyme elevations. I recommend to clarify the follow up steps needed for Mister with your veterinarian. I hope this helps and please feel free to post any additional questions.