Why is my dog dazed, falling, and showing elevated liver enzymes?

I assume when you say liver enzymes you mean ALT? There a few enzymes we look at and elevation in 1 value makes us consider different causes then elevation in another. ALT elevation is caused make liver cell injury and leakage of enzymes in to the bloodstream. As the liver sees all the blood of the body it can be quite a reactive organ. So the question is whether the liver enzyme is up because of something wrong with the liver/vessels to liver themselves (such as an infectious or inflammatory cause (hepatitis) or a shunt (more common in younger dogs)) or something the liver is responding too (toxicity, disease of over organs). Unfortunately all parts of sago palm are toxic to dogs with the seeds (nuts) being most toxic. And it can be quite challenging to know if this is the cause. If it is sago it depends on the degree of ingestion as to how severe the case is. Unfortunately the treatment for this is supportive as you have been doing. The values may continue to increase or hopefully may plateau off and remain mildly elevated or decrease again. Ultrasound will help to rule out other things going on in the abdomen, assess the liver for changes in texture (although a liver can appear normal on an ultrasound and not be functionally normal), and sometimes identify a portosystemic shunt. After the ultrasound then sampling either first by fine needle aspirate or with a biopsy (needed for many cases of hepatitis, some other issues) can be performed. Checking platelets and clotting times should be performed prior to liver sampling in patients whose livers are not normal to decrease the risk of bleeding from sampling. As shunts are more common in younger animals , if this is suspected, additional imaging may be recommended prior to sampling as ultrasound will not identify all shunts. There is also a disorder called microvascular dysplasia that can be found in the liver. This is best diagnosed by liver biopsy and the sample sent to a pathologist who specializes in liver pathology. I hope this has helped and not confused you more. It sounds like your vet has taken the appropriate steps thus far and has recommended the next best steps to try to rule out some other causes. Thank you for using Petco Pet Education Center, formerly Petcoach!

Hello, I am sorry to hear about Patches. The blood work that you’ve attached shows that Patches liver enzymes are elevated. There are a variety of causes for elevated liver enzymes including infection, inflammation, old age change, etc. Liver disease can definitely make dogs feel nauseous and have an altered appetite. If Patches is not acting like himself I would recommend having him evaluated by a veterinarian again. Having an abdominal ultrasound performed might be a helpful test as it would allow further evaluation of the liver. I hope this helps, good luck!

It's very hard to tell, he needs to be hospitalized and needs to receive treatment for liver failure, a liver shunt needs to be checked as well, only time will tell if he can be saved or not but this is definitely a very serious condition.

I'm very sorry to hear this. Unfortunately, liver disease is very complex. We notice elevation of the liver enzymes on the blood testing but that does not tell us why the liver is sick - only that it is sick. Multiple tests need to be done and even then, sometimes we can't figure it out. This happens in human medicine too. There are just some cases that are difficult. A liver ultrasound to look at the liver and gall bladder along with a biopsy should be done to look at the liver tissue. That would probably give you the most definitive answer if that has not already been done. ( https://vcahospitals.com/know-your-pet/liver-disease---testing )

There are many different causes that would include hepatitis (which can be bacterial or sterile), cancer, or an issue with his gallgladder. The next step I would recommend is an abdominal ultrasound with fine needle aspirate (FNA) to try to get some information about what is going on in the liver, and possibly a biopsy of the liver after that. The other courses of action is to try treating him to various medications to see if anything helps -- however this doesn't really make sense if he has no signs of illness. Or finally, doing nothing and checking again in 2 months to see if they are rising or staying the same. Sometimes we decide not to get to the bottom of something when there are no clinical signs.

I would be suspicious of a few things to cause these elevations, including: liver disease, or cholestatic disease (involving the gallbladder). Neoplasia also can't be ruled out here. I would highly recommend the next step here to be an abdominal ultrasound and a bile acid test to check the liver function. The ultrasound is valuable here b/c we can get a good look at the gallbladder and check for a mucocoele. I do hope that Bear's condition is able to be managed well moving forward. Best wishes and take care.

Hello and thank you for contacting Petco Pet Education Center, formerly Petcoach. Elevated liver enzymes and abnormal liver appearance on ultrasound scan does not necessary mean liver tumour or liver failure. Older dogs often have abnormal liver appearance, which is not related to any serious underlying problem. Liver enzymes level is a measure of 'damage' to liver cells but it is not directly related to prognosis. Again, older dogs often have mild elevation of liver enzymes I would think that the specialist will perform full abdominal scan and possibly take liver samples through a needle - this is commonly performed procedure in dogs with signs of liver disease. Based on the findings of the aspirate, the doctor will recommend further testing or prescribe treatment for Mars.