Why are my dog's liver enzymes elevated again after Udiliv treatment?

Veterinarians use medications like udiliv to treat liver disease and certain gallstones. It helps with regeneration of healthy liver tissue and some dogs stay on the medication long term. Your vet may want to keep your dog on the medication for 3 months and then recheck his bloodwork to see the improvement. If his liver values stay down after coming off the medication than he doesn't need it any longer. If not, he may need to stay on it long term.

Udiliv is ursodeoxycholic acid and is a medication usually prescribed for humans. Are you sure about the dosage for your dog (3000mg twice daily = 6000mg)? A normal dose for a dog would be 10 to 15 mg/kg(2.2lbs) every 24 hours. This would mean your dog (if it is a dog indeed) mean your dog weighs 400kg? Or is it a horse or cow you are asking about? So, unfortunately, without knowing the species of animal I cannot tell you how long it takes to be washed out from the body. It is usually used in aniumals with cholestatic liver disease. Your vet whould be able to answer your question easily, since he knows your animal.

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!

Mild increases in liver values can be seen for a number of different reasons, and sometimes it can be very difficult to determine what the underlying cause might be. Infections like leptospirosis, migrating parasites, congenital diseases like a portosystemic shunt or some toxins can cause liver values to increase. It seems like Leo is on supportive medications for the liver - it would be helpful to know if his values are increasing or decreasing since trends are most important. An abdominal ultrasound might be the next step, or you could also ask about referral to a specialist if available in your area.

These elevations are mild and not specific at this stage, especially if all the other findings at the physical examination are normal. I would recommend to follow the suggestions your local vet gave and repeat the blood tests in 2 weeks time to compare results.

ALT and GGT are both liver enzymes, so usually if they are elevated this would mean that Ginger may have a liver problem of some kind. These values can be elevated in dogs with hepatitis, gallbladder problems, or a tumor in the liver - but if the elevations are fairly mild, they can also be due to normal age-related changes in the liver, in which case there would be no reason to worry. For me personally, in an older pet that is otherwise healthy and does not have any symptoms of a problem, I often recommend repeating blood work in four weeks before doing anything else - liver values can fluctuate quite a bit, and often they are back to normal at the recheck appointment so we don't worry. If they are still elevated after four weeks, then at that point I would usually recommend abdominal x-rays and ultrasound to check for any problems. This is something that you can discuss with your vet if you're concerned, or get a second opinion if needed.

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.