Why is my dog's ALT high, spleen swollen, and no diagnosis found?

ALT is one of the most important liver indicators in dogs and cats. It can also be elevated in dogs and cats when there is significant damage to the muscle, but in general it is thought of as a fairly sensitive marker for some type of liver damage. There are also several other markers for liver disease, so only knowing about the elevations in ALT may be misleading. If ALT was the only marker elevated, this is usually an indication of an inflammatory or infectious disease causing harm to the hepatic system. If you would like to discuss all of the laboratory testing and diagnostic imaging performed by your veterinarian, I would be able to take a closer look at your dog's situation. Let me know if I, or one of the other experts, can help you out in any way.

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!

Hi there and thank you for using Pet Coach to address your concern. With these results I would advise you to have an abdominal ultrasound performed on Maxi to find out why the liver enzyme is elevated and abdomen swollen. This will give more detailed information on what the liver looks like and if there are any abnormalities in the abdomen. I hope this helps! Please let me know if you have any other questions or concerns.

This may be due to a congenital disorder (liver shunt) but ideally the ALT should be interpreted considering the reference ranges given by the lab. More tests should be ideally discussed (test of liver functionality like bile acids or ammonia or bile acids stimulation tests) in order to identify specifically the problem and give you a specific answer. If you have them, please write to us again or request a consultation and upload all the results of the tests available. Please do not hesitate to contact us again on the forum or by requesting a consultation if you have any more questions or to discuss it any further.

Thank you for using Petco Pet Education Center, formerly Petcoach! Abnormal liver enzymes typically indicate a more acute injury, and can actually return to normal as conditions become more chronic. Fluid build up can be due to low proteins in the blood, which are not being made by the liver or lost through the intestines or kidney. I hope this helps and am happy to answer any other questions you may have, or take a look at any results you have from Kimi.

Elevated ALT does not mean certain death for your dog, many blood test come back with elevated ALT and it is eventually treatable in most cases. Denamarin can help liver function in general but not always. if Prednisone is suspected to be the cause it may need to be stopped gradually.

My first question is whether your veterinarian tapped the abdomen to get a sample of the fluid....if so... what was it. With sudden abdominal distension, low red blood cell count I would be most concerned about a bleeding tumor. The fact that liver enzymes were elevated days following a steroid injection is hard to evaluate because the steroid injection wound cause a spike in the liver values....so were they elevated to start with or only following steroid administration. The best thing to do here is have an abdominal ultrasound and collect fluid. If the fluid is blood...there is likely a bleeding tumor. If the fluid is not blood....she may have right sided heart disease (heart worms or other cause), some type of cancerous process somewhere or other chronic metabolic disease. If you are uncertain about your veterinarian, ask for a referral for an ultrasound or seek a second opinion. I hope you find some answers . Thank you for using Petco Pet Education Center, formerly Petcoach.