My dog has high ALT, but vets can't find the cause. What now?

Hello, & thank you for using Petco Pet Education Center, formerly Petcoach. ALT is an enzyme that is released when liver cells are damaged. The normal values are usually less than 100. Unfortunately, the presence of the enzyme does not indicate the cause or reversibility of the damage, nor does it tell us if this is recent, but temporary damage, or on-going problems with the liver. Toxins, including plants, medications, such as steroids, viruses, & endocrine diseases can all cause increases in ALT. If Kobee is not having any problems, then I would recommend retesting in 6 weeks. If Kobee is sick, there are many more diagnostic tests that can be conducted to try & get to the cause of the problem. Often, we actually never find this out, & dogs do very, very well with moderately elevated values. We actually do not even get concerned until the values are at least 3xs normal, or there are other parameters that are abnormal. If Kobee is well, then all I might recommend is discussing with your vet about putting him on a neutroceutical called Denamarin. It can help with oxidative changes in the liver. I hope he does well. Take care.

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!

I would be interested to see what all of these lab results were as it would certainly let me be more helpful, but the liver elevations could be chirossis, hepatitis, or even neoplasia. In the meantime I would start her on Denamarin if she is not already on it, and keep at it with fluid therapy. She may be a good candidate for an exploratory surgery. If you would like, a consult may be a great way for us to go over all of this in depth, and let me collect some more info on her so that I can be more helpful.

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.

ALP is released by the liver when there is damage to the liver cells. Causes can be simply age related, or the elevation can be from diseases like Cushings or Addison’s. It can also be elevated when there is a growth in the liver. I would recommend having your vet retest this value in 2 weeks as long as your dog is doing well otherwise. If it’s still high I’d do more diagnostics (cushings test, ultrasound). Hope that helps and best to you and Olive.

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.

Hello. I am sorry to hear about Iako. ALT and AST can become VERY elevated so the values that you have listed are elevated, but only mildly/moderately so. The AST is mildly elevated. These enzymes need to be >2x for us to even look at them. ALP is usually elevated if the liver is irritated or 'upset'. This can also go up with exogenous steroid administration (which you likely got with the Addison's disease) so it depends on when these bloods were taken in relation to his diagnosis. Dehydration (which often occurs with an Addisonian crisis) or hypotension (also occurs) can make these values elevated. They are sensitive. I would recommend just getting the medications under control for the hypothyroidism and the Addisons, and rechecking the liver values 2 weeks after everything has settled down a bit. Good luck with Iako. The alternative is getting a liver biopsy, however I would just monitor and recheck the liver values first. I am not too concerned with these values.