My Yorkie has high bile acids with no symptoms. What's the next step?

Thank you for using Petco Pet Education Center, formerly Petcoach. There is no clinical significance to a low amylase, and I do not believe I would have been concerned with this finding. That bile acid result is high, but I don't see a fasting level. I'm not sure if the blood was obtained only once, or if you did a 12 hour fast and then offered a fatty meal and had another blood sample drawn. Regardless of how it was obtained, it is a high value, and I suppose it is hard to completely ignore. There are a couple different ways to approach this. Recommending ultrasound and biopsy is not wrong, but you could be a little more conservative and simply recheck the bile acids in 2-4 weeks. I would definitely recommend a 12 hour fast for the pre-prandial blood draw, and then feeding a fatty meal, and then obtaining another sample two hours later. A single bile acid level is not enough information. If upon recheck the findings are abnormal, then you can feel more justified in pursuing ultrasound and biopsy. I hope this helps.

The bile acids results are certainly consistent with a dog that has a portosystemic shunt. Dogs with liver shunts do not always display the common neurologic signs, like circling or head pressing. Yorkies are also prone to developing lymphangiectasia which could be causing the gassy issue, or even IBD - but I would work up the possible shunt first. I think nuclear scintigraphy is a logical next step based on the information you have provided. Here is some more information about portosystemic shunts: http://www.veterinarypartner.com/Content.plx?P=A&S=0&C=0&A=2533 Intestinal lymphangiectasia: http://www.veterinarypartner.com/Content.plx?P=A&S=0&C=0&A=1381

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 thanks for using Petco Pet Education Center, formerly Petcoach. When you get Rocky I would have your own primary vet repeat the bloodwork to get an updated baseline, and because the units measured and normal range can differ from one lab machine to another. If decreased liver function is suspected, you should plan to run a fasted bile acids (liver function blood test). The next diagnostic step would then likely be an ultrasound with a liver biopsy, if your vet thinks that’s necessary. Of course, I would defer to the vet who’s actually examining the dog, as there may be clues in the exam to justify going a different direction with diagnostics. But this is what I’d be anticipating. Hope this helps.

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!

It is difficult to state exactly what would be the next step if I do not have the actual blood work but if the liver values are elevated I would agree with your veterinarian that an ultrasound is not a bad idea for Tiny. With the ultrasound they will be able to see if it is generalized enlargement and damage or if there are lesion that would be a good thing to biopsy. I would recommend having an internal specialist perform the ultrasound (and biopsy if they feel it is needed). I would not change Tiny's diet yet until they find out what is going on with Tiny's liver. Thank you for using Petco Pet Education Center, formerly Petcoach.

Hello and thank you for contacting Petco Pet Education Center, formerly Petcoach. The blood results show that Finn definitely has some problems with the liver. Some of the liver enzymes and bilirubin are mildly elevated, which is never normal. What is more, ALP and GGT results could not be determined. It means that there was a machine fault when measuring these parameters, or these values were too high for the machine to read. I would suggest to run bile acid stimulation test, ultrasound scan of the liver and repeat the blood test that was run at your vets on the 7/15/20. You may consider running ACTH stimulation test to check for Cushing's disease, but it is unlikely that Finn has this problem. Based on these results, it can be decided what to do next.