Dog lethargic, won't eat, elevated liver enzymes. What to do?

I would strongly recommend to have his bile acids ran to see if his liver is functioning properly. I would also recommend to have an abdominal ultrasound with possibly liver biopsies by an experience ultrasonographer or radiologist so you can find out more information about his liver. This could be due to a toxin that you are unaware of, copper storage disease, cancer, a bacterial infection or something else. I think more diagnostics need to be done to determine the cause and therefore the best treatment for him. I hope this helps!

Thanks for using Petco Pet Education Center, formerly Petcoach. First of all, each lab company/machine has its own “normal” ranges so I cannot exactly interpret this. But I will say, compared to the reference ranges I am used to, these are all pretty mild elevations. Unfortunately livers elevations can be mildly or moderately elevated for about a dozen reasons including: gastrointestinal upset, trauma to the liver area, toxin, infection, inflammation, cancer and more. I usually do not put much significance on them or draw any conclusions from them unless I see them trending upward with time or at a very high level. An antibiotic and liver supplement are a great place to start for these non specific signs and mild elevations in my opinion. If that it not improving things, consider an abdominal ultrasound or X-rays. Best wishes to you and Gizmo.

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 am sorry Chucky is not feeling well. I do not think the blood work is very helpful in this situation because ALP can be elevated in a younger dog and the AST is just a mild increase again which can happen in a younger dog. The total bili can go up with gall bladder contraction or even other issues like viruses and diet. I would recommend discussing this with your vet because there might be a higher concern for disease in India than the USA. I would be concerned about parasites, foreign object ingested, gastric upset, parvo virus or even an infection. Chucky might need more testing like x-rays or a fecal exam. I hope he feels better soon

Hello, sorry to hear about Noa. Based on the information you provided, I would be most concerned with liver disease. This may require further diagnostics to rule out an infectious cause vs an inflammatory cause vs cancer. Most commonly in cats, we can see infectious and inflammatory causes for liver disease. Other diagnostics your veterinarian may offer is additional bloodwork, an abdominal ultrasound, and a biopsy of the liver. Hope this helps and best of luck!

The bilirubin is a bit high, as is the ALP (alkaline phosphatase) but neither of these values is super specific in terms of what the cause or the best treatment is. We can see the ALP be elevated with stress, age, and sometimes even normal cell regeneration within the liver. The bilirubin can be slightly elevated when the blood sample is what we call "hemolyzed," which can sometimes happen when blood is spun down for a blood test to be run. Therefore, if he is still showing symptoms of illness, I would echo what Dr Ana said; it may be time to consider imaging. Either X-rays or an abdominal ultrasound maybe helpful in identifying the problem and therefore identifying the best way to treat it. Take him back to the vet if he's still having troubles, as he probably is in need of some more fluids as well. Thank you for asking Petco Pet Education Center, formerly Petcoach, I hope he's feeling better.

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.