My dog's liver is failing. What tests can help diagnose the cause?

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!

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!

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.

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.

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.

Getting down to the cause of the liver failure is important for treatment. I would be concerned about the lumps and irregular breathing pattern. Chest x-rays would be helpful to determine if there is an abnormality with the heart or lungs or enlarged lymph nodes within the chest. The lumps could indicate cancer, either primary or secondary to another location. The liver is a common site of cancer or metastatic cancer. I would recommend talking to your vet about a liver biopsy or biopsying the masses to determine if they are cancerous. Antibiotics and steroids can help with infections of the liver or an inflamed liver, but if there was poor response then these are unlikely the causes of the elevated liver values. Denamarin is a supplement that contains antioxidants to protect the liver; it does not treat liver failure.

That list is quite long. However infectious (hepatitis, leptospirosis, etc), fatty liver syndrome (hepatic lipidosis), simple loss of function due to old age, cancer, toxins, etc. The best indicator of liver function is the bile acid test. Unfortunately we have no other early indicators of liver function because regular serum chemistry testing that looks at elevated ALT, AST enzymes will only be able to detect liver problems when more than 60% of liver function has been compromised. However the bile acid test is a direct measure of liver function.