Dog liver and neurological issues: Should I get a second vet opinion?

This sounds like Coco may now have acquired portosystemic shunts. These shunts form to bypass the liver when blood pressure through the liver becomes too high. Unfortunately these shunts cannot be surgically corrected and managing symptoms with medications is the only treatment option. I'm so sorry about Coco's diagnosis. Hopefully you can get some guidance from her veterinarians about what to expect.

Hi there and thank you for using Petco Pet Education Center, formerly Petcoach to address your concern. If Pako has a deficiency of Taurine and L-carnitine, then yes, he should be on a supplement. However, that being said, most commercial dog food diets have sufficient amounts of both and most dogs do not need supplementation. If your veterinarian thinks this will help, I would look at ordering the following product, which can be found online quite easily. Liver support medications such as Hepagen C as well as a low protein, low fat diet such as Purina NF, Hills L/D diet, or Royal Canin Hepatic Support diet can help as well. These diets are formulated especially for dogs that have liver problems such as liver shunts, and they make it easier for the liver to metabolize nutrients that are provided to the body. Pako will have a decreased live span without surgical treatment of this disease. He may live a few years without many problems, but the disease can become refractory, and the neurological signs may worsen over time. I hope this helps! Please let me know if you have any other questions or concerns and I would be more than happy to help you further.

Hi, thanks for using Petco Pet Education Center, formerly Petcoach! Medical treatment for liver shunts consists of: Liver diet so despite him being a puppy I'd put him on Hill's l/d if a small breed dog or Purina HA for growth (Soy based and less likely to form ammonia) Lactulose Prilosec (omerprazole) to prevent gastric ulcers exacerbating signs Antibiotics usually short term but sometimes long term I hope this helps!

Hi, thanks for using Petco Pet Education Center, formerly Petcoach! Poor Holly! I would consider doing a bile acid test if her ALT is still elevated at the recheck. That can help with the diagnosis of a liver shunt. Yes, dogs can live a relatively normal life if the symptoms of the liver shunt can be managed with diet, antibiotics and laxatives. That is if she is even experiencing hepatic encephalopathy signs. I hope this help and I wish Holly the very best!

Poor Bruce! This is quite scary new, I know but it can be quite treatable. If you can afford it and for the best possible outcome, I would ask for a referral to a specialist. A specialist will be able to do a thorough abdominal ultrasound to see the shunt and determine what type of surgery might be needed. Surgery is the best option as it can usually repair the problem and he can live a normal life. If this isn’t an option, then yes I would certainly try to manage it medically. You can switch to a special food and add in a medicine that will help decrease the toxins that his body isn’t able to get rid of on his own. Unfortunately neither option is 100% guaranteed to work, but I have see good success with both especially with early intervention. I hope this helps and gives you some peace of mind. There are options. You just have to decide which is best for you and Bruce. Please let us know if you have additional questions. I have included an article with more information. Hugs! https://vcahospitals.com/know-your-pet/portosystemic-shunt-in-dogs

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'm sorry to hear that! It really depends on the severity of the shunt and what kinds of symptoms she's showing, so this would be a good question to discuss with your veterinarian - but in general, surgery is strongly recommended for dogs with liver shunts who are having neurologic symptoms. Medication and diet are usually not sufficient to control their symptoms without surgery.