My rescue dog's liver values are worsening. What tests are next?

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.

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 your question on Petco Pet Education Center, formerly Petcoach. I would classify those liver elevations as mild to moderately elevated. Liver values can be quite fluctuant - those elevations are somewhat nonspecific and simply indicate that there is higher liver cell turnover than what would typically be normal. This can be due to anything inflammatory, infectious, cancerous, or otherwise disturbing to the liver. A blood test alone cannot usually say exactly why the liver values are elevated - to have more information, a liver function test such as bile acids could be run, or the liver could be evaluated via ultrasound to make sure it still has normal architectural appearance. If these results are 8 months old, then the best next step would simply be to repeat a liver panel of bloodwork, and see if those values have remained elevated. It's very possible they may have normalized by now; if they haven't, your vet can discuss the best next step with Bear's other history and exam findings. If the values are still elevated but you choose not to pursue further diagnostic testing, there are liver protective medications that your vet may recommend to help protect the liver from oxidative damage. 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.

Thanks for using Petco Pet Education Center, formerly Petcoach! The liver function tests commonly available in a routine chemistry panel are glucose, albumin, cholesterol and BUN. A more specific, though separate test of liver function is bile acids which is the gold standard as far as liver function goes. Good luck!

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.