My 10-year-old Pomeranian has rising liver enzymes and hepatitis. What now?

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 thank you for your interesting question. The first thing I would do is schedule another blood work up appointment to look at the liver enzymes in about two weeks after the first sample was taken. If the liver enzymes, specifically ALT, are still elevated, then there is some evidence that there’s been hepatocellular or liver disease or damage. I understand the veterinarian not wanting to test for Cushing’s disease, especially with the age and the lack of symptoms. But if the enzymes are still elevated, I would ask the vet if it would be worthwhile to start a liver protectant daily medication such as Denamarin. This medication given daily could potential he slow the damage to the liver cells and you may never exhibit clinical signs for the remainder of life and this medication has very little side effects. The other thing that you could possibly do if the liver enzymes are elevated used to start a liver protectant diet which is usually a prescription diet that is dispensed that your veterinary clinic. Again, these are two fairly easy, noninvasive ways to protect your pets liver from whatever is causing the cellular damage. I hope I’ve given you some information that helps. Have a great day.

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.

Hello and thank you for contacting Petco Pet Education Center, formerly Petcoach. Elevated liver enzymes and abnormal liver appearance on ultrasound scan does not necessary mean liver tumour or liver failure. Older dogs often have abnormal liver appearance, which is not related to any serious underlying problem. Liver enzymes level is a measure of 'damage' to liver cells but it is not directly related to prognosis. Again, older dogs often have mild elevation of liver enzymes I would think that the specialist will perform full abdominal scan and possibly take liver samples through a needle - this is commonly performed procedure in dogs with signs of liver disease. Based on the findings of the aspirate, the doctor will recommend further testing or prescribe treatment for Mars.

Pardale is a non-steroidal anti-inflammatory medication that contains acetaminophen and codeine. Acetaminophen can cause liver toxicity in some dogs, especially if used inappropriately. Since he seems to be feeling better, there is a chance his liver will go back to normal with the discontinuation of the drug. Your vet could put him on a liver supplement, like Denamarin, to help his liver function better. Your vet can repeat bloodwork in a month to recheck his values. I would definitely be reluctant to put him back on a non-steroidal type medication for his arthritis or use one in very low doses. You could put him on a joint supplement, like Dasuquin and see if that help his joints.

These elevations are mild and not specific at this stage, especially if all the other findings at the physical examination are normal. I would recommend to follow the suggestions your local vet gave and repeat the blood tests in 2 weeks time to compare results.

Hi, Oscar needs to be hospitalized and treated with IV fluids, antibiotics, and gastrointestinal protectants. Additionally, he should be tested for infectious diseases such as leptospirosis and ultrasounded to determine if he has any problems in his liver or kidneys.