My Doberman's stomach is still swollen with high ALT. What to do?

I would be interested to see what all of these lab results were as it would certainly let me be more helpful, but the liver elevations could be chirossis, hepatitis, or even neoplasia. In the meantime I would start her on Denamarin if she is not already on it, and keep at it with fluid therapy. She may be a good candidate for an exploratory surgery. If you would like, a consult may be a great way for us to go over all of this in depth, and let me collect some more info on her so that I can be more helpful.

My first question is whether your veterinarian tapped the abdomen to get a sample of the fluid....if so... what was it. With sudden abdominal distension, low red blood cell count I would be most concerned about a bleeding tumor. The fact that liver enzymes were elevated days following a steroid injection is hard to evaluate because the steroid injection wound cause a spike in the liver values....so were they elevated to start with or only following steroid administration. The best thing to do here is have an abdominal ultrasound and collect fluid. If the fluid is blood...there is likely a bleeding tumor. If the fluid is not blood....she may have right sided heart disease (heart worms or other cause), some type of cancerous process somewhere or other chronic metabolic disease. If you are uncertain about your veterinarian, ask for a referral for an ultrasound or seek a second opinion. I hope you find some answers . Thank you for using Petco Pet Education Center, formerly Petcoach.

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, & thank you for using Petco Pet Education Center, formerly Petcoach. ALT is an enzyme that is released when liver cells are damaged. The normal values are usually less than 100. Unfortunately, the presence of the enzyme does not indicate the cause or reversibility of the damage, nor does it tell us if this is recent, but temporary damage, or on-going problems with the liver. Toxins, including plants, medications, such as steroids, viruses, & endocrine diseases can all cause increases in ALT. If Kobee is not having any problems, then I would recommend retesting in 6 weeks. If Kobee is sick, there are many more diagnostic tests that can be conducted to try & get to the cause of the problem. Often, we actually never find this out, & dogs do very, very well with moderately elevated values. We actually do not even get concerned until the values are at least 3xs normal, or there are other parameters that are abnormal. If Kobee is well, then all I might recommend is discussing with your vet about putting him on a neutroceutical called Denamarin. It can help with oxidative changes in the liver. I hope he does well. Take care.

Hello. Her liver values are not bad at all, & her liver does not look enlarged. You might want to request a test to look at bile acids & perhaps an abdominal ultrasound to see if the x-ray has missed something in the abdomen. Finish the Doxycycline, & see if she truly has Ehrlichiosis or if this is just a red herring. Thanks for using Petco Pet Education Center, formerly Petcoach.

ALT is one of the most important liver indicators in dogs and cats. It can also be elevated in dogs and cats when there is significant damage to the muscle, but in general it is thought of as a fairly sensitive marker for some type of liver damage. There are also several other markers for liver disease, so only knowing about the elevations in ALT may be misleading. If ALT was the only marker elevated, this is usually an indication of an inflammatory or infectious disease causing harm to the hepatic system. If you would like to discuss all of the laboratory testing and diagnostic imaging performed by your veterinarian, I would be able to take a closer look at your dog's situation. Let me know if I, or one of the other experts, can help you out in any way.

Thank you for using Petco Pet Education Center, formerly Petcoach! Abnormal liver enzymes typically indicate a more acute injury, and can actually return to normal as conditions become more chronic. Fluid build up can be due to low proteins in the blood, which are not being made by the liver or lost through the intestines or kidney. I hope this helps and am happy to answer any other questions you may have, or take a look at any results you have from Kimi.