My 6-month puppy has high liver enzymes. Is it a liver shunt?

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!

This may be due to a congenital disorder (liver shunt) but ideally the ALT should be interpreted considering the reference ranges given by the lab. More tests should be ideally discussed (test of liver functionality like bile acids or ammonia or bile acids stimulation tests) in order to identify specifically the problem and give you a specific answer. If you have them, please write to us again or request a consultation and upload all the results of the tests available. Please do not hesitate to contact us again on the forum or by requesting a consultation if you have any more questions or to discuss it any further.

Congratulations on your new baby! He is adorable! The most common tests we start with to evaluate for liver shunts are baseline labwork (which includes a full chemistry, complete blood count and urinalysis) as well as a pre and post prandial bile acid profile. The bile acid profile is to specifically look at the liver function. Any of those tests results are available within a couple of days. Unfortunately, sometimes those test results are inconclusive, and we have to do additional testing. I have included a link below with more information about liver shunts. https://www.veterinarypartner.com/Content.plx?P=A&S=0&C=0&A=2533 Good luck! I hope that was helpful! Thanks for using PetCoach.

She is a puppy. An elevated ALP is normal in puppies. ALP can go up because of liver problems, but also increases during bone growth. I see this elevation in about 80% of puppy bloodwork. I do not treat this as it it is not a problem and the value becomes normal when they stop growing. If there are other liver values elevated, then I am concerned, but ALP alone is not generally a problem. Per IDEXX, one of the largest veterinary pathology services in the United States, ALP values in puppies can be elevated 4 times normal (which is about where Luna is.) Denamarin, Vitamin B, and a low-carb diet will not hurt Luna, but they probably won’t change the ALP either. Best wishes to you and Luna.

Thank you for submitting your question regarding Luna. This value is a liver enzyme. It can be elevated due to liver disease or a skeletal muscle problem. Liver disease in young puppies can be congenital disorder such as a portosystemic shunt or secondary to an infection. When I have a result such as this, I will recheck blood work in a week. If the value is still elevated, then I will run a separate blood test known as a bile acids panel. This is a liver function test. The elevation could due to something as simple as her shaking during the blood draw (skeletal muscle), but you want to ensure she is not experiencing any disease. I hope this information helps!

Further testing including abdominal ultrasound are appropriate at this point. If this testing was or will be done, the results of a fine needle aspirate of the liver will help direct the course of treatment. If you have further questions, please feel free to request a consult with an expert where more questions can be asked and diagnostic data can be provided.

The bile acids results are certainly consistent with a dog that has a portosystemic shunt. Dogs with liver shunts do not always display the common neurologic signs, like circling or head pressing. Yorkies are also prone to developing lymphangiectasia which could be causing the gassy issue, or even IBD - but I would work up the possible shunt first. I think nuclear scintigraphy is a logical next step based on the information you have provided. Here is some more information about portosystemic shunts: http://www.veterinarypartner.com/Content.plx?P=A&S=0&C=0&A=2533 Intestinal lymphangiectasia: http://www.veterinarypartner.com/Content.plx?P=A&S=0&C=0&A=1381