My senior dog has high liver enzymes. Is it medication or age?

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.

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!

The next logical step is liver biopsy. Please, discuss it with your vet. If they are not able to take a biopsy (not every veterinary practice is capable to perform this procedure) you should ask to be referred to specialists in internal medicine. They will be able to offer much wider range of investigation and treatment.

Acute hepatic intoxication is the main suspicion, considering the signs you reported. Denosyl (SAMe) will protect liver cells from further damage and death and it will certainly help to detoxify the liver. It is important to monitor ALT and AST, but clinical improvement is even more important. So i think that he is already improving, since he is eating and surely he is brighter than onset of the signs. It will take time the intoxication will resolve. 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.

Thanks for using Petco Pet Education Center, formerly Petcoach! Arthritis can happen in older dogs as you know. However, this is not the only condition that can cause lameness like that. I do not recommend using paracetamol without a veterinary evaluation. There are other arthritis supplements that you can start which would not hurt if this happens to not be due to arthritis and if it is, they can help a good amount. There are several joint supplements out there such as Cosequin and Dasuquin, among others. I would encourage you to start with that and if no improvement is observed, Rodger should be evaluated by a veterinarian for further assessment and treatment. Good luck and have a great day! I hope this helps!

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.

Hello, without knowing the reason for the Pred., I cannot comment fully of this particular situation, but yes, Pred. is often associated with the elevation of liver values. I would definitely have Piluko on a liver protectant like Sam-e with milk thistle ( we have Denamarin here in the US ). As for the vomiting, your vet may recommend the metoclopramide or another medication such as Cerenia to control it. You can also try ginger root as it does have anti-nausea properties. The dose is wide, from 15-200 mg/kg every 12 hours, so start low & look to find a ginger root capsule that contains no other ingredients, especially xylitol. Make sure you tell your vet if you decide to try this. Thanks for using Petco Pet Education Center, formerly Petcoach.