My senior dog is sick with high liver values. Should I re-ultrasound?

ALT and GGT are both liver enzymes, so usually if they are elevated this would mean that Ginger may have a liver problem of some kind. These values can be elevated in dogs with hepatitis, gallbladder problems, or a tumor in the liver - but if the elevations are fairly mild, they can also be due to normal age-related changes in the liver, in which case there would be no reason to worry. For me personally, in an older pet that is otherwise healthy and does not have any symptoms of a problem, I often recommend repeating blood work in four weeks before doing anything else - liver values can fluctuate quite a bit, and often they are back to normal at the recheck appointment so we don't worry. If they are still elevated after four weeks, then at that point I would usually recommend abdominal x-rays and ultrasound to check for any problems. This is something that you can discuss with your vet if you're concerned, or get a second opinion if needed.

The bilirubin is a bit high, as is the ALP (alkaline phosphatase) but neither of these values is super specific in terms of what the cause or the best treatment is. We can see the ALP be elevated with stress, age, and sometimes even normal cell regeneration within the liver. The bilirubin can be slightly elevated when the blood sample is what we call "hemolyzed," which can sometimes happen when blood is spun down for a blood test to be run. Therefore, if he is still showing symptoms of illness, I would echo what Dr Ana said; it may be time to consider imaging. Either X-rays or an abdominal ultrasound maybe helpful in identifying the problem and therefore identifying the best way to treat it. Take him back to the vet if he's still having troubles, as he probably is in need of some more fluids as well. Thank you for asking Petco Pet Education Center, formerly Petcoach, I hope he's feeling better.

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!

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.

I think it's worth having an ultrasound to check Russ's liver. Depending on the results of that, it may be treatable, but of course I can't say for certain without seeing him in person. He's only a middle aged dog, and if there is a chance you can treat him, I would follow up on the diagnostics to see for sure. I'm sorry he's so sick!

Thank you for submitting your question regarding Remi. In the bloodwork that was run, did it include GI specific testing such as cobalamin, folate, PLI and TLI levels. These are values that will give information such as the location of GI disease (small intestine vs pancreas) and treatment options. I typically do this planel in conjunction with an abdominal ultrasound. This information with the ultrasound can give insight into conditions such as inflammatory bowel disease, pancreatitis, exocrine pancreatic insufficiency, food sensitivities or as you mentioned cancer. The anti-inflammatory properties of the antibiotic she was on could help even with a tumor in GI tract, but there are so many other causes of diarrhea that would respond as well. I think it is worth pursuing further bloodwork and the ultrasound. If you can get a diagnosis, then a treatment plan can be developed. I hope this information helps!

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.