My Shih Tzu has high ALP. What should I do when the vet is unsure?

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.

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!

Thank you for submitting your question regarding Toro. Yes, I would still consider this cholestasis. You will want to determine the underlying cause such as primary liver disease, pancreatitis, or a bile duct obstruction for example. He may require an abdominal ultrasound. I hope this information helps!

There is really very little sense in speculating. Even a positive bile acid test will not definitively diagnose a portosystemic shunt. Only advanced imaging techniques can capture this condition. Alkaline phosphatase is an enzyme that is sometime utilized to support diagnoses of the liver and bile duct system. However, alone the number doesn't tell us much particularly in a young and from what it sounds like otherwise healthy puppy. The elevation you mentioned is also very mild, and we frequently see elevations in this enzyme in young growing animals. Just as it is found in the liver, it is also found in the bones which is why it is elevated during the time that pups are getting larger. I obviously don't know the whole situation and there is always the possibility your dog could have a shunt. However, so far you have given me no reason to suspect a serious problem. Please feel from to obtain a consult if you want to discuss the case in any greater detail.

Hi there and thank you for using Petco Pet Education Center, formerly Petcoach to address your concern. Unfortunately ALP is such a vague value and does not tell us much in the way of specific diseases that it is not a very useful value. In older dogs with a high ALP, this may be a normal finding not related to any disease. Cushing's disease can cause an elevated ALP along with many other causes. If the ALP continues to rise or does not resolve, I would consider testing for Cushing's disease and have an abdominal ultrasound performed. Bronchitis and a tooth infection generally would not cause an increase in this value in my experience. I hope this helps! Please let me know if you have any other questions or concerns and I would be more than happy to help you further.

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.

I'm sorry to hear about Chi Chi's recent issues. Vomiting and an anal gland abscess/rupture may cause some changes on the blood panel, but not typically ALP. When you have a significantly elevated ALP and normal ALT it is highly suggestive of Cushing's disease. Cushing's can be diagnosed with a few different tests, these tests involve taking blood, injecting a substance then taking blood again to see the body's ability to respond. I think it would be wise to have her checked. If she dies have Cushing's thankfully it is treatable with medication but this will be for life.