Elevated liver enzyme activity in a dog? An algorithm to help you determine “Now what?”

Elevated liver enzyme activity in a dog? An algorithm to help you determine “Now what?”

Whether a veterinary patient is symptomatic or asymptomatic, use this guide to help you get to a diagnosis.
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Sep 05, 2017

Click on the image to access a printable PDF.

If the patient is symptomatic:

When I have a sick dog with abnormal liver enzyme activities, the first thing I do is look for a primary, nonhepatic cause. Could it have gastrointestinal (GI) disease, pancreatitis, heart failure, septicemia or some other underlying disease?

If I identify a nonhepatic disease that could be the cause, I treat that first. If, on the other hand, I can’t find anything, I work up the patient’s liver.

Here's my list of liver workup considerations:

  • Abdominal radiographs
  • Serum bile acid concentration (in nonicteric patients)
  • Abdominal ultrasound
  • Hepatic fine-needle aspirate and cytology
  • Coagulation profile
  • Liver biopsy (via ultrasound-guided needle biopsy, surgery or laparoscopic biopsy).

 

If the patient is asymptomatic:

Determining what to do with an asymptomatic dog is more complex. First, I perform a full physical exam to make sure I’m not missing some occult disease, such as an endocrine or metabolic disease. I then check the patient’s drug history, as certain drugs (such as corticosteroids) can cause liver changes. I also check to see whether the patient is being given alternative medications because some herbals can cause liver disease as well.

If I don’t find anything and the animal’s completely healthy, I repeat the liver enzyme profile in six to eight weeks. During this interim period, I may consider giving the patient liver support medications (like S-adenosylmethionine, milk thistle, vitamin E or other antioxidants) or a course of antibiotic therapy if I suspect a bacterial infection (such as leptospirosis or bacterial cholangitis).

If the liver enzyme activities are still abnormal and the patient is still asymptomatic at the end of this six- to eight-week waiting period, I recommend to the client that we need to further investigate the patient’s liver.

One of the things I often do at this point is check the patient’s bile acid concentration. If the patient has an abnormal bile concentration and abnormal liver enzyme activities, I have strong evidence for recommending a liver workup because it suggests there is altered liver function of portal vascular shunting.

 

Dr. David Twedt is a professor in the Department of Clinical Sciences at Colorado State University.

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