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High Liver Enzymes


Guest MorganKonaAlex

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Guest MorganKonaAlex

Cinder has always been my chowhound until about 6 months ago. Her enthusiasm decreased and the last few weeks she started eating grass and vomiting some days. I also think her energy level has dropped. I've had her to the Vet and the physical exam didn't find anything. We de-wormed with Drontel (sp?) even though the fecal was negative. We had blood taken and it showed high ALT (284. Ref. range: 5-107), and AST (74 Ref. range: 5-55). ALK. Phosphatase was 126 (Ref. range: 10-150). Total bilirubin and direct bilirubin were normal. There wasn't anything remarkable from the urine tests. We're going to try Denamarin to see if it makes a difference in her appetite.

 

Has anyone dealt with elevated liver enzymes? What was the cause (if known)? What was the treatment?

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Guest greytexplorer

Please read my thread "Ester has low platelets", it's still current.

Ester started out with really bad numbers, initially looked like liver issues.

Now we are very confident that it's IMT (immune-mediated thrombocytopenia).

She has been on prednisone for a day and a half is doing markedly better.

 

I found a really good article written by Ellen Miller, DVM, MS, Diplomate, ACVIM online.

If you are interested, go to www.homevet.com/petcare/documents/ITP.pdf

 

If you haven't already done so, search "liver problems in dogs" and see what comes up.

 

Good luck! I'm feeling your pain.

 

Pat

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Is she taking any other meds or supplements? Has she ever had pancreatitis? Vomiting/diarrhea recently? Any of those things (and lots more) could cause the elevation you're seeing. If all the other bloodwork is within range and no specific symptoms, it might be worth treating with bland, low-fat diet (and the Denamarin if you like) and retesting in a week or two.

 

Hope she is feeling better soon!

Star aka Starz Ovation (Ronco x Oneco Maggie*, litter #48538), Coco aka Low Key (Kiowa Mon Manny x Party Hardy, litter # 59881), and mom in Illinois
We miss Reko Batman (Trouper Zeke x Marque Louisiana), 11/15/95-6/29/06, Rocco the thistledown whippet, 04/29/93-10/14/08, Reko Zema (Mo Kick x Reko Princess), 8/16/98-4/18/10, the most beautiful girl in the whole USA, my good egg Joseph aka Won by a Nose (Oneco Cufflink x Buy Back), 09/22/2003-03/01/2013, and our gentle sweet Gidget (Digitizer, Dodgem by Design x Sobe Mulberry), 1/29/2006-11/22/2014, gone much too soon. Never forgetting CJC's Buckshot, 1/2/07-10/25/10.

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Guest MorganKonaAlex

Thanks for the pointer Pat. Cinder's platelets are in the normal range for greyhounds. 124 (Ref. range for greyhounds is 80-150). It doesn't sound like Cinder's situation is the same as Ester's.

 

Batmom, Cinder doesn't take medication. The only supplements are Dasuquin and a salmon oil capsule daily. She's never had pancreatitis. No diarrhea. The vomiting is new the last few weeks and is always after eating grass. The only symptoms are decreasing appetite and energy the last 6 months and the grass/vomiting the last few weeks. She just turned 7 years old. I asked for the blood test to rule out kidney issues (I had a previous dog with the kidney failure). The blood test was normal except for the liver enzymes and the creatinine was high normal.

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Guest greytexplorer

I asked for the blood test to rule out kidney issues (I had a previous dog with the kidney failure). The blood test was normal except for the liver enzymes and the creatinine was high normal.

 

From "Greyhound Medical Idiosyncrasies", by Dr. William E Feeman III, DVM:

"Greyhound Bloodwork I: Greyhounds can have high normal BUN, creatinine, and AST levels. Some veterinarians may falsely interpret some high normal values as early kidney disease. If your Greyhound has nigh normal or just above normal kidney values...ask your veterinarian to run a urinalysis. Urine specific gravity that is >1.030 likely indicates that the blood levels are normal for the breed and not likely caused by kidney disease."

(bold print and italics are author's)

 

I can't find anything referencing liver enzyme values.

 

Does this help?

 

Pat

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Actually I think the values don't look too concerning but, denamarin is a wonderful (expensive) supplement so I would continue it. If you would like to perform more testing I would recommend running a bile acids test to check liver function.

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Cinder's liver enzymes really aren't all that high. The elevated ALT is a bit of a concern since that's the main one that can indicate liver damage, but a level that is about 2-3 times the high end of normal is a fairly mild elevation. With more severe problems, ALT can get into the thousands. There are a number of things that can cause elevated liver enzymes so these results on the bloodwork are pretty nonspecific and may or may not be related to her ongoing GI signs.

 

As the organ that processes most of the medications, toxins, and other 'bad things' that we are exposed to on a daily basis, the liver is always subject insults. Any of these day-to-day insults can cause temporary increases in liver enzymes, and then they go back down as the toxin is cleared and liver cells regenerate. It typically takes liver enzymes about 3-4 weeks go return to normal after a transient elevation in response to dealing with toxins. When I find elevated liver values on routine screening bloodwork in a dog who isn't showing any clinical signs, I usually just recheck after that time to see if the values have returned to normal, remained stable, or have increased further.

 

In Cinder's case, since she's been having some problems, I'd start to consider doing more of a workup. But since it sounds like most of her signs have been going on for a while, as long as she doesn't get significantly worse, I think it's also reasonable to try the Denamarin and recheck bloodwork in a few weeks to see what the trend is in her liver enzymes.

 

Obviously if the dog is very ill or declining, it is best to do additional testing more quickly. The recheck liver values after 3-4 weeks often determines how concerned we need to be about the numbers. If they are all back to normal, I chalk it up to temporary toxin exposure (such as eating something mildly poisonous, or something moldy and decaying in the yard, or even bacteria in raw food).

 

If the liver values continue to be high, especially if there's an increase, then the next steps are usually bile acids and abdominal ultrasound to determine what's going on inside the liver. Abdominal x-rays might be helpful in determining overall liver size and checking for obvious masses, but ultrasound gives you much more information. Liver enzymes like ALT and ALP only show damage to liver cells. Bile acids give an indication of how the liver is actually functioning.

 

If your going to spend the money on testing, I'd probably have Cushing's testing lower on the priority list. Cushing's usually causes an elevated alkaline phosphatase, not ALT, and Cinder's signs don't fit, as Cushing's usually causes increased drinking and appetite.

Jennifer &

Willow (Wilma Waggle), Wiki (Wiki Hard Ten), Carter (Let's Get It On),

Ollie (whippet), Gracie (whippet x), & Terra (whippet) + Just Saying + Just Alice

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Cinder's liver enzymes really aren't all that high. The elevated ALT is a bit of a concern since that's the main one that can indicate liver damage, but a level that is about 2-3 times the high end of normal is a fairly mild elevation. With more severe problems, ALT can get into the thousands. There are a number of things that can cause elevated liver enzymes so these results on the bloodwork are pretty nonspecific and may or may not be related to her ongoing GI signs.

 

As the organ that processes most of the medications, toxins, and other 'bad things' that we are exposed to on a daily basis, the liver is always subject insults. Any of these day-to-day insults can cause temporary increases in liver enzymes, and then they go back down as the toxin is cleared and liver cells regenerate. It typically takes liver enzymes about 3-4 weeks go return to normal after a transient elevation in response to dealing with toxins. When I find elevated liver values on routine screening bloodwork in a dog who isn't showing any clinical signs, I usually just recheck after that time to see if the values have returned to normal, remained stable, or have increased further.

 

In Cinder's case, since she's been having some problems, I'd start to consider doing more of a workup. But since it sounds like most of her signs have been going on for a while, as long as she doesn't get significantly worse, I think it's also reasonable to try the Denamarin and recheck bloodwork in a few weeks to see what the trend is in her liver enzymes.

 

Obviously if the dog is very ill or declining, it is best to do additional testing more quickly. The recheck liver values after 3-4 weeks often determines how concerned we need to be about the numbers. If they are all back to normal, I chalk it up to temporary toxin exposure (such as eating something mildly poisonous, or something moldy and decaying in the yard, or even bacteria in raw food).

 

If the liver values continue to be high, especially if there's an increase, then the next steps are usually bile acids and abdominal ultrasound to determine what's going on inside the liver. Abdominal x-rays might be helpful in determining overall liver size and checking for obvious masses, but ultrasound gives you much more information. Liver enzymes like ALT and ALP only show damage to liver cells. Bile acids give an indication of how the liver is actually functioning.

 

If your going to spend the money on testing, I'd probably have Cushing's testing lower on the priority list. Cushing's usually causes an elevated alkaline phosphatase, not ALT, and Cinder's signs don't fit, as Cushing's usually causes increased drinking and appetite.

 

As noted in this post, higher liver enzymes can be indicative of an exposure to a toxic substance which the "liver is clearing out". That substance could have been in the backyard (mushrooms come to mind) or medicines that the dog is on, maybe even something "dead" they picked up on a walk. Could also be something sprayed on a neighbor's lawn which managed to get on the borders of your yard.

 

As suggested, repeat the tests in a few weeks and see if they drop. If they are still high you might want to consider additional tests such as x-rays, ultrasound and as mentioned above "bile acids" (I'm not familiar with this test myself).

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Guest LindsaySF

I would do a bile acids test too. Sophie's vet says it's more accurate when looking for liver problems. (We check because of her seizure meds). Good luck!

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