1/10/2018 0 Comments Elevated Liver EnzymesElevated Liver EnzymesMarch 12, 2009 by Lisa Testing and Diagnosis of Canine Liver DiseaseJanuary 4, 2009 by Lisa A thorough approach is needed for a correct diagnosis of any liver problem. An organ like the liver that is so intimately involved with other important organs will exhibit symptoms that mimic disease in these other organs. Also, what initially might appear as a diseased liver is in reality a disease elsewhere in the body that is involved with the liver secondarily. This is why it is crucial to follow a thorough and methodical approach called the diagnostic process. Specifically noting signs which may indicate liver disease. Periodic ascites, intolerance of a high protein diet, icterus, chronic weight loss, abnormally colored feces or urine, bleeding disorders, chronic illness, and all that has been mentioned above. Sometimes urinary crystals formed from the improperly metabolized proteins and amino acids may indicate liver disease. Liver disease can occur in pets of any age. If it occurs in young animals we tend to think more of toxicity, a liver shunt or a viral disease like adenovirus in dogs. In older pets we tend to think more of inflammation and cancer as the cause of the liver problem. Several canine breeds are prone to getting liver disease: Bedlington terriers, Skye terriers, Doberman pinschers, and West Highland White terriers get a problem with excessive copper accumulation that results from failure of normal biliary excretion of copper. Cocker spaniels have an increased incidence of chronic hepatitis Early signs of liver disease are subtle, and might exhibit as some of the symptoms described above. It is important to remember that some pets do not show any symptoms early in the course of the disease. This is another reason for yearly exams, along with blood and urine samples in dogs and cats 8 years of age or more. Even though many cancers do not show up in a blood sample, we can sometimes get indirect evidence there is a problem, leading to additional diagnostic tests that might find cancer. The recent use of pesticides, insecticides, and drugs might give us a clue. Some Labradors are sensitive to the use of the arthritis medicine Rimadyl. These dogs should have a blood panel analyzed prior to initiating Rimadyl therapy. Every 6 months this panel should be repeated. A history of poorly controlled diabetes mellitus might also clue us in to liver problems. Pets with liver shunts might have stunted growth and become depressed right after eating. Routine physical exam findings might include: Distended abdomen due to enlargement of the liver (hepatomegaly) might be found. This can be palpated in some situations, especially in the smaller animals. an enlarged liver from a disease other than liver disease can cause hepatomegaly. This includes heart disease and Cushing’s Disease. Enlarged lymph nodes due to secondary bacterial infections or spread of a primary or metastatic Bruising (hematoma) might be observed under the skin, or when a blood sample is obtained. This is due to the liver’s affects on the clotting mechanism Fever- a rectal temperature of greater than 103 degrees F could accompany liver disease when inflammation or infection is present Skin infections and wounds that do not heal, or recur after antibiotics are stopped Yellowish discoloration (icterus or jaundice) of the ears, gums, or hairless areas of the skin Anemia might be observed by checking the mucous membranes for a normal pink color Extensive Blood Work and Diagnostic Testing A complete blood count to check for anemia and blood cell abnormalities. A CBC (complete blood A complete chemistry screen, including ALT, ALP, AST, bilirubin, glucose, urea, electrolyte levels, albumin, globulin and bile acid levels. The bile acid levels should be checked on an empty stomach and two hours after feeding. All these values, with the exception of the bile acids, usually are included on a standard Small Animal Data Base Screen. Traditionally the medical practitioner has measured the relative concentration of several enzymes which may indicate alterations in liver health. The following enzymes typically change values in the face of liver failure Alanine Aminotransferase: ALT – Liver specific. Cell damage will cause elevations of ALT due to leakage. The elevation of the enzyme correlates with the number of cells damaged. Falling levels of ALT may indicate recovery or may indicate a failing number of functional liver cells. Rapid increases in ALT may indicate an acute process, while slow increases may indicate bile duct obstruction. Normal Test Range: 10-100 U/L* Aspartate Aminotransferase: AST - an enzyme seen in the liver, heart, kidney, skeletal muscle and brain. The half life of the AST in the blood stream is much shorter than that of ALT, therefore the values of AST tend to drop more rapidly once liver function is resumed. AST elevations and ALT elevations should parallel each other in liver disease Normal Test Range: 5-55 U/L* Normal Test Range: 23-212 U/L* Gamma Glutamyltransferase: GGT – This enzyme is has its highest concentration in the kidneys and pancreas, but it is also found in the liver and other organs. The major proportion of GGT in the serum seems to come from the liver. Elevations of GGT in disease seem to stem from new synthesis rather than leakage, therefore the changes seen due to disease are not spectacular. Large elevations of GGT are more commonly associated with pancreatitis and bile duct obstruction. These series of organic acids circulate almost entirely in the localized blood flow between the intestines Normal Test Range: Pre = Less than 7.0 umol/L, Post = Less than 15.0umol/L* A complete urine analysis Check urobilinogen levels, bilirubin levels, glucose levels, protein levels. Again all this is usually on a standard urinalysis panel. X rays can show increased liver size, decreased liver size liver abscesses, abnormal mineralization , and circulatory abnormalities (using special dyes). While this is a surgical technique, it is the ultimate for diagnosis, since it allows us to directly examine and test liver tissue, give an absolute diagnosis and hopefully a final treatment regime. Biopsies can be taken by full laparotomy, where the surgeon actually looks at the liver and removes a small piece, or they can be done by a biopsy needle guided by ultrasound through the body wall. The liver will regenerate any piece that has been removed, therefore liver biopsy is usually a low risk procedure in capable hands. *The ranges for the test results listed above are dependent on the lab, the testing done and are relative. Some specialist allow for a much larger range before they diagnose “true” Liver Disease. After receiving your test results, please consult with an internal specialist and have them explain the results to you. Help Us Fight Canine Liver DiseaseYou can also donate DIRECTLY TO OUR CAUSE - Click on our button below to choose from various donation amounts Payment helps offset our hosting and server fees, printing costs and community education programs.
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