My yorkie has liver problems.

[smbritton]

OK so I'm new to the site. I found the site by googleing for information about Yorkies and this site came up so I figured I may get some answers from here.

For the last couple of weeks my 3 year old Yorkie Scout has been losing weight. We took him to the vet last week and they took some blood tests. The Liver test were extremly concerning so they referred us to a specialist to perform a ultra sound because the Vet suspected a shunt. The specailist couldn't find the shunt although she said she finds 70% of them if they are outside the Liver. She has put him on Metronidazole and Hill LD perscription low protein food.

Here are the concerns from his Liver results:
Actual. Desired.
ALT 606 10-118
GGT 5 0-7
BA 140 0-25
ALB 2.2 2.5-4.4
CHOL 82 125-270

We changed his diet 4 weeks ago from IAMS to Kible n Bits because he was having trouble chewing the IAMS and the Kible n Bits are easier to chew. But he never really took to the Kible n Bits. When we bought home the Hills LD food we mixed it with his Kible and Bits and he methodically seperated all the Kible N Bits away from the Hills and devoured the Hills. Now he eats the whole bowl of Hills in under 30 seconds, he loves it. I haven't seen him eat like this in 2 months (since the kible n bits came along). He is full of energy and shows no signs now of illness although I can't get the test results out of mind

My questions is:

Could changing his diet have caused this much problems to his Liver? Or is something else going on?

I realize the BA of 140 is really bad...

So, now that he is eating again what are the chances of his next Liver tests once he has completed his Anitbiotcs returning back to normal?

I appreciate any advice I can get becuase both Vets really don't have an answer for me?

If my dog is running around fine, eating fine, and showing no signs of illness do I just ignore the tests and go on if he is fine?

[Ellie May]

Welcome to YT.

Do you have the rest of his blood work results like BUN?
Was a urinalysis done? Were stones seen on the ultrasound?

It looks like the bile acids test is incomplete.
There should be two numbers, one before eating and one after.
Do you have the other one or did they not do the full test?

A change in diet can cause symptoms, especially if there was a protein increase or a difference in the type of protein given. Red meat and organ meat in particular produce the most ammonia (toxins) and a liver compromised dog can't process these properly, so they don't feel well, don't want to eat, have neurological symptoms (also called hepatic encephalopathy), etc. Liver compromised dogs are also very prone to developing ammonium urate stones.

A high bile acids test can only tell you that the liver isn't functioning properly. Liver shunt and MVD (microvascular dysplasia or small, inoperable shunting throughout the liver) are just two of the many possibilities. Unfortunately, neither disease is uncommon in Yorkies.

Ultrasounds are only 60-80% accurate when trying to diagnose a shunt. A test that you can do to try and differentiate between liver shunt and MVD is the Protein C Test. It is just a simple blood test sent to Cornell University. Normal numbers (70-80 or higher) usually mean normal or MVD and 70ish or lower usually means a shunt. If it comes back in shunt territory (or maybe even if it doesn't depending on the situation), a scintigraphy should be done. This is where radioactive dye is sent through the body to see if the liver is processing things properly. It is probably the best way to find a shunt. Because of the prognosis, most younger dogs with a shunt should have surgery. The two best places to have it done at are the University of Tennessee or Cornell University.

This is not something that should be let go. He is feeling well because he is on a food that his liver isn't having a hard time processing but it does nothing to fix the problem.

It is best to feed dogs with liver shunt or symptomatic MVD 4-6 times a day, otherwise the liver has to deal with too much at once. While the L/D dry is okay, L/D canned is preferred by some because the moisture is excellent for liver compromised dogs and the ingredients seem to be better. Royal Canin Hepatic LS 14 kibble is also a good choice if you dog isn't allergic to it.

SAMe (Denosyl or Denestra) should be given to prevent further liver cell death.

Milk thistle is sometimes recommended along with vitamin E.

Lactulose binds toxins and they are eliminated in the dog's stool. This is very important if any type of neurological symptoms are present but it may help in any case.

Local vets tend to not be much help in these cases.
They just don't see it that often.

Your vet(s) need to be very careful with the drugs used for the rest of his life if this is LS or MVD. Non-steroidal anti-inflammatories and certain anesthesias in particular should not be used.

However, because high bile acids can mean so many things, it is impossible to say whether this even applies. I would say if he is feeling better on the L/D, it does apply.

LS and MVD are not death sentences and can be managed, but in a lot of cases they are just a bit more tricky to take care of than other dogs.

[Ladymom]

What great post, Crystal.

I agree that the bile acid test resulst don't look right. They should take paired samples around a meal so there should be two numbers. The samples also need to be collected properly.

Here is a great article from the vet who developed the BAT:

PSVA and MVD Research Summary

As Crystal said, ultrasounds aren't that reliable for detecting shunts, especially in small dogs. After an abnormal BAT, the next step would be a Protein C test:

Comparative Coagulation -- NYS Animal Health Diagnostic Center

Are you close to a vet school? I would suggest you take Scout there. Most local vets don't have that much experience with liver shunts. You can waste a lot of time and money and get no real answers.

[smbritton]

WOW I have read on here about the BA test needing to be done once before eating and once after eaten although neither of my Vets have mentioned this.

My Vet has said to finish the Metronidazole and then we have to return to have the Liver test done again to see if there has been any change.

Should I mention to do one test before eating and another after eating?

I only posted the results of his test that had an asterix next to them meaning something was either too high or too low. All his other test are in line. When I go home I will post his whole test results.

Do you think that just because I changed his food and he didn't eat it for like for 2 months that this could explain the high BA results?

[smbritton]

Originally Posted by Ellie May

Welcome to YT.

Do you have the rest of his blood work results like BUN?
Was a urinalysis done? Were stones seen on the ultrasound?

It looks like the bile acids test is incomplete.
There should be two numbers, one before eating and one after.
Do you have the other one or did they not do the full test?

A change in diet can cause symptoms, especially if there was a protein increase or a difference in the type of protein given. Red meat and organ meat in particular produce the most ammonia (toxins) and a liver compromised dog can't process these properly, so they don't feel well, don't want to eat, have neurological symptoms (also called hepatic encephalopathy), etc. Liver compromised dogs are also very prone to developing ammonium urate stones.

A high bile acids test can only tell you that the liver isn't functioning properly. Liver shunt and MVD (microvascular dysplasia or small, inoperable shunting throughout the liver) are just two of the many possibilities. Unfortunately, neither disease is uncommon in Yorkies.

Ultrasounds are only 60-80% accurate when trying to diagnose a shunt. A test that you can do to try and differentiate between liver shunt and MVD is the Protein C Test. It is just a simple blood test sent to Cornell University. Normal numbers (70-80 or higher) usually mean normal or MVD and 70ish or lower usually means a shunt. If it comes back in shunt territory (or maybe even if it doesn't depending on the situation), a scintigraphy should be done. This is where radioactive dye is sent through the body to see if the liver is processing things properly. It is probably the best way to find a shunt. Because of the prognosis, most younger dogs with a shunt should have surgery. The two best places to have it done at are the University of Tennessee or Cornell University.

This is not something that should be let go. He is feeling well because he is on a food that his liver isn't having a hard time processing but it does nothing to fix the problem.

It is best to feed dogs with liver shunt or symptomatic MVD 4-6 times a day, otherwise the liver has to deal with too much at once. While the L/D dry is okay, L/D canned is preferred by some because the moisture is excellent for liver compromised dogs and the ingredients seem to be better. Royal Canin Hepatic LS 14 kibble is also a good choice if you dog isn't allergic to it.

SAMe (Denosyl or Denestra) should be given to prevent further liver cell death.

Milk thistle is sometimes recommended along with vitamin E.

Lactulose binds toxins and they are eliminated in the dog's stool. This is very important if any type of neurological symptoms are present but it may help in any case.

Local vets tend to not be much help in these cases.
They just don't see it that often.

Your vet(s) need to be very careful with the drugs used for the rest of his life if this is LS or MVD. Non-steroidal anti-inflammatories and certain anesthesias in particular should not be used.

However, because high bile acids can mean so many things, it is impossible to say whether this even applies. I would say if he is feeling better on the L/D, it does apply.

LS and MVD are not death sentences and can be managed, but in a lot of cases they are just a bit more tricky to take care of than other dogs.

Thankyou so much for the great reply.

He did have a urine test done and that was fine. They saw two tiny stones in one kidney although the specialist said these wouldn't be a factor.

The only results we got for the Bial test were 140 and this should be between 0-25.

Do you think the diet change could be causing this?

I know it's wishfull thinking although he seems totally normal now he is eating regularly and eating a lot?

My vet said I could go to Virginia Tech to have futher test done to look for a shunt. I don't know if I'm just trying for wishfull thinking although something is telling me a lot of this is due to him not eating becuase of the diet change. Thats when all this started although the Vet said the high BA test aren't a result of diet change.

[smbritton]

OK here is the results from his Mammalian Liver Profile.

ALP 116 20-150 U/L
ALT 606 10-118 U/L
GGT 5 5-7 U/L
BA 140 0-25 umol/L
TBIL 0.2 0.1-0.6 mg/dl
ALB 2.2 2.5-4.4 g/dl
BUN 10 7-25 mg/dl
CHOL 82 125-270 mg/dl

qc ok

HEM +2 LIP 0 ICT 0

[Ellie May]

Giving antibiotics is fine but I'd be very surprised if they significantly lowered the bile acids test results. Even if they were low the next time, there would still be concern that another draw would give you high results (that happened to my girl).

You could redue the BA if you want with paired samples but since you already know they are high, you could also just go straight to a Protein C Test. If the vets are going to recheck BA, then yes, they absolutely should be done in paired samples.

While the BUN is in reference range, it is a bit low which can indicate a liver issue.

[smbritton]

So you think that just the fact that he is eating better now and seems to be putting on weight still wouldn't change the Liver test results?

So there is no way his Liver test results were caused simply by changing his food and him not eating correctly for 2 months?

Can a regular Vet do the Protein C test?

[Ellie May]

The numbers may go down but they may not stay down or they may not go down. It is said that it is pointless to keep BATing a dog with MVD because the results will always come back high.

A change in food should not cause liver enzymes to go up.
Maybe if it was very high in protein (not the case here) but that really isn't agreed upon.

If hemolysis occured, the results could be skewed:
Hemolysis - Wikipedia, the free encyclopedia

If the blood for the panel and the BAT were drawn separately, this probably isn't the case because they are both "off."

Any vet can order tubes for the Protein C Test and perform it.

[TLC]

Crystal - WOW you got it all perfect in one shot



I agree with all posted above. A proper diet change, along with the Metro and Lactulose is ONLY going to make his liver's job less stressful. IF he has a Liver Shunt or MVD, his BAT will always be high. It may be within a range, but it will never come down to normal.

I don't think you should let this go. I think it is great that the new food is making him feel better, but it doesn't change the fact that he may have shunt or MVD. Also, as Crystal said above if you are feeding the L\D dry, you should be adding water (I think preferably distilled water) to the kibble. Or, you can get the L/D wet for more added moisture.

The Protein C test can be done by your Vet, but they need to contact Cornell Unv for the tubes and instruction on the draw, then they have to be overnighted to Cornell for the testing and results.

[smbritton]

Thanks so much for all the help guys. I can't believe that my Vet and the Specialist are of no help. I feel like I'm on my own with this

So should I have my Vet do a protein C test? If so should I do it after the antibiotics course?

Although, my dog apart from a little loose stool if fine

[smbritton]

Oh another thing the specialist did say when she did the ultrasound that his Liver looked mottled???

[Ladymom]

Yes, your vet can do the Protein C test, but I'd suggest trying to get a referral to a vet school. You will probably end up there since your vets don't know how to diagnose and treat liver disease. The vet school will repeat all the tests so it's just a waste of money to have your local vets do the test.

All the information about the Protein C test is in the link I posted in post #3.

[RONLYNN]

Originally Posted by smbritton

Thanks so much for all the help guys. I can't believe that my Vet and the Specialist are of no help. I feel like I'm on my own with this

So should I have my Vet do a protein C test? If so should I do it after the antibiotics course?

Although, my dog apart from a little loose stool if fine

You really really need to join this group: Liver_Shunt_And_MVD_Support : Liver Shunt & MVD/HMD Support

They are wonderful and so so knowledgeable about everything!!! My Teddi had a liver shunt and they were so helpful and she is now almost 3 years old and completely fine!!!

[dwerten]

Originally Posted by RONLYNN

You really really need to join this group: Liver_Shunt_And_MVD_Support : Liver Shunt & MVD/HMD Support

They are wonderful and so so knowledgeable about everything!!! My Teddi had a liver shunt and they were so helpful and she is now almost 3 years old and completely fine!!!

i agree with this 100% they will help you alot - my dee dee is mvd and i learned a ton from them