Liver Problem!

[Jaime7]

I brought my 7 month old Yorkie, Bruno, to the vet to be neutered. His presurgery blood work showed abnormal levels in his liver. He had an ultra sound done today and they did not see any obvious shunts (although I am told it does not rule it out) but his liver is inflamed and the vasculars are are small. They have done a Bile Acid Test and we are awaiting these results. I am told they will start him on a special Liver Diet right away but the Bile Acid Test results will narrow down the condition.

Can anyone provide any helpful information?

[Tae1107]

My Quinn has MVD which is a bunch of small shunts...he is on a low protein diet (prescription) and supplements...

When will you have the results? They will help guide you..there also are liver chats that you can join...

I know other members also have Yorkies with liver issues..

When you have his results post them here....

Kerri

[Ellie May]

Does Bruno have any symptoms like head pressing, circling, seizures, inappetance, depression?

Post meal bile acids should be under 15 or 20.
Quite often (there are many exceptions though) if it is over 100 it indicates a liver shunt and if it is over 20 but less than 100 it indicates microvascular dysplasia (small shunting throughout the liver that is managed by diet and supplements). Bile acids and liver enzymes can be up for other reasons though.

Was his BUN normal?

[Jaime7]

We will have his Bile Acid Test results tomorrow. Thank you for the useful information, now I will actually know what the number will indicate when I get it.

He has had no symptoms that I have noticed. I do not know what the actual BUN was I believe the vet said it was higher then normal?

Besides a liver shunt and the microvascular dysplasia what other conditions could this be?

The vet also mentioned that his liver looked small but this could be normal for him I guess meaning he is a small dog? He is just under 4 lbs.

I am picking him up in a little while and I am told they will start him right away on a liver diet. He has had constant diarrhea since his visit to the vet on Monday which I really think has to do with the stress of the vet visit. The vet said to mix some white rice in with the new food. Any other tips?

Thank you both for your responses I really appreciate it!

[TLC]

What is the 'new food' ?

[Jaime7]

They put him on Prescription Diet L/D (liver diet). I am reading mixed things about this food, my vet really recommends it though. Any thoughts?

[TLC]

Originally Posted by Jaime7

They put him on Prescription Diet L/D (liver diet). I am reading mixed things about this food, my vet really recommends it though. Any thoughts?

"I" suppose for right now, it's ok, until you get more answers that lean either way. But if he truly does have liver issues, if he were my dog, for long term feeding, I would contact a nutritionist (which I did, since I have an MVD dog too) and I would go the route of home cooked, low but quality food and supplements....and if he turns out not to have liver issues and you want him to eat dog food, then there lots of 'better' quality ones out there that can be suggested for you to try.

Please keep us posted, we are all waiting for the BAT result

[Yorkieluv]

Make sure to get canned L/D and not the dry kind...The dry contains ethoxyquin which is used as a preservative, but it is a carcinogen...
The canned L/D is used by many with liver compromised dogs. Royal Canin Hepatic LS 14 is a good dry food that is also used for liver compromised dogs.
If you want to homecook, that's an excellent option as well as long as you're willing to put in the time, effort, and also research that it takes to learn what foods should/should not be fed to liver compromised dogs.
A nutritionist is definitely recommended if you go this route
Let us know the BAT results...
Did your baby exhibit any symptoms like picky eating, lethargy (lack of energy at times), feeling bad about 3 hours after meals, vomitting, hypoglycemia, etc?

[Jaime7]

Thank you all so much for all the information!

No Bruno did not have any symptoms, the only reason we picked up on this is because of his presurgery blood work to have him neutered.

[Jaime7]

My dog Bruno's Bile Acid Test came back with a 63 pre test and a 103 post test. The vet said this suggests a liver shunt that they did not notice on the ultra sound. Since he is not showing clinical signs they do not suggest surgery at this time but to keep him on a liver diet (canned Prescription L/D) and have his blood and urine checked every 6 months. They also advised that it is safe to have him neutered.

Does this sound right? Has anyone had a dog neutered that has a liver shunt? Again any information anyone has is very appreciated.

[Yorkieluv]

Yes, my yorkie who has liver shunts was neutered, but they just have to be careful...Isoflourane is the anesthesia of choice. Make sure they don't inject him with barbiturates or anything like that...just the gas anesthesia...
Pain meds aren't really recommended for them either b/c they can cause really serious side effects for a liver compromised dog. My yorkie had a pretty severe reaction to pain meds after his surgery, and it was extremely scary...Every other time he has had surgery since then they have not given him any pain meds afterwards, and he has been just fine.

[Yorkieluv]

What were his ALB, ALT, BUN from the bloodwork that they did (presurgery)? Did he have a urinalysis? If so, did he have any crystals, blood, or protein in his urine?
Lactulose is something I feel is essential for liver compromised dogs along with milk thistle and denosyl to help their livers...

[Jaime7]

Thank you so much for the anesthesia information. I really want to make sure I understand what the risks are for Bruno and what I need to do to keep his liver functioning at its best.

They did not give me the details of the bloodwork they just told me the liver numbers indicated there could be a problem which is what prompted the ultra sound and bile acid test. I believe we are doing the urine test next. The vet suggested doing the blood and urine every 6 months to monitor his liver and check for bladder stones. Is this how you monitor your dog?

The doctor supplied me with denosyl but did not mention lactulose or milk thistle, can I purchase these on my own or should I go through my vet? Are they common supplements used for liver conditions? I am wondering why my vet didn't recommend them.

[Yorkieluv]

I am also wondering why your vet did not recommend them as they are staples in dogs with liver problems. Denosyl or vetri-dmg is also a an excellent supplement to give if liver issues are suspected.

Milk thistle is a supplement that you can buy at a health food store...I prefer to buy the capsules rather than liquid b/c the liquid form contains alcohol.

Here's some info on milk thistle:
MILK THISTLE
"Silymarin, which is itself a combination of several other active compounds, has been extensively studied around the world, and has been shown to be safe and effective in treating a variety of liver diseases and other conditions. It specifically protects the liver against toxins (including some drugs and heavy metals), activates protein synthesis, and stimulates growth of new liver cells to replace those that are dead or damaged. Milk thistle also has strong antioxidant (destroys oxygen free radicals) and anti-inflammatory actions."

Lactulose helps by basically pulling the toxins from the blood stream into the colon where it is then pushed out...The dosage should be completely dependent on your baby having 2 soft stools per day (not firm, not diarrhea). This is by prescription only, but has virtually no side effects other than diarrhea if you give too much of it. The dose should be split up into 3x/day.

Yes, my yorkie has bloodwork and urinalysis at least every 6 months. It's important to always have the urinalysis done to check for crystals. Ammonium biurate crystals are often times seen when a dog has liver problems.

[Ladymom]

Ultrasounds are not reliable for diagnosing liver shunts. They can be as low as 60% accurate according to Dr. Sharon Center.

Do you have a vet school near you? You can waste a lot of time and money with your regular vet. Most vets don't see enough liver disease in their practice to know how to diagnose and treat it.

The protocol has changed dramatically in the past few years. A bile acids test should have been done first, then a Protein C test should be done. Depending on the results, a scintigraphy is the next step.

Here is some information for you from the country's top two experts in liver disease:

Portosystemic Shunts FAQ

Hepatic Vascular Disorders - WSAVA 2006 Congress