Elevated liver enzymes...need advice!

[tokipoki]

So I took Toki in for a physical and a routine blood test this past Wednesday. The results of the blood test came back with high liver enzymes (the only value I remember was the ALT being 312...I can get more specific values Monday when I ask for a copy of her bloodwork results). The following day we got a bile acid test performed and her post-fast value was was 63 so now we have an ultrasound scheduled for Monday to check for a liver shunt.

This is all really surprising to me...we go in for a routine exam visit and now there is the possibility of liver issues. Toki's bloodwork was completely normal back in September/October when she had her FHO surgery and she has been asymptomatic, to my knowledge.

The vet gave me an antibiotic and a liver support supplement to give her in the meantime and I've switched her food to a kibble lower in protein and fat. Depending on the results of the ultrasound (which I know isn't the most reliable way to detect a shunt), my vet is going to discuss treatment and management plans with me.

I was just looking for similar experiences or any advice/recommendations or stories you all could share with me. I suppose it is better that we found out about potential issues before Toki started presenting outward signs/symptoms. I just hope we are able to pinpoint a specific cause for her elevated liver enzymes and BAT values.

[Maximo]

I'm sorry to hear this and I wish Toki and you the best, and praying this will turn out to be something that can be controlled with diet and meds. While I don't have any experience in this department, I wanted to bump your thread up for others to see. I do recall from previous threads mention of scintigraphy for diagnosing shunts.

[kjc]

Post #8... http://www.yorkietalk.com/forums/sic...h-ast-alt.html

[Mybrcc]

My dog recently has been suspected to either have MVD or Liver Shunt. Scheduling a appointment with a specialist this week. He was perscribed Royal Canine Hepatic dog food, and also is on Luctralose. Hope everything turns out OK with your dog, as this is costing me a fortune.

[Parka]

My yorkie had elevated bile acid levels at his last checkup. He also has seizures. I took him to a specialist and he told me that levels less than 100 are more likely to be MVD than an external shunt. We did an ultrasound - no external shunt, no gallbladder issues. The specialist said it could be MVD but it would be better to switch his diet and see if he improves than to do an invasive liver biopsy. He's doing just fine so far but we're waiting on a 6 month retest.

[kjc]

Originally Posted by Parka

My yorkie had elevated bile acid levels at his last checkup. He also has seizures. I took him to a specialist and he told me that levels less than 100 are more likely to be MVD than an external shunt. We did an ultrasound - no external shunt, no gallbladder issues. The specialist said it could be MVD but it would be better to switch his diet and see if he improves than to do an invasive liver biopsy. He's doing just fine so far but we're waiting on a 6 month retest.

Liver Shunts and Gall Bladder issues don't always show on Ultrasound. Sludge can develope in the bile duct from the liver to the GB, and cause similar test results as a Liver Shunt, including high BAT results.

[tokipoki]

Originally Posted by Maximo

I'm sorry to hear this and I wish Toki and you the best, and praying this will turn out to be something that can be controlled with diet and meds. While I don't have any experience in this department, I wanted to bump your thread up for others to see. I do recall from previous threads mention of scintigraphy for diagnosing shunts.

Thanks for thinking of us, Kristin. I do believe that a scintigraphy will most likely be our next step. I too am hoping for something that can be controlled without surgical intervention (I'm willing to do whatever is necessary regardless)...fingers crossed.

[tokipoki]

Originally Posted by kjc

Liver Shunts and Gall Bladder issues don't always show on Ultrasound. Sludge can develope in the bile duct from the liver to the GB, and cause similar test results as a Liver Shunt, including high BAT results.

I had actually come across that thread you mentioned...it has a ton of interesting information, especially with regards to different liver/gallbladder disorders and corresponding bloodwork values. I've been combing through that article you linked. It's so hard to even know what Toki has going on... her BAT values were under 100 and she has no symptoms...what if they don't find anything with the ultrasound? Will we have to do a biopsy? Or will they just give her medication and retest her values later on to see if anything has changed? Monday seems forever away. More time to do research though so that I can ask my vet appropriate questions and not spaz out on her.

[tokipoki]

Originally Posted by Parka

My yorkie had elevated bile acid levels at his last checkup. He also has seizures. I took him to a specialist and he told me that levels less than 100 are more likely to be MVD than an external shunt. We did an ultrasound - no external shunt, no gallbladder issues. The specialist said it could be MVD but it would be better to switch his diet and see if he improves than to do an invasive liver biopsy. He's doing just fine so far but we're waiting on a 6 month retest.

Please keep me updated. Has his seizure frequency decreased since changing his diet?

[tokipoki]

Originally Posted by Mybrcc

My dog recently has been suspected to either have MVD or Liver Shunt. Scheduling a appointment with a specialist this week. He was perscribed Royal Canine Hepatic dog food, and also is on Luctralose. Hope everything turns out OK with your dog, as this is costing me a fortune.

It certainly isn't cheap going through the steps of figuring out what is wrong...now I'm rethinking getting the pet insurance and glad that I have a savings account for her to help out. I was looking at your thread and it seems like we're going through a similar process ...please let me know how your appointment with the specialist goes.

[kjc]

Originally Posted by tokipoki

I had actually come across that thread you mentioned...it has a ton of interesting information, especially with regards to different liver/gallbladder disorders and corresponding bloodwork values. I've been combing through that article you linked. It's so hard to even know what Toki has going on... her BAT values were under 100 and she has no symptoms...what if they don't find anything with the ultrasound? Will we have to do a biopsy? Or will they just give her medication and retest her values later on to see if anything has changed? Monday seems forever away. More time to do research though so that I can ask my vet appropriate questions and not spaz out on her.

Many times if no tests are definitive, they will opt to retest in 1-3 months, sometimes after being on a low protein diet and/ or meds to see if there's any changes, esp with a dog with no symptoms. Also depends on her liver enzyme bloodwork.... Sometimes if it's just the ALT, it could be a toxin that was ingested (or toxic to the liver) (Tink ate rancid grease). The Denamarin (liver supplement) will be a great help there. A biopsy is best done during surgery to fix something else, ie: spay, LS, clear bladder stones, etc.

[LuvTaycieGirl]

I went through this last October with Taycie, through Biopsy she was diagnosed with MVD. Taycie has always had slightly elevated liver enzymes her entire life.. but nothing to scare me at the time. It was like 2 -5 points out of "normal range". I was always told this could be because stress at the vet office.

About a year prior to her diagnosis with MVD she had already has been diagnosed with SIBO or small intestinal bacteria overgrowth.. she was placed on tylan powder and I had already put her on lower protein food because she just simply could not tolerate anything with higher protein levels. Now.. looking back.. I think this bought us time.. and pacified the problem for the time being.

In June, 2012 she had a dental done. This time bloodwork was done her liver enzymes were 50 points above normal. My vet at the time, ( not my current vet now) told me we need to watch this.. Lets retest in 3 months and then schedule an ultrasound.

In October, it all came to a head she would get up in the night and pace.. and act very strange. I would find her curled up in the kitchen in the middle of the night.. Her stomach would be tight.. and she would be starting at nothing.. I scheduled the ultrasound..

Ultrasound results were inconclusive... A scintigraphy for us was not an option.. no one does this in Salt Lake

So.. back to the vet we went and at this point her enzymes were 100 points above normal. I requested a BAT and her pre meal was 24 post meal was 109.

Taycie at the time got extremely sick and was hosptilized for 3 days.. She was sent home on a feeding tube for a week and then a week later went in for exploratory surgery.. She had a biopsy of her small intestine and liver. This is finally when we were able to rule out a shunt.

Her Biopsy report came back with MVD. Taycie is on Metronidazole and Lactulose. She is also supported with a Homecooked Diet Formulated by Dr. Remillard. On the positive side she is doing VERY well now! I am so happy with her progress! I will keep Toki in my prayers. I know how much YT helped me when I went through all of this.

[tokipoki]

Originally Posted by LuvTaycieGirl

I went through this last October with Taycie, through Biopsy she was diagnosed with MVD. Taycie has always had slightly elevated liver enzymes her entire life.. but nothing to scare me at the time. It was like 2 -5 points out of "normal range". I was always told this could be because stress at the vet office.

About a year prior to her diagnosis with MVD she had already has been diagnosed with SIBO or small intestinal bacteria overgrowth.. she was placed on tylan powder and I had already put her on lower protein food because she just simply could not tolerate anything with higher protein levels. Now.. looking back.. I think this bought us time.. and pacified the problem for the time being.

In June, 2012 she had a dental done. This time bloodwork was done her liver enzymes were 50 points above normal. My vet at the time, ( not my current vet now) told me we need to watch this.. Lets retest in 3 months and then schedule an ultrasound.

In October, it all came to a head she would get up in the night and pace.. and act very strange. I would find her curled up in the kitchen in the middle of the night.. Her stomach would be tight.. and she would be starting at nothing.. I scheduled the ultrasound..

Ultrasound results were inconclusive... A scintigraphy for us was not an option.. no one does this in Salt Lake

So.. back to the vet we went and at this point her enzymes were 100 points above normal. I requested a BAT and her pre meal was 24 post meal was 109.

Taycie at the time got extremely sick and was hosptilized for 3 days.. She was sent home on a feeding tube for a week and then a week later went in for exploratory surgery.. She had a biopsy of her small intestine and liver. This is finally when we were able to rule out a shunt.

Her Biopsy report came back with MVD. Taycie is on Metronidazole and Lactulose. She is also supported with a Homecooked Diet Formulated by Dr. Remillard. On the positive side she is doing VERY well now! I am so happy with her progress! I will keep Toki in my prayers. I know how much YT helped me when I went through all of this.

Thanks for sharing your experience and keeping us in your thoughts. I'm really glad that Taycie is doing well now and it makes me hopeful...it seems like most of these pups fare well with a closely monitored diet and medication, even if surgery is not an option. I take my baby in for an ultrasound tomorrow morning so hopefully we will have more answers then. I'm assuming that we will be able to get a scintigraphy (if that is the next step) since we are right down the road from the NCSU vet school...I imagine they have lots of resources and specialists.

I am really hoping that we do not have to go through the process of exploratory surgery/biopsy though. I'm not sure what to expect with this ultrasound but I'll keep you all posted and give an update tomorrow. I am of course hoping that they don't find a large shunt although that result will lead to even more questions and options we'll need to explore. Thanks everyone for the information and support.

[LuvTaycieGirl]

Originally Posted by tokipoki

Thanks for sharing your experience and keeping us in your thoughts. I'm really glad that Taycie is doing well now and it makes me hopeful...it seems like most of these pups fare well with a closely monitored diet and medication, even if surgery is not an option. I take my baby in for an ultrasound tomorrow morning so hopefully we will have more answers then. I'm assuming that we will be able to get a scintigraphy (if that is the next step) since we are right down the road from the NCSU vet school...I imagine they have lots of resources and specialists.

I am really hoping that we do not have to go through the process of exploratory surgery/biopsy though. I'm not sure what to expect with this ultrasound but I'll keep you all posted and give an update tomorrow. I am of course hoping that they don't find a large shunt although that result will lead to even more questions and options we'll need to explore. Thanks everyone for the information and support.

Thinking about you today! Hope all goes well, and you get some answers. I so envy people that are nearby a vet school that is wonderful you can take her there.

Keep us posted!

[107barney]

Originally Posted by tokipoki

It certainly isn't cheap going through the steps of figuring out what is wrong...now I'm rethinking getting the pet insurance and glad that I have a savings account for her to help out. I was looking at your thread and it seems like we're going through a similar process ...please let me know how your appointment with the specialist goes.

Well it is too late for most pet insurance if the dog has already been evaluated for the symptoms so check carefully before signing on...

I hope you find out what is wrong. MVD can indeed be managed with a lower protein diet and sometimes medications/supplements. My dog has been a long time survivor, is almost 13, and runs around like a puppy. Even if it is a shunt, it is a pretty easy fix these days for most dogs that have an external shunt. LadyJane's 8 year old TeddyBear just had surgery for one and did fine.

Best wishes, I'll keep an eye out for your update.