YorkieTalk.com Forums - Yorkshire Terrier Community - View Single Post - My baby is sick :-(

TheresaG · 09-01-2009, 08:16 AM

History: His owner reports that for about three days last week, Corky
did not seem to be feeling well. He was shaking, lethargic, and not
eating. Lab work submitted at the end of last week showed a slightly
eleated ALT liver enzyme concentration and pre- and post-prandial bile
acids concentrations that were listed as greater than 30. Shortly after
his visit to the doctor Corky seemed to start feeling better, and he now
seems back to normal. No treatment was undertaken, so his issues seemed
to resolve without any intervention

Physical Examination findings: His general exam today was
unremarkable.

Weight: 4.05 lbs 1.840 kgs

Procedures: physical exam and consultation

Results as of 9/1/2009: We reviewed his history. We do not know
what caused his signs last week, but it is nice to see they have
resolved. Hopefully they will not come back.

There is no way to know if the lab work findings have anything to do
with why he did not feel well last week. It is possible that liver
disease is/was present, but it is also possible that his signs had
nothing to do with the changes found on lab work. Those changes raise
questions about the status of his liver, and given his breed, about the
status of the blood supply to his liver (ie the possibility of
abnormalities in the blood supply to the liver, commonly referred to as
shunts).

Options for dealing with the information gathered so far include
repeating lab work to see if the abnormalities noted last week prove to
be repeatable findings or not, or digging for more information by doing
tests like ultrasound or MRI. Ultimately, if the goal is to be as
certain as possible about his liver and its blood supply, the most
direct way to do this would be through exploratory abdominal surgery,
liver biopsy, and assessment of the blood supply to his liver with a dye
study called a portogram. Even though this is the most complete way to
proceed, I think it may be too aggressive as a next step at this point
in Corky's case.

My recommendation, as long as he seems to be doing well, is to repeat
his lab work (chemistry profile, bile acids profile that gives actual
numbers rather than a range like greater than 30) in 7-14 days. If that
lab work is normal, I'd check it a third time in a month or two to get a
third set of values for review. If it is abnormal, then decisions can be
made about which steps to take next to gather additional information

If Corky does not seem to be doing well, then he should be re-assessed
sooner, and the above plan can be modified to fit his changing
circumstances.

09-01-2009, 08:16 AM	#21
TheresaG Yorkie Talker Join Date: Jan 2009 Location: Odenton, MD Posts: 20	The emailed response from the doctor. History: His owner reports that for about three days last week, Corky did not seem to be feeling well. He was shaking, lethargic, and not eating. Lab work submitted at the end of last week showed a slightly eleated ALT liver enzyme concentration and pre- and post-prandial bile acids concentrations that were listed as greater than 30. Shortly after his visit to the doctor Corky seemed to start feeling better, and he now seems back to normal. No treatment was undertaken, so his issues seemed to resolve without any intervention Physical Examination findings: His general exam today was unremarkable. Weight: 4.05 lbs 1.840 kgs Procedures: physical exam and consultation Results as of 9/1/2009: We reviewed his history. We do not know what caused his signs last week, but it is nice to see they have resolved. Hopefully they will not come back. There is no way to know if the lab work findings have anything to do with why he did not feel well last week. It is possible that liver disease is/was present, but it is also possible that his signs had nothing to do with the changes found on lab work. Those changes raise questions about the status of his liver, and given his breed, about the status of the blood supply to his liver (ie the possibility of abnormalities in the blood supply to the liver, commonly referred to as shunts). Options for dealing with the information gathered so far include repeating lab work to see if the abnormalities noted last week prove to be repeatable findings or not, or digging for more information by doing tests like ultrasound or MRI. Ultimately, if the goal is to be as certain as possible about his liver and its blood supply, the most direct way to do this would be through exploratory abdominal surgery, liver biopsy, and assessment of the blood supply to his liver with a dye study called a portogram. Even though this is the most complete way to proceed, I think it may be too aggressive as a next step at this point in Corky's case. My recommendation, as long as he seems to be doing well, is to repeat his lab work (chemistry profile, bile acids profile that gives actual numbers rather than a range like greater than 30) in 7-14 days. If that lab work is normal, I'd check it a third time in a month or two to get a third set of values for review. If it is abnormal, then decisions can be made about which steps to take next to gather additional information If Corky does not seem to be doing well, then he should be re-assessed sooner, and the above plan can be modified to fit his changing circumstances.