Bile Acid Tests Elevated, I'm Panicked...
 

Maggie, my two year old yorkie is scheduled for bladder surgery tomorrow to remove a stone. The vet did a blood panel last week and bile acid test, but she did it at rest and Mags had eaten breakfast beforehand. The test came back elevated.

Maggie has occasionally staggered, is a low enery dog, sleeps a lot, and night before last after dinner of canned chicken, she was restless all evening, up during the night.

Of course, I'm panicked. The vet said blood panel looked fine, everything was okay. I no nothing about liver shunt. What should I be asking my vet? I know it's liver disease, can a dog live a relatively long life with it?

She is going to retake the test 10 days after Maggie's surgery, this time before and after feeding. And by then the stone will have been analyzed so we will know more about what's going on.

I don't want to worry prematurely, but I just have a feeling that she has it.

Thanks for any info you can give me. I'm so worried.

Do you know what the bile acids test number was? That would tell you if you may be dealing with a shunt or perhaps just asymptomatic mvd.

Before you panic, retest her. Then if her BAT is still high, a protein C test should be done to see if a shunt is likely.

Here are some good links to information from two experts on liver disease, Dr. Center and Dr. Tobias.

Hepatic Vascular Disorders - WSAVA 2006 Congress

The University of Tennessee - College of Veterinary Medicine - Portosystemic Shunts

What were her Pre and Post #s ????

Not to worry you more...but were it me...I think I'd hold off on the surgery until I had further information regarding the bile test with pre and post fasting results.

She didn't have the fasting one performed.

A fasting BAT is no longer recommended. Two paired samples around a meal is the updated protocol according to Dr. Center who developed the BAT.

This was taken from page 5 of Dr. Center's handout:

"7. Random "Fasting" Bile Acids ARE NOT reliable for RULING OUT liver dysfunction or abnormal portal circulation. Rather, you need PAIRED SAMPLES AROUND A MEAL. We no longer collect 12-hr fasting bile acids but instead collect a bile acid sample before a meal (pre-meal) and 2 hours after a meal (post-meal or postprandial)." (all emphasis was added by Dr. Center, not me)

We just went through this with Logan. His bile acid results were slightly elevated, so the vet put him on a low protein dog food, Lactulose, and Denamarin. He was retested last week, and his post-meal level was almost normal. His was 33, and normal is up to 20.

I would retest your Yorkie after going through a similar regimine. Don't panic yet!

Why would you hold off the surgery?
 

Why should the surgery be held off? Doesn't the stone need to come out of her bladder? I don't understand why we wouldn't go ahead with the scheduled surgery, and then do the tests after surgery. Could you please elaborate on why you think I shouldn't go thru with surgery. Thank youj.

Often dogs with LS don't do well under anesthesia — they have a hard time coming out of it I believe? (someone correct me if I'm wrong here…). Does your vet seem knowledgeable on shunts and liver disorders? I'm going through this with BOTH my dogs (just found out in the last month or so that they both are liver compromised) and my head was just swimming with all the information I found through my own research.

It really depends on your pup's test results though — Oscar's was only 51 or something (compared to Ruthie's who's pre was 249 and post was 231 and she had some symptoms) and we caught his by fluke in some bloodwork. He is completely asymptomatic and for now I'm holding off on any more tests, etc. He has been through FOUR surgeries in his life, one was just this past January, and has had ZERO problems. Maybe your pup's results were in the lower range and that's why your vet is confident in going through with surgery? If you do go ahead, then be sure to ask if/what extra precautions they take during the procedure to make sure there are no problems.

Good luck with your little one — both my babies are 2 years old as well so I thought I was in the clear when it came to LS, etc.... apparently not! Hope everything comes out well :)

I agree. Anesthesia can be very dangerous for liver compromised dogs. It's important to find out what you are dealing with before risking anesthesia.