Liver enzyme Gucci (morkie) was scheduled for his neutering this morning, but the blood test came back with an elevated liver enzyme, which apparently is common with yorkies? Our vet is taking precautions with him since he's only 4.2# and of course they love him over there! There's another test which I'm not exactly clear on, but it will enable them to see how and what to do in his case. She's pretty sure he'll be fine and able to reschedule, but I was wondering if anyone has information to share on this issue. Thanks, Kathy |
His ALT was probably up and they are probably going to do a bile acid test to rule out liver function problems like liver shunt and microvascular dysplasia. If that it is the case, it sounds like you have a good vet for paying attention.:) |
The vet told me that normally they get VERY concerned when it's elevated to the 200 level. She said that high is around 75 and Gucci is at 97. In an average sized dog probably wouldn't be as concerned, but because of his size, 4.2#, they're being extra careful. They've always very careful with him. |
Hi, I just went through this 3 weeks ago with Bella. I had her pre spay bloodwork done and her levels came back slightly elevated. So my vet suggested doing the bile acid test and checked her urine for crystals and I had to leave her at the vet all day long. It was excruciating for me and her both. Well her levels came back perfectly normal with 1 slightly elevated again so my vet called someone who is a specialist regarding Liver Shunts in Dogs and they said she was all clear and her levels were actually perfectly normal. My vet was just being overprotective (which I adore)!! So in all it took 4 days with the results and now I know I have a perfectly happy, healthy, recently spayed Yorkie.:) Good luck! |
Sounds like you have a great vet! Yorkies are 36 times more likely to have a liver shunt than all other breeds combined, so your vet is right to be extra careful and do a bile acids test. 97 is really only slightly elevated. (Normal is between 10-84) I'm sure he will be just fine. |
Thank you all for your responses. It makes me feel a little better although still worried. Not sure if a bile acid test was done, but he's due for his ultrasound on Monday. Please keep him in your thoughts. Thanks again, Kathy |
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Unfortunately, most vets just don't see enough cases to know the protocol for diagnosing and treating liver disease. Here are a couple of good links for you: Hepatic Vascular Disorders - WSAVA 2006 Congress PSVA and MVD Research Summary Portosystemic Shunts FAQ |
Actually, we have been referred to another vet for the ultrasound and they asked to have the blood tests forwarded to them. Before an ultrasound, I intend to have a very detailed question and answer session. I also believe the ultrasound may be overkill, but if it's needed will do. I've thought about the expense as well, but he is part of the family. I'm really confused because Gucci shows no symptoms that point to a problem. |
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He did have a bile acid test done and that's why we were referred to another vet who does have ultrasound equipment. I'm not sure what the reading was on that test, but they are faxing the results to him before we meet on Monday. Sounds like you either have medical experience or have been through this yourself. Thanks for your input. |
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Ultrasounds are not recommended anymore, scintigraphy is. Ultrasounds can be as low as 60% reliable. The next step is a protein C test, before imaging. Recent studies indicate that protein C deficiency is a marker of liver disease in dogs. Protein C deficiency develops in dogs with hepatic synthetic failure and in portosystemic shunting disorders. The protein C activity assay is especially useful as a non-invasive measure of portal blood flow. Dogs with congenital portosystemic vascular anomalies (PSVA) typically have low protein C activity, with values < 70% of normal. Although clinical signs and chemistry profiles of dogs with PSVA and microvascular dysplasia are similar, the finding of low protein C activity supports a diagnosis of PSVA. Furthermore, protein C activities can be monitored after shunt ligation to assess restoration of portal blood flow. This link explains the protein C test. Comparative Coagulation -- NYS Animal Health Diagnostic Center A lot of research has been done on liver disease in the past few years and most vets just aren't aware of the advances and changes in protocol. You can waste a lot of time and money getting the wrong tests done and end up with no conclusive answers. |
There are a couple of things the ultrasound is useful for...It can help determine if the liver has atrophied(shrunk) due to liver problems. It can also show if there are any bladder stones which are very common in dogs with liver problems. The type of stone that is consistent with liver problems is called ammonium urate and can ONLY be seen on ultrasound. They are NOT seen in x-rays. If neither of these things are found, then an ultrasound could be inconclusive and further testing will be needed anyway. Ultrasounds do not typically show a liver shunt. The shunt could be positioned in an area that cannot be seen by ultrasound. Also, an ultrasound won't show if your dog has MVD. |
1 Attachment(s) Okay, so this is the latest in Gucci's saga . . . After talking with the second vet, and explaining all I had learned from this site, he still felt it necessary to do an ultrasound. They also did another bile acid test, but just like my vet, the test is read in their facility and doesn't register over 30. It simply says it's above 30 - could be 32 or 102. Sooooo, we have to return to my vet for yet another bile acid test which they are sending out to an outside lab for reading - no cost. The ultrasound didn't show anything conclusive, right again, and fortunately they didn't charge me an arm and a leg for the tests. I asked about the protein C test, but didn't appear to understand what I was asking for. I was prepared for the worst, and when they asked for $100 I almost jumped the counter and kissed her! He's not showing any symtoms and even Scott agreed. We'll wait and see. I |
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Comparative Coagulation -- NYS Animal Health Diagnostic Center If they are not collecting the sample for the bile acids test properly, the results will be skewed. It doesn't sound like either of your vets know much about current protocol for diagnosing liver disease. As I said before, you can waste a lot of time and money if you don't deal with a vet who is knowledgable. This is from Dr. Center, the developer of the bile acids test: The bile acid test is very reliable but the red blood cells MUST be separated from plasma (the clear part of blood) before they are sent to lab for analysis (centrifuged or spun to allow plasma separation from blood cells). Results can be falsely abnormal if the bile acid samples are lipemic (lots of fat IF the fat is not adequately removed by the laboratory analyzing the sample) or if hemolysis (burst red blood cells, makes the plasma red) occurs. The red color interferes with the color of the end point dye in the bile acid test. A clinician can tell if the sample is hemolyzed when they centrifuge the sample to separate the red blood cells from the plasma. If it is hemolyzed they should collect another sample. Drawing blood with a vacutainer needle into a vacutainer (suction of the tube facilitates the collection) may be too traumatic for some red blood cells augmenting hemolysis. Using a syringe and needle or syringe and butterfly needle appears to collect the best samples. After the blood is collected, the needle should be removed from the syringe and the top removed from the vacutainer so that the blood may be gently transferred to the vial. Results of the bile acid test should state if the samples were lipemic or if hemolysis occurred. In this case, the tests should be repeated. PSVA and MVD Research Summary Dr. Center also recommends that the vet collect the blood in a plain red-top tube versus a serum separator. After the blood clots, it should be spun down and the serum put in another plain red-top to go to the lab. |
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