Sonopath Forum

Cause of Liver Enzymes Elevation

Tori, an 8 yr. old Maltese, was seen about a month ago by her vet for a cough…as part of the work-up bloodwork was done with the following: Alk Phos of 800 T. Bili of 2.5 ALT didn’t register. They did an U/S which was reported as normal. Other than the cough (which resolved on it’s own), the dog is totally normal with no problems.

Seen today for 2nd opinion/follow-up. Again, totally normal dog with no issues at all (except grade3/4 dental disease)

Repeated Labs: ALT didn’t register (usually suggests high value) Alk Phos of 927 GGT of 104 T. Bil down to 0.2

Did U/S looking for cause of enz elevations. To me the liver seems diffusely hyperechoic, the GB maybe is sl enlarged but normal wall and contents. The duodenum seems to have a prominent mucosa and measures slightly larger than normal, but no v/d in history. I think I see a CBD???

I’m trying to r/o obvious liver/biliary disease so I can pin this on dental disease w/ reactive hepatopathy…I’m not used to seeing the AP and GGT be so high w/ RH.

My next step would be needling the liver & a dental.

Thoughts greatly appreciated.

Comments

franklinanimalclinic

September 26, 2017 at 11:10 pm -

Another Image

Another Image

rlobetti

September 29, 2017 at 1:05 pm -

Would expected

Would expected reactive/vacuolar hepatopathy with a degree of increase in liver enzyme activity with dental disease but not to the level that this dog is showing. With the appearance of the duodenum and liver lymphoma is possible. FNA cytology, possibly a Tru-Cut biopsy, and endoscopy would be further asseement, as well as sorting the mouth out.

franklinanimalclinic

September 29, 2017 at 1:12 pm -

Thanks,
when you mention

Thanks,

when you mention duodenum changes, are you referring to the thickend wall and more prominent mucosa? I don’t see any loss of layering…

It’s totally wierd that this dog acts totally normal and yet has these enzyme elevations…I’m having a hard time convincing the owner to do anything…

Have a nice day,

Sam

rlobetti

September 29, 2017 at 1:17 pm -

Agree that the clinical

Agree that the clinical picture does not fit the biochmemical changes but often these curved balls are sent to keep us on our toes.

No loss of layering just the thickned wall – can be early lymphoma and can have no GI signs with severe intestinal signs – another curved ball

franklinanimalclinic

September 29, 2017 at 2:34 pm -

thought this was U/S not

thought this was U/S not baseball…

Thanks