One of the largest and best changes I (Perry Jameson) have noted in my nearly 30 years of veterinary practice is the ease of getting blood tests performed for my patients.
When I first started, our only option was to send blood to Lab Corp, the large human blood testing facility. There would be a 24-hour delay before we had any results back, meaning we were making educated guesses about therapy. The machines were calibrated for human blood, so the results could be skewed slightly. We had to keep this in mind when interpreting them.
Fortunately, about 15 years ago, the technology was developed for veterinarians to have small blood analyzers in their hospitals. This allowed us to obtain results within 15-30 minutes. We were able to diagnose and fine-tune treatment immediately rather than having to wait for days. For more detailed analysis, veterinary specific labs, such as Antech and Idexx, started where we could send samples.
The improved availability of veterinary specific testing has allowed us to perform annual blood tests for our patients the same way it is done in human medicine. The goal is to diagnose a problem early when it can be easily treated.
As an internist, this created one of the most common complaints I receive: elevated liver enzymes. If you own a dog long enough, you will hear those three words one day.
Liver enzymes are proteins that the liver cells release into the blood stream in small amounts all the time. Certain levels are normal. When elevated, it means there is some change triggering them to release more of these enzymes than normal.
The frustrating thing is their increase is not specific for one particular problem. Also, not only will diseases of the liver cause an increase but issues with the gall bladder can as well. The three patients I saw on the same day recently indicate how diverse the problems causing elevated liver enzymes can be.
Elroy, a 13-year-old schnauzer, had not been eating well nor was he as energetic as usual for the previous week. Mom took him to see his veterinarian. Blood tests were performed, which revealed elevated liver enzymes, so Elroy was referred to me.
After looking at Elroy and talking to his mom, I decided an ultrasound was the next step to noninvasively image his liver and gall bladder. As I always do, I explained that some liver issues, such as masses and abscesses, we can see on ultrasound, while others, such as hepatitis or toxic injury, are microscopic changes that we cannot.
Fortunately for Elroy, he had something I could see, a gall bladder mucocele, a cyst. This is a condition in older dogs where the bile, which should be thin as water, has solidified. In some dogs, they never have issues, while in others, like Elroy, they become infected, inflamed and, in the worst cases, can rupture the gall bladder. Dr. Henri Bianucci removed Elroy’s gall bladder and within 24 hours, he was eating all the food we offered.
Later that same morning, I saw Tiny, a 14-year-old dachshund. Dad had taken Tiny in as instructed for her annual blood tests and physical examination. These tests revealed elevated liver enzymes. Dad was shocked because as far as he could tell, she was 100 percent normal. He agreed to be referred to me to be safe.
We started with an abdominal ultrasound as well. I noted her liver and gall bladder were normal, but her adrenal glands were subtly enlarged. Dachshunds are a breed that can develop Cushing’s disease, where the adrenal glands produce too much of the hormone cortisol. This increased cortisol does not hurt the liver but does cause it to produce more liver enzymes than normal.
Tests of her cortisol levels confirmed she did have Cushing’s. Since she was asymptomatic, Dad and I decided to hold off therapy for now. If she developed symptoms, increased thirst, urination and hair loss, then we would treat. At least now we knew she did not have a liver issue we were ignoring.
Pete, an 8-year-old Labrador, was brought in for elevated liver enzymes, as well. Overall, he was doing well, but Mom and Dad thought maybe he was not as active and wasn't begging for food as he once had. At first, they thought it was just aging, but decided to have him checked to be sure.
As with Tiny and Elroy, we started with an abdominal ultrasound. His gall bladder was normal and maybe his liver was a little irregular along the margins, but nothing obvious. I informed his parents that a biopsy was the only way to know for sure what Pete’s problem was. To get an adequate sample, I recommended either laparoscopy or surgery.
Dr. Bianucci again obliged my request and was able to get several laparoscopic samples. He, too, felt the liver was mildly irregular but observed no other major visible changes.
The pathologist, however, was able to see a lot more was going on than we could. Pete had a form of hepatitis secondary to copper accumulation in his liver. Certain breeds will accumulate copper within their liver cells. It is not because they are eating too much copper, but due to a problem where their liver cells retain the copper. If left untreated, they will develop cirrhosis and fatal liver failure. Pete has been started on therapy and we will see how he does.
Elevated liver enzymes are a common issue for older canines and worth looking into as many causes can be treated if caught early enough.