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Elevated Liver Enzymes - Causes?

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25K views 37 replies 22 participants last post by  tamizami  
#1 ·
I know that this has probably been discussed before, if so please forgive my laziness in not researching more. Nikki went in for her spay today and the vet found elevated liver enzymes so they are not doing the surgery. Instead, they are doing a bile acids test. Her levels were at 400.


So while I sit here on pins and needles waiting for the doctor to call me to come and get Nikki, can someone tell me some of the causes of elevated liver enzymes? I know that in my Bichon it was Cushings. I read somewhere about Liver Shunt, but what else?

Thanks
 
#2 ·
I know that this has probably been discussed before, if so please forgive my laziness in not researching more. Nikki went in for her spay today and the vet found elevated liver enzymes so they are not doing the surgery. Instead, they are doing a bile acids test. Her levels were at 400.


So while I sit here on pins and needles waiting for the doctor to call me to come and get Nikki, can someone tell me some of the causes of elevated liver enzymes? I know that in my Bichon it was Cushings. I read somewhere about Liver Shunt, but what else?

Thanks[/B]
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My last Maltese Benson had elevated liver values, and it did turn out to be a liver shunt. That's not to say that something is wrong with Nikki -- the test could be wrong, most definitely. It may be nothing at all. :thumbsup:
 
#3 ·
K
#4 ·
Oh, I'm so sorry. :grouphug: I know how we worry about our babies. Before you panic if the bile acid test comes back with a suspected shunt, be sure to follow up with a Protein C test that is processed at Cornell. Several members here have had high bile acids but the Protein C test showed that they likely didn't have a shunt and had asymptomatic MVD.
 
#5 ·
I will do the protein C follow-up for sure.

I will know the results of the Bile Acids test on Monday, and Nikki will go in for a bloodwork re-check in 2 weeks, after she does a course of amoxicillan and Marin, which is basically an expensive version of Milk Thistle and Vitamin E. At some point after that I must have her spayed, but I don't know when it will happen. :smpullhair:

Nikki's regular vet is out of the country lecturing, and because she is in limited practice and no longer does surgery, we had to pick a different doc at the animal hospital for the spaying. She was very nice today, but I miss Dr. Wynn. I can't wait until she comes home next week. Dr. Wynn takes a great deal of time explaining things, and also discusses alternative medicine.

I went through the elevated liver enzyme thing with my Bichon who was borderline Cushing's. Today I kept thinking, "Oh no not again!"

This has been a rought week, as I just learned my good friend has ovarian cancer. :smpullhair:

So thanks for your thoughts and prayers. I will keep you updated.
 
K
#6 ·
I will do the protein C follow-up for sure.

I will know the results of the Bile Acids test on Monday, and Nikki will go in for a bloodwork re-check in 2 weeks, after she does a course of amoxicillan and Marin, which is basically an expensive version of Milk Thistle and Vitamin E. At some point after that I must have her spayed, but I don't know when it will happen. :smpullhair:

Nikki's regular vet is out of the country lecturing, and because she is in limited practice and no longer does surgery, we had to pick a different doc at the animal hospital for the spaying. She was very nice today, but I miss Dr. Wynn. I can't wait until she comes home next week. Dr. Wynn takes a great deal of time explaining things, and also discusses alternative medicine.

I went through the elevated liver enzyme thing with my Bichon who was borderline Cushing's. Today I kept thinking, "Oh no not again!"

This has been a rought week, as I just learned my good friend has ovarian cancer. :smpullhair:

So thanks for your thoughts and prayers. I will keep you updated.[/B]
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Oh, I'm so sorry to hear about your friend. It has indeed been a rough week for you. :grouphug: I sure hope that Monday's results are good. There are a lot of people here on SM who have first-hand experience with liver issues, so you should be able to get lots of info and support here.
 
#8 ·
I was checking for an update on Nikki, and didn't expect this! I'm so sorry, and I'm also sorry about your friend. :grouphug:

Susie and Sadie have suspected asymptomatic MVD - high bile acids, but their liver enzymes have been normal. Hopefully this is nothing serious for Nikki. I will certainly keep her in my prayers. :prayer:
 
#9 ·
I was checking for an update on Nikki, and didn't expect this! I'm so sorry, and I'm also sorry about your friend. :grouphug:

Susie and Sadie have suspected asymptomatic MVD - high bile acids, but their liver enzymes have been normal. Hopefully this is nothing serious for Nikki. I will certainly keep her in my prayers. :prayer:[/B]
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Shoni is like Susie and Sadie and has only high bile acids. We ran the test twice and also did the Protein C twice because the first one was bad, but the 2nd one was normal. Never has had high liver enzymes (yet anyway). If you get a high bile acid test and then do the Protein C to help rule out shunt and it is normal, then hopefully you can give him the Marin and I would get some Denosyl also--and keep on a fairly low protein diet and she'll be fine. Generally best to only use poultry, dairy and vegetable proteins.

We have only been mentioning shunt and MVD, but high liver enzymes can mean any number of other liver diseases or injury. It could just be stress or something with her teeth, or something else the amoxicillin will take care of. Dr. Dodds has a liver cleaning diet you could use for a while to let the liver rest. I think you would find it if you Google Dr. Dodds Liver Cleansing Diet.

Suzan, judging from the way your vet is handling this so far I would not worry because they are right on. Cushing's is usually a senior disease so I wouldn't think you would need to consider that. I hope you have results soon, waiting is so hard. :grouphug:
 
#12 ·
Mine both had high liver enzymes and high bile acids, but no shunts. It is estimated that about 60% of maltese have asymptomatic MVD (hepatic microvascular dysplasia). We see Dr. Dodds and her liver cleansing diet (I posted it in the recipe section of SM) lowered Shiva's enzymes by 200 points in 3.5 weeks on it. Its basically 1/3 white fish (we used Tilapia from Whole Foods since it is low in mercury, but only Whole Foods since its farm raised), 1/3 white potato and 1/3 sweet potato. A real miracle diet. Will do wonders to calm the liver down.

Call me or PM me if you want more info....Dr. Dodds is great and quite responsive via email. FYI, she is also doing the rabies challenge study.

Most importantly, don't panic and don't withhold protein since she is so young and has no symptoms. I'm sure she is just like 60% of all maltese :)
 
#14 ·
Wow!! What a week you are having. :grouphug: Praying you friend will work be okay. :prayer:
 
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K
#16 ·
Thanks to all for your kind thoughts, words, and prayers. I'll keep you posted, and I'll look into all your suggestions. Right now I am a little emotional about this because Nikki is the sweetest dog and I'd hate to have her be sick.

Thanks[/B]
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Oh, I understand how you feel. :grouphug: It definitely is so hard on us to think of our precious babies being sick. I hope that Nikki's situation turns out to be nothing serious. She is so adorable and I know how much you love her.
 
J
#18 ·
I am so sorry for what you are going through. My little Ava Jane had elevated liver enzymes and high bile acid numbers (pre-meal was 60, post-meal was 266). I took her to the University of Pennsylvania where they did a CT Angiogram and confirmed she had a single extrahepatic shunt. Her shunt was not normal though, because some blood was going through her liver and some was being diverted. She never displayed any outward signs of having a shunt and she grew to a healthy size. She was 6 pounds 14 ounces before surgery. What we did was pre-medicate her one month in advance of the CT angiogram. We treated her like she had MVD. She was fed Hill's L/D as well as Lactulose and Metronidazole. The day of her CT and then surgery, her blood values were normal. Although the recovery from the surgery was rough on her, she is now doing incredible. She weighs 7 pounds, 6 ounces (a little chubby I think) and her blood values are perfect, for the first time in her life with no medicine. I tell you all this so you know you can have a good outcome. If you want any more advice or details feel free to e-mail me. I am more than happy to help.
 
#20 ·
Sounds like you are on the right track.

Infection is a common cause of elevated ALT. That's why your vet suggested a course of antibiotics and a recheck. I have seen some cases where there was infection in the mouth because of double rows of teeth (retained deciduous teeth) and antibiotics and removing the teeth resolved the infection and elevated ALT.

Asymptomatic MVD in Maltese does not need treatment. Protein should not be restricted from the dog's diet unless they have protein intolerance (hepatic encephalopathy). Its something you want to know and note so a vet doesn't think they found a problem later on in life.
 
V
#21 ·
Oh no! I'm so sorry about this Suzan. I know it's going to be a long weekend to wait for the bile acid test. Karli had to go to the University of Tennessee to have a scintography to check for a liver shunt (she didn't have a shunt), so I know how stressful and worrisome all this can be. I'll pray for Nikki and for your friend as well. :grouphug:




Joy
 
#23 ·
Thanks again for your kindness.

Nikki does have a bunch of baby teeth that need to be pulled. I do hope that the high numbers were due to an infection and nothing more serious. We'll let you know when we hear the results.

I hope I didn't sound like I didn't like this doctor who is treating Nikki right now, because she seems fine. I just miss my regular vet, Dr Wynn, because she has a different "style."
 
#24 ·
Sounds like you are on the right track.

Infection is a common cause of elevated ALT. That's why your vet suggested a course of antibiotics and a recheck. I have seen some cases where there was infection in the mouth because of double rows of teeth (retained deciduous teeth) and antibiotics and removing the teeth resolved the infection and elevated ALT.[/B]
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I know a gal whose pooch ( an adult) had very high liver enzymes found prior to a dental ... further testing showed no problems and the vet said it could well be coming from the teeth ( apparently there was one bad tooth in the back). they went ahead with the dental, and sure enough the levels returned to normal. This was the first time I had heard of a connection between bad teeth and enzymes elevated.

Praying little Nikki's issues are easily rectified!
 
K
#25 ·
Thanks again for your kindness.

Nikki does have a bunch of baby teeth that need to be pulled. I do hope that the high numbers were due to an infection and nothing more serious. We'll let you know when we hear the results.

I hope I didn't sound like I didn't like this doctor who is treating Nikki right now, because she seems fine. I just miss my regular vet, Dr Wynn, because she has a different "style."[/B]
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Oh, I'm the same way about my vet. There are three others in the office who I'm sure are excellent but I have such a wonderful rapport with "my" vet that whenever I have to see someone else, it just isn't the same. I'm glad your vet will be back soon!
 
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