Incidental Liver Enzyme Elevations Flashcards
When are incidental liver enzyme elevations most commonly seen? How does this differ with age?
- routine wellness examinations
- pre-procedural blood work
- reactive hepatitis - <3x URI, typically very mild
DOGS 1-8 y/o = increased ALT 13%, increased ALP 28%
DOGS >8 y/o = increased ALT 23%, increased ALP 51%
In what 4 situations are elevated liver enzymes significant?
- magnitude >2-3 URI
- exclusion of other extrahepatic causes
- continued elevation over months
- disease that can be cured or managed - typically don’t wait for a Labrador or Doberman to be symptomatic for suspected copper hepatopathy
What are 3 common causes of extrahepatic disease causing elevation in liver enzymes?
- metabolic - vacuolar, hyperlipidemia, endocrinopathies
- reactive - inflammation associated with disease remote from the liver, like GI disease or pancreatitis
- hypoxemia - anemia
What are some drugs associated with liver disease?
- glucocorticoids - dogs only, cats lack cALP
- phenobarbital
- NSAIDs
- Acetaminophen
- Azathioprine
- CCNU
- TMS
- Azoles
- Methimazole
What are some “normal” cause of elevated liver enzymes?
- young dogs - growing = bALP
- breed - Siberian Husky
When are bile acids helpful to be measured? What can artificially change values?
hepatic function - does not correlate with severity, cause, or reversibility
cholestasis - NOT performed on icteric patients
What is considered a high bile acid measurement? What is considered a gray zone?
- > 25-30
- > 30 pre or post
25-40
Breed-associated hepatopathies:
Breed-associated hepatitis:
How is chronic liver disease diagnosed?
- ultrasound
- liver biopsy
What is the main risk of a liver biopsy? How is this risk assessed?
hemorrhage
measure BMBT and platelets prior
What are the 3 benefits to performing liver biopsies?
- identify the cause of liver disease - infection, copper, vascular, idiopathic, vacuolar, etc.
- prognosticate - fibrosis, architecture, cirrhosis
- guide treatment - copper, chronic
Diagnosing liver disease:
What empirical treatment is recommended for possible incidental liver enzyme elevations? What 3 treatments are not necessary?
- antibiotics - controversial, Clavamox
- hepatoprotectants - Denamarin, Ursodiol, Vitamin E
- Prednisone - can make underlying disease worse and liver enzyme interpretation difficult (cALP!), biopsy first
- D-penicillamine - not safe in patients without copper hepatopathy
- liver diet - restricting protein not necessary with liver disease
