Liver Enzyme Elevations Flashcards
Are liver enzyme elevations common?
yes (incidental or sick)
Which liver enzymes belong in the following categories?
Hepatocellular Injury:
Cholestasis/Enzyme Induction:
Indicating Impaired Function:
Hepatocellular Injury:
ALT and AST
Cholestasis/Enzyme Induction:
ALP and GGT
Indicating Impaired Function:
Bilirubin, Albumin, Glucose, Cholesterol and BUN
What is hepatocellular injury and what enzymes measure this?
ALT and AST
Increase injury due to necrosis or degeneration
Magnitude = number hepatocyte affected
Half life it 2.5 days
Persistent increase ALT = continued hepatocyte injury
Why might the AP be quite high but GGT normal or mildly elevated?
Hepatic Lipidosis in cats
What enzymes are indicators of cholestasis/enzyme induction?
ALP and GGT
(Decreased bile flow)
What organ produces clotting factors?
Liver
What are the indicators of liver function?
Bilirubin (Increase), albumin (Decrease), glucose (75% liver harmed to see decrease), cholesterol and BUN (Decrease)
What does prolonged clotting times suggest?
Significant hepatic disease
What is the most sensitive liver function test?
Bile acids
When is a bile acid test indicated?
Screen loss hepatic function, PSS
NOT for hyperbilirubinemia/jaundice (interfere)
> 25-30 abnormal
Why may ALP be high in young dogs?
Growth
What is the most common cause of abnormal liver enzymes?
Secondary to non-hepatic disease
-Drug or toxin
-Endocrine Disorder
-Dental Disease
-GI
-Metastatic neoplasia
-Nutritional abnormalities
-Cardiovascular
-Sepsis/infection
What are some symptoms you may find in the history that may point to non-hepatic dsiease?
PU/PD
Hyperactivity, weight loss
Excessive panting, hair loss
Vomit, Diarrhea, inappetence
Cough or difficulty breathing
Meds
Is it ok to do nothing at first?
Yes, if non-clinical do a recheck
When should you investigate further?
ALT more than 2x normal over several month
Unexplained liver enzyme elevation more than 6-8 weeks
non-hepatic ruled out
What are some differentials for primary liver disease?
Idiopathic, inflammation, copper associated, infectious hepatopathy, biliary tract,
What breeds are associated with hepatitis from idiopathic or copper causes?
Chronic hepatitis:
Lab
Cocker Spaniel
Doberman Pincher
West Highland
Copper:
Lab
Dalmation
Skye
Doberman
West Highland
Bedlington
What drugs may affect liver enzymes?
NSAID
Prednisone
Acetaminophen
Antibiotics
Anticonvulants
Supplements
What are some treatments to help with liver injury?
Denamarin - Sam E, milk thistle
Ursodiol
Vitamin E
Antibiotic - clavamox
What should you always do before performing a liver biopsy?
Check clotting factors
