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Should dog have a liver biopsy?

Species: Dog
Breed: dachshund/spaniel mi
Age: 8-11 years
My dog, Zora, was adopted from a rescue group in CA so we don't know much about her background. She appears to be a dachshund/spaniel mix and we believe that she is about 9 years old. She is a somewhat nervous and protective dog who has been a reluctant eater since her adoption in '07. We feed her on an elevated surface because our other small dog will steal her food before she can finish it. We feed our dogs Innova Adult small bites:
http://www.naturapet.com/products/901

We often give her a small amount of table scraps mixed in her food to help convince her to eat.

In April '12, she had an abces under her left eye for which we sought treatment. It turned out she had an abces tooth as well. Her tooth was removed, teeth cleaned, and both abces drained. At that time, her blood work showed elevated ALT at 250 IU/L (other levels included BUN: 17 mg/dl; Glu 111 mg/dl; ALP 31 IU/L; T-Pro 6.3 g/dl; Cre 1.2 mg/dl. She was given Distemper Adenovirus Type 2 Parainfluenza-Parovirus vaccine, Bordetella Bronchiseptica Bacterin, and Rabies vaccination the same day as this procedure. She was prescribed Clavamox and Tramadol for possible infection and discomfort which we gave to her for a week following the procedure. She is not having any other noticeable symptoms ongoing. She will occasionally vomit (not more than once every 4-6 months) but we aren't always sure if it's her, as we also have 1 other dog and 2 cats in the home. In the last two years she has developed more gray hair on her muzzle on stomach and has slowed down a bit but she is still generally active, engaged, sweet, happy dog.

We took her in on 5/12/12 for follow up Chem 27 labs b/c of the high reading in April. These showed HIGH results including: ALT(SGPT) 341 U/L, AST (SGOT) 57 U/L, CK 382 U/LH, HGB 19 g/dl, and Bilirubin 1+ (reference range NEGATIVE). Other results that were elevated but not HIGH were Chloride 115 mEq/L and HCT53.7. All other results were within normal limits.

The vet recommended Bile Acids test which were completed on 5/21/12. Her 12 hour fasting result was high 60.3 umol/L (reference range was 0.0 - 6.0 umol/L) and her Post Prandial test was 20.7 umol/L with the reference range noted 0.0 - 14.9.

Our vet is now recommending some sort of clotting test and then a liver biopsy to obtain more information about what might be happening in her liver. They suggest that this test/procedure should be completed right away. It's not clear if they are suggesting the fine needle type of biopsy vs. surgical procedure. I've read that when dog's Post Prandial Bile Acid test results are lower than the fasting results, it's a good idea to get a second opinion before proceeding. It is for this reason that I write.

Other important information about our family is that I am expecting our 2nd child, due 5/28. We have friends set up to stay at our house and care for our child and pets while in labor and while in the hospital, anticipated stay will be 2 -3 days. While I would like to pursue the most effective diagnostic and treatment course for Zora, I am concerned about scheduling a biopsy and then going into labor myself and not being able to care for her, as I am her primary caregiver. I'm wondering what course of diagnostic and/or treatment you might recommend. And, wondering whether it would be okay to wait a few weeks to pursue the next steps or if it seems that the next steps should be completed right away.

Thank you in advance for your help!
Stacy


Online vet, Dr. Marie

Dr. Marie replied:

Hi Stacy. Thanks for an interesting question.

I have had cases like this where the liver tests give us cause for concern and it is often difficult to know exactly what to do.

The liver enzymes that you have mentioned are, in my mind, a little high, but I don't usually get too concerned about mild elevations like this. What I usually do, when I get elevations like this is tell the owners that I don't think there is anything serious going on, but just to be sure, I recommend a bile acids test. (This sounds like exactly what your vet did.)

I hate when I get results like you did...and yes, it has happened to me. It is really frustrating when you get a case where the initial result is high and then the post prandial (i.e. after eating) result is normal or close to normal. A post prandial result of 20.7, in my books usually would not give me too much cause for concern.

There is controversy, even amongst vets to know what to do here. I'll tell you what I usually do. The last time I had results where the preprandial sample was high and the postprandial was lower, I consulted with a specialist and the recommendation was to actually ignore the preprandial result. Sometimes dogs can get a high preprandial bile acid test even if they smell food. The smell of food to a dog who is fasted can cause the gall bladder to contract and can cause an elevation in bile acids.

The whole point of the test is to see what happens to the bile acids after the liver is challenged by a fatty meal. In an animal with a diseased liver, when we give a high protein/high fat food and then measure the bile acids, we will see that the post prandial bile acids shoot up high. So, my interpretation, when post prandial bile acids are normal is that the liver is functioning just fine.

However, the difficulty in interpreting Zora's test is that the post prandial results still were higher than normal. But again, in my books, if there was a problem with the liver I would expect the results to be much, much higher.

So, if I got these results here is how I would be advising the case. (Keep in mind though that I don't have all of the facts on Zora's case.) The first thing I would consider is whether Zora was acting like a normal, healthy dog. If she seemed ill, was vomiting regularly, losing weight, or had a greatly reduced appetite then I likely would suggest the liver biopsy. However, if she was acting the same as she always had, then I would likely give you two choices.

The first choice would be to go ahead with the liver biopsy. Most likely they would do a fine needle or something called a tru cut biopsy, both of which can be done with an ultrasound and possibly light sedation. There is no cut into the abdomen and minimal risk to the dog that has a normal coagulation panel. (What this means is that if blood tests show that the dog clots blood like a normal dog, then there is minimal risk of internal bleeding and this is a safe test to do.)

The second choice would be to wait for a while, like perhaps 6 weeks, and do the liver enzymes plus bile acids test again to see if things have gotten worse. For some cases, during this 6 week period I would put the dog on SAM-e which is a supplement which helps the liver repair any damage that has been done to it.

It's a tough choice. If you feel that Zora is relatively healthy, then here is a way you can approach this with your veterinarian. You could perhaps ask your veterinarian, given your situation with a baby coming soon (congrats by the way!), if they feel it would be ok to wait for a while before doing the biopsy. And, perhaps they would be willing to simply repeat some blood tests to see how things are in a few weeks time.

If your vet feels this is urgent and needs to be done now, then you have two choices. One is to trust your vet and go ahead and the second is to get a second opinion, which is totally ok.

I do find that in 99.9% of the cases, the vet truly does have the best interest of the dog in mind and is not trying to do things just to make money. So, if your vet feels that it is important to continue, then this likely is the best decision.

I hope that helps!

Dr. Marie.



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Disclaimer: Although Dr. Marie is a qualified veterinarian, the information found on this site is not meant to replace the advice of your own veterinarian. AskAVetQuestion.com and Dr. Marie do not accept any responsibility for any loss, damage, injury, death, or disease which may arise from reliance on information contained on this site. Do not use information found on this site for diagnosing or treating your pet. Anything you read here is for information only.

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Dr. MarieDr. Marie is a veterinarian who practices in a busy animal hospital in Ottawa, Ontario. She created Ask A Vet Question as a resource for good, accurate veterinary advice online. Dr. Marie treats dogs, cats, hamsters, guinea pigs, and rats. She has been a vet since 1999.

Is an online vet visit just as good as a trip to your veterinarian? No! But, many times, asking an online veterinarian a question can help save you money. While Dr. Marie can't officially diagnose your pet or prescribe medications, she can often advise you on whether a vet visit is necessary. You can also ask Dr. Marie for a second opinion on your pet's condition.