High resting bile acids in dog with seizure like events

Re: High resting bile acids in dog with seizure like events

Andrew Kent — Wed, 13 Feb 2013 20:01:14 GMT

Whilst the total bilirubin isn't that high it does make the bile acids difficult to interpret due to slow biliary clearance and interference with colorimetric tests, so it may not be as high as you think and this could be cholestatic in origin.

Andy

Re: High resting bile acids in dog with seizure like events

Robin Grimmer — Wed, 13 Feb 2013 18:00:21 GMT

Other differential could be any chronic liver disease, especially end-stage eg cirrhosis. If there's not much functioning liver then liver enzymes can all be normal, but you need to do a post-prandial bile acids. Only way to go definitive is biopsy, but if owners are unwilling you could try managing the HE signs with lactulose, ABs, diet etc plus a hepatic supplement like Denamarin or Hepatosyl.

Re: High resting bile acids in dog with seizure like events

David Mills — Wed, 13 Feb 2013 12:17:27 GMT

Hepatic encephalopathy needs ruling out I think. Shunts can be acquired especially later in 2y to chronic hepatopathy/portal hypertension and if liver damage is chronic enough, no enzymatic rises may be detectable due to reduced cell numbers. It could also be due to advanced liver disease that means deammoniation of the blood is not taking place. A liver fna may give more clues especially regarding chronic changes- easily done on us-guidance and feel free to post images on here. Cheap to do if assessed in-house. The waxing and waning with gi signs could be to do with changing bacterial populations especially ammonia-producing ones precipitated by colitis / gi inflammation. Whilst dog normal most of the time these episodes may just tip the balance in favour of neuro signs. I suppose long term it depends how affected the dog is, some of these chronics do brilliantly on mdz.

Re: High resting bile acids in dog with seizure like events

CatherineThomas — Wed, 13 Feb 2013 12:01:36 GMT

Definitely sounds like a shunt should be on the list of differentials. I had a case of a 7year old dog who had always been thought to have had neurological deficits due to being a runt of the litter and having to be hand reared. He had a strange stiff gait and occasional diarrhoea. The only abnormality on his bloods was high bile acids. He was referred and had his shunt treated surgically and is now doing wonderfully.

As the next step in this case I would do a bile acid stimulation.