Liver disease?

RE: Liver disease?

ilanit — Thu, 28 Jan 2016 04:20:18 GMT

[quote user="Robin Grimmer"]Any neurological signs or fits, especially after feeding?[/quote]

No, no neurological signs. No vomiting and normal stools, generally 4 times a day, so a bit often. Stools are not pale, but owner has reported they are black at times, so possibly there is melena.

Dog is alert... he looks and behaves like a starving dog, rather than a dog with liver disease! Very weird.

RE: Liver disease?

Mark Hedberg — Wed, 27 Jan 2016 20:04:06 GMT

[quote user="ilanit"]

I cannot refer this dog for the simple reason that I am on an island without availability of specialists.

[/quote]

That would indeed make it tricky...good luck!

RE: Liver disease?

ilanit — Wed, 27 Jan 2016 19:32:03 GMT

Thank you for your replies.

Shouldn't bilirubin levels be normal in a congenital shunt?

I cannot refer this dog for the simple reason that I am on an island without availability of specialists. Will discuss with owners to see though if they are willing to go overseas, because I don't think i'll be able to diagnose a shunt on ultrasound.

will do the tli and cobalamin/folate... Thanks for the suggestion.

I was reading that dalmatians are predisposed to chronic hepatitis and have inherited copper storage problem as well. I guess these are considerations too? Although I guess these problems tend to occur at slightly older age.

RE: Liver disease?

Utlendigur — Wed, 27 Jan 2016 18:09:11 GMT

But it probably wouldn't hurt to just check TLI, folate and cobalamin +/- faecal sample since none are invasive tests just to rule things out, assess GI health eg whether cobalamin supplement needed and/or make sure it hasn't got more than one problem.

RE: Liver disease?

Robin Grimmer — Wed, 27 Jan 2016 18:04:56 GMT

Agree especially with a post prandial level like that. Typically shunts often have unremarkable liver enzymes, as there is no liver damage, just poor perfusion. The increase in ALP is due to being skeletally immature. I would refer the dog for further investigation.

Any neurological signs or fits, especially after feeding?

RE: Liver disease?

Thomas Johnson — Wed, 27 Jan 2016 16:35:01 GMT

[quote user="ilanit"]

Hi, would like you opinion on this case.

It's a 9-month old FE Dalmation with a 3 month hx of weightloss despite ravenous appetite.
On blood tests done by previous vet there has been a consistent increase in liver values. Mild ALKP around 400 on the top of my head (with lab giving upper ref range around 300)
TP and albumin have decreased over time and albumin on last test was 1.8.
Around this time the dog also developed ascitis which on exam turns out to be a pure transudate (looks like water. sp graf 1.004).

On exam dog is alert, emaciated, with pale mm (normal htc, but low hb). there is no hx of diarrhea or vomiting. Stools are normal, althiough owner says they are sometimes black (melena?).

Dog is not noticably jaundiced, but on preparing the blood for the BA stim test I noticed plasma was icteric.
The results from BA stim:
preprandial 12.5 umol/l
postprandial 504 umol/l
Liver on US looks unremarkable although to me seems subjectively small (but there is a lot of fluid and I am not a trained ultrasonographer).
Obviously all is pointing towards liver disease, but I cannot explain the ravenous appetite in this picture. When I fed the dog for the BA test he attacked the bowl as if he's never seen food. More like a dog with malabsorptive problems!

I came accross this on the Idexx page and wasn't aware of this and made me wonder:

"The bottom line is that if practitioners
obtain abnormal serum bile
acid concentrations in patients that probably
don’t have liver disease (based on
the entire clinical picture), they should
consider malabsorption diseases, such as
small intestinal disease and pancreatic
insufficiency, which are often associated
with changes in the intestinal microflora.
It may or may not be appropriate to
pursue possible liver disease further even
though serum bile acids are increased."

The dog is very emaciated and the low protein worries me to take biopsies. Haven't done coagulation yet.
Would you say this dog has liver disease as indicated by high postprandial bile acids or should I still consider GIT disorders? How can a dog with such severe liver disease have such a ravenous appetite?

Would appreciate your thoughts

[/quote]

I would have thought this dog has a porto-systemic shunt until proven otherwise, you can get polyphagia with shunts.