Pre-GA bloods and increases in liver enzymes

RE: Pre-GA bloods and increases in liver enzymes

Richard Carter — Wed, 12 Dec 2018 18:38:24 GMT

and also mild circulatory issues with reduced liver perfusion and a starved animal with full gall bladder.

Also as mentioned above - the in house equipment is showing 4+ type stars raised then the lab refers to 'mildly elevated' when you cross check. Bodyweight, appetite (nausea), albumin levels probably more important than a raised ALKP

RE: Pre-GA bloods and increases in liver enzymes

Thomas Johnson — Wed, 12 Dec 2018 17:51:48 GMT

[quote user="Kathryn Burton"]Discussion on merits (or not) of preGA blood testing aside, as it's our practice protocol to offer to all... I hate running preGA bloods to find liver enzymes are a bit up, and find it difficult to discuss with the client what to do. They're probably up because of the manky teeth that your pet is in to have addressed, but I cannot rule out that your pet has 1ry liver disease. Just interested to hear how others approach these situations. Some vets I've worked with delay procedure, stick the patient on Denamarin for a couple of weeks then recheck bloods. Others go for BA stim etc. Others go ahead with op then recheck bloods in a couple of weeks. I appreciate there's a not a set answer to this! Are there any guidelines as to what values are classed as mild/mod/severe?[/quote]

I suspect a lot of old dogs with mild elevation in liver enzymes have some degree of hepatic nodular hyperplasia which will never have any clinical significance. If the animal is clinically well I tend to carry on with the GA and procedure as planned. I may consider repeating the blood tests after a month to see if the numbers are changing. If there was low albumin I might investigate further before going ahead with the GA.

RE: Pre-GA bloods and increases in liver enzymes

Iain Richards — Wed, 12 Dec 2018 17:47:23 GMT

There was a letter in the BMJ recently reminding people that the normal range are the 95% confidence interval, so a little raised is actually normal. Pretty sure the BSAVA clin path book states 2x top end of ALT before you consider it a marker of actual liver disease. ALKP largely irrelevant. Raised liver enzymes doesn't bother me. Low albumin would.

RE: Pre-GA bloods and increases in liver enzymes

Anthony Todd — Wed, 12 Dec 2018 14:20:04 GMT

[quote user="Martin Atkinson"] If the animal was clinically well I would probably proceed with the dental unless it was just a routine scale and polish and address the issues later.[/quote]

We did an awful lot of geriatric dentals and, invariably, the animal was "healthier" and much happier after it. We regarded most dentals as necessary to relieve pain and suffering....

I don't think we ever had an animal die under or after,or even be fazed, by the GA either, but these were animals apparently in good health [apart from the grotty mouth].

RE: Pre-GA bloods and increases in liver enzymes

Martin Atkinson — Wed, 12 Dec 2018 14:06:43 GMT

Depends on the age of the dog as well. Many older dogs have idiopathic rises in ALP which I would consider a lot less that ALT and wouldn't worry unless it was >3x normal. I would then look at other parameters: Tbil, Alb, BUN, GGT, BA (not necessarily with a stim test). If they're all OK think about HAC and do a base line cortisol and/or UC:C ratio. If the animal was clinically well I would probably proceed with the dental unless it was just a routine scale and polish and address the issues later.

RE: Pre-GA bloods and increases in liver enzymes

Rob Loxley — Wed, 12 Dec 2018 13:49:34 GMT

I consider which of the liver enzmyes, by how much, other signs of significant liver dysfunction (e.g. low albumin, bilirubin), how is the dog (maybe most importantly?), what is the procedure and how might significant hepatic disease alter this, what drugs I might give might be affected etc.?

I'm not sure there's one answer/protocol that address all of these without further consideration.
Regarding magnitude of elevations, an article here http://veterinarymedicine.dvm360.com/canine-liver-enzymes-so-many-questions has some suggestions.

And beware that in a cirrhotic, endstage liver, liver enzymes could thereoretically not be massively high...