ALKP elevation

Re: ALKP elevation

Jean-Paul Schmidt — Sun, 04 Jul 2010 12:15:02 GMT

[quote user="Jean-Paul Schmidt"]dogs are not small cats[/quote]

you know what I mean't !!!

Re: ALKP elevation

Jean-Paul Schmidt — Sun, 04 Jul 2010 12:12:10 GMT

[quote user="Clive Ansell"]Any thoughts anyone?[/quote]

I would check for pancreatitis (fPL). There is no need for BAST as you point out and beyond this your next step should be coagulation profiling for biopsy and cholecentesis for definitive diagnosis.

Although bacterial cholangitis can be seen in dogs it is far less common. As we are told time and time again dogs are not small cats and this is never more true than with "hepatic enzymology" and hepatic disease.

Hope this helps the discussion,

J-P

Re: ALKP elevation

Mike Nikolaou — Sun, 04 Jul 2010 00:23:22 GMT

No steroids have been used and no obvious sign of bone involvement. The only reason I did the ACTH stim in the first place was because the owners were very stressed, altough the dog clinically was absolutely fine, so I suspect they're gonna badger me for answers next week...

Re: ALKP elevation

Mike Nikolaou — Sun, 04 Jul 2010 00:20:58 GMT

I've had in the past a cat with cholangeitis with a very similar clinical and lab picture to the above described, altough mine was slowly loosing weight. Colleagues had prescribed antibiotics which seemed to perk the cat up which made me suspect cholangeitis so I did a liver biopsy and bile culture and everything was textbook, down to the E.coli cultured from the bile.

Put it on a long course of clamoxyclav and everything was fine...

However this dog only has high ALKP, everything else was normal...

Re: ALKP elevation

ilanit — Sat, 03 Jul 2010 19:44:21 GMT

My first thought in this case would be chonic cholangiohepatitis, which can be very slowly progressive with vague symptoms. There's a nice article on feline linflammatory liver disease in in practice (Oct 2009; 31: 414 - 422.) Obviously there are other differentials and liver biopsy and culture of bile would be the next step.

Regarding the first case of the dog, I would start with a bile acid stim test. If that comes back normal I would probably recheck the bloods at a later point if the dog seems fine and the owner is not too keen on doing a lot of test initially.

Re: ALKP elevation

Clive Ansell — Sat, 03 Jul 2010 17:15:01 GMT

I have a similar ongoing case at the moment. Any thoughts anyone?

A 6 yrs old DSH cat presented for routine vaccination and I noticed her mm were severely jaundiced. She is well/normal otherwise; no pu/pd, ideal weight and no wt loss, no vomiting, no diarrhoea and normal coloured normal faeces, no pyrexia and no palpable abdominal masses.

Routine blood work showed highly elevated ALT, ALKP, TBil, Chol, BA, and a marginal neutrophilia. remainder inc electrolytes all normal, no anaemia or signs of increased erythropoiesis. I've not run a BAST, as fasting BA are >150, so feel it would not yield any further useful info?. US showed a liver of normal size, shape and echogenicity.

Cat is well and perfectly normal otherwise. Brain teaser ?????

Re: ALKP elevation

Kate Richardson — Sat, 03 Jul 2010 14:55:24 GMT

As Clive and Roberta have said, consider other sources of ALKP. Also could be early cushings or other reason for endogenous steroid release.

Here's another thought- if the dog is clinically well and no signs of disease, why not wait a couple of weeks and retest to see if persistent, declining or increasing? Save the owner the expense of further investigations that may not be necessary?

Re: ALKP elevation

Roberta Prina — Sat, 03 Jul 2010 13:50:31 GMT

Have steroids been used recently for any reason?

Re: ALKP elevation

Clive Ansell — Sat, 03 Jul 2010 12:48:40 GMT

A bile acid stimulation test may be a good idea, easy and cheap as it will indicate if hepatic function is normal, as opposed to ALT and ALKP which only assess hepatocellular damage. The raised ALKP could be from a source other than hepatic; bone, gut etc.