Raised liver enzymes with CHF.

Re: Raised liver enzymes with CHF.

James Laidlaw — Thu, 16 Jun 2011 13:38:25 GMT

What about lungworm? Any worming history? I understand caudo dorsal lung pathology is the most common presentation in lungworm posit dogs when x-rayed. Could explain liver enzymes if migrating larvae through liver as well?

Re: Raised liver enzymes with CHF.

HMC — Thu, 16 Jun 2011 10:47:49 GMT

I have seen 2 patients start vomiting on ACEi, enough to stop those meds. I cannot remember if I then recommended another type of ACEi or whether the owners went for that option or not. Vomiting is listed as a rare adverse reaction of benazepril in the BSAVA formulary.

Re: Raised liver enzymes with CHF.

Christopher Saul — Wed, 15 Jun 2011 22:22:25 GMT

Sorry for the quick reply as I'm in a bit of a rush but here's a couple of thoughts....

I would repeat biochemistry now that he's on BID furosemide, fortekor and vetmedin; it's unlikely that he's gone into renal failure but not impossible.

Definately do a PLI - pancreatitis is more common than you think, and it's thought that cocker spaniels may get a breed specific, immune-mediated form of this disease.

You could be looking at a gastrointestinal cause for the vomitting; as with any vomitting dog I would repeat the radiographs. B12/folate would be useful to aid the search for proximal SI disease.

Ideally ultrasound would be very useful - you can look at the liver, pancreas and GI motility as well as left atrial size.

Whatever the cause for the vomitting, gastroprotective therapy (H2 antagonists or omeprazole) may be a good idea. Could give cerenia if you're sure not obstuctive.

Hope this helps a bit

Chris

Re: Raised liver enzymes with CHF.

David Mills — Wed, 15 Jun 2011 17:11:23 GMT

Still on the pimo? If so is it being given an hour before food? It can certainly be a culprit in causing vomiting (or making existing causes worse) in around 10% of dogs.

Pancreatitis should be on the list for a fat dog. cPLI should help, fairly inexpensive. If you're concerned about fortekor then try enalapril ('prilenal') or the liquid imidapril ('prilium') as different formulations/carriers and nothing to choose between them clinically.

Re: Raised liver enzymes with CHF.

Tom Ward — Wed, 15 Jun 2011 16:39:49 GMT

I repeated bloods a week ago after ~10 days on frusemide, and they showed exactly the same changes (slight reduction in ALT relative to before), though this was after mostly SID. as I increased the frusemide after this sample was taken. Urea/crea fine. I haven't repeated them since increasing to BID again.

Re: Raised liver enzymes with CHF.

Hannah Wynne Richards — Wed, 15 Jun 2011 16:37:02 GMT

What's the urea like after increasing frusemide?

Wynne