Questions for Dr. Shawn - Liver Disease
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"Dear Dr. Shawn:
"My veterinarian says my dog has liver disease and he’s recommending a biopsy, yet my pet looks and feels fine. Is the biopsy really necessary?"
Answer:
”Before you your pet has a liver biopsy, it's important to make sure that the diagnosis is correct. In my practice, I often see pets whose prior veterinarians had diagnosed "liver disease" and recommended a biopsy, yet a review of the laboratory tests tells a different story. The confusion for veterinarians seems to arise from a misinterpretation of to test, the ALT test (which usually increases in liver disease,) and the ALP test (which can increase in liver disease that usually increases as a result of adrenal gland disease.) Often the veterinarian misdiagnoses liver disease when the ALP is increased. Most of these pets do not have liver disease but have an overproduction of steroid hormones from their adrenal glands. Doing a liver biopsy is not only unnecessary in these pets but can cause problems such as an increased rate of postsurgical infections in failure of the surgical wounds to heal properly.
I am reminded of a case I saw during my employment as a new veterinarian recently graduated from veterinary school. My boss, an older veterinarian at the time, misdiagnosed a taste of severe adrenal gland disease (called Cushing's disease) as a case of liver disease. The young dog, a female docs and, had surgery for a liver biopsy in her womb never healed properly. Unfortunately, once the pet was currently diagnosed, it was too late and she failed to respond to chemotherapy for Cushing's disease and ultimately was euthanized by her owner!
Therefore, prior to being liver biopsy on any pet it is imperative that a diagnosis of liver disease is properly made. Carefully assessing the results of a complete blood profile will help in this regard. If there still any question, an ultrasound examination of the liver, gallbladder, and adrenal glands is easily performed on the pet and can reveal a lot of information. Additionally, specialized blood tests to check for adrenal gland disease (an ACTH stimulation test and a low dose dexamethasone suppression test) can also be done.
Finally, if liver disease is truly the cause of your pet's increased liver enzymes, natural therapies using herbs such as milk thistle and homeopathics can often bring a resolution to the problem without the need for a liver biopsy or conventional medical therapy."
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