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Bloodwork- Alkaline Phosphatase
ALKP and ALT elevations query - part 2
Rises in Alt and Altk pos and Differential for Liver disease
Increases in Alkaline Phosphatase
High Alkaline phosphatase
High ALKP levels and diet
Increases in alkaline phosphatase (ALKP) levels
Elevated alkaline phosphate (ALKP) for the past three years
Increased alkaline phosphatase levels
also see Bloodwork
also see Seizures
also see Liver Problems
also see Cushing's
also see Prednesone
ALKP and ALT Elevations Query - part 2 - please see hepatitis for outcomeQuestion: Dear Dr. Richards:
I am a new subscriber and had written my initial question to you about my
7-year-old male Standard Poodle, Nicky. Briefly, he had recent pre-dental
blood work that revealed elevated ALKP (295 U/L, reference range 23-212) and
ALT (777 U/L, reference range 10-100). Bile Acids were 29.3 UM/L pre-meal
(reference range <13) and 27.7 post meal (reference range <25). The rest of
the findings were contained within my initial note.He weighs between 45.5 and 47 pounds normally and has always been very lean.
There has been no weight loss, no excessive drinking, no excessive urination,
no diarrhea and no vomiting. He has a good appetite and has been normal and
active in every way.Since my initial e-mail, Nicky has had the chest and abdominal x-rays and
ultrasound with liver biopsy.Chest and abdominal x-rays, were normal. Ultrasound showed no obvious
problems, but the internist said that the spleen was slightly enlarged. The
gallbladder was normal in appearance. The stomach appeared normal. She could
not adequately visualize the pancreas. The liver was of normal size. She said
there were some changes in the echogenicity on the left side of the liver
which were pretty uniform (no distinct masses or nodules). She obtained
several ultrasound-guided biopsy samples from that area, which she felt to be
of very good quality for submission and analysis. On gross visual inspection,
she said that all of the samples looked like normal liver tissue with no
obvious discoloration or changes.The internist said that she hoped the biopsy would help to diagnose or rule
out certain conditions such as cirrhosis, hepatitis, benign nodularity,
copper storage abnormalities and cancer, though she thought that the latter
was a more remote possibility (but, in the interest of full disclosure, she
said she was running through all the possibilities).By history, one year ago, Nicky had GDV and emergency surgery which included
a gastropexy. At the time of surgery, a 2-inch by 3-inch section of his
stomach had to be resected due to devitalization of tissue. He had
splenomegaly at that time, as well. His recovery has been uncomplicated and
he has been active.I would be interested in your thoughts as to whether the GDV could, in any
way, have caused or contributed to the present elevations in liver enzymes
and the changes noted (and vaguely described my me) on the ultrasound; your
thoughts as to differential diagnoses; your thoughts as to whether you think
it possible that these findings may be transient and benign, representing
something that may already be resolving itself or working its way out of his
system (and if so, what types of things can cause changes such as these?)I would add that we have another, larger, Standard Poodle and the two of them
had been out in the yard running and playing together in the two weeks prior
to the initial pre-dental blood work. Due to extreme cold and inclement
weather, they had not been able to do that for nearly a month. Though tired
from play, neither dog appeared to have been injured while at play.Thank you so much for your time and consideration. Karen
Answer: Karen-
We have had a number of patients who have had elevated liver enzyme levels that were discovered
because we drew blood without any expectation of finding liver disease. Some of these patients had
vague signs of illness but nothing that pointed towards a diagnosis. Others had blood drawn for
reasons such as presurgical cautiousness or because of signs of another illness. Many of these
patients have gone on to have normal liver enyzme levels on later testing. We never could come to a
final diagnosis as to what happened to cause the liver enzyme elevations in the first place in several of
these dogs, although the complete recovery from elevated enzyme levels made that almost
unimportant. Anything that causes the death of a number of liver cells will raise the ALT and AST
levels. This includes trauma, toxins, bacterial infections, lack of blood flow to a portion of the liver
for any reason (blood clots, low blood pressure, portosystemic shunts), bile duct blockages,
pancreatitis and many other conditions. It would not surprise me if adhesions to a surgical site
couldn't occasionally cause enough damage to lead to rises in liver values, although I can't actually
recall confirming that as a problem in any patients in our practice. We have seen small abscesses at
the site of intestinal resections (where we removed a small portion of the intestine) that smoldered on
for very long periods of time, causing subtle clinical signs. If that has happened in the neighborhood
of the liver it seems possible that it could cause rises in liver enzyme levels. Anesthestics will
sometimes cause liver damage and it is my understanding that this can sometimes be an ongoing
problem for a few months and sometime even longer, when it occurs. I believe that I saw this effect
in some patients when using methoxyflurane early in my practice career. I can't recall suspecting this
problem with either halothane or isoflurane but have spoken with vets who feel it is a possible
problem based on cases they have had. Those are the things that I can think of at this time that
might lead to liver damage associated with an abdominal surgical procedure.I hope that you have the biopsy reports by now and that they have been helpful in determining what
might be going on -- or that you are seeing a drop in the ALT and AST, even if there is no
explanation.Mike Richards, DVM
2/17/2001
Differences between rises in ALT and alkaline phosphatase and Differential for liver problems
Question: Dear Dr. Richards:
I have a 7-year-old male standard poodle named Nicky who recently underwent
routine blood chemistry screening prior to dental cleaning.Results revealed elevations in ALKP (295 U/L , Range 23-212) and ALT (777
U/L, Range 10-100). Cholesterol was listed as high normal (316.0 mg/dl, Range
110-320). Chloride was high normal as well (122.0 mmol/1, Range 109-122).ALB, AMYL, BUN, Ca, CREA, GLU, PHOS, TBIL, TP and GLOB, Sodium and Potassium
were all within normal limits at mid-range values except for AMYL, which was
low-normal (555 U/L, Range 500-1500).It doesn't appear that the screening included AST/SGOT or Gamma Glutamyl
Transferase.He has shown no evidence of illness; does not drink or urinate excessively;
does not vomit; shows no decrease in food consumption and has a good
appetite. Active in play when outside.Physical examination by our veterinarian revealed no abnormalities, no
enlargement of lymph nodes or liver; no tenderness to palpation.Due to the liver enzyme elevations, and since he had already fasted as a
prerequisite for the dental procedure, Bile Acids were tested. Fasting level
was 29.3 UM/L, Reference range given was less than 13. One hour post-meal,
Bile Acids were 27.7 UM/L, Reference range given was less than 25.His past medical history is significant for Bloat in November 1999. Surgery
with gastropexy was performed. Surgery revealed that a 2-inch x 3-inch
section of his stomach had been devitalized due to the torsion, and that area
was resected. He also had some splenomegaly as noted during surgery. His
recovery was largely uneventful and he has done very well since that time.We have scheduled an ultrasound examination due to the liver enzyme
elevations coupled with the Bile Acid study abnormality. It has not yet been
done as of this writing.My questions are threefold:
l.) Is it possible (or have you seen in your practice) any disruption in
hepatic function caused by the physical trauma and circulatory deficits
produced during GDV prior to surgical intervention?a.) Could this account for these recent laboratory findings regarding
the ALT and ALKP elevations and Bile Acid Assay results?2.) How significant are these laboratory findings in an otherwise
normal-appearing and normal-acting dog?3.) Given this scenario, what are the possible differential diagnoses?
I should add that this is the first blood chemistry screening that we have
done since November 1999. To the best of my knowledge, prior blood tests have
all been reported to be in the normal range.Thank you in advance for your kind assistance in this matter.
Very Truly Yours, Karen
Answer: Karen-
I think that the best way to approach your questions is to explain the differences between rises in
ALT and alkaline phosphatase and give you a list of causes for both conditions and then work from
there.ALT is short for alanine transferase. This is an enzyme that is present in the cells in the liver. In order
for it to be found in elevated quantities in the blood stream, liver cells have to be leaking the enzyme.
So rises in this enzyme indicate damage to liver cells sufficient to cause them to leak the enzyme.
Rises in ALT, even large rises, can occur due to problems that don't cause much change in liver
function, though. Trauma, liver toxins, blood clots and other insults to the liver which damage a large
number of cells in a small area of the liver may produce high rises in ALT that are essentially
meaningless, as the liver will recover with no problem. On the other hand, chronic liver diseases that
constantly produce damage to the liver but do so slowly may never cause strong rises in the ALT
levels even though liver function is deteriorating significantly. ALT levels may rise or fall fairly
rapidly, as the half-life of the enzyme in the blood stream is less than two days.Causes of increased serum ALT levels include almost all forms of liver disease (chronic active
hepatitis, cholangiohepatitis, liver storage diseases, portosystemic shunts, etc.), trauma, cancer,
ischemia (loss of blood supply for any reason to part of the liver, including blood clots), toxins, drug
reactions (phenobarbital, corticosteroids, griseofulvin, primidone, rarely antibiotics),
hyperadrenocorticism, severe anemia and hypotensive shock.ALKP is shorthand for serum alkaline phosphatase, also a liver enzyme and sometimes referred to
as SAP, as well. This enzyme is present in tissues other than the liver, especially bone. Rises in SAP
that relate to the liver usually occur when there is some form of slowdown or blockage in bile flow.
This can be a problem in the liver, in the bile ducts, the gallbladder or the intestine around the areas
in which the bile drains into the intestine.Problems that can result in rises in SAP include growth (from bone changes), hyperadrenocorticism,
drug reactions (especially phenobarbital and corticosteroids such as prednisone), most forms of
liver disease, gall bladder problems (stones, inflammation, rupture, infection), bile duct problems
(pancreatitis inflammation or scarring, cancer of the bile ducts, liver cancers, toxins, diabetes, heart
failure (due to circulatory problems in the liver), trauma, systemic or liver infections and really severe
bone infections. One form of liver disease, nodular hyperplasia, causes rises in alkaline phosphatase
levels but rarely causes any clinical symptoms, even through it is a chronic disease and may be
present for long periods of time. Usually, there is not much rise in ALT when nodulary hyperplasia of
the liver is present, though.I would be pretty surprised if the bloat was related to the current problem except for the possibility
of scarring of the area around the portion of the stomach in which part of the stomach wall was
removed that could conceivably be contributing to a bile duct blockage or partial bile duct blockage.
I think that you have to take an ALT rise of this magnitude seriously enough to pursue the testing that
you have done already (bile acids and ultrasound exam) and I think that in a seven year old dog in
which a repeat blood sample a week or so later continued to show similar elevations in ALT and
alkaline phosphatase I would strongly advocate a liver biopsy. This would allow the best
management of any chronic liver diseases which might be present.At least once a year we have a patient whose liver values are very high, which we find on routine lab
work or as part of a blood panel we have run due to vague signs of illness, even though there was
not any strong indication of liver disease being present. Many of these patients have resolution of the
high lab values within 2 weeks or so and most of the time they don't return. We never find out what
happened to these dogs but since they are better, there is consolation in the outcome.I hope that you and Nicky do get a good outcome from this.
Mike Richards, DVM
2/6/2001
Increases in alkaline phosphatase in Scottie and WestieQuestion: Dear Dr. Mike:
We're hoping you can help us out with what seems to be a medical mystery with
our Scottie, Alistair, and Westie, Max.In October 1999, Alistair had his first and only seizure, 20 seconds of
shaking and vocalizing, as well as a loss of use of his hindquarters.
Immediately following, he seemed better, got a drink of water, then lost
control of his bladder.We took him to our emergency veterinary clinic, but by then, he seemed fine.
However, his blood work showed an alkaline phosphotase count well over 800.Two weeks later, it was 998. Our vet recommended an abdominal ultrasound,
which showed no masses. He then underwent a liver biopsy, which also
indicated no disease. By this point, his alk phos was nearly 1,500.He has taken Lipoform and SAM-e, but neither dropped the alk phos count
significantly.Since he showed no signs of illness, we decided to test him again in six
months. That test, run Nov. 27, shows his count to now be 2,000, although he
still acts fine.However, now our Westie, Max -- whose alk phos count was 84 in November 1999
-- is now having problems, His blood work shows an alk phos count of 994.Both dogs are rescue pups. We presume Alistair is about 7, because he seemed
to be a year or so when we got him in July 1994. Max is 6, born in November
1994.Max took Prednisone throughout the summer for allergies, which we know could
cause his high count. However, it seems suspicious that both dogs have alk
phos problems.Do you know of any environmental causes for high alk phos results? We have
other blood test results as well, but don't know which ones would be germane
to this situation.Our veterinarian is aware that we are checking the Internet for information,
and has no problem with our efforts. We also would not proceed with any
medical procedures without talking it over with him, or with the specialists
we consulted for Alistair.We would appreciate any help you can give us. It breaks our hearts to think
that there is something in or around our home that is poisoning our boys.Thanking you in advance
Tracy and Tom
Answer: Tracy and Tom-
The four most common causes of increases in alkaline phosphatase, in the
absence of rises in other liver enzymes or evidence of liver disease are 1)
young dogs (growing dogs) have higher alkaline phosphatase levels 2)
hyperadrenocorticism (Cushing's disease) 3) hepatic nodular hyperplasia (
a benign condition) and 4) drug interactions. The drugs that are most
commonly associated with rises in alkaline phosphatase levels are
corticosteroids, phenobarbital and primodone, but other medications can
have this effect. I am not aware of any environmental factors that cause
rises in alkaline phosphatase levels independently of other liver enzymes.The usual approach to isolated rises in alkaline phosphatase is to rule
out drug therapy, then to rule out hyperadrenocorticism and finally to rule
out benign hepatic nodular hyperplasia, if possible or desired.
Unfortunately, this often requires surgical exploration of the liver
because the nodular hyperplasia does not always show up on ultrasound exam
or biopsy of the liver. Since this is a benign condition and you have
already ruled out other liver diseases with the biopsy, at least to the
extent that is possible, it seems reasonable not to do anything except
consider the other possibilities, at this point. Many dogs have elevated
alkaline phosphatase levels for long times during their life without any
clinical signs ever emerging. Hopefully this will be the case for
Alistair. Max's problem is more likely to be due to the corticosteroid
use, but the levels should drop within a few weeks of discontinuing these
meds, so you can check for drops during the seasons it is not necessary to
medicate Max.Mike Richards, DVM
1/4/2001
Question: Dear Dr. Richards,
Question: I have e-mailed you before about my dog, Luke, who is 12 years old. But here's the latest. Today he had his blood tested because over the past 8 years, his Alkaline phoshatase (sp) level has ranged from 600 to 1200. My vet suspected Cushings but Luke had (has) none of the outward symptoms - I had an ultrasound done as well - it was normal. My vet talked to an endocrinologist ?? (I think that was the specialist- it's been a while) who said that if Luke isn't exhibiting any symptoms of Cushings, then just keep an eye on him because the treatment for Cushings treats the symptoms - not the disease.
Well today his Alk. phosphotate (sp) level came back at 1600!!! This is the highest it's ever been. His ALT was 126. In Jan, he had a Bile Acids test which was normal (also when he had the ultrasound). His vet is going to check the internet to see if she can find out what to do next (other than repeat the ultrasound and bile acids test??) - what would you suggest? I told her I would check with my internet "connection" as well. Luke eats Science Diet Prescription R/D & eats a lot of rawhide treats. Any possibility that either of these could cause this reading?
Thanks for your help/any suggestions for further testing/treatment!
Elizabeth
Answer: Elizabeth-
The two most likely causes of alkaline phosphatase rising independently of other liver enzymes are
hyperadrenocorticism and nodular hypoplasia, a benign condition that occurs in older dogs.I agree that it isn't necessary to treat hyperadrenocorticism unless the clinical signs are a problem,
although I am currently trying selegiline (Anipryl Rx) when the cost is not prohibitive for the client,
because there is some chance that it can slow the growth rate of pituitary tumors that cause some
cases of Cushing's disease.Nodular hyperplasia of the liver does not require treatment. Bile acid response testing for liver
function should be normal when this problem is present, despite the high alkaline phosphatase levels.
Liver biopsy may help to determine if this is the condition that is present, although the biopsy sample
must be taken from an affected area of the liver. This may require a surgical biopsy because the
nodular hyperplasia may or may not show up with ultrasound exam.I know of no evidence that rawhides or r/d (tm) diet cause increases in alkaline phosphatase levels.
Hope this helps.
Mike Richards, DVM
9/19/2000
High ALKP levels and dietQuestion: Doctor;
I have contacted you before relative to a high ALKP (1488) in my dog
Brandy.In February 2000 the Alkp was 763.
July 19,2000 the Alkp was 1488.In February I was advised to put the dog on a diet of 50% Hills Canine
W/D and 50% Hills Canine L/D.Previously she was on a diet of Canine W/D.
I have noticed no difference in ALKP in fact it has gone up 95%+.
Do you feel that the L/D food is of any benefit to the lowering of ALKP
or to the dog.
Thank you, Ray
Answer: Ray-
I would be surprised if l/d (tm) diet would work to lower an elevated
alkaline phosphatase level that is not accompanied by elevations in alanine
transferase (ALT) or bile acids.I would be equally surprised if the l/d diet caused a rise in alkaline
phosphatase levels.Even though the alkaline phosphatase level is rising it is often hard to
correlate that with any significance in evaluating liver function. I would
not be worried any more by an alkaline phosphatase of 1500 IU/L than I am
of one of 750 IU/L.I think you would be OK switching back to w/d (tm) diet alone if you wanted
to but it would be best to discuss this with your vet.Mike Richards, DVM
8/8/2000
Increases in alkaline phosphatase (ALKP) levels
I have a Red Hound that is 10 years old.
February 28,2000 from a lab test her ALKP (liver) was 763
July 19,2000 from a lab test her ALKP (liver) was 1488.
From my vet I was told that the normals are 23-212
Her ALT in February was 26
Her ALT in July was 31
I am quite concerned about this as the dog seen to be very healthy with
the exception of being a little over weight, her weight in this month is
83 pounds.What is your opinion on any action I should take in this condition of the dog.
Thank you, Ray
Answer: Ray-
The most common causes of increases in alkaline phosphatase (ALKP) without a
rise in alanine transferase (ALT) are hyperadrenocorticism (HAC or
Cushing's disease) and medications such as phenobarbital and
cortisones. Another possible cause is hepatic nodular hyperplasia, a
generally benign disorder in which nodules form on the surface of the
liver. Sometimes other liver diseases will occur in which only the alkaline
phosphatase level rises but this is less likely since your hound doesn't
seem to be ill.Hyperadrenocorticism causes increased drinking and urinating, thinning of
the skin, muscular weakness, a pendulous abdomen, increased susceptibility
to infections and other clinical signs. If no signs of this disease are
present, it is also questionable whether it is necessary to try to
determine if it is present through lab testing.Nodular hyperplasia of the liver can be diagnosed by ultrasound exam in
some dogs but may not show up in others. Surgical exploration and
visualization of the liver may be necessary to diagnose this condition but
this also seems excessive for a condition that is usually benign.So most of the time, in dogs with no clinical signs of illness but
increases in serum alkaline phosphatase, we just monitor the situation and
wait for evidence of a condition we can treat. If we are using cortisones
or carprofen (Rimadyl Rx) we might try to find an alternative medication.
If we are using phenobarbital we monitor the liver values on a regular
basis but this is a common side effect of this medication and often no
perceptible liver damage ever occurs despite the persistent high alkaline
phosphatase levels.Your vet may have a different approach to this situation and certainly has
a better idea of the total medical condition of your hound, so if there are
differences in our opinions I'd advise putting more weight on the advice of
the vet who has seen the patient.Mike Richards, DVM
7/26/2000
Elevated alkaline phosphate (ALKP) for the past three years
Question: Dear Dr. Mike,
I have a 12-year-old male cocker spaniel mix who has had an elevated alkaline phosphate (ALKP) for the
past three years. His ALKP level has been as followsALKP Summary Karl Barx
Date ALKP Weight in lbs.
6/4/00 1605 16.2
3/31/00 890 16
11/17/99 424 15.75
9/15/99 372 17
8/2/99 981 19
6/3/99 313
4/8/99 308
1/11/99 458
11/5/98 365 17
8/31/98 368
4/28/98 761 18
3/4/98 994 19
1/6/98 947 17
10/9/97 581 19
9/19/97 853 18
8/28/97 1438
The original high ALKP level was detected in pre-surgery blood work and since then he has been
monitored closely. He was tested for Cushing s disease but the test came out negative. Our old vet
prescribed metronidazole 250-mg tablets (he gets a half tablet every other day) and that seemed to bring
the ALKP level down but it never got within the normal range. Most recently we moved and now we have
a new vet. Prior to our move his ALKP level was up to 890 so we tried giving him the metronidazole every
day for eight weeks to bring the level down. (This did work in the past.) Unfortunately, when we got to
our new home and had his blood work done his ALKP was 1605. All his other blood values are normal
(and have always been so.) The vet did an ultrasound to see if there were any masses or legions and she
said everything looked really normal. I had her stop short of doing a liver biopsy because I was concerned
about putting my dog through this when there was only this one elevated level and no other clinical (he
acts like he feels great) or laboratory signs. Our old vet recommended Denoysl as something we could try
so we are in the process of ordering that to add in to his drug therapy. I told our vet if we didn't see a
reversal of the ALKP level in 30 days she could try the liver biopsy.He currently takes:
Sentinel, 1 tablet monthly for heartworm and flea control
Vetrazene, 1 tablet daily as a supplement to help his joints
Efa-Caps 2 daily to help his skin and coat
Metronidazole ½ 250 mg tablet every other day
Enacard ½ 5 mg tablet every day for mitral valve regurgitation (which appeared stable when he was given
his repeat echocardiogram in January of this year)He currently gets ½ can Canine WD canned food, plus 1/3 cup + 24 nuggets of Canine Control formula
(Innovative Veterinary Diets to help balance his urine pH) daily.Is this level something to be really concerned about? What other tests could be performed to determine
why this level is so high? Should we go ahead with the liver biopsy if the ALKP level continues to rise or
remains stable? Our dog is really healthy, happy and active so I hesitate to do anything that is really
invasive or uncomfortable for him. Any advice you have would be greatly appreciated. If I ve failed to
provide any necessary information please let me know as I have a copy of his complete chart from our old
vet.Thanks, Gaynol
Answer: Gaynol-
There are dogs who have elevated alkaline phosphatase (ALKP) levels for a long time prior to
any other clinical signs of hyperadrenocorticism. Other dogs have hyperplasia of the liver for no
apparent reason and have high ALKP levels that do not lead to clinical disease. This can occur
in stressful conditions from any cause due to elevations in cortisol levels, as well.My inclination in these cases is to run a bile acid response test to make sure that the liver is
functioning normally and then wait to do anything else until symptoms of an underlying disease
emerge, as long as I feel comfortable that we have ruled out another systemic illness to the best
of our ability. If the bile acid response test is abnormal, then it is more important to me to get a
liver biopsy done. However, I think that a liver biopsy is reasonable in this situation and your vet
may have had experiences that make him or her believe it is important to do this test now.Denosyl SD4 (tm) is a form of S-Adenosylmethionine (SamE). This compound is advocated in
the treatment of liver disease by several of the leading liver disease experts in veterinary
medicine but I don't know if these recommendations are supported by objective research at this
time. It is not likely to be harmful based on clinical experiences so far, though.Hyperadrenocorticism may take several tests to confirm and it is always good to keep an eye
out for symptoms of other disorders that may be contributing to the problem, such as weight
loss, increased drinking or urinating, lethargy, etc.Hope this helps some.
Mike Richards, DVM
6/16/2000
Increased alkaline phosphatase levels in Schipperke
Question: I have a 9 y/o Schipperke that has a tentative diagnosis of Cushing's.
Back in Nov, she had elective surgery to remove a cyst on her upper
eyelid. She had some "routine" lab work, pre-op due to her age. All of
her lab work came back within normal limits, expect for her alk phos,
which was off the scale at about 2000! She has no symptoms of Cushing's
what so ever and continues to be a healthy and active dog.Based on that increased alk phos, my vet decided to do an ACTH stress
test. That test result came back normal. Based on the fact that
decided to wait and see.Now here in May, again Billie is the hill and trail runner (very active),
healthy skin and coat, no ill effects noted what so ever...we do another
blood test (urine too) and every thing is normal, except for her alk phos which is
still off the scale at 2000 or so. This dog has the coat of a thick
pile carpet and no pot belly. She has no increased thrist or appetite.
She is not obese. She does not pant excessively. She has great skin.This time my vet decides to do a Dexamethasone challenge (low dose I
believe). This time the 4 hr level of cortisol was depressed, but the 8
hr level was elevated to about 2.4. He felt this would indicate
pituitary driven Cushing's, although the internal med special vet
(consult) said that there are a number of false positive tests and
according to her history (health and activity level) he would have a
hard time labeling her as Cushing's.The next thing we measured was biliary salts fasting and then 2 hours
after eating. Those tests came back with normal limits. Now the next
step according to the vet, if I want to pursue this... is an abdominal
ultrasound and true cut needle biopsy of the liver.According to my vet, there are certain histological changes in the liver
associated with Cushing's and the liver biopsy would be the best way to
determine this. Also the abd ultrasound would rule out any masses that
may be present.My question ( and his too it seems), do you treat a dog for Cushing's
that has no symptoms? How would you determine the effectiveness of the
medication, if there are no symptoms to relieve? Is a high alk phos in
and of itself problematic? Are the other zebra's out there that may be
responsible for her high alk phos? Are we on the right track? Why subject
her to an general anesthetic and liver biopsy, if she doesn't need to be
treated anyway?Sorry for the long email, but I hope that you can give me some insight
that I might not otherwise have access to.
Thanks in advance for any help.Jane
Answer: Jane-
I would tend to ignore this lab finding until there were clinical signs of
some disease but lots of vets, and many pet owners, are not comfortable
with this approach.I would not treat a dog for Cushing's disease with no clinical symptoms and
this sort of lab work unless the clients just wanted to try selegiline
(Anipryl Rx) since we have not had much problem with side effects with this
medication.Increased alkaline phosphatase levels occur as an idiopathic (unexplained)
finding in some patients. If there has never been previous lab work done it
is hard to say if this is the problem, or not. Dogs with idiopathic
alkaline phosphatase levels often have this all of their lives. Other dogs
have conditions such as nodular hyperplasia of the liver which usually
causes no disability.Liver biopsy may be helpful in establishing a cause for this condition.
Repeating the low dose dexamethasone testing may also be helpful in
clarifying things. Waiting a month or two and retesting to see what the
alkaline phosphatase level is then is probably acceptable, too. Your vet
may have a reason to be more concerned about your dog than just this one
lab test, so talk this all over and then work together to decide what is
best to do.Mike Richards, DVM
6/5/2000
Last edited 01/30/05