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Discussion Starter · #1 ·
My dog Enzo, a standard poodle, who is 8 years old has elevated liver enzymes. The doctor recommended a biopsy done laparoscopically. He feels well at this point as we identified the problem on a routine screening. He took denamarin for several months with no improvement in his lab results. Has anyone had experience with this? Thanks
Kathleen
 

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Hi Kathleen - This seems invasive. Are his levels dramatically elevated?

When my last girl Gracie (a minipoo mix) had elevated liver enzymes, it was due to early Cushing’s Disease. It also presented with other symptoms, which increased over time, such as pot-bellied appearance, hair loss, increased appetite, panting, and eventually cognitive dysfunction. For diagnosis, my vet did a test that required three blood draws spread out across one day of fasting. I believe it was the low dex:

 

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Discussion Starter · #3 ·
Hi Kathleen - This seem invasive. Are his levels dramatically elevated?

When my last girl Gracie (a minipoo mix) had elevated liver enzymes, it was due to early Cushing’s Disease. It also presented with other symptoms, which increased over time, such as pot-bellied appearance, hair loss, increased appetite, panting, and eventually cognitive dysfunction. For diagnosis, my vet did a test that required three blood draws spread out across one day of fasting. I believe it was the low dex:

His ALT is greater than 1,000. His ALP is 324.
 

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Biopsy is really the only way of confirming what is going on, but I would ask about how the results would influence treatment plans. When Poppy was diagnosed with acute liver failure a year ago we planned a biopsy, but she was too ill to go through with it; instead the vets moved swiftly to treatment with steroids etc. In her case it would have made little difference to the treatment, but her liver appeared normal on the ultrasound so Enzo's case may be very different.

Poppy's liver failure has now been managed reasonably well for over a year with drugs and special diet (RC hepatic with extra chicken to increase the protein levels). She is showing the effects of long term steroids - very similar to the Cushings symptoms PtP describes - but is happy, bouncy and enjoying life very much.
 

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Discussion Starter · #6 ·
Biopsy is really the only way of confirming what is going on, but I would ask about how the results would influence treatment plans. When Poppy was diagnosed with acute liver failure a year ago we planned a biopsy, but she was too ill to go through with it; instead the vets moved swiftly to treatment with steroids etc. In her case it would have made little difference to the treatment, but her liver appeared normal on the ultrasound so Enzo's case may be very different.

Poppy's liver failure has now been managed reasonably well for over a year with drugs and special diet (RC hepatic with extra chicken to increase the protein levels). She is showing the effects of long term steroids - very similar to the Cushings symptoms PtP describes - but is happy, bouncy and enjoying life very much.
As of right now, they are considering two major possibilities, an auto immune disease or poor absorption of copper. But the reality is they won’t know what to do until they have the biopsy results. He has been fairly healthy so it seems a good time to do the biopsy when he can handle it. If anyone has had a dog get a liver biopsy, I would love to know how he/she tolerated it. Thanks for telling me about Poppy. They seem hopeful that there will be some treatments that will help. Thanks you all for your support. I really appreciate it.
 

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Hi Kathleen! I'm currently 2 months away from graduating vet school. While I have not had a personal pet undergo this procedure, one of my patients on my medicine rotation had a laparoscopic liver biopsy performed, so hopefully I can help put your mind at ease some.

We'll call my patient Rover. Rover was an senior dog who had other health issues being managed medically. He originally came to us at the specialty hospital because he had GI signs (vomiting/diarrhea) and his vet at home had found persistently elevated liver enzymes. Rover was referred to us for an ultrasound (with liver aspirates) and liver biopsy. The biopsy procedure was over in about 40 minutes. While there are many different ways to perform a laparoscopic surgery, I believe the most common is what Rover had done, where a 2-3 inch incision was made on the center of an abdomen (like a spay). There are fancy ports that allow the surgeon to use all of their tools in this one incision. Another option is two smaller incisions further towards the flanks (not favored by my hospital). One of the tools is a little pair of grabbers (grasping forceps) that goes in and (carefully) munches on the liver. Multiple samples can be taken from different parts of the liver, which allows for multiple tests to be performed (including histopathology, copper levels, and bacterial culture). Rover had 8 samples taken. The grabbers crush the blood vessels as they take a sample, so there is minimal bleeding. Rover woke up very quickly and was able to go home that evening, with strict instructions for cage rest and monitoring for any surprise bleeding. On our follow up calls, Rover has continued to do very well at home.

Specifically for your Enzo, I would expect him to do at least as well as Rover, if not even better due to being asymptomatic. Before any liver biopsy, I would expect your vet to do clotting tests on his blood to make sure that the clotting factors (which are produce by the liver) are doing their jobs. After that, the recovery should be almost the same as an uncomplicated spay. The incision will be of moderate size, so a cone will be necessary to prevent any issues there. The chance of bleeding after surgery should be minimal (as long as clotting tests are normal). Your vet should give you a list of things to watch for at home, if they are not available for 24 hour monitoring the night following the surgery.

I hope you are able to get a good diagnosis for Enzo and that everything proceeds safely! I'd be more than happy to answer any other questions that you may have.
 

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Discussion Starter · #8 ·
Hi Kathleen! I'm currently 2 months away from graduating vet school. While I have not had a personal pet undergo this procedure, one of my patients on my medicine rotation had a laparoscopic liver biopsy performed, so hopefully I can help put your mind at ease some.

We'll call my patient Rover. Rover was an senior dog who had other health issues being managed medically. He originally came to us at the specialty hospital because he had GI signs (vomiting/diarrhea) and his vet at home had found persistently elevated liver enzymes. Rover was referred to us for an ultrasound (with liver aspirates) and liver biopsy. The biopsy procedure was over in about 40 minutes. While there are many different ways to perform a laparoscopic surgery, I believe the most common is what Rover had done, where a 2-3 inch incision was made on the center of an abdomen (like a spay). There are fancy ports that allow the surgeon to use all of their tools in this one incision. Another option is two smaller incisions further towards the flanks (not favored by my hospital). One of the tools is a little pair of grabbers (grasping forceps) that goes in and (carefully) munches on the liver. Multiple samples can be taken from different parts of the liver, which allows for multiple tests to be performed (including histopathology, copper levels, and bacterial culture). Rover had 8 samples taken. The grabbers crush the blood vessels as they take a sample, so there is minimal bleeding. Rover woke up very quickly and was able to go home that evening, with strict instructions for cage rest and monitoring for any surprise bleeding. On our follow up calls, Rover has continued to do very well at home.

Specifically for your Enzo, I would expect him to do at least as well as Rover, if not even better due to being asymptomatic. Before any liver biopsy, I would expect your vet to do clotting tests on his blood to make sure that the clotting factors (which are produce by the liver) are doing their jobs. After that, the recovery should be almost the same as an uncomplicated spay. The incision will be of moderate size, so a cone will be necessary to prevent any issues there. The chance of bleeding after surgery should be minimal (as long as clotting tests are normal). Your vet should give you a list of things to watch for at home, if they are not available for 24 hour monitoring the night following the surgery.

I hope you are able to get a good diagnosis for Enzo and that everything proceeds safely! I'd be more than happy to answer any other questions that you may have.
Thank you so much for the information. I will check on whether they plan to test for clotting factors as that is a really good idea. He is in good shape right now and he is also a rather stoic dog. My younger one would have much more trouble as he gets anxious. Enzo is fairly calm about life. They do plan on keeping him for one night which is fine with me. He is scheduled for early March unless they get a cancellation. I will let you all know how he does. Again thank you so much for the information. And congratulations of finishing vet school. I am an epidemiologist and have had a number of students who were also in vet programs.
 

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We lost our standard poodle yesterday, 7.5 years old, liver failure end stage. He went from small symptoms such as weight loss, to not eating, to death in less than a week. We are horrified and shocked. Liver enzymes were odd, and we tried Denamarin for almost two months before. We didn't get time to do a biopsy, he became too weak too suddenly. I don't know that we would have done it anyway, internal medicine said he was in end stage liver failure and nothing would have made a difference.

This is an intense situation, and I don't want to scare you, but the liver is very serious and temperamental. Often times the dogs are asymptomatic until a progressive and destructive stage.

My belief is that he had chronic hepatitis, which poodles are prone to. It is genetic, and SHOULD have been bread out of his genetics. Please let me know what happens and if I can help in any way by advice or strategy.
 

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Discussion Starter · #10 ·
We lost our standard poodle yesterday, 7.5 years old, liver failure end stage. He went from small symptoms such as weight loss, to not eating, to death in less than a week. We are horrified and shocked. Liver enzymes were odd, and we tried Denamarin for almost two months before. We didn't get time to do a biopsy, he became too weak too suddenly. I don't know that we would have done it anyway, internal medicine said he was in end stage liver failure and nothing would have made a difference.

This is an intense situation, and I don't want to scare you, but the liver is very serious and temperamental. Often times the dogs are asymptomatic until a progressive and destructive stage.

My belief is that he had chronic hepatitis, which poodles are prone to. It is genetic, and SHOULD have been bread out of his genetics. Please let me know what happens and if I can help in any way by advice or strategy.
I am so sorry you lost your dog. This is all very tough. The biggest advantage we have with Enzo is he is still asymptomatic so we are hoping to be able to treat him before he gets sick. I won’t know much more until after the biopsy and I will definitely post the results here. Thank you again for writing.
 

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I am so sorry you lost your dog. This is all very tough. The biggest advantage we have with Enzo is he is still asymptomatic so we are hoping to be able to treat him before he gets sick. I won’t know much more until after the biopsy and I will definitely post the results here. Thank you again for writing.
That is very good. I think you are on the right track, it's so much better when they are asymptomatic in my non-expert opinion. Enzo will be in my thoughts! <3
 
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