Should dog have a liver biopsy?

Dr. Marie replied:

Hi Stacy. Thanks for an interesting question.

I have had cases like this where the liver tests give us cause for concern and it is often difficult to know exactly what to do.

The liver enzymes that you have mentioned are, in my mind, a little high, but I don't usually get too concerned about mild elevations like this. What I usually do, when I get elevations like this is tell the owners that I don't think there is anything serious going on, but just to be sure, I recommend a bile acids test. (This sounds like exactly what your vet did.)

I hate when I get results like you did...and yes, it has happened to me. It is really frustrating when you get a case where the initial result is high and then the post prandial (i.e. after eating) result is normal or close to normal. A post prandial result of 20.7, in my books usually would not give me too much cause for concern.

There is controversy, even amongst vets to know what to do here. I'll tell you what I usually do. The last time I had results where the preprandial sample was high and the postprandial was lower, I consulted with a specialist and the recommendation was to actually ignore the preprandial result. Sometimes dogs can get a high preprandial bile acid test even if they smell food. The smell of food to a dog who is fasted can cause the gall bladder to contract and can cause an elevation in bile acids.

The whole point of the test is to see what happens to the bile acids after the liver is challenged by a fatty meal. In an animal with a diseased liver, when we give a high protein/high fat food and then measure the bile acids, we will see that the post prandial bile acids shoot up high. So, my interpretation, when post prandial bile acids are normal is that the liver is functioning just fine.

However, the difficulty in interpreting Zora's test is that the post prandial results still were higher than normal. But again, in my books, if there was a problem with the liver I would expect the results to be much, much higher.

So, if I got these results here is how I would be advising the case. (Keep in mind though that I don't have all of the facts on Zora's case.) The first thing I would consider is whether Zora was acting like a normal, healthy dog. If she seemed ill, was vomiting regularly, losing weight, or had a greatly reduced appetite then I likely would suggest the liver biopsy. However, if she was acting the same as she always had, then I would likely give you two choices.

The first choice would be to go ahead with the liver biopsy. Most likely they would do a fine needle or something called a tru cut biopsy, both of which can be done with an ultrasound and possibly light sedation. There is no cut into the abdomen and minimal risk to the dog that has a normal coagulation panel. (What this means is that if blood tests show that the dog clots blood like a normal dog, then there is minimal risk of internal bleeding and this is a safe test to do.)

The second choice would be to wait for a while, like perhaps 6 weeks, and do the liver enzymes plus bile acids test again to see if things have gotten worse. For some cases, during this 6 week period I would put the dog on SAM-e which is a supplement which helps the liver repair any damage that has been done to it.

It's a tough choice. If you feel that Zora is relatively healthy, then here is a way you can approach this with your veterinarian. You could perhaps ask your veterinarian, given your situation with a baby coming soon (congrats by the way!), if they feel it would be ok to wait for a while before doing the biopsy. And, perhaps they would be willing to simply repeat some blood tests to see how things are in a few weeks time.

If your vet feels this is urgent and needs to be done now, then you have two choices. One is to trust your vet and go ahead and the second is to get a second opinion, which is totally ok.

I do find that in 99.9% of the cases, the vet truly does have the best interest of the dog in mind and is not trying to do things just to make money. So, if your vet feels that it is important to continue, then this likely is the best decision.

I hope that helps!

Dr. Marie.


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