Dog with high bile acid level, but no diagnosis

[HomelessPony]

My vet and I are at loss for what’s going on with my pup. He’s a chi/JRT mix, about 8 years old. He went in for a regular blood test that came back high on liver enzymes, so we tested him again a few months later and some levels were worse. We did some additional testing, bile acid test, ultrasound, and a liver biopsy. Vet is stumped as the biopsy showed no sign of cancer, infection, cushings, liver shunt, microvascular dysplasia, etc. and the dog has no real symptoms other than the very high bile acid count. Vet has reached out to several colleagues for additional opinions, but for now, we wait.

Just curious if anyone has any suggestions? Or if anyone wants to drown themselves in wine with me over how much money we spend on our pets :lol:

[Zu_Zu]

Jingles & AO for your dog ~ ((hugs)) for his family during this stressful time ~

I would travel to a ‘specialty’ vet for more and different professional eyes ~

ETA … anything in the yard he may be ingesting ??? acorns, ??? leaves ?
insecticide …?

[Horsegal984]

Was the ultrasound done by your regular vet or by a boarded specialist? Either an internist or radiologist.

If you haven’t seen an internal medicine specialist yet that would be my next step.

[Beethoven]

Yes, time for a specialist. Was a culture done on part of the biopsy?

Any other levels abnormal in his bloodwork?

[HomelessPony]

Thanks guys! I should have specified in the first post that my vet has reached out to some specialists to get their opinion. If her contacts don’t have any ideas, I will look for someone else. I don’t have his numbers with me, but all the liver enzymes were bad, though some were more just on the very high side of normal. The ultrasound was done by a radiologist that they bring in, my vet just relayed his findings.

Beethoven - vet said there was no sign of bacteria, infection or anything like that based on the biopsy.

Zu Zu - nothing in the yard as we’re in NYC with no yard! :lol: So only time he’s outside is on the leash.

[Zu_Zu]

Jingles & AO for your dear dog ~ ((hugs)) for you during this stressful time ~

Elevated liver enzymes … liver issues are scary and should always be treated with the utmost seriousness … regardless of the victim… dog, cat, or horse / pony !

Glad you are being pro-active … Again move on to ‘Specialist’ who sees this type of issue ALL. THE. TIME. and can hopefully help with

a diagnosis and treatment plan …

Again Jingles !

• if no yard … what’s inside that he is ingesting or coming into contact with ??

Keep searching for answers … and give him a kiss on the head for me ~

[Beckham03]

I think it’s time to see internal medicine. So this dog is not clinical?

I have seen this…but the dog presents with “very high bile acids” and my Drs look at the numbers and aren’t really concerned. And how high were the initial liver values? Which enzymes were high?

So radiologist report shows completely normal liver? Was it an actual liver bx vs a fine needle aspirate?? Livers do not slough well and aspirates, bad biopsies can often reveal nothing.

Good luck! At least you are in an area with specialists!!

[SquishTheBunny]

Protein c blood test and ct angiography are your next steps (after.of course repeating bile acids!). Liver shunts are not always seen on ultrasound so a ct will be needed to rule it out. Trans splenic bubble study is an option as well but more.difficult to do.

Or… I’d your dog isn’t clinical for anything the wait and see option +/- antibiotics isn’t always a bad idea!

[HomelessPony]

Thankfully we have access to some great specialists so my vet is reaching out to them before I go out on my own. He has no symptoms of anything. He is THE happiest dog on earth.

These are his most recent numbers from a few weeks ago:
ALP: 1400 (up from 900 in November)
ALT: 600 (down from 1200)
AST: 116 (down from 190)

I don’t have his bile acid results written out because I was at work when the vet called, but they were high enough to warrant the ultrasound and biopsy.

[DrBeckett]

Is he on Denamarin? That often helps liver issues.

[HomelessPony]

Denamarin and some diet changes are likely the next step if we can’t find anything else wrong.