scott@vtx-cpd.com

Replying to Laura S. 23/08/2025 - 20:29

No problem!

I will definitely check secondary coagulation factors before surgical liver biopsy, but not with FNA’s.

Would love to hear if other do differently!

Scott 🙂

Replying to Laura S. 17/08/2025 - 17:34

Hi Laura,

Thank you for these brilliant questions.

Yes, you are exactly right that severe dental and periodontal disease can be a source of systemic inflammation, and it is not unusual to see concurrent mild to moderate ALT or ALP elevations on pre-anesthetic bloodwork. In many cases, these enzymes normalise after the dental disease is addressed, sometimes with adjunctive hepatic support like Denamarin. So, in that sense, proceeding with the dental procedure can indeed be both therapeutic and diagnostic. The caveat, as you noted, is the anesthetic risk if there is concurrent, undiagnosed liver disease. The pragmatic approach with limited finances is to weigh welfare benefit against risk: if the enzymes are only mildly to moderately raised, the patient is otherwise stable, and the dental disease is severe and painful, then addressing the dental disease is a reasonable decision with informed owner consent. If the liver values are markedly elevated, synthetic function is impaired (low albumin, low urea, low cholesterol, abnormal clotting times), or the patient is systemically unwell, then I would be much more cautious.

This is supported by a growing body of evidence linking periodontal infection to distant organ changes in the liver, kidneys, and heart. Colin Harvey’s 2022 review (Vet Clin Small Anim, 52:121–137) summarises that bacteremia is common in dogs with periodontal infection, that stress indicators such as CRP and serum amyloid A increase with severity of periodontal disease, and that histopathological liver changes are more severe in dogs with advanced periodontal pathology.

Hepatic disease specifically has been linked with periodontal infection in two studies that found a correlation between increasing severity of gingivitis and periodontitis and increasingly severe microscopic changes in hepatic tissue (Pavlica et al. J Vet Dent 2008;25:97–105; DeBowes et al. J Vet Dent 1996;13:57–60). The liver is also the site of production of acute-phase proteins such as CRP and amyloid A, which increase with systemic inflammation and can be measured in serum, further reinforcing the systemic link between oral and hepatic health.

Yes, you are correct. In anorexic cats, it is not unusual to see mild hyperbilirubinemia, often related to cholestasis that develops secondary to reduced bile flow with fasting and dehydration. This is usually mild, transient, and resolves with rehydration and restoration of adequate caloric intake. Of course, one always has to be mindful of the possibility of true hepatobiliary disease in cats, but mild bilirubin elevation in an otherwise straightforward anorexic or dehydrated patient can often be explained by stasis.

From a safety point of view, I do not routinely run secondary coagulation parameters before performing FNAs of the liver. The most important thing is to ensure that the patient has an adequate platelet count, since platelets are the main determinant of whether a clinically significant bleed is likely. The relationship between liver disease and coagulation abnormalities is complex, because the liver produces both pro-coagulant and anti-coagulant factors, so standard clotting times do not correlate perfectly with bleeding risk. For this reason, I do not think they provide a reliable measure of safety in most cases. The key consideration is to establish that there is no obvious severe bleeding tendency, and I would only be especially cautious if there was evidence of more advanced hepatic dysfunction or distortion.

In practice, I have not encountered clinically significant haemorrhage from liver FNAs, whereas the risk with biopsy is considerably higher. So overall, FNAs are safe, routine coagulation profiles are not always essential, and the main thing is to ensure there is an adequate platelet count and the patient is clinically stable.

I hope that helps. Let me know if you have any other questions!

Scott 🙂

Replying to Elizabeth Murch 16/08/2025 - 13:13

Hey Elizabeth!

We are so lucky to have two specialist radiologists where I work! Makes my job a lot easier and means I can share these lovely reports/conclusions.

I am glad this was helpful. Let me know if you have any other questions.

Scott 🙂

Replying to Kerry Doolin 22/08/2025 - 01:09

Thank you Kerry!

So interesting. Thanks for sharing the links.

Scott 🙂

Replying to Sarah Keir 14/08/2025 - 09:37

Thanks Sarah, totally agree, DCM is a real consideration at this stage and something we’ll need to keep on the radar going forward, I must admit I often forget this sort of thing!. Look forward to your thoughts on the liver side when you’re back.

Best,

Scott 🙂