Hello.
Yes, if there are elevations in liver enzymes and you are pretty sure it is primary liver then ultrasound would be a next good step.
It is important to remember that the liver may appear sonographically unremarkable even in the presence of severe disease. While an unremarkable ultrasound exam was statistically significantly associated with the absence of histopathologic liver disease (in one study), 63% of these cases had abnormalities on histopathology in a study comparing hepatic ultrasound findings with histopathology. An normal ultrasound would not mean that FNA’s/biopsies would not be carried out.
While bile acids are quite useful for the diagnosis of PSS in dogs and cats and cirrhosis in dogs (sensitivity of essentially 100%), their value is limited for the screening of most other hepatobiliary diseases (sensitivity 54-74%). Higher pre- than postprandial values may occur secondary to interdigestive gallbladder contraction or due to variations in gastric emptying, intestinal transit, or response to cholecystokinin release. This has no clinical significance, and whichever value is highest is used for interpretation. Falsely elevated postprandial values can occur with lipemia. Falsely decreased postprandial values may result from failure of cholecystokinin release to result in gallbladder contraction if the meal is inadequate in fat or protein content or an insufficient amount is consumed. Severe ileal disease or previous resection of the ileum can decrease bile acid reabsorption, thus decreasing postprandial bile acids. When used as a test of hepatobiliary function, the magnitude of elevation in serum bile acids does not allow differentiation of the category of disease, with the exception that patients with vacuolar hepatopathy rarely have marked elevations (greater than 75-100 mcmol/L).
I really only find BAS useful in cases where I suspect a vascular abnormality of the liver.
I hope that helps.
Scott 🙂
