I am so blown away by your comments. It really is so kind of you to share that. I am so honoured to have a played a small part in keeping you in the veterinary loop. I honestly forget people listen and am so blown away when they say they do.
Truly, thank you. I hope you and yours have had the most wonderful Christmas.
Another brilliant question. Really there can be many extra hepatic causes of increased liver parameters. I think it all has to be taken in the context of the case. There can definitely be increases in liver parameters with more severe dental disease. Mild/moderate increases in ALP in these cases would not stop me from going ahead with the GA in these cases. It is when the increases in ALT become more significant that I start to worry a little more.
With the mild increases in ALT and ALP, it is most likely to be a reactive hepatopathy. I would consider UDCA/sAME as support but would still go ahead with procedure.
Hope you are well. Really lovely to hear from you. I am in awe that you have found the time to listen to the lectures and have such a young child in the house!
It is a really good question. I definitely a belt and braces approach to leptospirosis diagnosis if possible. I would try and get blood and urine for PCR as well as sending off the MAT serology. The antibiotics will definitely affect the PCR results quite quickly but you will still get a rising antibody despite antibiotic therapy. How much this will dampen/affect the titre is difficult to determine and poorly documented. I am not able to find a huge amount in the literature. Basically, it would never be a reason to hold off the antibiotics and you should still see a rise in the titre.
Hope you are well. These are always more tricky cases when they are closer to work and home! Is the ALKP the only value that is increased related to the liver? If this is the case, then I would honestly worry about it a huge amount less. I think it is most likely to be reactive and this could easily be explained if there is more going on systemically. It would involve more FNA/biopsy type investigation to be looked in to further.
I would definitely continue the UDCA and consider also using something with sAME (Denamarin is my favourite). The other options sampling wise would be to FNA a bit of liver that you could access or also consider cholecystocentesis. Both may or may not give you information.
Thank you both for your comments. I agree, the urate component can definitely not be ignored! I agree reviewing the case for liver disease/cPSS is a good shout. I am always amazed by the number of dogs I diagnose with cPSS in later life! Many of these present with urinary signs as their only presenting sign.
I think this is a case where monitoring (imaging and urine analysis) is really key. It is maybe difficult to predict which bits of the stone will recur (if any)… but better to be on the front foot!
Thanks again.
Scott 🙂
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