David C. Twedt1, DVM, DACVIM; Jörg M. Steiner2, Dr.med.vet., PhD, DACVIM, DECVIM-CA, AGAF
Case 1. The Normal Dog with Abnormal Liver Enzymes
Hattie is a 6-year-old female spayed mixed-breed terrier-type dog weighing 9 kg that was presented for elevations in liver enzyme activities. Approximately 1 month earlier, Hattie was stepped on by the owner's horse and was acutely lame in the right rear leg. The owner's veterinarian examined Hattie and diagnosed a partial tear in the right anterior cruciate ligament. The treatment plan was to limit exercise and prescribe an NSAID. Prior to treatment, however, a CBC and biochemical profile were performed. The following abnormalities were identified:
|
Test
|
Value
|
Normal
|
|
ALT
|
479
|
< 110 IU/L
|
|
AST
|
69
|
< 50 IU/L
|
|
ALP
|
535
|
< 140 IU/L
|
NSAID therapy was not given and a joint supplement was prescribed instead. Hattie was reported to be in good health prior to the lameness episode and was on no other medications. The owners were advised to obtain a second opinion on the abnormal liver enzymes.
At the time of your examination the owner felt Hattie was normal. There was no lameness identified and a complete physical exam was unremarkable. Repeat laboratory testing (1 month later) had the following abnormalities:
|
Test
|
Value
|
Normal
|
|
ALT
|
732
|
< 110 IU/L
|
|
AST
|
94
|
< 50 IU/L
|
|
ALP
|
649
|
< 140 IU/L
|
|
GGT
|
88
|
< 9 IU/L
|
The owner agreed to a further evaluation of Hattie.
Questions
What are your differentials for elevated liver enzyme activities?
What additional diagnostics or treatment would you consider?
Case 2. The Cat That's Losing Weight
Tiger is a 10-year-old male castrated domestic Shorthair cat with a history of weight loss over the last month from 3.0 kg down to 2.4 kg. The cat is also partially anorectic. Upon presentation the cat is alert and responsive, but has dry mucous membranes and a decreased skin turgor. Body temperature is 38.4°C, heart rate is 144 beats per minute, and the respiratory rate is 44 breaths per minute. Body condition score is judged to be a 2/9.
The initial problem list includes 3 problems:
1. Weight loss
2. Anorexia
3. Mild dehydration (approximately 5%)
The owner agrees to a full clinical evaluation of Tiger.
Questions
What are the possible causes of weight loss in Tiger?
What are the possible causes of anorexia in Tiger?
What are the possible causes of the mild dehydration in Tiger?
Would you want to address Tiger's mild dehydration and, if so, how?