Enlarged liver - should I be concerned? - YorkieTalk.com Forums

Parka · 01-21-2021, 07:45 AM

Hey everyone. Long time no post. Kirby is still going strong and has reached the ripe old age of 13. He is in good spirits but his mobility is not what it used to be.

On his last 3 or 4 x-rays, the radiologist has noted an enlarged liver. The xrays were taken for other reasons - both orthopedic and internal. Is this a cause for concern/further investigation? He is 13 years old and relatively content, so I don't want to subject him to stressful testing and procedures without understanding the benefit first. The next step would be an ultrasound, but what exactly would that tell us?

Other info:

His blood work is all within range and has consistently been within range for years, the only thing to note is his ALT hangs out at the high end. He has never had crystals in his urine but he has had a couple UTIs. He is epileptic and has a history of IBD. He's had two terrifying bouts with HGE and four less terrifying bouts with pancreatitis. He also has cervical IVDD which has caused a mild loss of mobility in his right thoracic limb, but he gets around just fine. I know this sounds like a million things but I assure you he's a pretty happy little dude and I love him to bits.

He has three very small kidney stones in the right kidney only, but I believe these are related to a particularly severe UTI and not an indicator of kidney dysfunction.

I have considered Cushings, but he doesn't have Cushings symptoms other than he likes to eat. He's not overweight, and he's not constantly hungry, but he sure lets me know when he thinks it's food time.

He eats i/d gastrointestinal low fat canned food (he's low on teeth at this point) and he has been on this type of food for over 10 years. No treats, no people food. He also takes keppra (epilepsy), gabapentin (IVDD), and methocarbamol (IVDD) plus Advita probiotic (IBD). Again, I know this sounds like a lot of things, but he's been on all of these medications for many years without complication.

On an unrelated note: as some of you may remember, he had a double enucleation in 2018. That was a very hard surgery with a very difficult recovery, and I had to yell at some people to get him pain medication. I really don't like yelling at people. I worried I had done the wrong thing choosing the surgery, even though I had dragged him to every specialist within 100 miles before deciding to do it. But it ended up being the right decision and he's better for it.

ladyjane · 01-21-2021, 08:17 AM

What does your vet think?
Elevated ALT isn't always a reason for alarm, but with an enlarged liver perhaps further studies might need to be done.
He could have Cushings without all the typical symptoms. If your vet suggested lab studies to rule it out, I would probably go with it.

Parka · 01-21-2021, 08:22 AM

The vet thinks it's strange that he has an enlarged liver but his blood work is perfect. Her suggestion was to take him for an ultrasound, but I'm not clear on the purpose of the ultrasound or what we're trying to diagnose. The ultrasound referral would be to a friend of hers that is starting up a new practice, but she was transparent about the relationship.

Bluebells · 01-21-2021, 10:31 AM

Quote:

Originally Posted by Parka

The vet thinks it's strange that he has an enlarged liver but his blood work is perfect. Her suggestion was to take him for an ultrasound, but I'm not clear on the purpose of the ultrasound or what we're trying to diagnose. The ultrasound referral would be to a friend of hers that is starting up a new practice, but she was transparent about the relationship.

That’s certainly a question your vet should be willing and able to answer: “You’re recommending an ultrasound. Can you explain what the ultrasound is going to tell us? Do you believe it will result in a specific diagnosis and treatment recommendation?”

ladyjane · 01-21-2021, 02:25 PM

Quote:

Originally Posted by Parka

The vet thinks it's strange that he has an enlarged liver but his blood work is perfect. Her suggestion was to take him for an ultrasound, but I'm not clear on the purpose of the ultrasound or what we're trying to diagnose. The ultrasound referral would be to a friend of hers that is starting up a new practice, but she was transparent about the relationship.

How high is the ALT? Has it been redone?

You can go wherever you choose for an ultrasound. Honestly, I don't know what they might find and what she hopes to find/diagnose that would be treatable with a senior pup.

Ask her what the ultrasound might show that she could treat.

ladyjane · 01-21-2021, 02:26 PM

Quote:

Originally Posted by Bluebells

That’s certainly a question your vet should be willing and able to answer: “You’re recommending an ultrasound. Can you explain what the ultrasound is going to tell us? Do you believe it will result in a specific diagnosis and treatment recommendation?”

Saw this after I posted.

Parka · 01-21-2021, 02:40 PM

Here are his most recent ALT tests. I don't think his current level is cause for concern.

1/20/21 - 127
10/20/20 - 108
3/13/20 - 110 -> solved problem by switching medications
1/31/20 - 187 -> recheck to see if the October test was an outlier
10/29/19 - 188 -> this one indicated a problem
5/29/19 - 128
12/26/18 - 113
8/21/18 - 114
1/19/18 - 127

His very first test with me was on 12/4/09 and it was 142. He went on the i/d at that time.

I think you guys have given solid advice regarding the ultrasound, I will ask her to explain its diagnostic purpose in more detail.

ladyjane · 01-21-2021, 02:52 PM

I don't know what that lab has as normal but those levels don't sound all that high to me.

ALT is a pretty unreliable test... many things can alter the levels.

I totally don't understand doing an ultrasound. I am just a pet owner but one who has had many and I can tell you there is no way I would do one without a really convincing reason. Sounds like a waste of money ...definitely ask for your vet's reasoning here.

Parka · 01-21-2021, 02:57 PM

I apologize, I should have mentioned that the reference range for this particular ALT test is 10-125.

I think you can tell I am normally the do-all-the-things pet parent, but in this instance I don't understand the need for/use of an ultrasound either. He isn't ill. He's over here having a good time barking his head off at the UPS truck.

ladyjane · 01-21-2021, 04:41 PM

Quote:

Originally Posted by Parka

I apologize, I should have mentioned that the reference range for this particular ALT test is 10-125.

I think you can tell I am normally the do-all-the-things pet parent, but in this instance I don't understand the need for/use of an ultrasound either. He isn't ill. He's over here having a good time barking his head off at the UPS truck.

I am also one of them and can tell you there isn't a chance I would do it.

I chuckled over your last sentence.

01-21-2021, 07:45 AM	#1
Parka Yorkie Yakker Join Date: Nov 2009 Location: Roswell, GA USA Posts: 61	Enlarged liver - should I be concerned? Hey everyone. Long time no post. Kirby is still going strong and has reached the ripe old age of 13. He is in good spirits but his mobility is not what it used to be. On his last 3 or 4 x-rays, the radiologist has noted an enlarged liver. The xrays were taken for other reasons - both orthopedic and internal. Is this a cause for concern/further investigation? He is 13 years old and relatively content, so I don't want to subject him to stressful testing and procedures without understanding the benefit first. The next step would be an ultrasound, but what exactly would that tell us? Other info: His blood work is all within range and has consistently been within range for years, the only thing to note is his ALT hangs out at the high end. He has never had crystals in his urine but he has had a couple UTIs. He is epileptic and has a history of IBD. He's had two terrifying bouts with HGE and four less terrifying bouts with pancreatitis. He also has cervical IVDD which has caused a mild loss of mobility in his right thoracic limb, but he gets around just fine. I know this sounds like a million things but I assure you he's a pretty happy little dude and I love him to bits. He has three very small kidney stones in the right kidney only, but I believe these are related to a particularly severe UTI and not an indicator of kidney dysfunction. I have considered Cushings, but he doesn't have Cushings symptoms other than he likes to eat. He's not overweight, and he's not constantly hungry, but he sure lets me know when he thinks it's food time. He eats i/d gastrointestinal low fat canned food (he's low on teeth at this point) and he has been on this type of food for over 10 years. No treats, no people food. He also takes keppra (epilepsy), gabapentin (IVDD), and methocarbamol (IVDD) plus Advita probiotic (IBD). Again, I know this sounds like a lot of things, but he's been on all of these medications for many years without complication. On an unrelated note: as some of you may remember, he had a double enucleation in 2018. That was a very hard surgery with a very difficult recovery, and I had to yell at some people to get him pain medication. I really don't like yelling at people. I worried I had done the wrong thing choosing the surgery, even though I had dragged him to every specialist within 100 miles before deciding to do it. But it ended up being the right decision and he's better for it.

01-21-2021, 08:17 AM	#2
ladyjane Resident Yorkie Nut Donating YT 20K Club Member Join Date: Sep 2006 Location: Texas Posts: 27,466	What does your vet think? Elevated ALT isn't always a reason for alarm, but with an enlarged liver perhaps further studies might need to be done. He could have Cushings without all the typical symptoms. If your vet suggested lab studies to rule it out, I would probably go with it. __________________ CLOUD NINE BEDS--YORKIE HAVEN RESCUE MY ETSY SHOP

01-21-2021, 02:52 PM	#8
ladyjane Resident Yorkie Nut Donating YT 20K Club Member Join Date: Sep 2006 Location: Texas Posts: 27,466	I don't know what that lab has as normal but those levels don't sound all that high to me. ALT is a pretty unreliable test... many things can alter the levels. I totally don't understand doing an ultrasound. I am just a pet owner but one who has had many and I can tell you there is no way I would do one without a really convincing reason. Sounds like a waste of money ...definitely ask for your vet's reasoning here. __________________ CLOUD NINE BEDS--YORKIE HAVEN RESCUE MY ETSY SHOP

01-21-2021, 08:22 AM	#3
Parka Yorkie Yakker Join Date: Nov 2009 Location: Roswell, GA USA Posts: 61	The vet thinks it's strange that he has an enlarged liver but his blood work is perfect. Her suggestion was to take him for an ultrasound, but I'm not clear on the purpose of the ultrasound or what we're trying to diagnose. The ultrasound referral would be to a friend of hers that is starting up a new practice, but she was transparent about the relationship.

01-21-2021, 02:40 PM	#7
Parka Yorkie Yakker Join Date: Nov 2009 Location: Roswell, GA USA Posts: 61	Here are his most recent ALT tests. I don't think his current level is cause for concern. 1/20/21 - 127 10/20/20 - 108 3/13/20 - 110 -> solved problem by switching medications 1/31/20 - 187 -> recheck to see if the October test was an outlier 10/29/19 - 188 -> this one indicated a problem 5/29/19 - 128 12/26/18 - 113 8/21/18 - 114 1/19/18 - 127 His very first test with me was on 12/4/09 and it was 142. He went on the i/d at that time. I think you guys have given solid advice regarding the ultrasound, I will ask her to explain its diagnostic purpose in more detail.

01-21-2021, 02:57 PM	#9
Parka Yorkie Yakker Join Date: Nov 2009 Location: Roswell, GA USA Posts: 61	I apologize, I should have mentioned that the reference range for this particular ALT test is 10-125. I think you can tell I am normally the do-all-the-things pet parent, but in this instance I don't understand the need for/use of an ultrasound either. He isn't ill. He's over here having a good time barking his head off at the UPS truck.