Friday, May 3, 2019

3317. High cholesterol level and liver disease in an older Miniature Schnauzer

May 3, 2019

A 12-year-old male neutered Miniature Schnauzer had not been eating for a week. He was certified fit to travel from the USA to Singapore 3 months ago. He had been "coughing" phlegm for some days. He is not on medication including steroids. 


He was fed a BARF (Biologically Appropriate Raw Food Diet) for around 2 months and then home-cooked chicken diet for the past month. Dog treats were given.

Physical examination

Thin, no fever. No icterus. Heart sounds muffled. Slight anterior abdominal pain. No abdominal masses were palpated.

Radiography

The heart and liver are not enlarged. The liver size and shape are normal. No large abdominal masses.



Blood test.
1. High total cholesterol. Triglyceride level is normal.
2. Low fasting glucose
3. High ALT and AST (markers of hepatocellular damage). Alanine aminotransferase (ALT) is found in the mitochrondria and cytoelevated when  and aspatate aminotransferase (AST)AS


Total cholesterol  22.4 mmol/L (3.5 - 7.2)
Triglyceride 1.8 mmol/L  (0.3 - 3.3)

ALT  3722 U/L  (10 - 109)

AST   587 U/L  (13 - 15)

4. No leucocytosis or leucopaenia. Unlikely to have leptospirosis or viral infections but this cannot be ruled out.
5. Kidney function is normal

Ultrasonography (focal liver lesions, diffuse liver disease or biliary disease like cholestasis), evaluation of urine or serum bile acids and liver biopsy (fine needle aspiration, laparoscopy, exploratory laparotomy) were not done owing to financial constraints.  On a routine biochemical profile it is important to note the liver function tests including bilirubin, albumin, glucose, BUN, and cholesterol.

Conclusion 


An increase in total cholesterol, ALT and AST liver enzymes indicate liver disease in the dog. 

Persistent ALT increases should be investigated when they are greater than twice normal. The most important diagnosis to make is chronic hepatitis. Early diagnosis and prompt therapy improves patient survival

Some cases of liver failure can be reversed. The causes can be hepatic or non-hepatic (.
The laboratory tests must be correlated with the history, physical examination to arrive at a diagnosis. 

In this case, the dog is not overweight. The high total cholesterol might be due to the diet including dog treats.

Miniature Schnauzers are a breed predisposed to liver disease during old age. A common condition in the older dog is idiopathic vacuolar hepatopathy resulting in elevated ALP.


In conclusion, 4 categories of causes of elevated liver enzymes in the dog are:
1. Primary hepatobiliary diseases.

2. Secondary to extra-hepatic diseases
3. Benign condition (hepatic nodular hyperplasia)

4. Progressive condition (chronic hepatitis, neoplasia). 


Advices to the old dog owner
Repeat blood test in 4 weeks. If liver enzymes are elevated, further tests are needed (ultrasonography, bile acids, wedge liver biopsy) to check for chronic hepatitis, hepatic neoplasia, benign hepatic nodular hyperplasia and diffuse vacuolar hepatopathy
.  
Low fat high fibre quality maintenance diet. Hand-feeding is important.
Liver support therapy eg. Zentonil








VIDEO
24 HOURS after treatment




Day 3 of treatment. Mild jaundice is seen in the eye sclera which is stained very light yellow.




Day 4 of inpatient
Can stand, walk, poop. On I/V drip.  Not eating the K/D and A/D today. Hand fed. Urine testing.
Eye sclera looks more yellowish.













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 Hyperlipidemia is a condition in which the amount of fats (also called lipids) in the blood are elevated. The most important lipids are cholesterol and triglyceride. Hyperlipidemia is a common and under-diagnosed dog health problem that can negatively impact health and longevity.


Several metabolic diseases demonstrate hyperlipidemia, including diabetes, hypothyroidism and Cushing’s syndrome. Some dog breeds are genetically predisposed to hyperlipidemia. 

Hyperlipidemia does not normally lead to heart disease, but can decrease lifespan and cause obesity, neurologic and metabolic issues.



Genetic predisposition – Miniature schnauzers and Beagles tend to be genetically predisposed to hyperlipidemia.



Symptoms of hyperlipidemia can include: Decreased appetite Vomiting Diarrhea Abdominal pain Bloated abdomen Cloudy eyes Fatty deposits under the skin Hair loss Itching Seizures



Diagnosis of High Cholesterol in Dogs You may want to eliminate all table scraps and gradually switch your pet over to a low-fat, high-fiber dog food as diets high in fat are a common cause of hyperlipidemia. However, results from diet changes can take 6-8 weeks.

 If you are seeing symptoms associated with hyperlipidemia in your pet, you will need to visit the veterinarian to determine the underlying cause. 

A full history of your pet and a thorough physical exam will determine what diagnostic tests may be necessary. Laboratory tests used to help diagnose hyperlipidemia and identify any underlying causes can include a complete blood cell count to detect blood abnormalities, biochemistry to examine kidney and liver function, urinalysis to examine urinary tract function, a thyroid test to measure thyroid hormone production, a CPL (canine pancreatic lipase) assay to measure lipase levels and detect possible pancreatitis, lipid tests to examine levels of various lipoproteins to aid in locating where the metabolic issue lies and a cortisol test to measure adrenal gland function. The pet must not eat any food or treats 12 hours prior to the cortisol test. Morning appointments are best






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