Page 686 - Clinical Small Animal Internal Medicine

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Table 60.1 Typical examples of use of pattern recognition in clinical pathology for canine liver disease
ALT ALP Bilirubin Serum bile acids Ammonia Albumin Glucose Other
Acute hepatitis/ Rapid ++ to +++ Slower, + to ++ N to +++ with the N to +++ depending N to ++ N May be low with
hepatic necrosis latter in severe cases on overall severity depending on fulminant disease
overall severity
Chronic Persistent + to Persistent + to ++ N to ++ possible but N to ++ N to ++ but N early in disease. More Usually N May see poikilocytes.
hepatitis ++ possible. May May fluctuate over time the latter only occurs insensitive likely to decrease with One report 44%
fluctuate over with late‐stage later disease and often inflammatory
time disease poor prognostic indicator leukogram
Cirrhosis N to ++ N to ++ N to +++ increased + to +++ N to ++ Reduced Hypoglycemia with May have low serum
with disease More sensitive than Latter occurs end‐stage disease. urea. May see
progression bilirubin late in disease Poor prognostic poikilocytes
process indicator
Congenital N or + N or + N Fasting samples may + to +++ Frequently reduced May be low Microcytosis frequent
portosystemic be N to ++ Postprandial finding in dogs.
shunts Postprandial samples sampling Ammonium biurate
typically ++ to +++ increases crystaluria common
sensitivity
Biliary tract N to ++ +++ ++ to +++ Increased but N N N Hypercholesterolemia
obstruction The latter measurement not
occurring with indicated with
chronicity jaundice
Nonobstructed N to ++ + to ++ N N N N N
biliary tract The latter May see mild
disease occurring with increase if significant
chronicity cholestasis
Hepatic N to ++ N to ++ May see jaundice if N most commonly Most Most commonly N Occasionally May see
neoplasia biliary carcinoma. but may be + commonly N hypoglycemia with hypercalcemia with
Other tumor types large hepatomas lymphoma
infrequently cause
jaundice
Glucocorticoids + to ++ typically. + to ++ Marked N Usually N Usually N N May also have mild May also be
Marked interindividual variation. but + to ++ possible hyperglycemia hypercholesterolemia
interindividual Typically with vacuolar
variation disproportionate increase hepatopathy
in ALP compared to ALT
Benign nodular Usually N or + to +++ N N N N N
hyperplasia minimal increase
N Within the reference interval.
+ Mildly increased.
++ Moderately increased.
+++ Markedly increased.
Scottish terriers and Siberian huskies are noted to have elevated ALP activities compared to the general reference interval for all breeds.
ALP, alkaline phosphatase; ALT, alanine aminotransferase.