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Tag Archives: liver disease

Hepatic Encephalopathy, or “HE” is most simply described as brain disorders due to liver disease. I posted more info on HE a couple posts down.

HE symptoms can include shaking after a meal, aggression, glassy eyes and lethargy. The reason such neurological symptoms are expressed by dogs with liver disease is because damaged livers cannot efficiently clear the blood of toxins or proteins. When toxins remaining in the bloodstream travel to the brain, they cause the neurological symptoms.

A restricted low protein diet reduces the amount of protein in the blood and thus reduces the load on the liver. If the damaged liver can handle the reduced load, then the blood can stay relatively toxin free so that HE symptoms will be less likely to develop. Efforts to manage the liver disease condition and symptoms can make all the difference in a dog’s quality of life as well as his or her lifespan, but even the best efforts will not provide a cure or a symptom-free life.

Understandably, dogs on such restricted diets are often hungry. Some people supplement their dogs’ meals with natural pumpkin, which is low in protein and may help the dog feel more full. White potato soaked in water to remove potassium and phosphates, then boiled in new water and cooled was another recommended food by members of the Dog Liver Disease (DLD)** group.

[Update 5/30/14]: Now called the DLSD (Dog Liver Shunt and Disease) group. Yahoo group URL is now:


Providing the explanation took much longer than expected. I did numerous rewrites, checked my facts, had my sister who is a microbiologist proof it, and read it to various people to see if it was easily understood.

The sister who proofed it is the one who has the 1.5 year-old son with no functional small intestine and a liver that was failing. The link about baby Bo is in the side bar under “My Nephew’s Rare Disease

I have not done the ALT or bilirubin write-ups yet, but they’re coming. Please note that the BAT is usually one of several tests in a panel of tests for liver disease.

Back to the BILE ACID TEST (BAT). First, if you haven’t seen Shaili, the athletic Pug, she is featured two posts down. Her recent blood work came back with some high Bile Acid Test numbers:

Fasting Bile Acid Test (BAT):

    Shaili’s result: 13.4 µmol/L **HIGH**
    Normal range: (0.0-12.0) µmol/L

2HRS Bile Acid Test (BAT):

    Shaili’s result: 44 µmol/L **HIGH**
    Normal range: 5.0-25.0 µmol/L

“But what does this all mean?!” you ask?

Most dogs are given the BAT to determine if there is a problem with their liver, or if another test they had done for liver disease was inconclusive.

For instance, as in Shaili’s case, if liver disease is suspected, but the biliruben test shows normal levels, the BAT is run because it is a more sensitive test for liver damage.

The BAT result numbers show how much bile acid is in the blood stream at the time each blood sample was taken.

    1) On an empty stomach (no food for 12 hours)
    2) Two hours after a (high-fat) meal is eaten

A high amount of bile acids in either blood sample means the liver is not adequately doing it’s job of pulling bile acids out of the bloodstream, which indicates liver damage.

The bile acid level in the blood sample two hours after the meal should only be slightly higher than the bile acid level before the meal because a healthy liver is able to remove most of the bile acids after two hours.

When a dog eats, food going into his body is in part “digested” by the bile acids that break down fats. Those bile acids are initially released from the gall bladder into the intestine to help with digestion.

After the food is digested, the bile acids go into the blood stream where the liver retrieves them and returns them to the gall bladder for storage until the next meal. This is why some articles state that the liver “recycles” bile acids.

Here is a simplified progression of the events upon feeding the dog:

    1) The dog eats, triggering bile acids to be released from the gall bladder into the intestines.
    2) While in the intestines, the bile acids help digest the food and break down fats from the meal.
    3) After the food has been digested, the bile acids in the intestines move into the bloodstream.
    4a) At this point, a properly and fully functioning liver would efficiently take the bile acids out of the bloodstream and return them to the gall bladder to be released and used again at the next meal.
    4b) If the liver is damaged and not functioning properly, it will not be able to remove the bile acids at a normal rate, so the blood sample taken will show a high level of bile acids in it.

Upon eating, the body triggers the release of BA from the gallbladder into the intestine, where it helps break down fats ingested. Once the food is digested, the BA goes back into the bloodstream where it is recaptured by the liver.

Even though this test is a good indicator of liver disease, the results do not provide information on how severe the damage is, what caused the damage, whether the liver can recover and what the expected outcome would be.

Shaili’s “Fasting” Bile Acid Test is a bit higher than the normal range, and her “2-Hour” BAT level was double or more than levels in the normal range. Look at these results again along with the BAT results for a Pug Puppy that likely has a liver shunt:

Fasting Bile Acid Test (BAT):

    Normal range: (0.0-12.0) µmol/L
    Shaili’s result: 13.4 µmol/L **HIGH**
    Pug Pup with suspected liver shunt: 287 **VERY HIGH** This is 21 times Shaili’s BAT level

2HRS Bile Acid Test (BAT):

    Normal range: 5.0-25.0 µmol/L
    Shaili’s result: 44 µmol/L **HIGH**
    Pug Pup with suspected liver shunt: 1877 **VERY HIGH** This is over 42 times Shaili’s BAT level


    • “µmol/L”  is  “micromoles per Liter”
    • A mole (mol) is an amount of a substance that contains a large number (6 followed by 23 zeros) of molecules or atoms.
    • A micromole (µmol) is one-millionth of a mole. (definition from Healthwise web site)

A note about the Pug puppy above. If this puppy does have a liver shunt and it is operable, it actually has a chance of living a good quality of life as well as enjoying a longer or even normall life span given that it’s condition is managed by proper diet and supplements.

If you are looking for more information, a support group, and practical advice from experienced dog liver disease moderators, please visit the Dog Liver Shunt and Disease (DLSD) Yahoo Group. You are not alone if you have a dog with liver disease or suspected liver disease. There you will find hope and help for managing the condition, reducing the symptoms, and increasing the life span of your dog..

Yesterday…today… it’s all starting to look the same to me!

I am currently waiting for more news on Daisy and also waiting for text and photos to come in for some the dogs of the frequent posters on the Dog Liver Shunt and Disease (DLD) Group. In the meantime, you really have to see this picture of Shaili.

Kelly, the mom of Shaili (pronouced “shay-lee”) also sent me some info on her little athlete to go with the action photo of her below. Apparently she is at the top of her breed in agility which is pretty cool.

Shaili goes for it!

Shaili goes for it!

Kelly and Shaili are new members on the DLD group since Shaili’s recent blood work came back with some high Blie Acid Test (BAT) numbers and high ALT (Alanine aminotransferase).

“But what does this mean”, you ask. Well, I’m going to have to explain in another post. I did the research to find explanations in plain english, but then the post ended up being way too long, so just know for now that the results indicate that the liver isn’t fully functioning properly due to damage or dimished capacity.

I promise to post more info using Shaili’s stats, but I don’t have it in me right now.

Kelly wrote in her email to me that they rescued Shaili from “a less than ideal situation” and shares with us Shaili’s other health conditions as well as the agility work and play they have, and still do, enjoy together:

“[Shaili] is my “heart” dog and incredibly special to me. She has had her share of medical issues including luxating patella surgery, tooth extractions, Mast Cell tumor removals and severe hip dysplasia. However, she has always been a busy little thing, so I decided to try agility with her back in 2000, and she has since earned 100 agility titles (including several Championship Titles) in multiple agility organizations.

I tell her I love her every day and we will still play agility as long as she feels good. So far she has just been diagnosed with high ALT and elevated Biles Acid, so we are taking it day by day …we are cautiously optimistic that she will be OK and with us for many more years!!”

Kelly is understandably confused, because even after receiving the results from the Bile Acid Test (BAT), she doesn’t know exactly what is wrong with Shaili’s liver. From what I can tell from the reading I have done, the test does indicate liver disease but is not enough to show how severe it is, exactly what kind of liver disease it is, and what the prognosis is. Shaili is getting an ultrasound next week. If another step is needed after that it is often a liver biopsy.

Although Kelly reports that Shaili “is acting completely normal, great appetite, very active, doing all her normal stuff,” the symptoms may not express themselves until the condition worsens. The good news is that Kelly may have caught the disease in a relatively early stage and can manage the condition with the help of the DLD group so that it doesn’t get worse, and may even improve her liver functioning by putting less of a load on it with proper diet and supplements.

The reason the BAT was done was probably because her bilirubin count was normal. Mike Richards, DVM, states on his web site that “When there is reason to be suspicious of liver disease but bilirubin levels are normal or close to normal, then bile acid testing can be very useful since it is a more sensitive indicator of diminished liver capacity.” Will have to define “bilirubin” later too! ( Tests for Liver Disease in Dogs)

I hope everyone enjoyed meeting Shaili and learned a little bit more about liver disease in dogs.