Elevated liver enzymes in 15yo kitty

[Propagandalf]

I just took my 15yo neutered male kitty in for a wellness check and ran a senior panel to look for any issues (we do this annually). For the first time, he is showing “mild elevation” (vet’s words) in both ALT (280) and AST (150). Sounds like it could be either inflammation or a tumor/mass. Options are retest blood in six months, start course of denamarin and recheck in 1-2 months or do an ultrasound. If there is a mass, I will not be doing surgery. I’m finding it difficult to make a decision and wonder if others have been the something similar.

 

[Furballsmom]

Hi! I'm not a vet but I personally would do the denamarin and the ultrasound. Ask your vet if just milk thistle is an option.

 

[daftcat75]

How is his eating? His poop? Any vomiting? In the absence of gut or butt symptoms, he may have dental disease. When was the last time his teeth were checked under sedation with dental X-rays? My angel Krista had tooth resorption in her last two or three years. Her ALT would mildly elevate during times she needed extractions. ALT can also go high for pancreatitis, IBD, and lymphoma. All of those you would have symptoms besides abnormal blood results. The trouble with Denimarin is that it takes a long time to work and it’s difficult to pill. It’s a big pill that you’re told not to break.

I’m not a vet. I’ve just been down this road with liver enzymes before. When Krista’s liver was actually involved, her ALT reading was 1400! The good news is that the liver can heal itself (with medical support.)

I would recommend a dental exam with mouth xrays. I would also do the ultrasound because there very well could be a mass somewhere even without any other symptoms yet. I would want to rule some things out rather than pill and pray for the next two months.

 

[daftcat75]

You could also try the Denimarin in the meantime while you are seeking more answers.

 

[fionasmom]

If you can afford the ultrasound it will give you some answers one way or another which is better than going home and thinking that maybe your cat has a mass for the next 6 months or 2 months if you do Denamarin.

Years ago I told my vets that we were no longer doing imaging like ultrasounds, MRIs, etc just for academic purposes on very elderly animals. However, if it could be a question of a serious condition or potential suffering I would do them and have for my 15 year old GSD. My dog will never again have a surgical procedure, but at least we know what is around the corner and what to watch for in terms of quality of life.

And it is true that liver enzymes, particularly those two, are quite variable and can be easily elevated from non life threatening conditions.

 

[FeebysOwner]

Hi. I can't add much to what has already been said above, but following along the lines of Furballsmom suggestion about milk thistle - it is one part of what it Denimarin (liquid silymarin or milk thistle) is composed of. The other part being the amino acid called SAM-e (S-adenosylmethionine), and that is the part that requires it to be taken in 'whole' form. While it is preferred that it is taken on an empty stomach, a small amount of food can be used with it in cases where a cat won't take the pill alone or it affects their stomach by being taken without food. The efficacy of the med is reduced somewhat if taken with a bit of food.

If you think you'd be unable to administer the pill in a pill pocket - or a tiny amount of food - then you might want to ask if milk thistle could be of some help all on its own.

Please keep us posted. And, I hope you can find what you consider to be the best solution for your baby and you.

 

[Propagandalf]

In my haste to post this I forgot to mention that I’m seeing absolutely no other issues. Bright eyed, eating and drinking, no teeth issues (although he hasn’t had a cleaning in a long time). I am leaning toward trying to pill him in addition to going with the ultrasound. It’s a lot of money but my heart can’t take the stress of not knowing.

 

[Furballsmom]

my heart can’t take the stress of not knowing.

Bless you, I'm right there with you about that

 

[daftcat75]

In my haste to post this I forgot to mention that I’m seeing absolutely no other issues. Bright eyed, eating and drinking, no teeth issues (although he hasn’t had a cleaning in a long time). I am leaning toward trying to pill him in addition to going with the ultrasound. It’s a lot of money but my heart can’t take the stress of not knowing.

You can certainly start with the ultrasound and save the teeth for another time. I mention it because it’s not the first thing people think about with elevated liver enzymes. But it’s a back burner possibility to explore if the ultrasound and Denimarin doesn’t come to anything. I also mention it because senior kitties are prone to dental disease and very skilled at hiding any pain and discomfort.

 

[Propagandalf]

You make a good point about the dental disease and I’ll be sure to follow up next week. The vet noted some tartar but said gums looked good so I’m not sure what to think. It’s hard because he seems happy and healthy and yet his liver shows that something is going on.

 

[MissClouseau]

Hi there. I’m on a similar boat with high ALT. I hope your kitty is well - any updates?

 

[Propagandalf]

We got the ultrasound and there was no mass. However they noticed his kidneys were starting to look damaged (Not uncommon for his age, but that’s not showing up in the blood values) and they couldn’t find his gallbladder (?!). So we are using denamarin and going to recheck his blood in about six weeks. They said food was still in his belly despite being fasted for twelve hours but I’m not confident he didn’t steal something from either the kids or dog.