CANINE MEDICINE
In Summary
From the desk of Dr Marlies Bohm
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Scotties have higher ALP levels than other breeds.
In Scotties, ALP levels increase with age.
The pesky bit - Scotties also have a higher prevalence of diseases
associated with high ALP levels - Cushing’s, pancreatitis, cholestatic
liver disease, diabetes.
When Scotties have these diseases their ALP levels are much more
elevated than that of dogs of other breeds affected with the same disease. But then they also show the typical
changes on history, clinical exam and bloods for these diseases.
In your happy high ALP Scotties, ALT levels are typically mildly increased (usually < 3x), urine SG is decreased (typically
in the mid teens) and cortisol levels may be increased post ACTH in about 1/3 of dogs.
One retrospective study of 114 Scotties with high ALP showed that 34 eventually developed a hepatocellular carcinoma. But the dogs with a liver tumour lived just as long as the dogs that had just the vacuolar hepatopathy.
In your happy high ALP Scotties, ALT levels are typically mildly increased (usually < 3x), urine SG is decreased (typically
in the mid teens) and cortisol levels may be increased post ACTH in about 1/3 of dogs.
So:
• If a Scottie has high ALP levels and is otherwise well, leave him be.
• If you suspect pancreatitis, diabetes or Cushing’s you need to ignore the ALP in your work-up.This is particularly
important with Cushing’s.
• If you think he has another hepatobiliary disease you’re going to need more than an elevated ALP to suspect it
and a biopsy to prove it.
• Dogs with focal hepatocellular carcinoma can do very well after resection, so if you have a client that would operate on their dog serial ultrasounds could be considered.
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vet360
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