Monty: A case highlighting the poor sensitivity of ALT as a marker of liver disease in histologically confirmed chronic hepatopathy.
A 4 year old Male neutered cocker spaniel was presented to the R(D)SVS Internal Medicine Service for investigation of abdominal swelling 2 weeks duration.
- Clinical examination: No abnormalities other than ascites on abdominal palpation
- Clinical pathology: Haematology unremarkable, urinalysis, unremarkable, ALT normal, hypoalbuminaemia, elevated ALKP and bile acids
|ALKP IU/l||116 *||20-60|
|Bile acids μmol/l||26.0 *||0.7.0|
|Albumin g/l||18.1 * *||26-35|
This case highlights the challenges of non-invasive diagnostic assessment of liver disease.
A wide range of markers are historically evaluated with variable sensitivity and specificity
- ALT is widely considered the best available marker for liver disease
- There is increasing evidence of variable suboptimal sensitivity
- The fact ALT was normal in Monty’s case despite dramatic liver pathology highlights the need for novel biomarkers with better sensitivity and specificity for liver disease diagnosis