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
| Monty | Reference Range | |
| ALT IU/l | 52 | 21-102 |
| ALKP IU/l | 116 * | 20-60 |
| Bile acids μmol/l | 26.0 * | 0.7.0 |
| Bilirubin μmol/l | 0.1 | 0-6.8 |
| Creatinine μmol/l | 73 | 40-132 |
| Albumin g/l | 18.1 * * | 26-35 |
| Globulin g/l | 25.5 | 18-37 |
- Ascites
- Hypoalbuminemia
- Constriction of intrahepatic caudal vena cava
Recommendation following ultrasound and CT was surgical exploration and liver biopsy.
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