Case 2

Problem list

• Difficulty rising, decreased range of motion

• Hepatomegaly

As part of Spot's annual visit, you will run a CBC and serum chemistry panel, but given his hepatomegaly and difficulty rising, you also recommend abdominal and pelvic radiographs. The owner declines since she thinks Spot is doing fine and wants to wait and see what the blood tests show.

Laboratory results

These are the notable findings from your CBC and serum chemistry profile.

CBC with differential

All results normal

Serum chemistry panel

Patient values

Reference range

ALT (IU/L)

46

12-118

ALP (IU/L)

526

5-131

Bilirubin (mg/dl)

0.1

0.1-0.3

Albumin (g/dl)

3.2

2.7-4.4

Globulin (g/dl)

2.9

1.6-3.6

Glucose (mg/dl)

92

70-138

Cholesterol (mg/dl)

216

92-324

T4 (µg/dl)

1.2

1-4

QUESTION 1

What would be a reasonable next step in working up the elevated alkaline phosphatase (ALP) activity in this patient? (There is more than one correct answer.)

a) Inform the owner that we need to schedule Spot for a liver biopsy.

b) Since Spot is asymptomatic, consider rechecking the lab tests again in four to six weeks to see if there is any change.

c) Perform a low-dose dexamethasone suppression test.

d) Recommend an abdominal ultrasonographic examination.

e) Perform fasting and postprandial serum bile acid testing.

f) Measure the corticosteroid-induced ALP isoenzyme.

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