Case 2

Results of bile acid testing

Fasting bile acid = 10 µmol/L (reference range Postprandial bile acid = 30 µmol/L (reference range

QUESTION 2

What would your recommendation to the owner be at this time? (There is more than one correct answer.)

a) Based on his bile acid test results, you conclude that Spot has impaired liver function and recommend an abdominal ultrasonographic examination and liver biopsy.

b) Since the bile acids only show a mild elevation, there is no elevation in the alanine transaminase (ALT) activity, and Spot is not acting ill, you recommend starting an NSAID for the arthritis and a liver protectant such as

S-adenosylmethionine (SAMe). You want to see Spot again in four to six weeks for a follow-up liver profile.

c) The bile acid test results do not indicate marked liver dysfunction, so it is OK to start an NSAID; however, the elevated ALP is still worrisome. Given Spot’s age, you are still concerned about something more sinister, so you recommend an abdominal ultrasonographic examination.

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