당신은 주제를 찾고 있습니까 “bile acid test for dogs – Elevated Liver Enzymes in Dogs – Ignore or do all the tests?“? 다음 카테고리의 웹사이트 Chewathai27.com/you 에서 귀하의 모든 질문에 답변해 드립니다: Chewathai27.com/you/blog. 바로 아래에서 답을 찾을 수 있습니다. 작성자 Nashville Veterinary Specialists 이(가) 작성한 기사에는 조회수 11,198회 및 좋아요 186개 개의 좋아요가 있습니다.
The bile acid test is also used to detect congenital liver defects in very young pets that are not growing well, and it is an essential test for any pet that has had a seizure, since liver disease may be the root cause of the seizure disorder.The bile acid test could be recommended whenever there are signs that suggest the liver is damaged or defective. This would include when: pets have abnormally high liver enzyme values in the blood. The liver may be damaged and may not have enough healthy cells to do its job.When your pet’s liver cells (hepatocytes) are injured or fewer in number or the normal blood circulation within your pet’s liver is altered (portal blood flow), this process breaks down. In some of those instances, your dog or cat’s blood bile acid test result numbers increase.
- Upper abdominal pain that may be severe.
- Frequent heartburn — a burning sensation in your chest that sometimes spreads to your throat, along with a sour taste in your mouth.
- Nausea.
- Vomiting a greenish-yellow fluid (bile)
- Occasionally, a cough or hoarseness.
- Unintended weight loss.
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Veterinary Internal Medicine Specialist Dr. John Sessions reviews tests for elevated liver enzymes in dogs. Presented April 2018 by Nashville Veterinary Specialists.
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Bile Acid Test – VCA Animal Hospitals
Bile acs are made in the liver, released into the intestine to help digest fat, and are reabsorbed into the bloodstream. They can be measured in the blood …
Source: vcahospitals.com
Date Published: 3/21/2021
View: 1605
Bile Acids Testing in Dogs and Cats – Gribbles Veterinary
A bile acs “challenge” test with both a pre- and two-hour post-prandial blood collection is recommended over a single fasting or random sample (in dogs …
Source: www.gribblesvets.com.au
Date Published: 9/15/2021
View: 2459
Clinical Pathology Panels and Guidelines
Bile ac concentrations >25-30 umol/L in dogs and > 25 umol/L in cats are suggestive of hepatobiliary disease. These guelines are val for pre-prandial …
Source: www.vet.cornell.edu
Date Published: 12/16/2022
View: 7495
Bile Acid Stimulation Test – IDEXX
Used as a test of hepatic function. • Diagnostic test for feline and canine hepatobiliary diseases and portosystemic vascular abnormalities.
Source: www.idexx.co.uk
Date Published: 7/15/2022
View: 8596
Blood biochemistry: bile acids lab test | dogs – Vetstream
Find details on Blood biochemistry: bile acs in dogs. Lab test paper including overview, sampling, tests, result data and more.
Source: www.vetlexicon.com
Date Published: 10/22/2022
View: 8765
Bile acids – eClinpath
… can affect the interpretation of bile ac testing: … Increase fasting concentrations in dogs and cats: …
Source: eclinpath.com
Date Published: 6/9/2021
View: 2032
Diagnostic Utility of Bile Acid Determination in Dogs
Serum hepatobiliary enzymes cannot be used to assess the functional capacity of the liver. Hepatobiliary function must be assessed by assaying for substances …
Source: www.cliniciansbrief.com
Date Published: 12/10/2022
View: 4616
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주제와 관련된 더 많은 사진을 참조하십시오 Elevated Liver Enzymes in Dogs – Ignore or do all the tests?. 댓글에서 더 많은 관련 이미지를 보거나 필요한 경우 더 많은 관련 기사를 볼 수 있습니다.
주제에 대한 기사 평가 bile acid test for dogs
- Author: Nashville Veterinary Specialists
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- Date Published: 2021. 1. 26.
- Video Url link: https://www.youtube.com/watch?v=gMQVSVwKNZc
Why would a dog need a bile acid test?
The bile acid test could be recommended whenever there are signs that suggest the liver is damaged or defective. This would include when: pets have abnormally high liver enzyme values in the blood. The liver may be damaged and may not have enough healthy cells to do its job.
What causes high bile acid levels in dogs?
When your pet’s liver cells (hepatocytes) are injured or fewer in number or the normal blood circulation within your pet’s liver is altered (portal blood flow), this process breaks down. In some of those instances, your dog or cat’s blood bile acid test result numbers increase.
What are the symptoms of bile acid?
- Upper abdominal pain that may be severe.
- Frequent heartburn — a burning sensation in your chest that sometimes spreads to your throat, along with a sour taste in your mouth.
- Nausea.
- Vomiting a greenish-yellow fluid (bile)
- Occasionally, a cough or hoarseness.
- Unintended weight loss.
What are normal bile acid levels in dogs?
Serum bile acid (SBA) reference intervals were established by use of a radioimmunoassay method for fasting dogs to be 0.2 to 4.3 micro mol/L (n = 60) and for 2 hour postprandial samples to be 0.6 to 24.2 micro mol/L (n = 37).
Can my dog drink water before a bile acid test?
Before starting the test, the pet must be completely fasted (all food and water withheld) for 12 hours. It is important the animal does not smell or (think about food if possible). We want to prevent premature contraction of the gallbladder.
How long does it take for bile acid test to come back?
Bile acid results in the United States can take anywhere between 36 hours-10 days for results to return, as these are specialized tests that are only performed in a few laboratories in the country. Normal bile acids do not rule out an eventual diagnosis of Intrahepatic Cholestasis of Pregnancy.
What is the best diet for a dog with liver disease?
Often, dogs suffering from liver disease do extremely well on a low-protein, high-fat diet. Including as many sources of Omega 3 fats such as fish oil and flaxseed oil is a wonderful way to give your dog the healthy fats his body needs and will be able to effectively process.
How long can a dog live with high liver enzymes?
Abnormal liver enzyme levels can usually be detected in blood tests. In isolated cases it may be possible to surgical remove then affected lobe, however this is difficult. The prognosis in most cases is poor, deterioration is rapid once clinical signs develop and death usually results within 3-4 months.
Can liver damage in dogs be reversed?
Livers are regenerative, so if liver disease is caught early enough, dogs can recover and live a happy, healthy life. But in severe cases, your dog may require more intensive treatment and in extreme cases, liver disease may even be too advanced to be treated.
What color is bile in stool?
Bile is yellow-green, and as it travels through the gastrointestinal (GI) tract, enzymes cause changes that turn it brown. All shades of brown-colored stool are normal. If a person’s stool is red or black, or other changes remain longer than 2 weeks or come with other symptoms, they should consult a doctor.
What foods increase bile production?
Bitter foods are great at stimulating bile production. You can choose from all dark green leafy vegetables, as well as beetroot, artichokes and pickles. Drinks such as roasted dandelion root tea, lemon tea, celery juice and coffee all stimulate bile production.
What happens if bile acid is high?
Bile acid levels are increased in the serum and liver in patients with obstructive jaundice or cholestasis and, perhaps because of their inherent detergent activities, can cause hepatocyte injury. Thus, increased bile acid levels in hepatocytes may account for some of the liver damage in cholestatic liver diseases.
How do I know if my dog is in liver failure?
Signs that a dog has liver disease can vary and include loss of appetite, vomiting, stomach ulceration, diarrhea, seizures or other neurologic problems, fever, blood clotting problems, jaundice (a yellow tinge noticeable in the skin, mucous membranes, and eyes), fluid collection in the abdomen, excessive urination and …
How much does a bile acid test cost?
| City | Test Price Starting from |
|---|---|
| Bile Acid Serum Cost in Faridabad | ₹ 760.0 |
| Bile Acid Serum Cost in Ghaziabad | ₹ 760.0 |
| Bile Acid Serum Cost in Rohtak | ₹ 1100.0 |
| Bile Acid Serum Cost in Bangalore / Bengaluru | ₹ 1500.0 |
How do you know if your dog is dying from liver failure?
Vomiting and diarrhea. An increase in thirst, which will cause the dog to pee more frequently. Loss of appetite and weight loss. Changes in behavior, such as irritability, lethargy, or depression.
What do elevated bile acids mean?
Bile acid levels are increased in the serum and liver in patients with obstructive jaundice or cholestasis and, perhaps because of their inherent detergent activities, can cause hepatocyte injury. Thus, increased bile acid levels in hepatocytes may account for some of the liver damage in cholestatic liver diseases.
What does a bile acid stimulation test do?
Bile acids measurement is a highly sensitive assay to assess hepatobiliary function. Bile acids are derived from cholesterol in the liver, released into the intestine after eating to aid in fat absorption, then enter the portal circulation to be cleared by the liver and re-excreted into bile.
How long can a dog live with high liver enzymes?
Abnormal liver enzyme levels can usually be detected in blood tests. In isolated cases it may be possible to surgical remove then affected lobe, however this is difficult. The prognosis in most cases is poor, deterioration is rapid once clinical signs develop and death usually results within 3-4 months.
What toxins cause elevated liver enzymes in dogs?
Xylitol and paracetamol are commonly encountered substances which can cause liver toxicity in dogs. Some blue-green algae (cyanobacteria) and mushrooms produce compounds that damage the liver. Acute ingestion of some plants, particularly cycads, can cause liver failure in dogs.
Bile Acid Test
What are bile acids and what do they do?
Bile acids are compounds that are made in the liver and stored in the gall bladder. Bile acids help with digestion of foods, particularly fat. When food is eaten, the body sends a signal to the gall bladder to contract and push bile acids into the small intestine. The bile acids mix with the food in the intestine and break down large, complex fats into small particles that can be absorbed more easily.
What is the purpose of the bile acid test?
The bile acid test is a very useful test that helps to determine if the liver is working properly. Specifically, the test answers three questions:
Does the liver have enough healthy cells to do its job? Does the liver have a good blood supply? Is bile moving freely through and out of the liver?
The bile acid test is based on the principle that a healthy liver can “recycle” bile acids, while a damaged or defective liver cannot.
How does the liver recycle bile acids?
After the bile acids enter the intestine, they remain there until all the food has been digested. When digestion is finished, the bile acids are absorbed by the intestine, passed into the blood stream, and carried back to the liver. Once back In the liver, the liver cells retrieve the bile acids from the blood stream and return them to the gall bladder, where they are stored until the next meal.
When would the bile acid test be recommended?
The bile acid test could be recommended whenever there are signs that suggest the liver is damaged or defective. This would include when:
pets have abnormally high liver enzyme values in the blood. The liver may be damaged and may not have enough healthy cells to do its job.
pets have low albumin levels in the blood. Albumin is a type of protein made in the liver, and low levels of albumin signal that the liver may not have enough healthy cells to do its job.
very young pets are not growing well. There may be a congenital defect in the blood supply that is preventing the liver from doing its job.
a pet has seizures (also called convulsions). Liver disease is the cause of some seizure disorders because of poor blood supply or because there are not enough healthy liver cells to do the job.
Is there special preparation for the test?
Yes. Fasting is generally advised for 12 hours before performing the test. The fast is an important part of the protocol, and must be strictly enforced. Even treats and chew toys must be withheld. The fasting period gives the liver time to retrieve any bile acids remaining in the blood stream. This means that before the test starts there are no bile acids, or only very low levels of bile acids in the blood stream.
How is the test performed?
The test begins by collecting an initial blood sample, called the resting sample or preprandial (“before eating”) sample. This establishes a baseline or starting point. A small tasty meal of canned food is then offered to the pet. The animal is usually hungry, and eats the food quickly. Exactly 2 hours after the meal is finished a second blood sample is collected, called the postprandial (“after eating”) sample. Both blood samples are tested for bile acid levels.
How important is it to follow the protocol closely?
The protocol for the bile acid test is simple, but it must be followed precisely. Errors such as failing to enforce fasting properly, feeding too large a meal after the initial blood test, feeding dry kibble rather than canned food, or collecting blood samples at the wrong time can all affect the validity of the test results.
Are there situations when the bile acid test should not be done?
Yes. The test requires that the pet’s stomach and bowel are working properly. Therefore, the bile acid test should not be used in pets that:
have vomiting, diarrhea, or constipation. These problems may interfere with digestion or alter the rate at which bile acids are recycled.
have had previous surgery to remove a section of their small intestine. These patients may not be able to absorb bile acids from the intestine to recycle them.
have been sedated or are recovering from anesthesia. Stomach and bowel function may not be normal due to the effects of the drugs.
In addition, the bile acid test should not be done if the pet is being given bile acids as part of a treatment for liver disease. The medication needs to be withdrawn in order to get reliable results from the bile acid test.
How is the test interpreted?
If the liver is able to do its job, there would be very low levels of bile acids in the resting blood sample and only slightly higher levels of bile acids in the postprandial sample. This would indicate that bile acids released from the gall bladder during the test meal were adequately recaptured by the liver during the 2-hour period following the meal. The conclusion would be that the liver has enough cells to do its job, there is a blood supply, and bile is flowing properly.
If the bile acid test is normal, does it always mean the liver is completely healthy?
No. Sometimes the bile acid test results will be normal, even when there is a problem in the liver. This usually occurs when the problem is mild or affects only a small portion of the liver. In these situations, there is often no reduction in the overall ability of the liver to do its job, and the bile acid test will be normal, even though the pet has high levels of liver enzymes in the blood. In other situations, the gall bladder may not contract as expected, and bile acids levels will be low, even though a liver problem may exist.
If your veterinarian suspects that your pet has liver disease in spite of normal bile acid test results, additional diagnostic tests may be recommended to investigate the problem further.
If the bile acid test is abnormal, what then?
An abnormal bile acid test result indicates there is a problem in the liver, but it does not provide information about the cause, severity, or reversibility of the problem. Depending on how sick your pet is and how abnormal the test results are, your veterinarian may recommend monitoring the situation, or may suggest moving on to additional diagnostic tests including ultrasound of the liver, and possibly a liver biopsy.
Why Is My Dog Or Cat’s Bile Acid Level High or Low? – Ron Hines’ Vetspace – 2nd Chance – The Animal Health Website
Why Is My Dog Or Cat’s Bile Acid Level High or Low?
Ron Hines DVM PhD
See What Normal Blood & Urine Values Are
Causes Of Most Abnormal Blood & Urine Tests
See How Tests Are Grouped
Bile Acids Report with Notes
Ways To Bring Bile Acid Levels Down?
The Bile Acids Level In Your Dog Or Cat’s Blood
Bile acids are formed in your cat or dog ’s liver. The majority become a portion of your pet’s bile. These specialized digestive acids then collect in your pet’s gallbladder. From there they pass through its bile duct and into its upper intestine to aid in the absorption of the fat and oil in its diet. In that form they are called bile salts.
As bile salts move past the small intestine and into your pet’s colon, a large portion of them are chemically modified by the bacteria that reside there. They are change from their original form, primary bile acids, into secondary bile acids. Some leave in the stool, but while in the colon, much is reabsorbed into your pet’s blood stream. Some of those secondary bile acids have hormone-like actions regarding your dog or cat’s blood glucose and cholesterol levels. But the majority are returned to its liver and added to your pet’s bile in an endless cycle. When your pet’s liver cells (hepatocytes) are injured or fewer in number or the normal blood circulation within your pet’s liver is altered (portal blood flow), this process breaks down. In some of those instances, your dog or cat’s blood bile acid test result numbers increase. In others they decrease.
So your dog or cat’s bile acid determination is a very good way for your veterinarian to detect liver problems – particularly when your pet’s ALT and bilirubin tests are only borderline normal/abnormal and difficult to interpret. Although a single bile acids test can be informative, two tests are much better: A 12 hour fast – then the first measurement. Then a moderately sized meal. Two hours after that, a second measurement.
Abnormal liver enzyme results in your pet are the most common reason for running as double bile acids test. But another valid reason to perform a double bile acids test is if anesthetics or sedatives have unusually strong effects on your dog or cat. “went too deep” “slept too long” Yet another are neurological issues such as abnormal behaviors – particularly when the tend to occur after meals. Another reason is a pet that fails to grow as expected for his or her breed. The bile acids test is also a good screening test when your pet has consistently low blood albumin levels that might indicate chronic liver issues. The albumin in its blood is manufactured in its liver.
Health Problems That Can Causes Bile Acid Levels To Be High:
Many forms of liver disease, abnormal liver blood flow (= portosystemic shunts), impaired gall bladder and bile duct function (cholestasis, or a biliary tract obstruction), gallstones, liver cancer, Cushing’s disease, pancreatitis, hepatic encephalopathy (=your pet’s liver can no longer convert the free blood ammonia generated by metabolism into less toxic urea).
Cats that have developed hepatic lipidosis because they are not eating often have abnormally high bile acid values.
Lipemic blood samples can falsely increase bile acid readings.
An abnormal bile acid test is not unusual in toy breeds born with hepatic microvascular dysplasia. It has been reported that bile acid levels can be naturally high in the Maltese breed. But perhaps that is due to the hepatic microvascular dysplasia problem that is common to all the toy breeds.
Health Problems That Can Cause Bile Acid Levels To Be Low:
One reason is long-standing intestinal disease (such as IBD in your dog or in your cat when the upper portions of your pet’s intestine remain inflamed. Poor nutrient absorption (malabsorption/maldigestion) is another possible cause. Persistent diarrhea or starvation can all cause low blood bile acid readings.
Dogs less than 16 weeks old may have naturally lower levels. I do not know if the is also the case in kittens.
Serum bile acids can also be falsely reported as low if the blood sample was accidentally hemolyzed or lipemic. Low bile acid levels can result in a deficiency of the fat-soluble vitamins (=A,D,E & K). In cats, that problem has also been associated with a taurine deficiency.
Complementary Tests:
Complete blood chemistry including AP, GGT, Albumin, Glucose, BUN, AST, ALT, GDH/GLDH\ & bilirubin. A Liver doppler ultrasound examination. X-rays to see if your pet’s liver is of normal size. A Liver biopsy. Perhaps a blood ammonia level determination – although that test has procedural and significance issues.
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Bile reflux – Symptoms and causes
Overview
Bile reflux Open pop-up dialog box Close Bile reflux Bile reflux Bile is a digestive fluid produced by the liver and stored in the gallbladder. During bile reflux, digestive fluid backs up into the stomach and, in some cases, the esophagus.
Bile reflux occurs when bile — a digestive liquid produced in your liver — backs up (refluxes) into your stomach and, in some cases, into the tube that connects your mouth and stomach (esophagus).
Bile reflux may accompany the reflux of stomach acid (gastric acid) into your esophagus. Gastric reflux may lead to gastroesophageal reflux disease (GERD), a potentially serious problem that causes irritation and inflammation of esophageal tissue.
Unlike gastric acid reflux, bile reflux can’t be completely controlled by changes in diet or lifestyle. Treatment involves medications or, in severe cases, surgery.
Symptoms
Bile reflux can be difficult to distinguish from gastric acid reflux. The signs and symptoms are similar, and the two conditions may occur at the same time.
Bile reflux signs and symptoms include:
Upper abdominal pain that may be severe
Frequent heartburn — a burning sensation in your chest that sometimes spreads to your throat, along with a sour taste in your mouth
Nausea
Vomiting a greenish-yellow fluid (bile)
Occasionally, a cough or hoarseness
Unintended weight loss
When to see a doctor
Make an appointment with your doctor if you frequently experience symptoms of reflux, or if you’re losing weight without trying.
If you’ve been diagnosed with GERD but aren’t getting enough relief from your medications, call your doctor. You may need additional treatment for bile reflux.
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Causes
Bile is essential for digesting fats and for eliminating worn-out red blood cells and certain toxins from your body. Bile is produced in your liver and stored in your gallbladder.
Eating a meal that contains even a small amount of fat signals your gallbladder to release bile, which flows through a small tube into the upper part of your small intestine (duodenum).
Bile reflux into the stomach
Bile and food mix in the duodenum and enter your small intestine. The pyloric valve, a heavy ring of muscle located at the outlet of your stomach, usually opens only slightly — enough to release about an eighth of an ounce (about 3.75 milliliters) or less of liquefied food at a time, but not enough to allow digestive juices to reflux into the stomach.
In cases of bile reflux, the valve doesn’t close properly, and bile washes back into the stomach. This can lead to inflammation of the stomach lining (bile reflux gastritis).
Bile reflux into the esophagus
Bile and stomach acid can reflux into the esophagus when another muscular valve, the lower esophageal sphincter, doesn’t work properly. The lower esophageal sphincter separates the esophagus and stomach. The valve normally opens just long enough to allow food to pass into the stomach. But if the valve weakens or relaxes abnormally, bile can wash back into the esophagus.
What leads to bile reflux?
Bile reflux may be caused by:
Surgery complications. Stomach surgery, including total or partial removal of the stomach and gastric bypass surgery for weight loss, is responsible for most bile reflux.
Stomach surgery, including total or partial removal of the stomach and gastric bypass surgery for weight loss, is responsible for most bile reflux. Peptic ulcers. A peptic ulcer can block the pyloric valve so that it doesn’t open or close properly. Stagnant food in the stomach can lead to increased gastric pressure and allow bile and stomach acid to back up into the esophagus.
A peptic ulcer can block the pyloric valve so that it doesn’t open or close properly. Stagnant food in the stomach can lead to increased gastric pressure and allow bile and stomach acid to back up into the esophagus. Gallbladder surgery. People who have had their gallbladders removed have significantly more bile reflux than do people who haven’t had this surgery.
Complications
Bile reflux gastritis has been linked to stomach cancer. The combination of bile reflux and acid reflux also increases the risk of the following complications:
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Bile Acid Test
What are bile acids and what do they do?
Bile acids are compounds that are made in the liver and stored in the gall bladder. Bile acids help with digestion of foods, particularly fat. When food is eaten, the body sends a signal to the gall bladder to contract and push bile acids into the small intestine. The bile acids mix with the food in the intestine and break down large, complex fats into small particles that can be absorbed more easily.
What is the purpose of the bile acid test?
The bile acid test is a very useful test that helps to determine if the liver is working properly. Specifically, the test answers three questions:
Does the liver have enough healthy cells to do its job? Does the liver have a good blood supply? Is bile moving freely through and out of the liver?
The bile acid test is based on the principle that a healthy liver can “recycle” bile acids, while a damaged or defective liver cannot.
How does the liver recycle bile acids?
After the bile acids enter the intestine, they remain there until all the food has been digested. When digestion is finished, the bile acids are absorbed by the intestine, passed into the blood stream, and carried back to the liver. Once back In the liver, the liver cells retrieve the bile acids from the blood stream and return them to the gall bladder, where they are stored until the next meal.
When would the bile acid test be recommended?
The bile acid test could be recommended whenever there are signs that suggest the liver is damaged or defective. This would include when:
pets have abnormally high liver enzyme values in the blood. The liver may be damaged and may not have enough healthy cells to do its job.
pets have low albumin levels in the blood. Albumin is a type of protein made in the liver, and low levels of albumin signal that the liver may not have enough healthy cells to do its job.
very young pets are not growing well. There may be a congenital defect in the blood supply that is preventing the liver from doing its job.
a pet has seizures (also called convulsions). Liver disease is the cause of some seizure disorders because of poor blood supply or because there are not enough healthy liver cells to do the job.
Is there special preparation for the test?
Yes. Fasting is generally advised for 12 hours before performing the test. The fast is an important part of the protocol, and must be strictly enforced. Even treats and chew toys must be withheld. The fasting period gives the liver time to retrieve any bile acids remaining in the blood stream. This means that before the test starts there are no bile acids, or only very low levels of bile acids in the blood stream.
How is the test performed?
The test begins by collecting an initial blood sample, called the resting sample or preprandial (“before eating”) sample. This establishes a baseline or starting point. A small tasty meal of canned food is then offered to the pet. The animal is usually hungry, and eats the food quickly. Exactly 2 hours after the meal is finished a second blood sample is collected, called the postprandial (“after eating”) sample. Both blood samples are tested for bile acid levels.
How important is it to follow the protocol closely?
The protocol for the bile acid test is simple, but it must be followed precisely. Errors such as failing to enforce fasting properly, feeding too large a meal after the initial blood test, feeding dry kibble rather than canned food, or collecting blood samples at the wrong time can all affect the validity of the test results.
Are there situations when the bile acid test should not be done?
Yes. The test requires that the pet’s stomach and bowel are working properly. Therefore, the bile acid test should not be used in pets that:
have vomiting, diarrhea, or constipation. These problems may interfere with digestion or alter the rate at which bile acids are recycled.
have had previous surgery to remove a section of their small intestine. These patients may not be able to absorb bile acids from the intestine to recycle them.
have been sedated or are recovering from anesthesia. Stomach and bowel function may not be normal due to the effects of the drugs.
In addition, the bile acid test should not be done if the pet is being given bile acids as part of a treatment for liver disease. The medication needs to be withdrawn in order to get reliable results from the bile acid test.
How is the test interpreted?
If the liver is able to do its job, there would be very low levels of bile acids in the resting blood sample and only slightly higher levels of bile acids in the postprandial sample. This would indicate that bile acids released from the gall bladder during the test meal were adequately recaptured by the liver during the 2-hour period following the meal. The conclusion would be that the liver has enough cells to do its job, there is a blood supply, and bile is flowing properly.
If the bile acid test is normal, does it always mean the liver is completely healthy?
No. Sometimes the bile acid test results will be normal, even when there is a problem in the liver. This usually occurs when the problem is mild or affects only a small portion of the liver. In these situations, there is often no reduction in the overall ability of the liver to do its job, and the bile acid test will be normal, even though the pet has high levels of liver enzymes in the blood. In other situations, the gall bladder may not contract as expected, and bile acids levels will be low, even though a liver problem may exist.
If your veterinarian suspects that your pet has liver disease in spite of normal bile acid test results, additional diagnostic tests may be recommended to investigate the problem further.
If the bile acid test is abnormal, what then?
An abnormal bile acid test result indicates there is a problem in the liver, but it does not provide information about the cause, severity, or reversibility of the problem. Depending on how sick your pet is and how abnormal the test results are, your veterinarian may recommend monitoring the situation, or may suggest moving on to additional diagnostic tests including ultrasound of the liver, and possibly a liver biopsy.
Bile Acids Testing in Dogs and Cats
Bile acids measurement is a highly sensitive assay to assess hepatobiliary function. Bile acids are derived from cholesterol in the liver, released into the intestine after eating to aid in fat absorption, then enter the portal circulation to be cleared by the liver and re-excreted into bile. Serum bile acids concentrations may be elevated in diseased states leading to decreased functional liver mass, with obstructive cholestasis, and with congenital or acquired portosystemic vascular shunts. This test does not differentiate these underlying types of liver disease.
While biochemical changes including elevated ALT, AST, ALK, bilirubin with decreased albumin, urea, glucose, and cholesterol, and prolonged coagulation times may suggest liver failure, these analytes may be in normal reference interval with various liver conditions or be altered by non-hepatic diseases. They are not reliable primary indicators of liver function compared to bile acids measurement.
A bile acids “challenge” test with both a pre- and two-hour post-prandial blood collection is recommended over a single fasting or random sample (in dogs and cats) because it has substantially higher sensitivity for detecting disease. Feeding stimulates gall bladder contraction and the release of bile acids into the intestine and eventual portal circulation. This increased load can better “challenge” the liver’s ability to clear the increased bile acids presented to it.
Indications for testing
Bile acids challenge testing should be performed when there are clinical and biochemical findings that suggest liver dysfunction or portosystemic shunting.
Testing is NOT indicated if the patient is icteric from hepatic or post-hepatic cholestasis, as bile acids will inevitably be high and not provide additional information. In patients with pre-hepatic icterus (haemolysis), a bile acids challenge test can help rule out hepatic aetiology, if not readily apparent.
When used as a screening test in puppies from breeds that are predisposed to congenital portosystemic shunts, it is recommended to delay testing until after 16 weeks of age, as bile acid concentrations may be falsely lower in puppies younger than 16 weeks.
Test Protocol:
Sample haemolysis and lipemia can interfere with bile acids measurement and should be avoided by fasting, using a large gauge needle, jugular venepuncture, and separation of the serum after clotting.
1. Collect the fasting sample:
Fast the patient for 12 hours.
Collect the first blood sample, and label the tube with patient name and “0 hr” .
2. Feed a small amount (2-4 tablespoons) of canned maintenance-type diet. Note that a high-fat diet is NOT necessary, and can sometimes contribute to unwanted sample lipemia if given in excess.
3. Collect the post-prandial sample.
Two hours after feeding, collect the second sample and label with patient name and “2 hr”. Submit both tubes to Gribbles with the completed request form.
Interpretation of bile acids challenge test:
Using Gribbles reference intervals, post-prandial bile acid concentrations >31 umol/L (dogs) are suggestive of hepatobiliary disease (decreased functional mass, cholestasis or portovascular shunting). Values between 15-31 are equivocal, and such dogs may or may not have liver dysfunction. Most animals with congenital or acquired portosystemic shunting have markedly increased post-prandial bile acids concentrations.
Up to 20% of the time, the fasting bile acids may be higher than the post-feeding concentration. This can be due to a recent meal before testing, spontaneous gall bladder contraction, insufficient gall bladder contraction after feeding, or variations in gastric emptying, intestinal transit time or absorption. If both results are <31 umol/L (especially <15 umol/L), then hepatobiliary dysfunction is unlikely. Maltese dogs – Update! Gribbles has previously reported that bile acids measurement in the Maltese breed may have questionable utility, based on a 1995 Australian study (Tisdall et al, Aust Vet J) which found that this breed may have “artifactually” elevated serum bile acids caused by unknown reacting substances. In this study of 200 Maltese dogs, only 11 dogs had liver biopsies performed. More recent research presented by Sharon Center (Cornell University) at the 2012 ACVIM Conference refutes this supposition, based on genetic mapping work and liver biopsies from Maltese dogs. Center has found that Maltese often have portal hypoperfusion. In evaluation of 136 liver biopsies from Maltese dogs, 22% had congenital “classic” portosystemic vascular anomaly (PSVA) whilst about 60% had microvascular dysplasia (MVD) without PSVA. Every Maltese with portal hypoperfusion had high serum bile acids concentrations. In most of those cases, the presence of increased serum ALT in conjunction with high bile acids initiated the collection of a liver biopsy. With these recent findings, Gribbles confidently endorses the use of bile acids “challenge” test in Maltese dogs, as for other breeds. While ammonia tolerance testing remains an alternative test to assess liver function, ammonia measurement is problematic, inconvenient and very unstable. Species: Dog, Cat Specimen: Serum (minimum 1 ml) Container: Plain tube, gel tube References: Center SA. Breed-Specific Hepatopathies: Scottish Terriers and Maltese Dogs. ACVIM Proceedings 2012. Cornell University Veterinary School website. Bile Acids. https://ahdc.vet.cornell.edu/clinpath/modules/chem/bileacid.htm (visited 21/05/13) Shell, Linda et al for VIN community. Bile Acids, Medical FAQs 18290418, last updated 01/11/08. Stockham SL and Scott MA, 2008. Liver Function. In Fundamentals of Veterinary Clinical Pathology, 2nd ed., Ames, IA: Blackwell Publishing, pp. 675-706. Tisdall PL, Hunt GB, et al. Post-prandial serum bile acid concentrations and ammonia tolerance in Maltese dogs with and without hepatic vascular anomalies. Aust Vet J. 1995;72(4):121-6.
Clinical Pathology Panels and Guidelines
Panels
Chemistry Panels Bilirubin Panel Bilirubin, Direct
Bilirubin, Indirect
Bilirubin, Total Bovine Metabolic Panel Albumin
AST
BHBA
Cholesterol
NEFA
Triglycerides
Urea Nitrogen Camelid Liver Panel A/G ratio
Albumin
AST
Bilirubin, Direct
Bilirubin, Indirect
Bilirubin, Total
CK
GGT
GLDH
Globulin
NEFA
SDH
Total Protein
Triglycerides Canine Chemistry Panel See “Small Animal Chemistry Panel” Donkey Chemistry Panel A/G ratio
Albumin
Anion gap
AST
Bicarbonate
Calcium
Chloride
Cholesterol
CK
Creatinine
D. Bilirubin
GGT
GLDH/SDH
Globulin
Glucose
I. Bilirubin
Magnesium
Phosphate
Potassium
Sodium
T. Bilirubin
Total Protein
Triglycerides
Urea Nitrogen Electrolyte Panel Chloride (CL)
Potassium (K)
Sodium (NA) Electrolyte Panel, Urine* Chloride
Creatinine
Potassium
Sodium * Concurrent measurement of serum electrolytes and creatinine is required for fractional excretion values. Equine Chemistry Panel See “Large Animal Chemistry Panel” Equine Liver Panel AST
Bile Acids-Random
CK
D. Bilirubin
GGT
GLDH
I. Bilirubin
SDH
T. Bilirubin
Triglycerides Feline Chemistry Panel See “Small Animal Chemistry Panel” Iron Panel % Saturation
Serum Iron
Total Iron Binding Capacity (TIBC) Large Animal Chem Panel % Saturation
A/G ratio
Albumin
Anion gap
AST
Bicarbonate
Calcium
Chloride
CK
Creatinine
D. Bilirubin
GGT
GLDH
Globulin
Glucose
I. Bilirubin
Iron
Magnesium
Phosphate
Potassium
SDH
Sodium
T. Bilirubin
TIBC
Total Protein
Urea Large Animal Renal Panel Albumin
Anion gap
Bicarbonate
Calcium
Chloride
Creatinine
Phosphate
Potassium
Sodium
Urea Mineral/Lytes Panel Anion Gap
Bicarbonate
Calcium
Chloride
Magnesium
Phosphate
Potassium
Sodium Mineral/Lytes Panel, Urine Calcium
Chloride
Creatinine
Magnesium
Phosphate
Potassium
Sodium Mineral Panel, Urine Calcium
Creatinine
Magnesium
Phosphate Murine Liver/Renal Panel ALT
AST
CK
Creatinine
GLDH
LDH
Urea Nitrogen Non-Mammalian Chem Panel AST
Bile Acids
Calcium
Chloride
CK
GLDH
Glucose
Phosphate
Potassium
Sodium
Total Protein
Uric Acid Pre-Anesthesia Panel (Sm An) ALT
Anion Gap
Bicarbonate
Calcium
Chloride
Creatinine
Glucose
Potassium
Sodium Ruminant Chem Panel See “Large Animal Chemistry Panel” Ruminant Liver Panel A/G ratio
Albumin
AST
BHB
CK
GGT
GLDH
Globulin
NEFA
SDH
Total Protein Small Animal Chem Panel % Saturation
A/G ratio
Albumin
ALK PHOS
ALT
Amylase
Anion Gap
AST
Bicarbonate
Calcium
Chloride
Cholesterol
CK
Creatinine
D. Bilirubin
GGT
Globulin
Glucose
I. Bilirubin
LDH
Lipase
Magnesium
Na:K
Phosphate
Potassium
Serum Iron
Sodium
T. Bilirubin
TIBC
Total Protein
Urea Nitrogen Small Animal Liver Panel Albumin
ALK PHOS
ALT
AST
Cholesterol
GGT
Glucose
T. Bilirubin
Urea Nitrogen Small Animal Renal Panel Albumin
Anion gap
Bicarbonate
Calcium
Chloride
Cholesterol
Creatinine
Ionized Calcium
Phosphate
Potassium
Sodium
Urea Nitrogen Total Protein Panel A/G ratio
Albumin
Globulin
Total Protein Tot Protein Creatinine Ratio Creatinine
Protein:Creatinine Ratio
Total Protein Transition Cow Energy Panel BHB
NEFA Hematology Panels Blood Smear Eval, Mammalian or Non-Mammalian White Blood Cell Differential %
White Blood Cell Examination
Red Blood Cell Examination
Platelet Estimate
Parasite Check Hemogram, Automated Complete Bld Cnt Automated, or CBCA White Blood Cell Count (WBC)
Red Blood Cell Count (RBC)
Hemoglobin (Hb)
Hematocrit (Hct)
Mean Corpuscular Volume (MCV)
Mean Corpuscular Hemoglobin (MCH)
Mean Corpuscular Hemoglobin Concentration (MCHC)
Red Cell Distribution Width (RDW)
Automated Platelet Count
Mean Platelet Volume (MPV)
White Blood Cell Differential, Automated Hemogram, Non-Mammalian Non-Mammalian Compl Bld Cnt, or CBC White Blood Cell Count (WBC)
Packed Cell Volume (PCV)
Red Blood Cell Examination
White Blood Cell Differential (Diff)
White Blood Cell Examination
Platelet Smear Examination
Plasma Examination
Total Protein by Refractometer (TP-Ref) Hemogram, Partial Partial Blood Count, or PBC White Blood Cell Count (WBC)
Red Blood Cell Count (RBC)
Hemoglobin (Hb)
Hematocrit (Hct)
Mean Corpuscular Volume (MCV)
Mean Corpuscular Hemoglobin (MCH)
Mean Corpuscular Hemoglobin Concentration (MCHC)
Red Cell Distribution Width (RDW)
Automated Platelet Count
Mean Platelet Volume (MPV) Hemogram, Routine* Complete Blood Count, or CBC White Blood Cell Count (WBC)
Red Blood Cell Count (RBC)
Hemoglobin (Hb)
Hematocrit (Hct)
Mean Corpuscular Volume (MCV)
Mean Corpuscular Hemoglobin (MCH)
Mean Corpuscular Hemoglobin Concentration (MCHC)
Red Cell Distribution Width (RDW)
Automated Platelet Count
Mean Platelet Volume (MPV)
Red Blood Cell Examination
White Blood Cell Differential (Diff)
Platelet Smear Examination
White Blood Cell Examination
Plasma Examination
Total Protein by Refractometer (TP-Ref) * A reticulocyte percentage and absolute reticulocyte count are provided in anemic dogs and cats. White Blood Cell (WBC) Panel, Automated White Blood Cell Count (WBC)
White Blood Cell Differential, Automated White Blood Cell (WBC) Panel, Non-Mammalian White Blood Cell Count (WBC)
White Blood Cell Differential (Diff) White Blood Cell (WBC) Panel White Blood Cell Count (WBC)
White Blood Cell Differential (Diff)
Platelet Smear Examination
White Blood Cell Examination
Serum Bile Acids Results: Guidelines for Interpretation
Dogs and Cats
Bile acid concentrations >25-30 umol/L in dogs and > 25 umol/L in cats are suggestive of hepatobiliary disease. These guidelines are valid for pre-prandial (fasting), post-prandial and random (unrelated to eating) samples. Most animals have higher post-prandial than fasting bile acid concentrations, however some animals (up to 20% of dogs) may have higher fasting than post-prandial bile acid concentrations, due to a recent meal, gall bladder contraction during fasting, or delayed gastric emptying. In this scenario, if both results are < 25 umol/L (especially < 15 umol/L), hepatobiliary disease is unlikely. Based on studies done by Dr. Center at Cornell University, dogs with bile acid concentrations < 25 umol/L do not have evidence of hepatic pathology on biopsy, whereas dogs with values > 25 umol/L usually have hepatic pathology. Dogs with bile acid values between 15-25 umol/L are in an equivocal zone (i.e. may or may not have hepatic pathology). Most animals with congenital or acquired portosystemic shunting have markedly increased post-prandial bile acids concentration.
Prolonged fasting, intestinal malabsorption, or rapid gastrointestinal transit may lower bile acid concentrations and decrease the sensitivity of bile acid testing for hepatobiliary disease. Bile acid testing should not be done in an animal that is clinically icteric or has an increased direct (conjugated) bilirubin, since this test does not give any indication of hepatic function or portosystemic shunting in the presence of cholestasis.
Young dogs of breeds predisposed to congenital portosystemic shunts should be tested greater than 16 weeks of age, because bile acid concentrations may be falsely lower in animals younger than this. For stimulation testing, animals should be fed at their routine meal times (e.g. morning) and should be given their regular meal (amount and type).
Horses
Bile acids concentration greater than 11 umol/L can be the result of hepatobiliary disease. Slightly increased concentrations (up to approximately 20 umol/L) can result from decreased feed intake for a period of several days or longer. Most horses with hepatobiliary disease have markedly increased bile acids concentration.
Bile acid testing should not be done in an animal that has an increased direct (conjugated) bilirubin or bilirubinuria (both of which indicate cholestasis), since this test does not give any indication of hepatic function or portosystemic shunting in the presence of cholestasis.
Cows
Bile acids concentrations are extremely variable in health and therefore have not been found to be useful in diagnosis of hepatobiliary disease. For optimum diagnostic value, bile acids results should be interpreted with regard to clinical findings and other laboratory results.
Sample Index Results
You will find three test results following the results for both fasting and post-prandial bile acids results. These tests are titled LIPEMIA, HEMOLYSIS, and ICTERUS. These are actually indexes of sample quality and are assessed by the analyzer by passing light at different wavelengths through the sample. The number reported under LIPEMIA measures the turbidity of the sample, which may be due to lipid (fat). The number reported under HEMOLYSIS is a semi-quantitative measurement of the concentration of free hemoglobin in mg/dL. The number reported under ICTERUS is an estimation of the bilirubin concentration in mg/dL rounded to the nearest whole number. These indexes are more quantitative and consistent than visual assessment of these interferences in the sample. The LIPEMIA and HEMOLYSIS index results correlates with a visual assessment of the sample as follows:
LIPEMIA = 30 – 60 appears slightly turbid (hazy)
LIPEMIA = 60 – 120 appears moderately turbid (milky)
LIPEMIA > 120 appears markedly turbid (creamy)
HEMOLYSIS = 20 – 100 appears slightly hemolyzed (pink tinged)
HEMOLYSIS = 100 –300 appears moderately hemolyzed (red)
HEMOLYSIS > 300 appears markedly hemolyzed (dark red)
Lipemia (falsely increases) and hemolysis (falsely decreases) do interfere with bile acid measurement, so efforts should be undertaken to minimize these (by not feeding too large a meal and by separating serum from cells as soon as possible). Our laboratory indicates when bile acid concentrations may have been affected by these interferences. Bile acids should not be performed in an animal with icterus due to cholestasis or any biochemical evidence of cholestasis (high total and direct bilirubin with bilirubinuria), since in these cases, the test does not give any additional information about liver function or vascular abnormalities.
Protocol for performing a fasting and post-prandial bile acid test
For the fasting sample, blood should be collected after an overnight fast or alternatively just before a meal (when the animal is hungry). For the post-prandial sample, blood is drawn two hours after the animal is fed its regular meal (type of food and amount) to maximize the likelihood of gall bladder contraction. This is often best done at home (where the animal is more likely to eat and have normal gastrointestinal motility). Both blood samples should be collected into red-top vacutainers (serum is preferred for bile acid measurement) and serum should be separated promptly from cells.
Cholinesterase Results: Guidelines for Interpretation
Measurement of cholinesterase activity in serum or plasma is an inexpensive and quick screening test that is indicated for animals with a history of possible exposure to organophosphate or carbamate compounds and/or show clinical signs compatible with exposure.
Serum/plasma cholinesterase activity below the reference interval is consistent with exposure to cholinesterase- inhibiting compounds, including organophosphate and carbamate insecticides. If history and clinical signs are suggestive of organophosphate or carbamate poisoning, then testing of tissue, gastric contents, urine, or blood for these insecticides may be warranted.
Cholinesterase activity within the reference interval does not rule out exposure to organophosphate or carbamate insecticides since the range of activity within a species is so broad that an individual animal may have significant reduction of its pre-exposure activity and still be within the reference interval. Cholinesterase activity above the reference interval has no known significance. Hemolysis can increase cholinesterase activity in serum/plasma samples by release of cholinesterase from red blood cells.
Special Sample Collection Instructions for Ionized Calcium Testing
Test Name Calcium, Ionized or Ionized Calcium Test Days M-Sa Lag 1 day Samples 1 mL separated serum Container non-anticoagulant tube (plain red top) Coolant refrigerate
Please note that for ionized calcium testing, blood samples should be collected into non-anticoagulant (plain red top) tubes. The sample should then be centrifuged and the serum removed anaerobically (using an evacuated needle and syringe through the tube cap) and placed into a second non-anticoagulant tube (once again, inserting the needle through the cap of the tube). The tubes should not be uncapped under any circumstances. Keep the serum cool at all times. Analysis should be performed within 48 hours after collection for optimal results. Alternatively the serum can be frozen, shipped on dry ice, and analyzed within seven days.
Special Sample Collection Instructions for Ammonia
Measurement of ammonia is problematic as it rapidly increases with storage in whole blood and also increases with storage in separated plasma. As a result the following handling collection and handling instructions should be followed:
Mailed-in samples or samples that will not reach the lab within an hour of sampling
Blood should be collected into EDTA or heparin tubes, separated immediately and the plasma should be frozen. The frozen plasma sample should be shipped to the lab on dry ice (needs to stay frozen). Mark the outside of the shipping box in large letters with the following: PERISHABLE KEEP FROZEN. If the sample arrives at the lab thawed a comment will be added indicating that the ammonia value may be falsely increased from storage.
Local clients within a 1 hour drive from the lab
Blood should be collected into EDTA or heparin tubes, separated immediately and the plasma kept on ice until analysis. Ammonia is stable in plasma for a maximum of 3 hours under these conditions. If sample separation from cells cannot be achieved, the sample should be kept on ice until submission to the laboratory, however ammonia will be less accurate. Mark the outside of the shipping box in large letters with the following: PERISHABLE KEEP COOL.
Control samples (from a clinically healthy animal) collected and handled in the same manner should always be run in conjunction with patient samples, to ensure that sample collection and handling are not responsible for elevations in ammonia.
Please contact the lab prior to collecting and sending the sample. This way testing can be expedited once the sample arrives.
Non-Esterified Fatty Acid (NEFAs) in Transition (Pre-partum or Post-partum) Dairy Cows
Guidelines for Interpretation
The following interpretation guidelines are based on studies done at Cornell University and are valid for samples collected from ‘at risk’ TMR-fed cows between 2-14 days precalving (prepartum NEFAs) or 3-14 days post-calving (postpartum NEFAs). We recommend sampling at least 12 ‘at risk’ cows when evaluating total mixed ration (TMR)-fed herds for negative energy balance.
Cow level testing
Prepartum NEFAs: There is an increased incidence of postcalving diseases (displaced abomasum, metritis/retained placenta and clinical ketosis), decreased milk yield and decreased reproductive performance in the first 30 days in milk in Holstein dairy cows (fed TMR) with NEFA values > 0.30 mEq/L when tested 2-14 days before calving.
Postpartum NEFAs: There is an increased incidence of postcalving diseases (displaced abomasum, metritis/retained placenta and clinical ketosis), decreased milk yield and decreased reproductive performance in the first 30 days in milk in Holstein dairy cows (fed TMR) with NEFA values > 0.60-0.70 mEq/L when tested 3-14 days after calving. In the Cornell studies, postcalving NEFAs were actually a better predictor of than postcalving beta-hydroxybutyrate concentrations or precalving NEFAs.
Herd level testing
Prepartum NEFAs: At the herd-level, there is a significantly increased risk of post-calving metabolic and infectious diseases, decreased milk production or decreased reproductive performance if >15% of tested precalving cows have NEFA values > 0.30 mEq/L. Note, pooling samples from individual cows is not recommended for herd-level testing.
Postpartum NEFAs: At the herd-level, there is a significantly increased risk of post-calving metabolic and infectious diseases, decreased milk production or decreased reproductive performance if >15-20% of tested postcalving cows have NEFA values > 0.70 mEq/L. Note, pooling samples from individual cows is not recommended for herd-level testing.
ß-Hydroxybutyrate (BHB) Testing in Post-Partum Dairy Cows
Guidelines for Interpretation
The following interpretation guidelines are based on studies done at Cornell University and are valid for samples collected from ‘at risk’ TMR-fed cows between 3-14 days post-calving. We recommend sampling at least 12 ‘at risk’ cows when evaluating total mixed ration (TMR)-fed herds for subclinical ketosis.
Cow level testing: Post-calving BHB > 10 mg/dL is associated with a significant risk of post- calving metabolic or infectious diseases (displaced abomasum, clinical ketosis and metritis), decreased milk yield and decreased reproductive performance in individual TMR-fed Holstein cows.
Herd level testing: At the herd-level, there is a significantly increased risk of these post-calving diseases, decreased milk production or decreased reproductive performance if >10% of tested post- calving cows have BHB values > 10 mg/dL. Note, pooling samples from individual cows is not recommended for herd-level testing.
Clinical ketosis
Clinical ketosis typically occurs in cows during early lactation (usually the first 2-4 weeks). This is also called lactation or spontaneous ketosis and is a consequence of excess negative energy balance due to stresses of calving and lactation. Occasionally, dairy cows in late lactation can also develop clinical ketosis (pregnancy ketosis) due to negative energy balance. Affected cows are dull, inappetant, lose weight and have decreased milk yield. Cows with clinical ketosis in dairy herds fed concentrate rations are frequently concurrently hypoglycemc. This worsens the state of negative energy balance Blood, urine and milk BHB values are often quite high. Blood BHB values >27 mg/dL are considered compatible with clinical ketosis. Cows with underlying hepatic lipidosis may have concurrent elevations in liver leakage enzymes (AST, SDH, GLDH) or cholestatic enzymes (GGT, ALP).
Metabolic Profiles in Post-partum Dairy Cows
Guidelines for Interpretation
The following interpretation guidelines are based on studies done at Cornell University and are valid for samples collected from ‘at risk’ TMR-fed cows between 3-14 days post-calving. We recommend sampling at least 12 ‘at risk’ cows when evaluating total mixed ration (TMR)-fed herds for negative energy balance and subclinical ketosis.
NEFA: NEFAs are a biomarker of negative energy balance. NEFA concentrations are interpreted as the proportion of animals above a specific cut-off value. Based on studies done at Cornell University in total mixed ration (TMR)-fed dairy cows, we interpret results as follows: For individual dairy cows, there is an increased incidence of postcalving diseases (displaced abomasum, metritis/retained placenta and clinical ketosis), decreased milk yield and decreased reproductive performance in the first 30 days in milk in Holstein dairy cows with NEFA values > 0.60-0.70 mEq/L when tested 3-14 days after calving. At the herd-level, there is a significantly increased risk of post-calving metabolic and infectious diseases, decreased milk production or decreased reproductive performance if >15-20% of tested postcalving cows have NEFA values > 0.70 mEq/L. Pooling of samples is not recommended for herd-level testing.
Beta-Hydroxybutyrate (BHB): BHB is used as a marker of subclinical ketosis and values are interpreted similarly to NEFAs. For individual dairy cows, a post-calving BHB > 10 mg/dL is associated with a significant risk of post-calving metabolic or infectious diseases (displaced abomasum, clinical ketosis and metritis), decreased milk yield and decreased reproductive performance in individual TMR-fed Holstein cows. At the herd-level, there is a significantly increased risk of these post-calving diseases, decreased milk production or decreased reproductive performance if >10% of tested post- calving cows have BHB values > 10 mg/dL. Pooling of samples is not recommended for herd-level testing.
AST: This hepatocellular leakage enzyme is used as a marker of underlying hepatic lipidosis. However, AST is not specific for liver and will be increased with skeletal muscle injury. In addition, it does not appear to be a very sensitive test for lipidosis in dairy cows. Alternatives to AST include GLDH, which is more stable than SDH (both SDH and GLDH are markers of liver injury).
Urea: This is a reflection of the ammonia concentration in the rumen and the protein (and energy) content in the diet. Urea can be measured in blood, serum, plasma or milk, with results being interpreted similarly. The current recommendation (based on previous studies in the literature) is that the average urea concentration of the tested cows should be between 13-17 mg/dL. Both high and low values indicate the need for modifying the content of the ration.
Albumin: Albumin values are also used to reflect the nutrient and energy content of the diet. Some investigators use a goal of > 3 g/dl for an average albumin value of the tested animals. Note that albumin concentrations are also affected by other conditions including inflammatory states (albumin will decrease because it is a negative acute phase protein), liver disease (albumin is produced in the liver), and renal and gastrointestinal disease (albumin can be lost in these disorders).
Transition Cow Energy Profiles in Post-partum Dairy Cows
Guidelines for Interpretation
The following interpretation guidelines are based on studies done at Cornell University and are valid for samples collected from ‘at risk’ TMR-fed cows between 3-14 days post-calving. We recommend sampling at least 12 ‘at risk’ cows when evaluating total mixed ration (TMR)-fed herds for negative energy balance and subclinical ketosis.
NEFA: NEFAs are a biomarker of negative energy balance. NEFA concentrations are interpreted as the proportion of animals above a specific cut-off value. Based on studies done at Cornell University in total mixed ration (TMR)-fed dairy cows, we interpret results as follows: For individual dairy cows, there is an increased incidence of postcalving diseases (displaced abomasum, metritis/retained placenta and clinical ketosis), decreased milk yield and decreased reproductive performance in the first 30 days in milk in Holstein dairy cows with NEFA values > 0.60-0.70 mEq/L when tested 3-14 days after calving. At the herd-level, there is a significantly increased risk of post-calving metabolic and infectious diseases, decreased milk production or decreased reproductive performance if >15-20% of tested postcalving cows have NEFA values > 0.70 mEq/L. Pooling of samples is not recommended for herd-level testing.
Beta-Hydroxybutyrate (BHB): BHB is used as a marker of subclinical ketosis and values are interpreted similarly to NEFAs. For individual dairy cows, a post-calving BHB > 10 mg/dL is associated with a significant risk of post-calving metabolic or infectious diseases (displaced abomasum, clinical ketosis and metritis), decreased milk yield and decreased reproductive performance in individual TMR-fed Holstein cows. At the herd-level, there is a significantly increased risk of these post-calving diseases, decreased milk production or decreased reproductive performance if >10% of tested post-calving cows have BHB values > 10 mg/dL. Pooling of samples is not recommended for herd-level testing.
Blood biochemistry: bile acids lab test
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Bile acids – eClinpath
Physiology
Bile acids are a group of amphipathic steroids synthesized by hepatocytes from cholesterol and excreted into bile. They function to emulsify fat in intestine and facilitate nutrient absorption and are highly conserved via enterohepatic circulation as outlined below. This emulsification is possible because of their amphipathic nature and tendency to form micelles.
To produce bile acids, cholesterol is first degraded to a “primary” bile acid (mostly cholic acid or chenodeoxycholic acid) via hydroxylase enzymes. The primary bile acids are then conjugated to glycine, taurine (particularly in cats), glucuronic acid and sulfates within the hepatocyte and excreted into bile canaliculi via the bile salt export pump (BSEP) and multidrug resistance-associated protein-2 (also transports conjugated bilirubin). The excretion of bile acids into the biliary canaliculi sets up an osmotic gradient, which draws water into bile and drives bile salt-dependent bile flow. Once in the intestine, conjugated bile acids are reabsorbed by active transport receptor-mediated mechanisms in the ileum, which is greater than 90% efficient. The receptor is called the intestinal bile acid transporter (IBAT) and is structurally related to the uptake transporter on the canalicular surface of the hepatocyte (Ntcp) that extracts bile acids from blood (and is also sodium-dependent). In dogs, the IBAT protein is primarily expressed in the ileum, cecum and colon. The receptor is downregulated in dogs with chronic intestinal inflammation, leading to increased loss of primary bile acids in feces (Giaretta et al 2018). Bile acids that are not absorbed (10% or less) can be deconjugated by intestinal bacteria (particularly if they pass into the colon, but also in the ileum) and are then passively absorbed in the colon. Colonic absorption of these unconjugated bile acids will be increased in malabsorption due to ileal disease or resection when more bile acids are presented to the colon. Bile acids can also be dehydroxylated by enteric bacteria to produce “secondary” bile acids (deoxycholic acid and lithocholic acid), which are also absorbed in the colon or excreted in the feces. After absorption, the unconjugated and conjugated bile acids enter the portal blood, where >95% are extracted by the hepatocyte via a sodium-dependent taurocholate cotransporter (Ntcp – this takes up conjugated and some unconjugated bile acids) and the family of organic anion transporting polypeptides (OATP – this take up unconjugated bile acids, and likely unconjugated and conjugated bilirubin). Thus, very small amounts of bile acids (generally <15 μmol/L) are seen in fasting blood samples of dogs and cats due to the efficiency of ileal resorption and hepatic extraction of the recycled bile acids. Naturally, gall bladder contraction in these species will result in an extra load of bile acids being excreted into the intestine and reabsorbed, so higher concentrations are expected after gall bladder contraction (which we mimic in the clinic by providing food and then measuring a post-prandial bile acid concentration – the goal of which is to “challenge” the liver to see if it can handle this extra load). Note that both the excretion of bile acids into the canaliculi and extraction of bile acids from the portal blood involve energy-dependent pumps which can be disrupted in a variety of conditions including cholestasis from obstruction or inflammation (cytokine-mediated). There are some confusing terms associated with bile acids (which we have used here as a generic term). Bile acid actually refers to the unconjugated forms (produced in the liver from cholesterol and in the intestine, the latter by deconjugating action of enteric bacteria) actually refers to the unconjugated forms (produced in the liver from cholesterol and in the intestine, the latter by deconjugating action of enteric bacteria) Bile salt more accurately refers to the conjugated form, which is produced in the hepatocyte. Conjugation increases their water solubility, preventing passive re-absorption once secreted into the small intestine. As a result, the concentration of bile acids in the small intestine can stay high enough to spontaneously form micelles (called critical micellar concentration) and solubilize lipids. Bile salts are also more efficient at emulsifying fats than bile acids because at intestinal pH, they are more electrically charged. more accurately refers to the conjugated form, which is produced in the hepatocyte. Conjugation increases their water solubility, preventing passive re-absorption once secreted into the small intestine. As a result, the concentration of bile acids in the small intestine can stay high enough to spontaneously form micelles (called critical micellar concentration) and solubilize lipids. Bile salts are also more efficient at emulsifying fats than bile acids because at intestinal pH, they are more electrically charged. Primary bile acids are formed by synthesis in the liver and consist of chenodeoxycholic acid and cholic acid (which can be conjugated or unconjugated). are formed by synthesis in the liver and consist of chenodeoxycholic acid and cholic acid (which can be conjugated or unconjugated). Secondary bile acids are those made by bacteria in the gut, specifically by dehydroxylating primary bile acids. As a result, lithocholic acid (dehydroxylated chenodeoxycholic acid) and deoxycholic acid (dehydroxylated cholic acid) are secondary bile acids. These bile acids are poorly water soluble and toxic to cells. Methods The following method is used by Cornell University to measure bile acids. Reaction type Kinetic/enzymatic reactions Procedure In the first reaction of this two-step process, 3α-hydroxysteroid dehydrogenase (3α-HSD) catalyzes the oxidation of the bile acids to 3 oxo-bile acids. This reaction occurs concurrently with the reduction of NAD to NADH. The NADH is oxidized back to NAD, whilst diaphorase reduces nitro blue tetrazolium salt (NBT) to formazan. The formazan is measured photometrically and is directly proportional to the bile acid concentration. The reactions are shown below: Bile acids + NAD 3α-HSD > 3-Oxo Bile acids + NADH
NADH + NBT diaphorase > NAD + formazan
Units of measurement
At Cornell University, the results are reported in μmol/L (SI units).
The conversion from conventional (mg/mL) to SI (mmol/L) units is as follows:
Total bile acid: mg/mL x 2.547 = mmol/L
Sample considerations
Sample type
Serum, plasma
Timing
In dogs and cats, both random (not related to eating or fasting), fasting (preferably overnight or collected just before the routine meal) or post-prandial (2 hours after eating a standard meal) bile acid concentrations can be measured, although a bile acid panel, consisting of fasting and post-prandial samples is preferred due to its increased sensitivity to hepatic dysfunction. This is done because it is a “challenge” test – gall bladder contraction initiated by feeding creates a bolus of bile acids for the liver to extract after intestinal absorption. This is not done in grazing animals (also horses lack a gall bladder). Both blood samples should be collected into red-top vacutainers (serum is preferred for bile acid measurement) and serum should be separated promptly from cells.
Anticoagulant
Heparin is acceptable.
Stability
If not processed on the same day, refrigeration at 2 – 8°C or freezing at -20°C is required.
Interferences
Lipemia, hemolysis: Lipemia (falsely increases) and hemolysis (falsely decreases) do interfere with bile acid measurement through optical interference, so efforts should be undertaken to minimize these (by not feeding too large a meal and by separating serum from cells as soon as possible). Our laboratory indicates when bile acid concentrations may have been affected by these interferences, which is based on a prior publication (Solter et al 1992).
Lipemia (falsely increases) and hemolysis (falsely decreases) do interfere with bile acid measurement through optical interference, so efforts should be undertaken to minimize these (by not feeding too large a meal and by separating serum from cells as soon as possible). Our laboratory indicates when bile acid concentrations may have been affected by these interferences, which is based on a prior publication (Solter et al 1992). Icterus: High bilirubin per se does not interfere with test measurement. It is more that testing for b ile acids should not be performed in an animal with high bilirubin or icterus due to cholestasis or that has any biochemical evidence of cholestasis (high total and direct bilirubin, bilirubinuria), since in these cases, the test does not give any additional information about liver function or vascular abnormalities.
Test interpretation
Bile acid measurement provides useful information about the portal venous circulation and hepatic function. They are produced in the liver from cholesterol and are stored in the gall bladder. Gall bladder contraction with feeding releases bile acids into the intestine. Bile acids undergo enterohepatic circulation, i.e. they are absorbed in the intestine and taken up by hepatocytes for re-excretion into bile. Measurement of bile acid concentrations is, therefore, a good indicator of hepatobiliary function, but is not specific for the type of underlying liver disease and diseases that secondarily affect the liver (e.g. metabolic diseases like hyperadrenocorticism) can also increase bile acid concentrations. They are also used as a marker of abnormal portal blood flow.
Increased concentration
Bile acid concentrations will be increased under the following situations:
Hepatocellular dysfunction : Inability of the hepatocyte to produce or extract bile acids from the portal circulation.
: Inability of the hepatocyte to produce or extract bile acids from the portal circulation. Abnormal portal blood flow : Portosystemic shunts or microvascular dysplasia will cause portal blood to “bypass” the liver, not allowing hepatocytes to efficiently extract the bile acids that would be normally presented to them. Abnormal blood flow also results in liver dysfunction (loss of trophic substances).
: Portosystemic shunts or microvascular dysplasia will cause portal blood to “bypass” the liver, not allowing hepatocytes to efficiently extract the bile acids that would be normally presented to them. Abnormal blood flow also results in liver dysfunction (loss of trophic substances). Cholestasis: Any interference with the transporters that deliver bile from the hepatocyte to the biliary canalicular system will result in an increase in bile acid concentrations (some of these transporters, such as MRP2, are shared with conjugated bilirubin). This will occur in structural and “functional” cholestasis. This is not only because bile salts are “retained” in the hepatocyte or reflux via cholestasis-induced alterations in the hepatocyte cytoskeleton causing cellular retraction and paracellular permeability, but under conditions of cholestasis, certain sinusoidal transporters (MRP3, 4, and the organic solute transporters, OSTα and OSTβ) are also induced or stimulated to pump the bile salts back into the circulation. Thus, there is no point in measuring bile acids in animals that are known to be cholestastic (increased direct bilirubin etc), because the cholestasis will mask our ability to detect hepatic dysfunction or abnormal blood flow. Through their emulsifying action on membranes, bile acids are toxic to cells and their build up within hepatocytes in cholestatic conditions can result in hepatocellular injury and altered signaling, leading to fibrosis and aberrant growth, including hepatocellular carcinoma formation (at least in rodent models). Hepatocytes have developed techniques to reduce bile acid toxicity in cholestatic conditions, including reversal of transporters to pump bile acids back into blood, as indicated above, and downregulation of bile acid production, through binding to nuclear receptors, such as the Farsenoid X receptor (Li and Apte 2015).
Note, that high bile acid concentrations are not specific for underlying liver dysfunction or abnormal portal blood flow. Increases can be seen in animals without clinical or other laboratory evidence of liver disease (e.g. dental disease in dogs).
Variables affecting test interpretation
Several variables can affect the interpretation of bile acid testing:
Interferences : Hemolysis and lipemia both affect test results (see above).
: Hemolysis and lipemia both affect test results (see above). Lower concentrations : Prolonged fasting, intestinal malabsorption, rapid gastrointestinal transit, delayed gastric emptying or ineffective gall bladder contraction may lower bile acid concentrations and decrease the sensitivity of bile acid testing for hepatobiliary disease.
: Prolonged fasting, intestinal malabsorption, rapid gastrointestinal transit, delayed gastric emptying or ineffective gall bladder contraction may lower bile acid concentrations and decrease the sensitivity of bile acid testing for hepatobiliary disease. Increase fasting concentrations in dogs and cats: Gall bladder contraction during the fast.
Species-specific comments
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