Alkaline Phosphatase (SAP), High

A 2-year-old MN Doberman Pinscher presented on April 4th due to a sock foreign body. He underwent exploratory surgery with a resection and anastamosis. This was the second resection and anastomosis surgery for this patient since February. After the first surgery, the patient had a septic abdomen. After that surgery, he was managed with a drain in an emergency hospital for several days. He had initial hepatic enzyme elevations which resolved with resolution of sepsis. At the second surgery on April 4th, adhesions were noted throughout the abdomen. There was an area of adhesions in the left inguinal area that was extremely friable. A drain was placed following this surgery as well. Intracelluar bacteria were noted in the drainage fluid. The patient was discharged from the hospital on April 8th. The following medications were sent home: Cefaseptin, 750 mg BID x 5 days Baytril, 150 mg BID x 5 days, Metronidazole, 500 mg BID x 5 days Cerenia and codeine were also dispensed. Clinically the patient is doing very well. He is eating, drinking, urinating and defecating normally. His activity level is good. Blood work from April 7th: Alb=21 (better than pre-op) ALP=241, lymphocytes=0.88, monocytes=1.57, Neutrophils=12.15, suspected bands. A follow up ultrasound 14 days post-op from the second sock foreign body surgery was performed.

Patient was presented for ataxia, icterus, lethargy, and vomiting. History of atypical vaccine reaction after first DHLPP-ADR, enlarged peripheral LN. The patient has not been 100% since. Blood chemistry and CBC revealed BUN 3, TP 4.3, Alb 1.9, ALT 457, ALKP 869, GGT 20, Tbili 5.1, chol 84, amylase 216 and HCT 31%.

A 13-year-old MN Beagle mix with history of increased weakness and respiratory effort presented for a heart murmur, suspected pulmonary edema, enlarged liver, and possible cranial abdominal mass. The patient was abdominally retracting while breathing, but his mucous membranes remained consistently pink. The patient was started on furosemide 12.5 mg 3 tabs BID and Pimobendan 5 mg BID. CBC and blood chemistry found moderately high WBC count; poss. bands, Alk. Phos. 663. Urine specific gravity was 1.023.

The patient presented for pre-anesthetic work up for a TPLO surgery and it was noted that the patient's abdomen appeared larger than normal. Radiographs of the abdomen were inconclusive and an ultrasound was performed.

The patient was presented for painful abdomen, pyrexia, vomiting, and anorexia. After 12 hours on IVF and supportive care the patient's pyrexia resolved and there was no further vomiting. A painful abdomen persisted and mild icterus was evident in both the sclera and mucous membranes. The patient was treated with Cerenia, Unasyn, Metronidazole, Gabapentin, and Famotidine. Blood chemistry found AST 70, ALT 553, ALK. Phos. 8162, GGT 46, T. Bili. 7.2, K 3.4, Chol. 720, Trig. 609, amylase 2038, PSL 697. Urine specific gravity 1.011, proteinuria 2+, bilirubinuria 3+.

An 11-year-old MN Maltese mix was presented for evaluation of progressive elevation of liver enzyme activity. Blood work showed elevated ALT (530) and ALP (1255) activity and mildly elevated cholesterol.

An 11-year-old MN Yorkshire Terrier presented for a second opinion for a 4-week history of back pain; an L2 lesion is suspected. Previous treatments were Gabapentin and Tramadol, but the patient showed no improvement. The patient was still very painful, reluctant to move, and baring teeth when owner tried to pick him up. The area of L2 appeared normal on radiographs. CBC was WNL, blood chemistry found an Alk. Phos. of 187 and a PSA lipase of 528. Urinalysis showed 2+ protein. A left medial liver nodule, likely lipogranuloma or benign lesion with minor renal mineralization was seen on ultrasound. The sonographic findings were not contributing to this patient's pain and there was no evidence of visceral disease that could be contributing to the clinical signs. A CT of the spine with contrast was strongly recommended given the patient's symptoms.

An 8-year-old, F/S, 77 lb, Pitbull terrier was presented at RDVM for decreased activity level and behavioral changes. Blood work was performed and showed an increase in ALKP. The patient also had a dental cleaning recently where they extracted multiple teeth and put her on oral Tramadol. Owner says that she was “normal” on March 20th but has slowly been declining. Repeat blood work showed an increase in ALKP. Unable to perform physical exam due to hyper response. Owner reported the patient had become very head shy and aggressive with other dogs and had drastically changed in personality. RDVM recommended a brain CT scan and it was decided to include the liver due to increased ALKP.

The patient was presented for vomiting 3-4 days prior. Was recently gagging, not urinating often despite normal drinking. The patient had a decreased appetite or was not eating at all and having innappropriate defecation in the house. Blood chemistry showed liver enzyme elevation and low BUN. Bile Acids test results were high at 464.6 umol/L. An abdominal ultrasound was recommended to rule out PSS, liver disease. possible infection- Lepto? (patient from Ontario, Canada), toxin, glomerulopathy, protein starvation, chronic non-obstructive FB, Addison, glomerulopathy, other.

 12-year-old MN Labrador mixed breed was presented for evaluation of anorexia, vomiting, and lethargy. Abnormalities on CBC and serum biochemistry were severe leukocytosis,neutrophilia, hemococentration, and elevated ALP (600).