Liver Biopsy in Dogs

Liver Biopsy in Dogs - Conditions Treated, Procedure, Efficacy, Recovery, Cost, Considerations, Prevention

Most common conditions

Cirrhosis and Fibrosis of the Liver / Hepatitis / Cancer

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Rated as moderate conditon

12 Veterinary Answers

Most common conditions

Cirrhosis and Fibrosis of the Liver / Hepatitis / Cancer

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Liver Biopsy in Dogs - Conditions Treated, Procedure, Efficacy, Recovery, Cost, Considerations, Prevention

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What is Liver Biopsy?

The liver is an amazing organ that plays a multitude of roles in maintaining good health. Given the number of duties the liver undertakes, a rise in liver enzymes alone on a blood test tells the clinician very little as to the cause of the problem. Indeed, because the liver 'cleans' the blood, the rise may even be due to pressure on the liver due to non-liver-related illness. 

What's for sure is that untreated liver disease progresses more rapidly than treated, with the risk of complications and extensive scar tissue formation. The gold standard for diagnosing the exact nature of liver disease remains taking a biopsy sample. This enables a histologist to examine the structure on a cellular level to determine the problem and the best treatment for it. 

Liver Biopsy Procedure in Dogs

There are several options for obtaining a sample of liver tissue. These methods vary in invasiveness and the size of sample obtained. However, regardless of which method is used, it's important to check the dog does not have a coagulopathy (difficulty clotting blood) prior to sampling, as the liver has a large blood supply and is prone to bleeding. 

Ultrasound guided biopsy

Usually performed under deep sedation or full anesthesia. An ultrasound image is used to guide placement of a large bore biopsy needle. This is the least invasive method as it only requires a small nick in the skin. However, the sample harvested is small, and there is a risk of missing relevant pathology. 

Laparoscopic biopsy

Also known as keyhole surgery, this is performed under anesthesia and involves passing a laparoscope through a small incision in the skin. A small camera allows the surgeon to see the liver and identify the best area to harvest. This is moderately invasive and collects a sample size intermediate between a needle biopsy and wedge biopsy. 

Wedge biopsy taken during a laparotomy

A laparotomy (surgically opening into the abdomen) is performed under general anesthesia. The surgeon can directly examine all the abdominal organs, and chose the exact piece of liver they wish to harvest. This allows for collection of wedges of liver, which are of high diagnostic value. 

Efficacy of Liver Biopsy in Dogs

Liver biopsy is a tool that facilitates the clinician reaching a diagnosis. How useful a biopsy sample is for diagnostic purposes depends on the size of the sample and the area sampled. For example, an ultrasound guided biopsy is most useful for generalized liver disease, where the chances of sampling an area affected by the process is high. That said, if the disease is localised, the ultrasound image helps guide the clinician to the relevant area. 

To reach an accurate diagnosis the histologist needs to see 16 triads (an architectural landmark within the liver) worth of tissue. This is easily achieved with the second two methods of sampling. 

Unfortunately, the implication is that if too small a sample is obtained, or it is harvested from an area that doesn't represent the ongoing pathology, that a 'normal' sample can be obtained despite the dog having liver disease. The chances of this are minimized via laprascopic or laparotomy collection. 

Liver Biopsy Recovery in Dogs

The recovery time to a large extent depends on how sick the patient was initially, and the method of collection. For a fit dog that has a sample collected via ultrasound guidance, they may be bouncing around again within 2 - 3 days of the anesthetic. 

For dogs that undergo laparotomy, the recover time is around two weeks, which is also the time until the skin incisions is healed. However, it may be necessary to rest the dog and avoid vigorous exercise for 3 - 4 weeks, since some types of liver disease can result in delayed healing times. 

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Cost of Liver Biopsy in Dogs

The cost of a liver biopsy needs to be considered as part of a larger procedure, since it will invariably involve imaging (such as ultrasound) or invasive surgery (such as laparotomy), plus anesthesia. 

The cost of an ultrasound scan varies depending on the experience of the operator, but a fee of around $200 is to be expected. The cost of histology by an outside laboratory is typically around $80 - $100, with specialist stains looking for copper or the like being additional to this. 

The cost of a  full general anesthesia and laparotomy depends on the dog's size and how long the procedure takes. A minimum fee of $750 is to be expected. 

Because a liver biopsy is liable to be performed on a sick dog, anticipate extra fees such as intravenous fluids (estimated $50) or drugs such as vitamin K injections. 

Dog Liver Biopsy Considerations

The are risks associated with liver biopsy, of which the greatest is hemorrhage. This is because the liver is richly served with blood vessels, added to the fact that a disease liver may not produce enough clotting factors which leads to a tendency to bleed. 

The clinician will carefully screen the dog prior to surgery, to identify any bleeding tendencies. If a problem is detected, this can mean postponing surgery until that issue is corrected. Action may mean giving vitamin K injections or a transfusion of plasma-rich with clotting factors. 

Other considerations include balancing the invasiveness of the procedure against the size of sample obtained and visualization to choose the most useful piece of tissue. Thus, although laparotomy is the most invasive method, it is also the one most likely to harvest a diagnostic sample. 

Liver Biopsy Prevention in Dogs

Prevention of the need for a liver biopsy is largely a matter of preventing liver disease and promoting good health. Conditions such as infectious canine hepatitis are largely preventable through regular vaccination, so keeping up to date with innoculations is advisable. 

Some pedigree breeds such as Bedlington terriers are prone to an inheritable form of liver disease, so screening of parent stock prior to breeding is essential. When carriers of inherited liver disease are detected, then they should not be breed from. 

Liver enzymes can be elevated due to non-liver disease, such as Cushing's disease or even dental infections. With this in mind, the clinician may need to running tests screening for these other problems, in order to rule them out (or reach a diagnosis which makes the need for a liver biopsy redundant).

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Liver Biopsy Questions and Advice from Veterinary Professionals

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Gidget

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Unknown

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12 Years

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Mild condition

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0 found helpful

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Mild condition

Has Symptoms

Lethargy, Thirsty, Nausea

Our 70 lb. mixed breed dog started having elevated ALT (178) and ALK (174) in 2012. She was diagnosed with possible liver disease and they did an ultra sound (normal except for "abnormally widened caudal vena cava") and wanted to do a biopsy. Now, 6 years later (Gidget is now 12) has ALT (564), ALK (1560) and GGT (6) still shows no signs of jaundice or most symptoms associated with liver disease. The vet still wants a biopsy and we really are not sure if we should put Gidget through the trauma and us through the expense. After our research, we are not even sure liver disease is causing the numbers to be so elevated. Her litter mate (Tango who is our other dog) also has the elevated enzymes but not nearly as high as hers. Thanks for your input. Paul & Corine

Aug. 27, 2018

Gidget's Owner

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3320 Recommendations

The elevated liver enzymes may be related to a few different conditions which may include inflammatory disease, infection, poisoning (chronic), metabolic disease, congenital disorders among many other conditions; a liver biopsy would be valuable to understand what is happening so that a diagnosis and treatment plan can be made. Regards Dr Callum Turner DVM

Aug. 27, 2018

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Jody

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Golden Retriever

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13 Years

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Moderate condition

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1 found helpful

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Moderate condition

Has Symptoms

Focal Seizures,

My 13 year old golden retriever has liver disease with mass effect, meaning the enlarged liver has pushed the kidneys, and spleen. She also is showing signs of neurological problems (small focal seizures) and the occasional "drunken" walk. Her hips are problematic. We have her on a small dose of Galliprant (30mg) for hip pain and just started Gabapentin (300 mg) 1x day to start and then increase to 2x a day. The next possible step would be to do an ultrasound, and possible biopsy but we feel this might be too risky for her, in terms of recovery and I believe anesthesia. Am I doing the right thing? She seems happy, gets around, doesn't show signs of pain, and is clear-minded (with the exceptions listed above). Keeping her comfortable but doing the right thing is what I want. Am I doing the right thing? I've listed her condition as moderate, but it could be more serious.

Aug. 18, 2018

Jody's Owner


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Dr. Michele K. DVM

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1611 Recommendations

There does come a point in everyone's life where you can continue to test and treat, but you need to decide if you should continue to do so. If your veterinarian feels that the liver condition is treatable, it may be worth pursuing diagnostics, but if Jody is comfortable and is doing well, you may want to continue to treat her, keep her happy, and monitor her for any changes.

Aug. 18, 2018

Thank you so much for your response. It was very helpful and made me feel more comfortable in how to move forward. With appreciation, MBU

Aug. 18, 2018

Jody's Owner

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Oreo

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toy poodle

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7 Months

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Fair condition

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0 found helpful

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Fair condition

Has Symptoms

None

Our toy poodle is 7 months old and has a spay appointment later this week. Her ALT test result was 220 and the vet decided to run a GGT bile test. Her pre score reading was 14.4 and after eating ( I assume that is how it is determined) it finished at a 13.7. The vet said the secondary reading was consider moderate/high. They have suggested a liver biopsy during they spay since she will already be under anesthesia. They first would like to have a coagulation test ran. My question is, with readings that are high, but relatively moderate, is it worth the extra risk of complications of a biopsy or would you wait and monitor over the next 6-12 months. The vet suggests now simply because the spay is scheduled. Note: yard was recently fertilized and trees mulched, which puppy ate and vomited 7 days ago so perhaps that caused an elevated level. I chose fair because website would not let me exit but her health, other than test results, is fantastic.

June 20, 2018

Oreo's Owner

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3320 Recommendations

Some fertilizers may cause liver damage and elevated liver enzymes however it depends on the specific fertilizer; if it is caused by fertilizer poisoning, this should be addressed first. It does make sense to to the liver biopsy during the spay some the liver is right there in the abdominal cavity and would give a wealth of information from a histopathology report. Regards Dr Callum Turner DVM

June 20, 2018

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Brini

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Yorkshire Terrier

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12 Years

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Mild condition

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-1 found helpful

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Mild condition

Has Symptoms

Enlarged Liver

I have a Yorkshire terrier, almost 13, has high blood pressure, trechhia issues, pooping knee caps, but most recently an abnormal ultrasound of her liver that showed an ENLARGED liver and she has elevated liver enzyme values. Elevated blood counts are RBC - 9.13, HEMATOCRIT - 57.0, Platelet - 560, Platelet count manual if indicated - 558, ALT - 174, ALP - 452. She has taken Denamarian for a year and liver values would go down. Being on preicox for knees would bring liver values back up. Vet did ultrasound and does not think it’s cancer but isn’t sure what it could be otherwise. He also does not think it’s cushings because adrenal glands appear normal. He wants to do a guided needle biopsy. I’m concerned due to age and blood pressure. She is also really struggling to walk because of her knees and arthritis. Is the biopsy a good idea?

May 15, 2018

Brini's Owner

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3320 Recommendations

This is your third question asking if a liver biopsy is appropriate or not for Brini, some cases are never as straightforward as yes or no especially when we haven’t personally examined a patient ourselves (we’re not talking about draining oil from a car). If you have concerns, you should visit another Veterinarian for a second opinion because on paper it may seem suitable but not once you’ve made a physical examination. Regards Dr Callum Turner DVM

May 16, 2018

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Brini

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Yorkshire Terrier

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12 Years

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Moderate condition

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0 found helpful

pill-rating-filledpill-rating-filledpill-rating-filledpill-rating-filledpill-rating-filled

Moderate condition

Has Symptoms

Blood Counts, Bp, Abnormal Liver

I have a Yorkshire terrier, almost 13, has high blood pressure, trechhia issues, pooping knee caps, but most recently an abnormal ultrasound of her liver and elevated liver enzyme values. Elevated blood counts are RBC - 9.13, HEMATOCRIT - 57.0, Platelet - 560, Platelet count manual if indicated - 558, ALT - 174, ALP - 452. She has taken Denamarian for a year and liver values would go down. Being on preicox for knees would bring liver values back up. Vet did ultrasound and does not think it’s cancer but isn’t sure what it could be otherwise. He also does not think it’s cushings because adrenal glands appear normal. He wants to do a guided needle biopsy. I’m concerned due to age and blood pressure. She is also really struggling to walk because of her knees and arthritis. Is the biopsy a good idea?

May 14, 2018

Brini's Owner


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recommendation-ribbon

3320 Recommendations

Abnormal ultrasound of the liver isn’t very descriptive; was the liver enlarged? Was there a mass(es)? Other issues? It is difficult to know whether or not a needle aspirate or biopsy is indicated without knowing more. A needle aspirate of the liver may be indicated to send for histopathology so that the types of cells and morphology of cells may be examined to see if this helps to narrow down a diagnosis. Regards Dr Callum Turner DVM

May 15, 2018

She has an enlarged liver

May 15, 2018

Brini's Owner

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Lance

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Beagle

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11 Years

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Moderate condition

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0 found helpful

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Moderate condition

Has Symptoms

Lance has been experiencing elevated liver values for about 4 years now. Denamarin helped at first, ultrasound was not significant for any abnormalities, and his most recent bloodwork resulted in a largely elevated ALKP and mildly ALT. I've been recommended to an internist who is pushing an abdominal CT and biopsy (while under anesthesia for CT). We've re-tested for Cushings now that it has been 4 years and all came back mostly OK (except for Androstenedione ng/ml baseline 1.17 - post acth 6.26). Lance is still able to hike with me is enthusiastic about food, walks, rides, but does seem legarthic between. I'm seeking recommendations for the biopsy and the invasiveness of the procedure. What is the typical experience for senior dogs? Should I be concerned? I want answers, but I also love my dog and want to protect his happiness at vigor for life in his later years. I understand it is difficult to make conclusions when not having his medical history, but I am seeking more past experiences with the procedure and recovery in older pets.

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Keva

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Irish Terrier

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5 Years

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Fair condition

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0 found helpful

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Fair condition

Has Symptoms

None

I have a 5.5 year old female Irish Terrier, that has had elevated ALKP levels for 1.5 years as well as low platelet counts. She has had 2 ultrasounds a year apart that only noticed a brighter than normal liver on the 2nd ultrasound. Tests have ruled out likely Cushings disease. Her bile acid tests were also normal. Specific tests ruled out any tick born or parasitic infections. She has twice been on Doxycycline for 1 month, since her liver enzyme levels improved the 1st time. Cortisol level tests were also normal. She has been on Denamarin for about 6 months, Melatonin for 2 months and Ursodiol for 1.5 months and her ALKP reduced to 1600 and her platelets increased to 57 but her ALT increased to 400, which is the highest in her yearlong treatment. Specific blood tests at several University veterinary clinics have not been able to pinpoint the source or cause of her elevated enzymes. She is not symptomatic in anyway, other than occasional diarrhea over her lifetime. At 1.5 years old her blood counts were completely normal. She is not visibly sick, the only thing wrong is the reoccurring high enzymes. Her internist has recommended a laparoscopic liver biopsy, which I will consider but I am concerned with her platelet levels could increase the chance of excessive bleeding. Laboratory examination of her platelets revealed small clumping which may lower the counts. She has not had any severe bleeding after many blood tests this year. Any advice or suggestions would be appreciated.

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Zoe

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Standard Poodle

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6 Years

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Fair condition

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0 found helpful

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Fair condition

Has Symptoms

None

Zoe was hit my a car two months ago. She was bleeding internally but is back home and acting normally. Her bloodwork is not. Her ALT was off the charts at the emergency vet. A month later it was 800 and then a month later it was still very high but down to 600. She also has anemia. We have no idea if this is new from the accident or preexisting. Anyway vet is wanting to do a liver needle biopsy. She is having no symptoms.

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Private

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Spaniel

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5 Years

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Fair condition

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1 found helpful

pill-rating-filledpill-rating-filledpill-rating-filledpill-rating-filledpill-rating-filled

Fair condition

Has Symptoms

High Liver Enzymes, Asymptomatic

My dog is a small mix (cavalier/papillon is best guess; 15 lbs.). She's had repeated high liver enzymes. Two ultrasounds have shown small abnormalities. An oncology vet aspirated and the results did not indicate cancer. We were then referred to internal medicine vet and after additional bloodwork (full liver panel) and bile acid test she will now have laparoscopic liver biopsy. I wanted to provide this input in order to share cost, which will be approximately $2,400. She is not symptomatic in anyway (i.e. not a sick or very sick dog as indicated in the article), the only thing wrong is the reoccurring high enzymes. I'm sharing this to give a more realistic cost for anyone searching for that information. I feel like the estimated costs provided in this article are way off.

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Lilly

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Pembroke Welsh Corgi

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4 Years

pill-rating-filledpill-rating-filledpill-rating-filledpill-rating-filledpill-rating-filled

Moderate condition

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1 found helpful

pill-rating-filledpill-rating-filledpill-rating-filledpill-rating-filledpill-rating-filled

Moderate condition

Has Symptoms

Raised Alt

My dog had to have surgery on her ear and at that time the blood work came back that she had an ALT just over 600. The vet said she wasn’t very concerned about it and everything else on the blood work was normal and to just keep an eye on it. A month later we brought her in for her general check up and this time her blood work came back with an ALT just over 700, but again everything else normal and no symptoms or unusual behavior. The vet recommended we do a bile acid test, and the results were a slightly elevated post meal number. From there the vet had us do an ultra sound. The vet said the ultra sound showed a slightly “curved” liver but everything else looked normal and because of her young age and no symptoms she believed it was a liver infection and had us do 2 weeks of anti biotics and re test bloodwork. We did that and now her ALT was over 3000! Again nothing else was off on the bloodwork and she is acting completely normal. What could be causing this? Would a liver biopsy be able to diagnose the issue? Why is nothing else showing up other than this one very elevated enzyme? How scared should I be?

Cannanine