Help! My Vet Suggests a Biopsy for My Dog! (Vet Answered)
This question has been answered by a vet
Veterinarian & Animal Behaviorist
With nearly two decades in veterinary medicine, Dr. Paola brings hands-on experience across multiple species. A graduate of the University of Guadalajara, she specializes in preventive care, animal welfare, and positive reinforcement training.
The Question
“Hi Dr Paola,
I have a 10-year-old female mini Labradoodle named Riley. She weighs 14 pounds. We had Riley’s bloodwork checked recently, and her ALT was 1100 U/L and ALP 4400 U/L. She also had an ultrasound.
The vet has prescribed a medication starting with DEM (I don’t have it with me) for her liver. They said that she has liver issues, and they put her on special dog food for the liver. They also gave her an antibiotic.
What are your suggestions? I’m really upset because we had this done two weeks ago. The doctor is now recommending a biopsy, but I don’t want to put her through that. She also has weak legs.”
– Joanbe
Quick Info about Riley
Hello Joanbe,
I can understand why you’re feeling upset. In many laboratories, ALT values are typically below about 125 U/L and ALP values are often below about 150 U/L, although reference ranges vary slightly. If Riley’s ALT is around 1,100 U/L and her ALP is around 4,400 U/L, those are substantial elevations that indicate her liver deserves further investigation.
However, liver enzymes are not a diagnosis by themselves. Think of them as a smoke alarm. They tell us something is happening, but they do not tell us exactly what started the fire. ALT is released when liver cells are damaged, while ALP can increase with bile duct disease, certain hormonal disorders, medication effects, or other liver conditions. A dog with chronic hepatitis, gallbladder disease, a benign liver change, or even some endocrine disorders may have similar enzyme elevations, particularly hyperadrenocorticism, also known as Cushing’s syndrome.
This is why your veterinarian recommended an ultrasound and is now discussing a biopsy. The ultrasound can reveal changes in the liver’s size, texture, and surrounding structures, but it often cannot determine the exact cause of those changes. A biopsy provides a small tissue sample that can sometimes distinguish between inflammation, scarring, copper accumulation, cancer, or other liver diseases. The important question is whether the results would change Riley’s treatment plan or provide information that could improve her quality of life and long-term outlook.
The medication you mentioned that starts with “DEM” is likely Denamarin, a commonly prescribed liver support supplement that contains S-adenosylmethionine (SAMe) and silybin, a purified extract from milk thistle. It is not a cure for liver disease, but it can help support liver cells and is often used alongside a therapeutic liver diet as part of a comprehensive treatment plan.
It is also worth remembering that many dogs with liver disease can enjoy a good quality of life for months or even years with appropriate management, depending on the underlying cause. Because Riley is also experiencing weakness in her legs, her overall health and comfort should be part of any decision about additional testing.
If you are uncertain about proceeding with a biopsy, a consultation with a veterinary internal medicine specialist may help you better understand the potential benefits, risks, and alternatives. To get the most out of that consultation, ask your veterinarian for copies of Riley’s complete medical records, including her blood work results, urinalysis (if one was performed), ultrasound report and images, any radiographs, a list of current and previous medications and supplements, the liver diet she has been prescribed, and notes documenting her clinical history and physical examinations. Having all of this information available allows the specialist to evaluate the full picture and provide the most informed recommendations, helping you make a decision that feels right for both you and Riley.
Kind regards and best wishes,
– Dr. Paola