Liver enzyme elevations in dogs: diagnostic approach.

Increased liver enzyme activities are sensitive indicators of hepatic disease, but their limited specificity can make their interpretation a challenge. A stepwise approach to diagnosing the source of increased liver enzyme activity involves characterization of the clinical picture, identification of the predominant enzyme activity pattern, elimination of common extrahepatic diseases, and a systematic diagnostic workup for hepatobiliary disease. Comprehensive hepatobiliary testing includes a complete blood count, biochemical profile, and urinalysis; coagulation and liver function tests; abdominal imaging; bile cytology and culture; and liver biopsy for histopathology, culture, and metal analysis.