Dog's Enlarged Liver May Cause Disorientation

Q: My husband's 6-year-old Maltese is beginning to lose her balance and stumble around. She is also not responding to my husband's voice. She has a collapsing trachea and the vet said her liver is enlarged. Do you know of specific food that would help a dog that may be suffering from an enlarged liver? Also, do you have any ideas as to why the dog might be losing her balance?

A: I am sorry to hear your husband's dog is having such serious problems.
 
Episodes of disorientation and stumbling could be related to her liver. The liver detoxifies digested food into harmless byproducts, which circulate through the bloodstream and then are eliminated. If the liver is enlarged, there may be inflammation that is preventing detoxification. This can lead to elevated levels of toxic substances, such as ammonia, which cause delirium and disorientation when they reach the brain.
 
Several blood tests can help rule out a liver problem that could be causing these signs. Blood ammonia levels and bile acids can be measured. Some veterinarians are able to perform these tests in their own lab; others may have to send the blood to an outside lab.

Another option is more expensive, but reveals more information. Your vet can take a biopsy of the liver, guided by an ultrasound, and submit it for analysis. Some veterinarians are also able to perform laparoscopy, a non-invasive procedure that allows them to see the liver and other abdominal organs, take pictures of them, and safely collect samples.
 
If your husband's dog does have hepatic encephalopathy (liver inflammation leading to circulating toxins in the bloodstream), the signs can be lessened with certain medications and dietary modifications. A low-protein diet will reduce the amounts of circulating ammonia. This is the same diet dogs with kidney failure would eat.
 
You could try a low-protein diet with your dog to see if it makes any difference, or pursue testing to get more definite answers.

Jon Geller, DVM