Ah, those liver enzymes... sometimes they are up when you don't expect them to be. Sometimes they're up a bit... but not that much, so you don't know if it's actually significant. Or sometimes they're way out of whack, but you're not sure what that means exactly, or what to do next. In this episode, Small Animal Medicine Specialist, RCVS Course Director and clinical reasoning guru Prof Jill Maddison helps us take a fresh look at  liver enzymes. We review what each enzyme tells us in dogs and in cats, how to interpret changes in both the 'well' patient with the surprise finding on bloods, and in the sick patient, and Prof Jill clears up common misconceptions and pitfalls around ALP, ALT, GGT, and bile acids. This clinical episode has been unlocked for you by Vetnostics Pathology, one of the largest veterinary pathology groups in Australia with the most veterinary pathologists and veterinary medicine consultants. Vetnostics is the new nationally aligned name of what used to the SVS Pathology Network ( (Vetnostics NSW/ACT, Vetpath Laboratory Services WA/NT, ASAP Laboratory Vic , QMLVetnostics Qld/NNSW and TML Vetnostics Tas), with a new consolidated website (www.vetnostics.com), but the same exceptional quality diagnostics, same extensive courier network and same veterinary pathologists and veterinary medicine consultants on other the end of the phone or email to talk you through any tricky results and cases.  Join our community of Vet Vault Nerds to lift your clinical game and get your groove back with our up-to-date, easy-to-consume clinical episodes at ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠vvn.supercast.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠. Get help with your tricky cases in our ⁠⁠⁠⁠⁠⁠⁠⁠Specialist Support Space.⁠⁠⁠⁠⁠⁠⁠⁠ ⁠Subscribe to our weekly newsletter⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠here⁠⁠⁠⁠⁠⁠ ⁠for Hubert's favourite clinical and non-clinical learnings from the week. Episode Topics and Timestamps 05:01 ALT and ALP: Detailed Analysis 05:40 Challenges in Diagnosing Liver Disease 06:40 Liver Enzymes in Cats vs. Dogs 20:44 Bile Acids and Liver Function 26:51 Pre-Anaesthetic Liver Checks 36:35 Understanding Cholangitis in Cats 36:53 The Complexity of Diagnosing Liver Disease 37:45 The Role of Blood Tests in Wellness Checks 38:11 Interpreting Reference Ranges 40:53 Case Studies: Real-World Examples 42:05 The Challenges of Wellness Screening 44:21 The Importance of Biopsies 55:14 Biases in Diagnosis