From:
Bruce Williams, DVM
Date: 2001-11-26 23:13:00 UTC
Subject: Re: Path interpetation and what to do now?
--- In Ferret-Health-list@y..., Ruesterx1@h... wrote:
> I will try to make this brief. Seven year old ferret refusing to
eat,
> scant poop. Put on flagyl and amoxi. Two days later, total
collapse,
> not eating, no poop. Exploratory surgery Friday to check for FB. No
> FB found, but stomach full of undigested food and fluids. Vet took
> samples from stomach and intestine. This is the path report
diagnosis:
>
> 1.Extensive deep lymphocytic eosinophilic gastritis with occ
mitotic
> figures. 2. Mild lymphocytic cholangiohepatitis. 3. Mild to mod
> hepatocellular vacuolization. 4. Mod lymphoplasmacytic eosinophilic
> enteritis,jejunum. 5. Accessory spleen
>
> The comment suggests mitotic figures in stomach could lead to
> lymphosarcoma.
>
> My question is what should be her treatment now? She is still
> recovering from surgery, but doing pretty good, eating and
pooping.
> Sould she go back on the amoxi/flagyl routine? Also, my vet wanted
to
> wait until she was healed from the surgery to start her on high
doses
> of pred. (maybe trying Imuran if pred doesn't help.) Does she need
to
> be on antibiotics if this is more an allergic type inflammation?
>
Dear Julie:
There is no mention of lymphoma here, and I would have to wonder
about the remark that suggests that mitotic figures in the stomach
might lead to lymphoma - that one doesn't register, and if you are
thinking about starting pred treatment for lymphoma - don't.
The lymphocytic enteritis in this case is assuredly the result of
Heicobacter, and has apparently progressed to chronic atrophic
gastritis - a disease that results in markedly impaired digestion due
to destruction of the cells in the stomach which produce acid. I
believe the mitotic figures in question are reparative attempts by
the stomach.
The cholagniohepatitis is secondary to the inflammationin the
intestine and stomach, and in itself, is not causing any problems,
nor is the hepatocellular vacuolization.
One item that I am somewhat concerned about here is the eosinophilic
inflammation in the stomach and intestine. While a low level of
eosinophilic inflammation is often seen, if the degree of this type
of inflammation is sever, we may be dealing with a case of
eosinophilic gastroenteritis - a totally separate disease. I believe
that it is probably worthwhile to discuss this possibility with the
pathologist and find out if they believe that EE is also in the
differential.
Without having seen the slides here, I guess at this point I see no
evidence of any disease other than severe Helicobacter infection, and
believe that a full regimen of Helicobacter treatment
(amoxi/flagyl/pepto, or amoxi/biaxin) for the appropriate time period
is probably the most apropos treatment at this time. At this time, I
see no reason for a high dose prednisone regimen.
With kindest regards,
Bruce Williams DVM