From:
"Sue Liszewski"
Date: 2004-05-05 04:59:19 UTC
Subject: RE: [ferrethealth] Postop complications
To: ferrethealth@smartgroups.com
Message-ID: <BAY15-F39zXotJAadVe00003132@hotmail.com>
How is your kid today? With the jaundice I wonder about biliary obstruction
of some sort. I have seen it in a ferret. The question is the cause is it
sludge that is cleaned up and removed or is it a mass or something causing
it. Did the vet eval the liver and the gall bladder while in there? The
duct normally drains into the small intestine and can obstruct at that level
and thus lead to problems.
Dr. Sue
>From: ELNRRGBY1@aol.com
>Reply-To: ferrethealth@smartgroups.com
>To: ferrethealth@smartgroups.com
>Subject: [ferrethealth] Postop complications
>Date: Mon, 3 May 2004 02:59:26 EDT
>
>Hi everyone,
>
>I have a 6-year-old MF male who just underwent a pretty involved
>exploratory
>on Thursday. He ended up having a splenectomy, left adrenalectomy, liver
>and
>intestinal biopsies, a large mammary tumor removal and a mast cell tumor
>removal (for those wondering, I just took him in a week prior to surgery as
>a
>permanent foster). I don't have a lot of the surgery details but was told
>that
>the left adrenal was "gigantic" and was somewhat adherent to the left
>kidney.
>The spleen was also huge, but wasn't weighed unfortunately. There were
>also a
>few small white foci on the liver and a spot on the intestines that didn't
>look right and these areas were all biopsied (don't even know where on the
>intestines though).
>
>He was doing fairly well immediately postop and had begun eating on his own
>almost immediately after surgery and continued to eat and do well all day
>Friday but by Friday night/very early Saturday morning he started to
>decline and
>stopped eating unless finger fed. By Saturday afternoon food/meds were
>being
>vomited back up immediately after being given and he was having severe
>mucousy
>diarrhea. He also had become rapidly dehydrated, was very depressed, had a
>temp of only 98.7 and had some mild jaundice.
>
>Blood work was done at my clinic and showed a PCV of 39%. Preop it had
>been
>in the mid 50 range I believe. The chemistry results were albumin 0.7
>(Vetscan machine couldn't read it first time due to being so low), ALP 31,
>ALT 954,
>AMY 8, TBIL 0.6, BUN 115, CA++ 8.9, PHOS 18.1 (unreadable first time
>because so
>high), CRE 1.3, GLU 182, NA+ 131, K+ 4.8, TP 6.6, GLOB 0.0 (unable to be
>read
>first time). Also worth noting is that this glucose reading was with at
>least a 4 hour fast.
>
>I was advised to basically make him NPO for 24 hours due to the vomiting as
>he has no issues with low glucose and to push subcu fluids - as much as I
>could
>get in him basically. I was told by the surgeon that I could also try
>cimetidine if I was sure there was no bowel obstruction but to date I have
>not
>attempted this, mainly out of fear since I'm not exactly sure what is going
>on with
>him. There definitely isn't a complete blockage, but there is also
>definitely something going on with his GI tract.
>
>He has had about 350 cc of subcu fluids in the past 36 hours but there has
>been only very minor improvement in his overall condition. The vomiting
>and
>pawing at the mouth/gagging did stop with his NPO status and he was
>willing/able
>to take some Nutrical earlier today with no problem, but the gagging/pawing
>are back now with any attempt to give him anything orally, including water,
>and
>occasionally even when not being given anything. I have been able to keep
>him from actually vomiting by doing only very small amounts at any given
>time,
>but he definitely appears to be very nauseaus still.
>
>The only meds he is on at this point are Pet Tinic, Clavamox, Carafate, and
>the subcu fluids. I do have Torb on hand for pain control if needed but
>have
>been reluctant to use it as he is already so depressed.
>
>He is urinating frequently with the added fluids, but I can't quantify
>exactly how much urine output there has been. Stools are frequent, but
>scant due
>to limited oral intake, and they are primarily green/yellow mucus and he
>does
>appear to have some intestinal cramping going on with sudden "urges" to
>defecate. The jaundice seen yesterday appears to have resolved and his
>postop
>bruising on his abdomen is also resolving. Mucus membranes are pale but
>moist. CRT
>is normal. Turgor is normal again. Eyes, nose, mouth/throat are clear but
>there is a pinpoint ulceration starting on the roof of his mouth tonight.
>Heart rate has been semi-normal and is currently in the 200 bpm range.
>Breathing
>is somewhat labored at times, but lungs are clear. His abdomen seems to be
>nonpainful for the most part and is not distended but it does feel doughy
>to me.
> No sign of infection, seeping or oozing at the incision sites. He also
>can
>and does get up and walk around at times but tires after only a few steps
>most of the time. Other than that, he has no interest in anything going on
>around him and makes no effort to move away from me when I put him on my
>lap or lay
>him on the floor while I clean his cage.
>
>So, at this point, I'm just not sure what else to do for him or what else
>to
>try other than a second emergency surgery to see what is actually going on
>in
>his belly. At the very least, I would like to hold out for the pathology
>report to get back before even considering a second surgery since lymphoma
>is high
>on the list of possibilites, but while I'm waiting I feel like I need to do
>something else or try something else. I will at least be rechecking lab
>values
>tomorrow and will hopefully be able to get a CBC done this time as well as
>a
>UA, but other than that I'm just not sure.
>
>Anyone have any other suggestions? Any chance of this being some kind of
>Addison's crisis? I know the chem results don't really support it and he
>does
>have his right gland, but I'm grasping at straws here trying to figure it
>out.
>
>
>
>Thanks!
>Stacia
>
>
>
>
>--
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>
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