From:
grape_apes@charter.net
Date: 2005-08-13 04:02:34 UTC
Subject: ileus/gastric stasis
To: ferrethealth@smartgroups.com
Message-ID: <31538514.1123908050037.JavaMail.nobody@chromium.smartgroups.com>
Hi. Does anyone have any experience with ileus or gastric stasis, especially postop,
and if so, what have you done to treat it? I have a rescue who is about three weeks
postop for a left adrenal adenoma, insulinoma, undifferentiated pancreatic nodule
and a mast cell tumor (benign, as usual). She was doing great, but became very
icteric about 1 week postop-her bilirubin was 17.1! among other high values.
However, she was ridiculously stable-eating, drinking, active, normal poop, very
yellow but consistent urine... We waited over the past weekend to do surgery in
case she started leaking biliary fluid ino her abdomen while my surgeon was away
(we suspected we'd have to resect her biliary ducts...).
Anyway, on Tuesday we rerouted her biliary duct thru the duodenum-she healed too
quickly, I guess, as scar tissue from the removal of the undifferentiated pancreatic
mass blocked a duct. The surgery went well, with good drainage of the biliary duct
and no apparent leakage. (A reroute thru the gall bladder would be our next
option.)
She did great the day after surgery, eating well, acting very energetic, normal
eliminations, and her icterus improved markedly.
At about 2 am Thursday, she stopped eating and only had one BM (normal) and one
urination until she became increasingly lethargic and less responsive thru 12am on
Friday, when I took her to XXX Veterinary School's emergency hospital. She had
been getting 30 ml of SQ LRS every day for a week (she is about a pound), 0.5mg
pepcid SQ SID, amoxicillin BID for her UTI (diagnosed 2.5 weeks ago), and I started
syringe feeding A/D and Bob's chicken gravy during the day Thurs. She started
gagging around 11:30pm after having taken the food well from the syringe all day.
She really had little response to Nutrical when she seemed to be crashing a bit,
which had helped during what seemed like a hypoglycemic epsiode the day before
the second surgery (Mon). Her temp got dowmn to 97.8.
She was much brighter at XXX (I'm apparently a pretty good emergency tech, and
probably didn't need to take her, but I'm paranoid), and her BG was 125. They tried
to force feed her (no interest on her own) and shw vomited. Got more SQ LRS. Her
BG this am was 169!!!! With no food at all really from 11pm until I fed her at 5pm
today... Hmmm... She did not maintain her temp unless supported (i.e. incubator,
heating pad in hospital) all night and day. (Stayed low without assistance.)
An xray and exam today revealed no abdominal effusion (fluid) this afternoon, but a
lot of gas. An ileus is suspected, though localized leakinjg of biliary fluid is
obviously not ruled out. Ultrasound in this case did not seem preferable to just
exploring if leakage is suspected.
We started reglan and sucralfate and are continuing fluids, pepcid and her amoxi,
although the concern there is killing off her good bacteria, too-but her UTI was bad.
Still no interest in food two doses of reglan (SQ injections, FYI, at .3mg TID, if I am
remembering right-middle to high range of dosing) and sucralfate (15mg PO TID)
today with more fluids. Not drinking either. Two more stools-one dark orange-
brown and diarrhea, one dark brown and more normal, and two urinations-very
small. She is still pretty lethargic, though did run around a bit tonight-stole her
crochet egg and tried to steal the big penny jar.
I syringe fed her about 12cc A/D and chicken, but I read that in people, you NPO
them in favor of just parenteral fluids; that seems bad in a ferret, especially one with
what the lab said had been an insulinoma. Odd that her BGs are so high with so
little nutrition.
Any ideas, experience would be helpful. Thanks!
-April and Daisy