From:
"sukiedaviscrandall"
Date: 2010-05-14 14:31:52 UTC
Subject: [ferrethealth] Re: URGENT: Extreme pain after 5 days post-op
To: ferrethealth@yahoogroups.com
Relevant resources from two ferret veterinary
pathology experts who are world known
for those who are not used to ferret livers
(owners, vets, and pathologists):
http://www.afip.org/consultation/vetpath/ferrets/Clin_Path/ClinPath.html
includes:
BEGIN QUOTE
Probably the most common misinterpretation
that I see on a routine basis is in the area of
hepatic enzymes. Remember, that the ferret,
being by nature an obligate carnivore, has an
extremely short digestive tract, and requires
meals as often as every four to six hours.
Should food not be available, it possesses the
ability to quickly mobilize peripheral fat stores
in order to meet energy requirements. When
this physiologic mechanism is activated, the liver
is literally flooded with fat, which results in
hepatocellular swelling which may be marked. The
result of this swelling is the leakage of membrane
enzymes such as alanine aminotransferase, and as
the hepatocellular swelling increases, occlusion of
bile canaliculi occurs, resulting, over time, in elevation
of alkaline phosphatase.
In conjunction with this physiologic change, elevations
of ALT up to 800 mg/dl can be seen, and alkaline
phosphatase up to approximately 100 mg/dl. This
often causes confusion to practitioners, who render
an erroneous diagnosis of unspecified hepatic disease.
However, hepatic disease is quite uncommon in this
species; the most common cause of true hepatic disease
in the ferret is neoplasia, with lymphosarcoma causing
95% of cases. Rarely bacterial infections of the liver or
biliary tree may be seen.
The diagnosis of hepatic disease in the ferret must be
based not only on ALT and alkaline phosphatase, but
other clinical indicators in the CBC and chem panel.
Clinical elevation of icterus or an elevated bilirubin is
an excellent indicatior of primary hepatic disease, or
concomitant leukocytosis or pyrexia may lend additional
credence to a diagnosis of primary hepatic disease.
Decreased total protein and mild hypoalbuminemia is a
common finding in both ill and older ferrets. Most
commonly, hypoalbuminemia indicates prolonged anorexia
in the ferret, but it is also a common feature in long-standing
inflammatory disease of the gastrointestinal tract. In older
animals, gastroduodenal infection by Helicobacter mustelae is
a common cause of mild hypoalbuminemia, and in young
animals, any inflammatory bowel disease may cause this sign.
An interesting finding in evaluating the renal enzymes of
ferrets is the relatively insensitivity of creatinine as an
indicator of renal failure. Kawasaki et al. In 1995 documented
a number of cases in which animals with histologic evidence
of end-stage kidneys and blood urea nitrogen levels of
300-400 had creatinine levels lower than 3.0 mg/dl. In fact,
the normal creatinine of this species averages approximately
half the level of the dog and cat. In evaluation of azotemia,
the prudent practitioner should also evaluate urine specific
gravity on a routine basis, rather than awaiting elevations in
creatinine for confirmation of renal disease.
Finally, one of the most commonly aberrant values in the
chemical profile of the older ferret is the blood glucose level.
As insulinoma is the most common neoplasm of the American
ferret (interestingly, this is an uncommon disease in other parts
of the world), a recommendation for yearly evaluation of this
parameter after the age of three appears prudent. Ferrets with
levels of insulin less than 80 g/dl should suggest a possibility
of insulinoma,, and levels between 60 and 80 necessitate further
testing, to include a fasting glucose test, and possibly, an amended
insulin/glucose ration. (Absolute insulin concentrations in this
species may result in false negative findings). Ferrets with blood
glucose levels less than 60 g/dl, especially in the presence of clinical
signs of lethargy and stupor, should be considered candidates for
surgery as soon as possible after stabilization. In cases of
hypoglycemia, elevated hepatic enzymes may result from inanition
and mobilization of peripheral fat stores. Contrary to published
information, this is not evidence of hepatic metastasis of
insulinoma; in fact, metastasis of islet cell tumors has not been
documented in this species. As opposed to islet cell neoplasia in
the dog and cat, islet cell tumors in the ferret exhibit benign
behavior and metastasis is not seen. However, 40% of ferrets will
develop additional neoplasms within 10 months. This however, is
not consistent with the definition of metastatic disease or malignant
behavior.
END QUOTE
and pages 3 and 4 of
http://www.afip.org/consultation/vetpath/ferrets/PDF/Ferret_GI_path_reports.pdf
are relevant.
See this other ferret pathology expert resource, also:
http://www.ferrethealth.msu.edu/Diseases/Gastrointestinal.pdf
where hepatic lipidosis is discussed near the bottom (above and
below that are hepatic neoplasums)
Notice that it is a common finding which causes confusion.
Note, too, that it points out that ferrets do not get Fatty Liver
Syndrome.
Sukie (not a vet)
Recommended ferret health links:
http://pets.groups.yahoo.com/group/ferrethealth/
http://ferrethealth.org/archive/
http://www.afip.org/ferrets/index.html
http://www.miamiferret.org/
http://www.ferrethealth.msu.edu/
http://www.ferretcongress.org/
http://www.trifl.org/index.shtml
http://homepage.mac.com/sukie/sukiesferretlinks.html
all ferret topics:
http://listserv.ferretmailinglist.org/archives/ferret-search.html
"All hail the procrastinators for they shall rule the world tomorrow."
(2010, Steve Crandall)
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