>He had a bilateral adrenectomy last month.  While the doctor was in
>there, he found that Gavin had white spots all over his liver.
>Additionally several of his lymph nodes in that area were enlarged.
>
>These were biopsied and the diagnosis on the liver spots was: "Mild to
>Moderate multifocal, chronic-active, lymphocytic, portal hepatitis.
>
>He recommended that my local vet begin treatment for the hepatitis with
>3 weeks of Clavamox .5ML twice daily, two weeks of Pedia-pred .3ML twice
>daily, and then four weeks of Pedia-Pred .3Ml once daily.
>
>At the four week mark, he wanted to do a CBC and check his liver values.
>
>He said that if they are normal, then the hepatitis is considered cured.
>If not, we'd have to try another medical avenue.
>
>Here is my problem: Gavin had a CBC done the day of his surgery - all
>liver values were normal.  He also had a CBC done yesterday.  We started
>treatment for the hepatitis yesterday and wanted to measure if his values
>had elevated since the surgery.  They remain normal.
>
>My vet who did the surgery said that there isn't much, if anything,
>written about hepatitis in ferrets.  Does anyone have experience with
>hepatitis in ferrets?  Or a bit of a better way to determine that the
>hepatitis is "cured"?  Short of doing another surgery, we couldn't think
>of a way and that is too drastic to do again.
 
Dear X:
 
Portal hepatitis is a common incidental finding in ferrets which is seen
in association with any chronic inflammation of the bowel in ferrets
(which, as you say, Gavin likely has, as evidence by his chronic
diarrhea).  In general, it is not worth treating.
 
Additionally, it is not the cause of the white spots seen in the liver.
These spots are small accumulations of fat in hepatocytes - fat in the
liver is commonly seen in ferrets who are not eating well.  Once again,
not something that gets any definitive treatment.
 
I am not surprised that Gavin's baseline liver values are normal - neither
of these problems generally result in any elevation.  it is usually only
when you see distention of all of the hepatocytes by fat (diffuse hepatic
lipidosis) that you will see elevations of hepatic enzymes.
 
By far, changes in the liver cause more confusion among veterinarians than
any other, and it is the most common area of misdiagnosis.  We tend to
overtreat "liver problems" far too often.  In this case, there is no
evidence of a definitive liver disease ongoing in Gavin, only changes
secondary to his bowel inflammation.  Let's go after the bowel changes,
and the liver will clear itself up.
 
With kindest regards,
Bruce Williams, DVM
[Posted in FML issue 3566]