>I assumed he had developed ulcers or had a hairball.  After numerous
>tests and medication we finally had to take him for exploratory surgery
>as his last hope, even though he was high risk due to his asthma.  He made
>it through the surgery fine, but no blockages or ulcers were found in his
>stomach or intestines.  There were no tumors, the only thing my vet found
>was a very pale liver, and a cyst near the rt.  adrenal gland, and I
>believe he said something about the medistinal area, but unable to take a
>biopsy there due to the amount of blood vessels in that region.
 
Dear X:
 
This sounds very much like an ulcer - most ulcers are not seen at surgery -
many vets do not open the stomach if they do not feel anything abnormal.
If they do, often the small incision does not facilitate a full 360 degree
examination of the pylorus, where most ulcers occur.  However a diagnosis
of ulcer may be made at surgery if the lumen of the stomach contains black
coffee-ground material (digested blood) which MAY be seen anytime that
stomach is open.
 
The mediastinum is in the chest, and it is doubtful that your vet went
anywhere near there.
 
>Here are his lab results:
> WBC 1.7 (plt clumping may have lowered result)
> HCT 41.0 L
> Bands 59, Lymphs 23, monos 16
> Glucose 79, Bun 10 L, CA 8.7 L, TP 7.4, Alb 2.2 L, Alt 555 H
 
Overall not that bad, the WBC is indeed low, but it sounds as if the blood
clotted a bit.  I doubt the 59 represents bands, but neutrophils.  (Bands
are immature neutrophils, and I've never seen them go that high in
ferrets.) The ALT is elevated, but likely due to not eating properly.
 
>Path report:
> Diagnosis: 1. Severe hepatic fatty changes with mod to severe
> lymphoplasmacytic histocytic cholangiohepatitis.
>            2. Cyst lined by cuboidal epithelium and mod
> lymphohistiocytic inflammation in cyst wall with mineralization.
 
The fatty change is consistent with not eating and goes along with the
ALT.  Fatty change in the liver causes it to turn yellow.  The cyst is
actually an adrenal cyst, and is commonly seen at the area where the liver
and ft. adrenal touch.  It is of no clinical significance in this case.
 
The case sounds very much like a case of gastric ulcers - there is no
indication of any other diseases going on, and it does not appear that
any lung samples were taken, that might shed light on his previous lung
problems.
 
With kindest regards,
Bruce Williams, dVM
[Posted in FML issue 3473]