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AAA VMS4007 > Ferret Medicine > Flashcards

Ferret Medicine Flashcards

1
Q

Common reasons for presentation

A
  • D+ + V+ - gastroenteritis
  • Dental disease
  • Fight wounds
  • Insulinoma
  • Lymphoma
  • Adrenal disease
  • Cardiac disease
  • Persistent oestrous
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2
Q

D+ + V+ - GIT physiology

A
  • Typical diet = dry ferret diet (35-40% protein)
  • Hunting ferrets - fresh carcass feeding
  • Short simple GI tract (no caecum)
  • Rapid transit time (~ 3
    hours)
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3
Q

Infectious causes of GI disease - bacterial

A
  • Helicobacter mustelae - gastritis
  • Campylobacter jejunae
  • Lawsonia intracellularis
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4
Q

Infectious causes of GI disease - viral

A
  • Coronavirus (ECE) (Epizootic Catarrhal Enteritis)
  • Canine distemper
  • Rotavirus
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5
Q

Infectious causes of GI disease - parasitic

A
  • Coccidia
  • Giardia
  • Cryptosporidium
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6
Q

Non-infectious causes of GI disease

A
  • Inflam - IBD
  • Neoplastic - lymphoma
  • Traumatic - FB
  • Stress/diet change
  • Idiopathic - megaoesophagus
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7
Q

Coronavirus

A
  • Epizootic catarrhal enteritis (ECE) - spread by contact
  • Ferret shows, rescue ferrets
  • Green slime disease
  • Dx: faecal PCR
  • Tx - general supportive care - allow to develop immune response
  • Beware systemic FIP-like form
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8
Q

Helicobacter mustelae

A
  • Ulcerative gastritis
  • CS - Anorexia, nausea, V+/D+, abdo pain, melaena * Recent stress
  • Dx - Gastric biopsy and histopathology
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9
Q

Helicobacter mustelae

A
  • Amoxicillin 20 mg/kg PO q 12 h
  • Metronidazole 20 mg/kg PO q 12 h
  • Bismuth subsalicyclate (Pepto-bismol) 0.25 mL/kg PO q 4 - 6 h
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10
Q

Arenal disease

A
  • Neutered ferrets
  • Middle aged
  • Aged 3 ½ to 4 ½ years peak time
  • Neutered > 18 months previous
  • Indoor pets
  • light > 8 h/day
  • No sex predilection
  • Overproduction of sex hormones, most common cause = hyperplasia of adrenal gland(s) (+ tumours seen)
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11
Q

Adrenal disease CS

A
  • Asymptomatic
  • Tail alopecia, comedones
  • Progressive bilateral
    flank alopecia - easily epilated, may be pruritic (40%)

Sex hormone changes
- Vulval swelling
- Dysuria with prostatomegaly
- Aggression/sexual behaviour
- Increased scent
- Mammary gland enlargement
- Petechiae

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12
Q

Adrenal disease Dx

A
  • CS + signalment - suggestive but not pathognomonic - older ferret, recently neutered
  • Exclusion of other causes - parasitic skin disease, ovarian remnant
  • Further diagnostics needed to confirm adrenal cause
  • Hormone panel
  • US
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13
Q

Adrenal disease hormone panel Dx

A

Measurement of multiple
sex hormones
- Oestradiol
- 17-hydroxyprogesterone
- Androstenedione
- Dehydroepiandrosterone sulfate
- False negatives possible as only the three most common hormones are included in most panels

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14
Q

Adrenal disease US Dx

A

Right adrenal gland
- Identify vena cava at the level of the right kidney
- Adrenal gland adjacent to vena cava, where portal vein joins
- Should be less than 10 mm long and 4 mm wide

Left adrenal gland
- Identify renal artery at level of cranial left kidney
- Adrenal gland between aorta and renal artery
- Should be less than 10.5 mm long and 4 mm wide

Common abnormalities
- Increased size
- Rounded appearance
- Altered echogenicity

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15
Q
A
  • Normal left adrenal gland
  • Elipsoid
  • Within expected size parameters
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16
Q
A
  • Left adrenal hyperplasia
  • Rounded
  • Excessively wide (6.1 mm)
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17
Q
A
  • Right adrenal adenocarcinoma
  • Enlarged (8.4 mm
  • Impinging on vena cava
  • Irregular echogenicity - mottled (not homogenous)
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18
Q

Adrenal enlargement

A
  • Adrenal hyperplasia (56%)
  • Adenocarcinoma (26%)
  • Adrenocortical adenoma (16%)
  • Cystic/other change (2%)
  • All presumed to be related + progressive changes
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19
Q

Adrenal disease medical therapy

A
  • Mitotane/Trilostane - no effect on sex hormone production, dec cortisol, cushing;s Tx in dogs
  • Melatonin implant - cosmetic effects
  • Androgen/oestrogen blockers - can be used short-term to reverse severe clinical signs - get to urinate
  • GnRH agonist - Desloerlin acetate implant - lasts > 18 m, expensive, easy to obtain
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20
Q

GnRH agonist MoA

A
  • Pulsatile release of GnRH is overcome
  • Constant high level of GnRH - > negative feedback
  • Lack of release of FSH + LH - > shutdown of adrenal stimulation
  • Ineffective if autonomous tumour has developed - tumour -> adrenalectomy
  • Effective if hyperplasia, before neoplasia
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21
Q

Adrenal disease prevention

A
  • Data indicates surgical neutering main factor
  • Removal of gonads prevents negative feedback on
    hypothalamic-pituitary axis
  • LH and FSH levels high
  • Adrenal receptors present
  • Adrenal hyperstimulation and exogenous sex hormone
    production results
22
Q

Reasons for neutering - even though risk of adrenal disease

A
  • Breeding control
  • Reduce aggression
  • Minimise ‘unpleasant’ scent
  • Prevent reproductive neoplasia/infections
  • Prevent oestrogen toxicity in unmated jills
  • Adrenal disease not seen widely in UK, risk of oestrogen marrow suppression bigger risk - when remain in season + not mated (induced ovulators)
23
Q

Options for neutering/contraception

A
  • Sx neuter
  • Deslorelin implant
  • Both neuter + deslorelin implant
  • Vasectomised hob
  • ‘Jill jab’
24
Q

Sx neuter

A
  • Introduces risk of adrenal disease
  • Likely that some degree of hormonal alteration will occur
  • Not all neutered ferrets will develop clinical disease
  • Outdoor ferrets low-risk
  • Cost effective
  • Permanent and reliable method of preventing
    pregnancy and marrow suppression
  • Can use deslorelin should adrenal disease develop
25
Q

Chemical neuter - Deslorelin implant

A
  • Appears safe and effective
  • Not permanent
  • 4.7 mg: recommended to replace every 12 - 18 m
  • 9.4 mg: lasts 3 - 4 years
  • Expensive
  • NB used off licence in most cases
  • 9.4 mg licensed for chemical
    castration of male ferrets
26
Q

Both neuter + deslorelin implant

A
  • Spay prevents breeding and marrow suppression
    permanently
  • Deslorelin acts as concurrent preventative treatment for
    negative adrenal aspect of spay
  • Expensive combination for many owners
  • Need to replace implant in future
27
Q

Vasectomised hob

A
  • Sterile mating brings entire females out of season by mating w/ them, won’t produce viable ejaculate
  • Only one animal requires surgery
  • No need for medical intervention in any animal
  • Utilises physiological contraceptive
  • Hob can inflict bite injuries on females
  • False pregnancies common
28
Q

‘Jill jab’

A
  • Injected when signs of oestrus seen, requires vigilance by owner
  • Variable costs - repeated consults, single use vials raise costs
  • Potential for pyometra (rare)
    rare
  • Delvosteron (0.5 mL) - licensed - not currently available
  • HCG (100 iu) – off licence, risk of reduced efficacy or anaphylaxis with repeat injection - okay as one-off, efficacy can reduce as Ab develop against hormone
29
Q

Decision on neuter/contraception protocol

A
  • Rescue centre = Sx neuter
  • Working ferrets = vasectomised hob
  • Per ferrets = any options
30
Q

Insulinoma

A
  • Pancreatic islet B-cell neoplasm
  • Overproduction of insulin - drives glucose into intravascular space
  • Hypoglycaemia
  • Episodic lethargy and ataxia
  • Approx 25% of ferret neoplasms - genetic cause, excessive CHO exposure, common in middle-aged ferrets = approx 4 y/o
31
Q

Insulinoma Dx

A
  • Blood glucose < 3.4 mmol/L highly indicative if not starved
  • If not convincing then fast for 3 - 4 h + retest
  • Ensure ongoing observation
  • Measurement of insulin ideal
  • Normal/high insulin in face of hypoglycaemia indicative
  • ALT and AST may be elevated due to hepatic lipidosis
  • US = limited use: microadenomas, can use to assess for metastasis (liver, lymph nodes)
32
Q

Insulinoma - first aid Tx

A
  • Offering food often sufficient
  • Syrup on mucosa for inappetant patients
  • IV glucose in comatose patients = 50% dextrose (0.25 - 2 mL) as slow bolus + maintain on glucose saline
  • Fluid therapy
  • Ad lib food high protein, low carbohydrate food access
  • SC glucose = one-ff - don’t used repeatedly - will get irritation
33
Q

Insulinoma - long-term care Tx

A
  • Partial pancreatectomy - methylene blue IV for visualisation, not used clinically
  • Px - Histopathology indicated as adenomas,
    carcinomas and hyperplasia have different prognoses
  • Diet management
  • Diazoxide
  • Prednisolone
  • Octreotide
  • Monitor BG - initially q 3 - 4 d -> stable, q 2 m, point measurement before medication admin, O can do at home
  • Survival 12 - 24 m - low rate of metastasis, progressively refractive to medical management
34
Q

Insulinoma Tx - partial pancreatectomy

A
  • Methylene blue IV - enhances visually, not used clinically
  • Histopath - indicated as adenomas, carcinomas + hyperplasia - diff Px
35
Q

Insulinoma Tx - diet managment

A
  • Low CHO, high meat diet
  • Ad lib access to food
36
Q

Insulinoma Tx - Diazoxide (Eudemine)

A
  • 5 - 15 mg/kg BID
  • Inhibits insulin secretion
  • Promotes gluconeogenesis + glycolysis
  • Inhibits glucose uptake
37
Q

Insulinoma Tx - Prednisolone

A
  • 0.25 - 2 mg/kg BID
  • Inc hepatic gluconeogenesis
  • Dec peripheral tissue glucose uptake
  • Inhibits insulin binding to receptors
  • Control symptoms while disease progresses
  • Either 1y or rescue therapy
38
Q

Insulinoma Tx - Octreotide

A
  • Somatostatin analogue
  • Used for refractory cases in other species - limited benefits in ferrets
39
Q

Lymphoma

A

Two distinct subtypes
- Juvenile lymphoma
- Adult onset lymphoma
- Transmissible + seen as ‘outbreaks’
- Viral aetiology?
- Transplantable neoplastic cells? - through bites
- Predominantly T cell lymphoma

40
Q

Juvenile lymphoma

A
  • Aged < 3 y, typically 1 y
  • Lymphoblastic
  • Organomegaly due to diffuse infiltration
  • Thymus enlargement common
  • Poorly responsive to treatment
41
Q

Adult onset lymphoma

A
  • More common
  • Aged > 3 y
  • Lymphocytic
  • Peripheral + abdominal LN enlargement
  • Clinically ‘well’ initially
  • Eventual infiltration into viscera -> progressive non-specific signs -> splenomegaly common in ‘normal’ and neoplastic cases
42
Q

Lymphoma Dx

A
  • FNA of organ/lymph node
  • Incisional biopsy of viscera
  • Excisional biopsy of lymph node - avoid mesenteric nodes due to interference with vasculature
  • Cytology of fluid
43
Q

Lymphoma Tx options

A
  • Prednisolone - sole therapy
  • Cyclophosphamide + vincristine = poorly tolerated, cause Tx-limiting neutropaenia
  • TUFTS oral + SC multidrug protocol
  • Mean survival = 6 m (0.5 - 19 m) - T cell = 5 m, B cell = 8.4 m
  • On chemo survival: T cell = 4.3 m; B cell = 8.8 m
44
Q

Lymphoma - sole prednisolone therapy

A
  • Often gives remission for weeks to months
  • Resurgent (relapse) lymphoma is resistant to further chemotherapy
  • Rapid deterioration following recurrence
  • Cheap, simple and non invasive
45
Q

Lymphoma - TUFTS protocol

A
  • Oral and SC multidrug protocol: Prednisolone; L-asparaginase; Cyclophosphamide; Cytarabine; Methotrexate; Chlorambucil; Procarbazine
  • 26 week treatment period with 19 visits
  • 7 haematology samples
46
Q

Co-morbidity of adrenal disease, insulinoma + lymphoma

A
  • AKA = Multiple Endocrine Neoplastic Syndrome
  • Chronic inflammatory process?
  • Viral aetiology
  • Coincidence - ferrets living longer lives; common diseases of elderly animals; chronic conditions only detected on presentation
47
Q

Routine vaccination

A
  • Distemper = only routine given in UK
  • Full vs 1/2 or 1/4 / yearly, two yearly or 6 yearly boosters
  • Give 1 full vial at > 12 w/o
  • Booster q 2 y
  • High risk animals - initial dose 8 w/o + 2nd 12 w/o, e.g. Rescues, kept outdoors, risk of fox contact
48
Q

Elective vaccs

A
  • Feline parvovirus (feline panleucopoenia) - requested vacc, but ferret virus different
  • Parvovirus in ferrets (Aleutian disease) is caused by a mink parvovirus
  • No vaccine for aleutian disease in the UK
  • No clinical evidence that vaccination with feline parvovirus is protective
  • Not currently advisable
49
Q

Parasite control - fleas

A
  • Cat flea (Ctenocephalides felis)
  • Routine control not commonly used unless persistent problems exist
  • Frontline Combo + Advocate both licensed for use in ferrets
50
Q

Parasite control - ticks

A
  • More of a problem in working ferrets
  • Frontline combo licensed
51
Q

Parasite control - endoparasites

A
  • Not Tx routinely
  • No licensed drugs
  • Fenbendazole (cestodes, nematodes, mesocestoides sp.) - either 20 mg/kg PO q 24 h for 5 d or 50 mg/kg PO q 24 h for 30 d
  • Piperazine (intestinal nematodes) - 50 - 100 mg/kg PO q 14 d
  • Praziquantel (cestodes) - 5 - 10 mg/kg PO, SC repeat in 10 - 14 d

AAA VMS4007 (9 decks)

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