5/6/2010 1 A three year old female intact domestic A three year old female intact domestic rabbit ( rabbit (Oryctolagus cuniculus Oryctolagus cuniculus) ) Three day duration of anorexia Three day duration of anorexia Diet of pellets, vegetables, fruit, and a Diet of pellets, vegetables, fruit, and a small amount of alfalfa hay (given twice small amount of alfalfa hay (given twice Case 1 small amount of alfalfa hay (given twice small amount of alfalfa hay (given twice weekly) weekly) One other intact female rabbit in the One other intact female rabbit in the house house Exhibiting increased nesting behavior Exhibiting increased nesting behavior Small, dry, scant feces Small, dry, scant feces Drinking less water than usual Drinking less water than usual Bright, alert, and responsive Bright, alert, and responsive 2.25 Kg 2.25 Kg Abdomen was distended and firm Abdomen was distended and firm Feces small, dry, and scant Feces small, dry, and scant Case 1: Physical exam Heart rate was greater than 200 beats per Heart rate was greater than 200 beats per minute minute Respiratory rate was greater than 88 Respiratory rate was greater than 88 breaths per minute breaths per minute Sniffing Sniffing Multiple 3 Multiple 3-5 mm in length calculi 5 mm in length calculi Smoothly marginated, mineral opaque Smoothly marginated, mineral opaque In the urinary bladder In the urinary bladder An 11 mm in length mineralized structure An 11 mm in length mineralized structure Case 1: Radiographic interpretation Oblong, smoothly marginated Oblong, smoothly marginated In the fat within the left inguinal region In the fat within the left inguinal region A large amount of fat within the mid A large amount of fat within the mid ventral abdomen ventral abdomen Likely the broad ligament of the uterus Likely the broad ligament of the uterus
Transcript
5/6/2010
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A three year old female intact domestic A three year old female intact domestic rabbit (rabbit (Oryctolagus cuniculusOryctolagus cuniculus) )
Three day duration of anorexiaThree day duration of anorexia
Diet of pellets, vegetables, fruit, and a Diet of pellets, vegetables, fruit, and a small amount of alfalfa hay (given twice small amount of alfalfa hay (given twice
Case 1
small amount of alfalfa hay (given twice small amount of alfalfa hay (given twice weekly)weekly)
One other intact female rabbit in the One other intact female rabbit in the house house Exhibiting increased nesting behaviorExhibiting increased nesting behavior
Small, dry, scant feces Small, dry, scant feces
Drinking less water than usualDrinking less water than usual
Bright, alert, and responsiveBright, alert, and responsive
2.25 Kg2.25 Kg
Abdomen was distended and firmAbdomen was distended and firm
Feces small, dry, and scantFeces small, dry, and scant
Case 1: Physical exam
Heart rate was greater than 200 beats per Heart rate was greater than 200 beats per minuteminute
Respiratory rate was greater than 88 Respiratory rate was greater than 88 breaths per minutebreaths per minute Sniffing Sniffing
Multiple 3Multiple 3--5 mm in length calculi5 mm in length calculi Smoothly marginated, mineral opaqueSmoothly marginated, mineral opaque
In the urinary bladderIn the urinary bladder
An 11 mm in length mineralized structureAn 11 mm in length mineralized structure
In the fat within the left inguinal regionIn the fat within the left inguinal region
A large amount of fat within the mid A large amount of fat within the mid ventral abdomenventral abdomen Likely the broad ligament of the uterusLikely the broad ligament of the uterus
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An illAn ill--defined oblong soft tissue opacity defined oblong soft tissue opacity Caudal aspect of this intraCaudal aspect of this intra--abdominal fat abdominal fat
Abdominal structures displaced craniallyAbdominal structures displaced cranially Secondary to the large amount of intraSecondary to the large amount of intra--
abdominal fatabdominal fat
Right kidneyRight kidney Several 3Several 3--4 mm in length linear mineral 4 mm in length linear mineral
opacities within the renal pelvis and cortex opacities within the renal pelvis and cortex
Multiple cystic calculiMultiple cystic calculi
Multifocal right renal mineralization Multifocal right renal mineralization Nephroliths or diverticular mineralizationNephroliths or diverticular mineralization
Left inguinal mineralized structure is likely Left inguinal mineralized structure is likely
Case 1 Radiographic summary
g yg ya benign structurea benign structure Such as mineralized fatSuch as mineralized fat
Uterus is mildly enlargedUterus is mildly enlarged Hydrometra, mucometra, pyometra, or Hydrometra, mucometra, pyometra, or
uterine neoplasiauterine neoplasia
Results Referencea
WBC x103/ul 13.6 6.3-11.0
Neutrophils x103/ul
6.9 1.5-3.2
Lymphocytes x103/ul
4.9 3.4-7.0
Monocytes x103/ul
0.8 0.1-0.5
Eosinophils x103/ul
0.5 0-0.2
Basophils x103/ul
0.3 0.1-0.4
Plasma protein g/dl
7.8 ---
Case 1
g/RBC x 106/ ul 5.87 4-8
Hb g/dl 13.1 8-15
PCV % 42 30-50
MCV fl 72 58-76.2
MCHC g/dl 31 29-34
RDW 12.3 ---
Platelets 103/ul
507 290-650
MPV fl 7.2 ---
Reticulocytes 0.1 ---
aCampbell TW, Ellis CS. 2007. Avian and Exotic Animal Hematology and Cytology, 3rd
ed. Ames: Blackwell Publishing, 245.
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Mild leukocytosis with a heterophiliaMild leukocytosis with a heterophilia
Inflammatory leukogramInflammatory leukogram
Case 1 Hemogram
The heterophil morphology appears normal The heterophil morphology appears normal
HyperglycemiaHyperglycemia Stress response and increase corticosteroid Stress response and increase corticosteroid
releaserelease
High calcium concentrationHigh calcium concentration Common in rabbitsCommon in rabbits
Case 1 Diagnostic panel interpretation
Co o abb sCo o abb s
The low bicarbonate concentrationThe low bicarbonate concentration Compensation for a respiratory alkalosisCompensation for a respiratory alkalosis
Apparent anion gap acidosis Apparent anion gap acidosis A blood gas evaluation is required to better evaluate the A blood gas evaluation is required to better evaluate the
acidacid--base statusbase status
Surgery for a cystotomy and ovariohysterectomySurgery for a cystotomy and ovariohysterectomy
Preanesthetics 30 minutes prior to induction:Preanesthetics 30 minutes prior to induction:
Ketamine (11.3 mg) and midazolam (0.63 mg) IVKetamine (11.3 mg) and midazolam (0.63 mg) IV
Intubation for Isoflurane anesthesia more Intubation for Isoflurane anesthesia more difficult than expected difficult than expected
The rabbit was placed in dorsal recumbency The rabbit was placed in dorsal recumbency for the abdominal exploratory surgery for the abdominal exploratory surgery
Th bl dd d th fl h d tTh bl dd d th fl h d t
Case 1 Summary
The bladder and urethra were flushed to The bladder and urethra were flushed to dislodge two 1 mm calculidislodge two 1 mm calculi
A mass was identified on the distal right horn A mass was identified on the distal right horn of the uterusof the uterus
The reproductive tract was removed and The reproductive tract was removed and submitted for histopathologysubmitted for histopathology
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Histopathology of the uterusHistopathology of the uterus Moderate cystic endometrial hyperplasiaModerate cystic endometrial hyperplasia
Histopathology of the ovariesHistopathology of the ovaries Bilateral luteomasBilateral luteomas
PP
Case 1 Summary
PostPost--op treatment op treatment Critical care feed (45 ml PO)Critical care feed (45 ml PO)
Sq fluids (250 ml lactated ringer’s solution)Sq fluids (250 ml lactated ringer’s solution)
Meloxicam (0.5 mg/kg PO BID x 5 days)Meloxicam (0.5 mg/kg PO BID x 5 days) Suspected meloxicam would also aid with any Suspected meloxicam would also aid with any
inflammation associated with the larynx inflammation associated with the larynx
The rabbit returned two days later due to The rabbit returned two days later due to dyspneadyspnea
Respiratory sounds over the trachea were Respiratory sounds over the trachea were increased with normal lung soundsincreased with normal lung sounds
The skin over dewlap was fluctuantThe skin over dewlap was fluctuant
The rabbit worsened over the next 24 The rabbit worsened over the next 24 hours and was euthanizedhours and was euthanized
Necropsy findingsNecropsy findingsP iP i
Case 1 Summary
Pneumonia Pneumonia
Esophageal perforation with associated Esophageal perforation with associated fascial abscesses and communication into fascial abscesses and communication into the tracheathe trachea A chronic process not related to the intubation of A chronic process not related to the intubation of
the patient according to the pathology reportthe patient according to the pathology report
Likely the cause of the inflammatory leukogramLikely the cause of the inflammatory leukogram
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A 6 year old intact male guinea pig (A 6 year old intact male guinea pig (Cavia Cavia porcelliusporcellius) presented with a six month ) presented with a six month history of excessive drinking and history of excessive drinking and urination soft stools and weight lossurination soft stools and weight loss
Case 2
urination, soft stools, and weight lossurination, soft stools, and weight loss
Lived alone in a commercial cageLived alone in a commercial cage Diet: commercial guinea pig pellets and Diet: commercial guinea pig pellets and
grass hay grass hay Multiple episodes of voluminous diarrheaMultiple episodes of voluminous diarrhea
Case 2
Physical exam findings: Physical exam findings: Very thin and weighed 820 gmVery thin and weighed 820 gm Abdomen palpation revealed intestines that Abdomen palpation revealed intestines that
contained excessive amounts of gas contained excessive amounts of gas PeaPea--sized mass was easily palpated in the sized mass was easily palpated in the
upper throat region upper throat region
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CBCCBC
Plasma diagnostic panelPlasma diagnostic panel
Imaging Imaging
Case 2 Diagnostic plan
Cytology of FNA of massCytology of FNA of mass
Day 1Day 1 5 years prior5 years prior ReferenceReferenceaa
aQuesenberry KE, Donnelly TM, Hillyer EV. 2006. Biology, husbandry, and clinical techniques of guinea pigs and chinchillas. In Quesenberry KE, Carpenter JW (eds) Ferrets, Rabbits, and Rodents Clinical Medicine and Surgery 2nd ed, 243.
Day 1Day 1 5 years prior5 years prior ReferenceReferenceaa
Plasma protein Plasma protein g/dlg/dl
------ 6.06.0 ------
RBC x 10RBC x 1066/ ul/ ul 6.36.3 5.55.5 3.23.2--8.08.0
Hb g/dlHb g/dl 17.217.2 14.314.3 1010--17.217.2
PCV %PCV % 4949 4646 3232--5050
MCV flMCV fl 7878 8383 7171--9696
MCHC g/dlMCHC g/dl 3535 3131 2626 3939
Case 2 Hemogram
MCHC g/dlMCHC g/dl 3535 3131 2626--3939
Reticulocytes/Reticulocytes/ul ul
50,48050,480 ------ ------
%% 0.80.8 ------ ------
RDWRDW 13.413.4 15.415.4 ------
Platelets Platelets 101033/ul/ul
285285 690690 260260--740740
MPV flMPV fl 7.77.7 7.67.6 ------
Clumped Clumped plateletsplatelets
nonenone existexist
aQuesenberry KE, Donnelly TM, Hillyer EV. 2006. Biology, husbandry, and clinical techniques of guinea pigs and chinchillas. In Quesenberry KE, Carpenter JW (eds) Ferrets, Rabbits, and Rodents Clinical Medicine and Surgery 2nd ed, 243.
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Day 1Day 1 5 years prior5 years prior ReferenceReferenceaa
aQuesenberry KE, Donnelly TM, Hillyer EV. 2006. Biology, husbandry, and clinical techniques of guinea pigs and chinchillas. In Quesenberry KE, Carpenter JW (eds) Ferrets, Rabbits, and Rodents Clinical Medicine and Surgery 2nd ed, 243.
Day 1Day 1 5 years prior5 years prior ReferenceReferenceaa
aQuesenberry KE, Donnelly TM, Hillyer EV. 2006. Biology, husbandry, and clinical techniques of guinea pigs and chinchillas. In Quesenberry KE, Carpenter JW (eds) Ferrets, Rabbits, and Rodents Clinical Medicine and Surgery 2nd ed, 243.
Normal erythrocyte parametersNormal erythrocyte parameters
Stress leukogramStress leukogram
Hyperglycemia supports a stress responseHyperglycemia supports a stress response
Slight increase in plasma ALT and AST Slight increase in plasma ALT and AST
Case 2 Blood profile interpretation
ggactivitiesactivities Values may not be significantly elevatedValues may not be significantly elevated
Normal CK Normal CK
Previous high ALP valuePrevious high ALP value Osteoblastic activity in a young growing animal Osteoblastic activity in a young growing animal
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Highly cellular sample of primarily Highly cellular sample of primarily epithelial cellsepithelial cells Occur in adherent groupsOccur in adherent groups Round to oval nucleiRound to oval nuclei
BlueBlue--black granules within cells as well as in black granules within cells as well as in the noncellular background the noncellular background
Either cellular hyperplasia or benign Either cellular hyperplasia or benign neoplasia (adenoma) of the thyroid gland neoplasia (adenoma) of the thyroid gland The blueThe blue--black granules are indicative of black granules are indicative of
colloid associated with cells from the thyroid colloid associated with cells from the thyroid glandgland
Case 2 Cytodiagnosis
glandgland
Blood total T4 concentrationBlood total T4 concentration 6.7 µg/dl6.7 µg/dl
Published normal values (2.3 Published normal values (2.3 –– 3.5 µg/dl) for 3.5 µg/dl) for malesmales
Case 2 Additional diagnostics
males males
Thyroid scan Thyroid scan 298 microcuries of technetium (Tc) was 298 microcuries of technetium (Tc) was
injected in the cephalic vein of the left injected in the cephalic vein of the left forelimb forelimb
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Immediate marked radiopharmaceutical Immediate marked radiopharmaceutical uptake in the region of the thyroid uptake in the region of the thyroid
Large misshapen gland in the center of Large misshapen gland in the center of the neckthe neck
Case 2 Thyroid scan interpretation
the neckthe neck
Likely unilateral Likely unilateral
Neoplastic process Neoplastic process
Surgery to remove the abnormal thyroid Surgery to remove the abnormal thyroid gland that was contributing to his gland that was contributing to his systemic disease of hyperthyroidism systemic disease of hyperthyroidism
Given subcutaneously one hour prior to Given subcutaneously one hour prior to anesthetic inductionanesthetic induction
Maintenance using 2% Maintenance using 2% isofluraneisoflurane by face by face mask and mask and midazolammidazolam (0.5 mg/Kg) (0.5 mg/Kg) intravenously. intravenously.
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Skin incisionSkin incision
Blunt dissection to the mass Blunt dissection to the mass
An enlarged right thyroid gland was An enlarged right thyroid gland was dd
At the time of suture removal 10 days At the time of suture removal 10 days following surgeryfollowing surgery Clinical signs had disappearedClinical signs had disappeared Healthy and gaining weightHealthy and gaining weight
Case 2 Summary
The guinea pig lived for another 16 The guinea pig lived for another 16 monthsmonths LeftLeft--sided heart failure sided heart failure Resulted in pulmonary edemaResulted in pulmonary edema
RightRight--sided heart failure sided heart failure Hepatic congestion and centrilobular degenerationHepatic congestion and centrilobular degeneration
Case 2 Summary
Hepatic congestion and centrilobular degenerationHepatic congestion and centrilobular degeneration
No evidence of neoplastic metastasis in any No evidence of neoplastic metastasis in any organsorgans
An incidental leiomyoma within the serosa of An incidental leiomyoma within the serosa of the small intestine the small intestine
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A threeA three--year old male, intact ferret year old male, intact ferret ((Mustela putorius furoMustela putorius furo) )
O k hi f l h d i hO k hi f l h d i h
Case 3
One week history of lethargy and weight One week history of lethargy and weight lossloss
Obtained from a friend in California Obtained from a friend in California approximately one year earlier with no approximately one year earlier with no known medical problems known medical problems
Obtunded and minimally responsiveObtunded and minimally responsive
Blood was collected immediatelyBlood was collected immediately
710 grams: Body condition score of 3/9710 grams: Body condition score of 3/9
Intravenous catheter Intravenous catheter
Case 3
Increased respiratory rate and effortIncreased respiratory rate and effort
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Perianal pasting with melena Perianal pasting with melena
Abdominal palpation: an irregular spleen Abdominal palpation: an irregular spleen with multiple small masseswith multiple small masses
Case 3
with multiple small masseswith multiple small masses
NotedNotedaColorado State University reference ranges.bFox JG. 1988. Normal clinical and biological parameters. In Fox JG ed. Biology and Diseases of the Ferret. Lea and Febiger, Philadelphia, 159-173.cCarpenter JW. 2005. Exotic Animal Formulary, 3rd ed. St. Louis; Elsevier Saunders, 464 (male fitch ferret).
aNormal range provided by Colorado State University clinical pathology laboratory. http://www.cvmbs.colostate.edu/pathology/clinpath/2006%20Formulary.htmbFox JG. 1988. Normal clinical and biological parameters. In Fox JG ed. Biology and Diseases of the Ferret. Lea and Febiger, Philadelphia, 159-173.cCarpenter JW. 2005. Exotic Animal Formulary, 3rd ed. St. Louis; Elsevier Saunders, 464-465 (fitch ferret).
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Leukocytosis with neutrophilia and Leukocytosis with neutrophilia and monocytosismonocytosis
Elevated plasma protein (refractometric)Elevated plasma protein (refractometric)
The presence of band cellsThe presence of band cells Indicates accelerated demand for neutrophilsIndicates accelerated demand for neutrophils
Case 3 CBC interpretation
Indicates accelerated demand for neutrophilsIndicates accelerated demand for neutrophils Left shiftLeft shift
Associated with an inflammatory stimulus Associated with an inflammatory stimulus
Inflammatory leukogram that is possibly Inflammatory leukogram that is possibly associated with an infectious etiologyassociated with an infectious etiology
Severe hypoglycemiaSevere hypoglycemia Insulinoma Insulinoma Decreased glucose absorptionDecreased glucose absorption
StarvationStarvation MalabsorptionMalabsorption
Hepatic failureHepatic failure SepsisSepsis
N l i h h b llN l i h h b ll
Case 3 Plasma chemistry interpretation
Neoplasia other than beta cell tumorsNeoplasia other than beta cell tumors
AzotemiaAzotemia Likely loss of 85% of the GFRLikely loss of 85% of the GFR
Hypoalbuminemia associated with a normal or Hypoalbuminemia associated with a normal or increased globulin concentrationincreased globulin concentration Hepatic failureHepatic failure
Hepatobiliary disease Hepatobiliary disease
Case 3 Plasma chemistry interpretation
Electrolyte imbalances with increased anion Electrolyte imbalances with increased anion gap acidosisgap acidosis
Multiple organ involvement, such as hepatic Multiple organ involvement, such as hepatic and renal failureand renal failure
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Multiple ultrasoundMultiple ultrasound--guided aspirates guided aspirates were obtained from the nodules palpated were obtained from the nodules palpated on the spleen as well as those found on on the spleen as well as those found on the liverthe liver
Case 3
the liver. the liver.
Macrophagic inflammationMacrophagic inflammation Predominance of macrophages and Predominance of macrophages and
lymphocyteslymphocytes
Case 3 Cytodiagnosis
Macrophages that contain negative Macrophages that contain negative staining filamentous inclusionsstaining filamentous inclusions
Suggestive of mycobacteriosis Suggestive of mycobacteriosis
The ferret was euthanized because of a The ferret was euthanized because of a poor prognosis for survivalpoor prognosis for survival
Necropsy revealed multiple Necropsy revealed multiple granulomatous lesions throughout the granulomatous lesions throughout the
Case 3 Summary
spleen and liverspleen and liver White, firm, multiple granulomas in spleen White, firm, multiple granulomas in spleen
and liverand liver Pinpoint to five millimetersPinpoint to five millimeters
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Mediastinal lymph nodesMediastinal lymph nodes Four times twice normal sizeFour times twice normal size
Mesenteric lymph nodes Mesenteric lymph nodes
Case 3 Summary
y py p Twice normal sizeTwice normal size
The lung lobes were bilaterally mottled and firmThe lung lobes were bilaterally mottled and firm
Multiple granulomas with extracellular Multiple granulomas with extracellular and intracellular acidand intracellular acid--fast filamentous fast filamentous bacteriabacteria Lungs, liver, spleen, mesenteric and Lungs, liver, spleen, mesenteric and
Myocardial degeneration with interstitial Myocardial degeneration with interstitial fibrosis fibrosis
MycobacteriumMycobacterium sp. sp.
Mycobacterium goodiiMycobacterium goodii
Case 3 Bacterial culture
Using 16S rDNA sequencingUsing 16S rDNA sequencing
This species of mycobacterium has not been This species of mycobacterium has not been reported in ferrets but has been reported in reported in ferrets but has been reported in dogs dogs
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A five year old male castrated ferret A five year old male castrated ferret ((Mustela putorius furoMustela putorius furo) presented with ) presented with lethargy, dyspnea, diarrhea, polyuria, and lethargy, dyspnea, diarrhea, polyuria, and polydypsiapolydypsia
Case 4
polydypsiapolydypsia
Two day history of anorexiaTwo day history of anorexia
During the past few monthsDuring the past few months Eating and drinking more than normal Eating and drinking more than normal
causing causing diarrhea and difficulty breathing diarrhea and difficulty breathing
Case 4
Owned since he was less than a year oldOwned since he was less than a year old
Ferret lives with a healthy four year old Ferret lives with a healthy four year old castrated male ferretcastrated male ferret
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Diet: commercial kibbled diet designed Diet: commercial kibbled diet designed for ferretsfor ferrets
This is the first time any of the ferrets had This is the first time any of the ferrets had been sickbeen sick
Case 4
Current treatment with amoxicillin for Current treatment with amoxicillin for cystitiscystitis
Obtunded on presentationObtunded on presentation
1.7 Kg1.7 Kg
Case 4 Physical examination
Dehydration based upon the tenting of Dehydration based upon the tenting of the skinthe skin
Palpable abdominal mass near left kidneyPalpable abdominal mass near left kidney
%% ------ ------ 00--22 00--2.7(0.7)2.7(0.7)aColorado State University reference ranges.bFox JG. 1988. Normal clinical and biological parameters. In Fox JG ed. Biology and Diseases of the Ferret. Lea and Febiger, Philadelphia, 159-173.cCarpenter JW. 2005. Exotic Animal Formulary, 3rd ed. St. Louis; Elsevier Saunders, 464 (male fitch ferret).
PolychromasiaPolychromasia SlightSlight ------ ------ ------aColorado State University reference ranges.bFox JG. 1988. Normal clinical and biological parameters. In Fox JG ed. Biology and Diseases of the Ferret. Lea and Febiger, Philadelphia, 159-173.cCarpenter JW. 2005. Exotic Animal Formulary, 3rd ed. St. Louis; Elsevier Saunders, 464 (male fitch ferret).
A/G ratioA/G ratio 1.21.2 1.01.0--2.22.2 ------ 1.31.3--2.1(1.8)2.1(1.8)
Cholesterol Cholesterol mg/dlmg/dl
193193 7070--2002006464--296296 ------
T. Bilirubin T. Bilirubin mg/dlmg/dl
0.10.1 0.00.0--0.30.3<1<1 ------
aNormal range provided by Colorado State University clinical pathology laboratory. http://www.cvmbs.colostate.edu/pathology/clinpath/2006%20Formulary.htmbFox JG. 1988. Normal clinical and biological parameters. In Fox JG ed. Biology and Diseases of the Ferret. Lea and Febiger, Philadelphia, 159-173.cCarpenter JW. 2005. Exotic Animal Formulary, 3rd ed. St. Louis; Elsevier Saunders, 464-465 (fitch ferret).
aNormal range provided by Colorado State University clinical pathology laboratory. http://www.cvmbs.colostate.edu/pathology/clinpath/2006%20Formulary.htmbFox JG. 1988. Normal clinical and biological parameters. In Fox JG ed. Biology and Diseases of the Ferret. Lea and Febiger, Philadelphia, 159-173.cCarpenter JW. 2005. Exotic Animal Formulary, 3rd ed. St. Louis; Elsevier Saunders, 464-465 (fitch ferret).
Caudal aspect of cranial mediastinum is Caudal aspect of cranial mediastinum is widenedwidened
F l l l i h di lF l l l i h di l
Case 4 Radiographic interpretation
Focal alveolar pattern in the medial Focal alveolar pattern in the medial aspect of the caudal left lung on the VD aspect of the caudal left lung on the VD imageimage
Portions of the margins of the cardiac Portions of the margins of the cardiac silhouette are not well seensilhouette are not well seen
Heart may be mildly enlargedHeart may be mildly enlarged
Loss of serosal detail within the abdomenLoss of serosal detail within the abdomen
Liver is enlarged causing caudal Liver is enlarged causing caudal di l f h hdi l f h h
Case 4 Radiographic interpretation
displacement of the stomachdisplacement of the stomach
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A lobulated soft tissue opacity causing A lobulated soft tissue opacity causing displacement of the surrounding bowel displacement of the surrounding bowel within the medial caudal mid left side of within the medial caudal mid left side of the abdomen L3 through L5the abdomen L3 through L5
Case 4 Radiographic interpretation
the abdomen, L3 through L5the abdomen, L3 through L5
Right kidney is faintly visualized Right kidney is faintly visualized
There is an illThere is an ill--defined soft tissue mass defined soft tissue mass with associated mass effect in the region with associated mass effect in the region of the right kidney of the right kidney related to the mesentery or possibly arelated to the mesentery or possibly a
Case 4 Radiographic interpretation
related to the mesentery or possibly a related to the mesentery or possibly a neoplasia involving one of the adrenal glandsneoplasia involving one of the adrenal glands
Both kidneys appear normalBoth kidneys appear normal Some indistinctness of the dorsal cranial Some indistinctness of the dorsal cranial
Bilateral pleural effusionsBilateral pleural effusions Right heart failureRight heart failure Cardiomyopathy cannot be ruled outCardiomyopathy cannot be ruled out
Case 4 Lateral radiographic interpretation
Possible fluid within the mediastinumPossible fluid within the mediastinum
Increase in the PCV and hemoglobin Increase in the PCV and hemoglobin concentrationconcentration
HyperproteinemiaHyperproteinemia
Case 4 Blood profile
HyperproteinemiaHyperproteinemia
AzotemiaAzotemia
Likely associated with dehydration Likely associated with dehydration
An ultrasoundAn ultrasound--guided fineguided fine--needle needle aspirate of the abdominal mass for aspirate of the abdominal mass for cytologic interpretationcytologic interpretation
Case 4 What next?
y g py g p
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Homogeneous population of mononuclear Homogeneous population of mononuclear cellscells Eccentric nucleusEccentric nucleus
Abundant basophilic cytoplasmAbundant basophilic cytoplasm Contains small vacuolesContains small vacuoles
Case 4 Cytodiagnosis
Contains small vacuolesContains small vacuoles
Prominent large nucleoliProminent large nucleoli
Neuroendocrine in originNeuroendocrine in origin
Adrenal adenocarcinoma based upon the Adrenal adenocarcinoma based upon the anatomical location of the massanatomical location of the mass
Estradiol: 363.0 pmol/L Estradiol: 363.0 pmol/L Normal Range 30Normal Range 30--180180
17 OH P 0 48 l/L17 OH P 0 48 l/L
Case 4 Ferret adrenal panel
17 OH Progesterone: 0.48 nmol/L 17 OH Progesterone: 0.48 nmol/L Normal Range 0Normal Range 0--0.800.80
2 Androstenedione: 7.1 nmol/L 2 Androstenedione: 7.1 nmol/L Normal Range 0Normal Range 0--1515
Client decided on euthanasia Client decided on euthanasia Based upon the size of the adrenal massBased upon the size of the adrenal mass
Age of ferretAge of ferret
Condition of the ferretCondition of the ferret
Case 4 Summary
Condition of the ferretCondition of the ferret
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Left adrenal gland effaced with a 5.5 cm x Left adrenal gland effaced with a 5.5 cm x 5.5 cm x 2 cm mass5.5 cm x 2 cm mass Multinodular with areas of necrosis and Multinodular with areas of necrosis and
hemorrhagehemorrhage
Case 4 Necropsy
hemorrhagehemorrhage
40 ml of serosanguinous fluid in the 40 ml of serosanguinous fluid in the peritoneal cavityperitoneal cavity
70 ml of serosanguinous pleural effusion70 ml of serosanguinous pleural effusion
LiverLiver Severe diffuse acute congestionSevere diffuse acute congestion
M d l f i blM d l f i bl
Case 4 Necropsy
Moderately friableModerately friable
Cobblestone surfaceCobblestone surface
Left adrenocortical carcinomaLeft adrenocortical carcinoma
Moderate chronic lymphocytic portal Moderate chronic lymphocytic portal h i ih i i
Case 4 Necropsy diagnosis
hepatitishepatitis
Moderate to marked acute pulmonary Moderate to marked acute pulmonary congestion and edemacongestion and edema
Spleen with diffuse moderate reactive Spleen with diffuse moderate reactive hyperplasia hyperplasia
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A seven year old castrated male guinea pig A seven year old castrated male guinea pig ((Cavia porcelliusCavia porcellius) presented with a three ) presented with a three day history of partial anorexia and day history of partial anorexia and decreased water intakedecreased water intake
Case 5
decreased water intakedecreased water intake
Housed alone in a commercial guinea pig Housed alone in a commercial guinea pig cage cage
F d i il h di tF d i il h di t
Case 5 History
Fed primarily a grass hay dietFed primarily a grass hay diet Supplemented with a variety of leafy Supplemented with a variety of leafy
vegetablesvegetables
Limited amount of commercial guinea pig Limited amount of commercial guinea pig pelletspellets
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Past three daysPast three days Eating and drinking lessEating and drinking less
Producing fewer than normal feces Producing fewer than normal feces
Case 5 History
No previous health problemsNo previous health problems
698 gm 698 gm
Appeared thin and lethargicAppeared thin and lethargic
Pulse rate greater than 250 beats per Pulse rate greater than 250 beats per ii
Case 5 Physical exam findings
minuteminute
Respiratory rate of 32 breaths per minuteRespiratory rate of 32 breaths per minute
Temperature 100Temperature 100oo F F
CBCCBC
Plasma chemistry profilePlasma chemistry profile
ImagingImaging
Case 5 Diagnostic plan
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ReferenceReferenceaa
WBC x10WBC x1033/ul/ul 14.014.0 5.55.5--17.517.5
Neutrophils Neutrophils x10x1033/ul/ul
11.811.8 ------
%% 8484 2222--4848
Lymphocytes Lymphocytes 101033/ l/ l
2.02.0 ------
ReferenceReferenceaa
RBC x 10RBC x 1066/ / ulul
4.164.16 3.23.2--8.08.0
Hb g/dlHb g/dl 10.010.0 1010--17.217.2
PCV %PCV % 3030 3232--5050
MCV flMCV fl 7373 7171--9696
Case 5 Hemogram
x10x1033/ul/ul%% 1414 3939--7272
Monocytes Monocytes x10x1033/ul/ul
0.10.1 ------
%% 11 11--1010
Eosinophils Eosinophils x10x1033/ul/ul
0.10.1 ------
%% 00 00--77
Basophils Basophils x10x1033/ul/ul
00 ------
%% 00 00--2.72.7
MCHC g/dlMCHC g/dl 3333 2626--3939
ReticulocyReticulocytes/ul tes/ul
------ ------
%% ------ ------
RDWRDW 12.112.1 ------
Platelets Platelets 101033/ul/ul
364364 260260--740740
MPV flMPV fl 7.57.5 ------
aQuesenberry KE, Donnelly TM, Hillyer EV. 2006. Biology, husbandry, and clinical techniques of guinea pigs and chinchillas. In Quesenberry KE, Carpenter JW (eds} Ferrets, Rabbits, and Rodents Clinical Medicine and Surgery 2nd ed.,243.
aQuesenberry KE, Donnelly TM, Hillyer EV. 2006. Biology, husbandry, and clinical techniques of guinea pigs and chinchillas. In Quesenberry KE, Carpenter JW (eds} Ferrets, Rabbits, and Rodents Clinical Medicine and Surgery 2nd ed.,243.
Erythrocytes with mild anisocytosis Erythrocytes with mild anisocytosis
Heterophils exhibiting hypersegmentation Heterophils exhibiting hypersegmentation of the nucleus of the nucleus
L l h i h K l ff b dL l h i h K l ff b d
Case 5 Hemic cytology
Large lymphocyte with a Kurloff bodyLarge lymphocyte with a Kurloff body
Stress responseStress response Normal total leukocyte count with a relative Normal total leukocyte count with a relative
heterophilia and lymphopeniaheterophilia and lymphopenia Heterophils with nuclear hypersegmentationHeterophils with nuclear hypersegmentation
Case 5 Hemogram interpretation
p yp gp yp g
The number of platelets is normalThe number of platelets is normal
A nonregenerative, normocytic, normochromic A nonregenerative, normocytic, normochromic anemia anemia Relative lack of polychromasia in the blood filmRelative lack of polychromasia in the blood film Normal MCV and MCHCNormal MCV and MCHC Marrow dysfunctionMarrow dysfunction
Case 5 Hemogram interpretation
Marrow dysfunctionMarrow dysfunction Lack of erythropoietinLack of erythropoietin Renal failureRenal failure Inflammatory diseaseInflammatory disease
Anemia of chronic disordersAnemia of chronic disorders
Endocrine disorderEndocrine disorder Such as, hypothyroidismSuch as, hypothyroidism
AzotemiaAzotemia Hypercalcemia and hypophosphatemia are Hypercalcemia and hypophosphatemia are
commonly finding in the blood profile of horses commonly finding in the blood profile of horses suffering from renal failuresuffering from renal failure
Case 5 Plasma chemistry interpretation
Markedly elevated plasma amylase activityMarkedly elevated plasma amylase activity A common finding in dogs and horses with renal A common finding in dogs and horses with renal
failurefailure
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Hypoalbuminemia with a normal globulin Hypoalbuminemia with a normal globulin concentrationconcentration Decreased production or increased loss of albumin Decreased production or increased loss of albumin
H k l i lik l i d i h d dH k l i lik l i d i h d d
Case 5 Plasma chemistry interpretation
Hyperkalemia likely associated with decreased Hyperkalemia likely associated with decreased urinary excretion of potassiumurinary excretion of potassium
Renal failure Renal failure
Guinea pig was euthanizedGuinea pig was euthanized Because of the poor prognosis of renal failureBecause of the poor prognosis of renal failure
Client elected not to pursue further diagnostic Client elected not to pursue further diagnostic testing and treatmenttesting and treatment
Case 5 Summary
testing and treatmenttesting and treatment
No necropsy was performedNo necropsy was performed
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Case 6Case 6
A six year old male castrated ferret A six year old male castrated ferret ((Mustela putorius furoMustela putorius furo) presented with a ) presented with a one day history of pawing at his mouthone day history of pawing at his mouth
Case 6 HistoryCase 6 History
At four yearsAt four years A left adrenalectomyA left adrenalectomy Partial pancreatectomy as treatment for an insulinomaPartial pancreatectomy as treatment for an insulinoma Treated for Treated for HelicobacterHelicobacter gastritisgastritis
During the past nine monthsDuring the past nine months Bilaterally symmetrical alopeciaBilaterally symmetrical alopecia
Signalling recurrence of adrenal disease Signalling recurrence of adrenal disease Second surgery or pursue medical treatment Second surgery or pursue medical treatment
Financial reasonsFinancial reasons Current treatmentCurrent treatment
Flutamide Flutamide
Case 6 HistoryCase 6 History
Housed with a female ferret of the same Housed with a female ferret of the same ageage Presented five days earlier showing similar Presented five days earlier showing similar
clinical signs of pawing at the mouthclinical signs of pawing at the mouthclinical signs of pawing at the mouthclinical signs of pawing at the mouth
Dx: insulinoma and hepatocellular disease of Dx: insulinoma and hepatocellular disease of unknown etiologyunknown etiology
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Case 6 Physical exam findingsCase 6 Physical exam findings
1.4 Kg1.4 Kg
Alert and activeAlert and active
1 cm diameter cutaneous mass1 cm diameter cutaneous mass Left flankLeft flank
Well delineated, reddened, partially devoid of Well delineated, reddened, partially devoid of hair with a central white areahair with a central white area
aColorado State University reference ranges.bFox JG. 1988. Normal clinical and biological parameters. In Fox JG ed. Biology and Diseases of the Ferret. Lea and Febiger, Philadelphia, 159-173.cCarpenter JW. 2005. Exotic Animal Formulary, 3rd ed. St. Louis; Elsevier Saunders, 464 (male fitch ferret).
aColorado State University reference ranges.bFox JG. 1988. Normal clinical and biological parameters. In Fox JG ed. Biology and Diseases of the Ferret. Lea and Febiger, Philadelphia, 159-173.cCarpenter JW. 2005. Exotic Animal Formulary, 3rd ed. St. Louis; Elsevier Saunders, 464 (male fitch ferret).
aNormal range provided by Colorado State University clinical pathology laboratory. http://www.cvmbs.colostate.edu/pathology/clinpath/2006%20Formulary.htmbFox JG. 1988. Normal clinical and biological parameters. In Fox JG ed. Biology and Diseases of the Ferret. Lea and Febiger, Philadelphia, 159-173.cCarpenter JW. 2005. Exotic Animal Formulary, 3rd ed. St. Louis; Elsevier Saunders, 464-465 (fitch ferret).
aNormal range provided by Colorado State University clinical pathology laboratory. http://www.cvmbs.colostate.edu/pathology/clinpath/2006%20Formulary.htmbFox JG. 1988. Normal clinical and biological parameters. In Fox JG ed. Biology and Diseases of the Ferret. Lea and Febiger, Philadelphia, 159-173.cCarpenter JW. 2005. Exotic Animal Formulary, 3rd ed. St. Louis; Elsevier Saunders, 464-465 (fitch ferret).
Increased Increased ClostridiumClostridium--like bacteria in like bacteria in fffecesfeces
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Case 6 Hemogram interpretationCase 6 Hemogram interpretation
Macrocytic, hypochromic erythrocytes in a nonMacrocytic, hypochromic erythrocytes in a non--anemic ferretanemic ferret Macrocytic erythrocytesMacrocytic erythrocytes
Lidocaine block (2 mg/Kg) around the Lidocaine block (2 mg/Kg) around the mass was made prior to surgical removalmass was made prior to surgical removal
Case 6 TreatmentCase 6 Treatment
Meloxicam (0.3 mg/Kg, PO, BID) for 3 daysMeloxicam (0.3 mg/Kg, PO, BID) for 3 days
Amoxicillin (11 mg/Kg, PO, BID) for 10 days for a Amoxicillin (11 mg/Kg, PO, BID) for 10 days for a potential clostridial overgrowthpotential clostridial overgrowthpotential clostridial overgrowthpotential clostridial overgrowth
