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Ferret Has Elevated Liver Enzymes

Is it a concern if a ferret that was ill now acts normally but still has elevated liver enzymes?

By Karen Rosenthal, DVM, MS
Posted: January 1, 2012, 5 a.m. EST

Q: I have a 3.5 year-old, male ferret. The only illness he has had was a possible ulcer eight months ago, but he responded to treatment and was fine. About three weeks ago all he would do is sleep. He was very lethargic. He would get up, eat a little, take a few sips of water and then go back to sleep again. I took him to the veterinarian and he was tested for insulinoma, but it was negative. His blood test showed elevated liver enzymes. We redid the test last week and it shows the liver enzymes have risen again. My vet is stumped. He is considering an ultrasound and a procedure that uses a needle to take a few cells from the liver. Since last week, though, my ferret is completely back to normal. He is playing, eating, drinking and going to the bathroom like he did before. It is like he had a bug and is now over it. The only worry is the elevated liver enzymes. Do you have any idea what my vet should look for or what we should do?

A: Your veterinarian has made some excellent suggestions for your ferret. The liver has many functions and can be affected by numerous conditions including infections, toxins and cancer. Many of these conditions cause different degrees of liver dysfunction that vary from mild changes to fatal liver failure.

In the early stages of liver disease, there may be no way to discern which type of condition is present in your ferret without some slightly invasive diagnostic testing. Liver analytes (sometimes called enzymes) on the biochemistry panel can alert us that the liver is not healthy, but this cannot tell us exactly what is causing the liver dysfunction. Radiographs can tell us if the liver is enlarged but not what is causing the enlargement.

In extremely severe liver dysfunction, the liver is unable to remove and eliminate contaminates from the bloodstream. When these contaminates reach a high enough level in the bloodstream, a ferret becomes very sick and the skin and membranes take on a yellowish hue. At that point, the liver is so unhealthy that it can be difficult to reverse the course of illness. Therefore, the goal of veterinarians is to make a diagnosis during the early stages of liver disease and begin treatment so the liver can regain most, if not all, of its previous function.

An abdominal ultrasound reveals much about the changes to the appearance of the liver but not exactly what is causing those changes. By inserting a very thin needle into the liver, using ultrasound to guide its placement, it is possible to remove hundreds of thousands of liver cells and view them under a microscope to aid in making a diagnosis.

Your question, though, is a very good one. If your ferret is improving, should you do this test? A needle, albeit a very thin one, will be inserted into your anesthetized ferret, which is a risk, although a very small one. The easy way to answer your question is that ferrets have a remarkable ability to adapt to illness and they can appear to be well even if they are still sick. I suggest that you revisit your veterinarian and if he/she feels there is still a danger of liver disease, then it makes sense to do the liver test to make sure the disease is not still present or has progressed.

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Reader Comments
Hi Yumi, Glad that your ferret is doing better! Thank you very much for the detailed post.
Marylou, Irvine, CA
Posted: 9/19/2012 10:56:44 AM
My 5 year old male neutered ferret with adrenal gland disease suddenly became lethargic and his urine became orange overnight (found out because we use puppy training pad for lining my ferrets' bathrooms) and his stool soft but not diarrhea. He seemed to have become dehydrated and probably ate only a tbsp of kibbles by the next morning. He urinated but defecated once only a tip-of-a-pinky size that was normal hardness. We went to UT vet around noon as emergency patients.

1st day: He had CBC/Chemistry, Ultrasound (since this for his adrenal gland was due in few weeks anyways), Urinalysis, Radiographs done that day and stayed at the hospital due to tests being done late and doing the CBC again the following day.

The results from the first day showed that his Chemistry was 8/29 and ALT 2396 and Bilirubin 8.8, which were all high. The images did not show any sign of infiltration problem or cyst or mass in his liver or gall bladder, and thankfully, his adrenal gland have stayed very similar in size as the last image. All of his other glands were functioning well and no lymph nodes or prostate was enlarged. The gall bladder and common bile duct were moderately distended. That night, they gave him fluids and milk thistle.

2nd day: The vet and the medical team suspected that this could highly likely be cholangiohepatitis or other liver insult (toxin, infection, other inflammatory process). Therefore, instead of performing liver biopsy that was initially planned,they performed liver and gall bladder aspirate. He had another CBC/Chemistry done to check his platelets again and chemistry had gone down to 8/30 and ALT to 1643, Bilirubin was 9.0. However, by this time, he had lost 0.4lbs.

He was then put on a treatment, clavamox and ursodiol, while we waited on the results from the aspirate, and came home that day. That night, he was in pain from the illness and also from getting bruised from the aspirate and urinalysis, and refused to eat or drink and was very lethargic. I gave him clavamox and urisodiol fed water with a syringe. He urinated soon after and this time, his urine had a lighter orange color than before. He drank water on his own after that, but still refused to eat. I grounded up his kibble and added luke warm water to make a paste and put some on his mouth, which he ate about 2tsp each time. This feeding continued every 3-4hrs until the next morning. Then he started eating on his own around noon and seemed a little more energetic.

Results from the aspirate came back, and as suspected, he had bacterial infection in his gall bladder. It turned out to be enterococcus gallarinum and got on ursodiol, clavamox, and milk thistle for 6wks. His bloodwork turned out normal after one week of treatment, and waiting for the next bloodwork at the end of the treatment.

Thanks to the UT vets, he is doing great so far and has the energy back again!

Hope this information helps other ferrets with similar symptoms!
Yumi, Knoxville, TN
Posted: 9/18/2012 9:41:44 AM
My 4 year old ferret recently tested with elevated ALT and was dehydrated. He too is losing muscle mass and lost 6 ounces in two months. Ultrasound revealed no masses so a liver biopsy was done and returned with no neoplastic cells. He had been to six different vets in almost three years over a hacking cough being treated for everything from hairballs, nasal allergies and asthma. He improved each time on steriods and/or antibiotics but symptoms always returned. In Jan it was found he had an enlarged heart but nothing severe enough to warrant meds. My current exotic specialist just submitted a throat culture which showed Methicillin Resistant Coagulative Negative Staph infection. She suspects all along this may have caused the heart and liver damage. He is now on six weeks of Orbax along with SamE and Milk Thistle for his liver. Any other suggestions of what we can do to eradicate the MRCoNS before it depletes all his organs? Is there any chance of a full recovery?
Susan, Odessa, TX
Posted: 7/16/2012 11:17:52 AM
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