Gastrointestinal Diseases in the Ferret (Part II)

Katrina D. Ramsell Ph.D, DVM

(February 2004)

In this article I would like to discuss some of the common gastrointestinal (GI) diseases of ferrets more thoroughly.  In the previous issue, an overview was presented with a list of some ferret GI diseases as well as signs and symptoms to watch for when your ferret is suffering from an illness associated with the stomach or intestines.  Diseases discussed in this issue include ulcers, foreign bodies, and Epizootic Catarrhal Enteritis (ECE).  Other GI diseases such as inflammatory bowel disease, bacterial overgrowth of the intestines, and GI cancer will be discussed in an upcoming issue.

1. Ulcers – mouth, stomach, and intestines

GI ulcers are commonly observed in ferrets.  These are areas where there is an open sore in the mouth (oral ulcer), in the stomach (gastric ulcer), or in the intestines. These ulcers appear as reddish, raw areas and can sometimes bleed.  Oral ulcers often occur from self trauma when a ferret digs at its mouth with its front paws in response to nausea or a bad taste in the mouth. Nausea can occur from abdominal pain (for example from stomach ulcers or foreign bodies), from low blood sugar levels (observed with insulin secreting pancreatic tumors known as insulinomas), and from foul tasting medications such as Metronidazole (an antibiotic which is also know as “Flagyl”), certain preparations of prednisone, and Pepto Bismol to name a few.    The best way to treat oral ulcers is to fix the underlying problem (eg. raise blood sugar levels, remove a hairball in the stomach, stop giving bad tasting medications).  Antibiotics are frequently given to minimize secondary bacterial infections, and a medication called Carafate (sucralfate) can be given to help protect the ulcerated tissue and facilitate the healing process.  Trimming the front toenails to a short length is also very helpful and something that the owner can do at home.  If a foul tasting medication must be given, restraint of the ferret during and after administration of the medication can be helpful as well as giving a chaser (eg. Ferretone, Karo syrup) immediately after giving the medication.  In severe cases where the oral ulcer is severe, bleeding, and not healing with the usual treatments, the ferret must be anesthetized so that the ulcer can be chemically cauterized by your veterinarian.

Most stomach and intestinal ulcers are recognized when a ferret is having black or tarry stools.  The black color represents digested blood, and digested blood comes from the stomach and small intestine (occasionally it is from swallowed blood from an oral ulcer).  Blood from further down in the intestinal tract, such as from the colon, is usually more of a bright red color and is referred to as “frank” blood.  Ulcers associated with the stomach and intestines can be from a number of underlying problems such as foreign bodies, inflammatory bowel disease, stress, and infections.  It is an emergency if you see black or tarry stools from your ferret, and you should get your ferret to a veterinarian as soon as possible.  If a stomach or intestinal ulcer becomes deep enough, it can perforate through the lining of the stomach or intestine.  This can result in spillage of intestinal contents, including bacteria, into the abdominal cavity, and this can lead to peritonitis.  If this happens, your ferret may have only a few hours left to live.  The prognosis is very grave unless the “hole” can be surgically repaired, and often by this time, the ferret is not stable enough to survive surgery.  Treatment of the stomach and intestinal ulcers includes administration of Carafate (a drug that binds to ulcerated areas to protect them from stomach acid and promote healing) and antibiotics.  Medications such as ranitidine (Zantac) and omeprazole can be given to reduce stomach acid, which can also facilitate healing.Helicobacter is a type of bacteria that can produce stomach ulcers, and a combination of medications is given if aHelicobacter infection is suspected.  If a foreign body is suspected based on the ferret’s clinical signs, or if it is confirmed either by feeling an object or by seeing it on radiographs (x-rays), then the ferret is first stabilized and then the object can be removed surgically.  It is important to identify and treat GI ulcers in ferrets as early as possible, so take a good look in your ferret’s mouth occasionally (especially the roof of the mouth) and watch those stools!

2. Foreign Bodies

GI foreign bodies can be located anywhere along the GI tract.  Foreign bodies in the oral cavity are rare and can usually be observed by the owner.  An example of a temporary oral foreign body that does occur somewhat frequently is a piece of food that gets wedged against the roof of the mouth between the upper teeth.  The stomach is the most common site for a foreign body.  Gastric foreign bodies are usually rubbery objects (most commonly seen in young ferrets with a tendency for chewing on things such as shoe insoles, etc.) or hairballs (more often seen in older ferrets, especially those with inflammatory bowel disease).  Ferrets with gastric foreign bodies frequently do not exhibit any obvious signs, but if they do, signs can include nausea, tooth grinding, pawing at the mouth, vomiting, abnormal stools, weight loss, and lethargy.  Foreign bodies in the stomach can occasionally be felt by a veterinarian, but it can be extremely difficult to feel very soft objects such as hair and styrofoam.   Radiographs with a contrast dye called barium can sometimes help to visualize an object in the stomach, but sometimes mucous-coated objects are still difficult to see as the dye is unable to adhere to the object.  Ferrets exhibiting signs of a possible gastric foreign body should have blood work done, as there are some blood chemistry values that can help determine if there is irritation or damage being done to the stomach lining.  Signs associated with a gastric foreign body usually resolve upon removal (usually surgical) of the object from the stomach.

Intestinal foreign bodies usually result in drastic, obvious signs, as nothing is able to pass through the GI tract.  Often a ferret with an intestinal blockage will not want to eat, will vomit anything it does eat or drink, can have some diarrhea but generally has decreased fecal output, and they can have a painful, distended abdomen.  Unless the object passes on its own, and does so relatively quickly, the ferret will usually become very lethargic, get “shocky” (more mentally dull, low body temperature, low blood pressure, etc.), and will get progressively worse in a matter of hours or a couple of days at best.  It is rare for an intestinal foreign body of any significant size to pass all the way through the intestines on its own.  The object must frequently be removed surgically, and the ferret’s prognosis is greatly dependent on how stable the ferret is going into surgery.

Prevention of foreign bodies can be accomplished to a certain degree.  Obviously, restricting a ferret from access to any soft, rubbery or chewy objects can be extremely helpful.  Hairballs can be somewhat prevented by brushing or plucking loose hair from a shedding ferret.  Washing bedding frequently, especially when a ferret is shedding heavily can also be helpful, as bedding can collect hair which can be potentially ingested.  Hairball laxatives can also be useful in preventing hair from accumulating in the stomach.  Some ferrets with significant inflammatory bowel disease, especially in the stomach, can have reduced gastric motility and may be at higher risk for retention of hair and subsequent hairballs.

3. Epizootic Catarrhal Enteritis (ECE) – “Green Slime Diarrhea”

ECE is an important disease to discuss, as it appears to affect a vast number of ferrets not only in ferret shelters but also in many households.   This disease appeared on the East coast in 1993 and seemed to follow shows around that region.  It rapidly spread across the U.S., likely as a result of large-scale breeder facilities infected with the disease.

The causative agent of ECE is a coronavirus.  The virus is unusual in that younger ferrets have fewer clinical signs than older ferrets.  Ferrets under 4 months of age often show no signs of the disease.   Ferrets 4-18 months old usually show mild to moderate signs, and older ferrets, especially those over 4 years of age when first exposed, appear to suffer the most and have the most severe signs associated with ECE.  The virus can remain in the intestinal tract for months after all signs have resolved.  This produces what is referred to as a “persistent carrier” which is highly contagious for up to 6 months or more.

A typical history includes recent exposure to a new, young ferret.  This can include going to a pet store to play with the baby ferrets, and then returning home to interact with your ferrets without proper sanitation in between. Onset of clinical signs is typically 48-96 hours.  Affected ferrets are often initially anorexic and lethargic.  They then often produce a green, mucoid diarrhea, often referred to as bright or neon green diarrhea.  The diarrhea is not always green however, and can just be very loose and/or birdseed like.  Very mild cases may show only brief diarrhea.  Severe weight loss can be observed, and loss of body fat and muscle can be extreme within the first 7-10 days, even if the ferret is initially still eating well.  The ECE virus affects the lining of the intestine, making it difficult for the ferret to absorb nutrients and fluids appropriately.  The virus can also cause damage to the intestine in such a way that the ferret actually can loose protein, and therefore nutrients, from their gut.  Even after appearing to recover from ECE, some adult ferrets have persistent, intermittent diarrhea that is often “seedy”  (seedy stools indicate food that has not been completely processed, digested, and absorbed).  These ferrets can show clinical signs for weeks or even months, and changing the diet to one that is more easily absorbed (eg. Science Diet z/d) can sometimes facilitate recovery and help them maintain their body condition.

Although fewer ferrets seem to die from ECE these days, many ferrets (especially middle to older aged ferrets) still need to be treated.  Sick ferrets should be treated with antibiotics and supportive care, and some ferrets, especially those that become dehydrated should be treated with aggressive fluid therapy.  It is important to keep sick ferrets eating.  Well-balanced, palatable foods such as Science Diet a/d may be easily syringe fed if the ferret is not eating very well on its own.  High caloric supplements may also be given, such as Nutrical or the human products Deliver 2.0 or Ensure.

Ill and recovered animals should be isolated from unexposed ferrets for 6-12 months.  Pets already exposed are most likely now carriers, even if they are not showing signs.  Extreme care must be taken not to transmit the virus on clothing, especially in shelter and hospital situations.  All young ferrets should be treated as potential ECE carriers, and good sanitation habits, such as disinfecting hands, clothes, and cages, must be practiced to help minimize the spread of this highly contagious disease.