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com
Companion animal practice
Brigitte Lord graduated from
the Royal Veterinary College in
2002. After a period in exotic and
small animal practice, she spent
time at the Royal (Dick) School of
Veterinary Studies in Edinburgh
and the University of Bristol/
Bristol Zoo, and ran a rabbit and
exotics veterinary referral service in
south-west England. She returned
to Edinburgh in 2008 as a lecturer
in rabbit medicine and surgery,
and is now head of the universitys
exotic animal handling facility.
She is also the veterinary adviser
for the British Rabbit Council.
She holds the RCVS certificate
in zoological medicine and is
currently working towards the
diploma in zoological medicine.
doi:10.1136/inp.e328
90 In Practice February 2012 | Volume 34 | 9096
Gastrointestinal disease in rabbits
1. Gastric diseases
Brigitte Lord
Gastrointestinal diseases in rabbits are being recognised with increasing
frequency. A pet rabbit presented with anorexia, weight loss, changes
in defecation and depression can present a diagnostic and therapeutic
challenge for the clinician. Diet- and stress-related problems predominate,
and preventive treatment plays a large role in managing these conditions.
However, gastric ulceration and bacterial, viral, parasitic, idiopathic and
neoplastic diseases are also seen frequently in pet rabbits. This article
provides an overview of the common gastric conditions seen in rabbits,
including their diagnosis and the options for treatment. The common causes,
diagnosis and approach to the management of intestinal diseases will be
discussed in an article to be published in the March issue of In Practice.
History and physical examination Diagnostic approach
When presented with a rabbit with gastrointestinal A presumptive diagnosis may be possible based on
disease, it is important to obtain a complete history, as the history and clinical signs. However, rabbits
this may indicate the duration and severity of the dis- presenting acutely depressed or with chronic gastro
ease. Young rabbits are more likely to develop bacterial intestinal disease will need a complete diagnostic
or parasitic disease and, unlike other species, are also work-up.
more likely to be affected by neoplasia. The feeding his-
tory is often of value, as it may draw attention to dietary Faecal examination
indiscretions or an inappropriate diet being fed. Gross faecal inspection
The owner should be asked about: If the rabbit is producing faeces, a sample should be
The duration of anorexia, decreased defecation or assessed for size, shape and consistency. Normal
diarrhoea, as appropriate; hard droppings are typically 5 to 10 mm in diameter,
The appearance of the rabbits faeces; although this may vary with the size of the animal.
Whether there are uneaten caecotrophs in the They have a regular spherical shape, are easily crum-
rabbits housing; bled and contain visible undigested fibre (Fig 1). In
Whether signs of abdominal discomfort (eg, press- contrast, abnormal hard droppings are smaller, irregu-
ing the abdomen to the floor, flinching or bruxism) larly shaped and firm (Fig 2).
are apparent; A normal caecotroph is a mucus-coated cluster
Whether the rabbit has lost weight. of soft spheres (similar in appearance to a bunch of
Rabbits do not vomit, as they have a well-
developed cardiac sphincter and lack a vomit centre
in the brain.
It is also important to perform a complete physi-
cal examination. Abdominal palpation is particularly
useful in rabbits and may reveal abnormalities such as
dough-like contents of the stomach and/or caecum,
a gas- or fluid-filled stomach or bowel loops, or the
presence of a neoplasm, intussusception or ascites.
Auscultation of the abdomen should be carried out to
assess the gut sounds. These are intermittent and their
absence should not be over-interpreted.
The possibility of an extra-gastrointestinal disease
should also be considered; for example, a thorough
Fig 1 (left): Normal hard rabbit droppings have a
oral examination, under sedation if required, should
regular spherical shape.
be carried out to rule out dental disease as a primary Fig 2 (right): Abnormal hard droppings are smaller
or complicating factor. than normal droppings and have an irregular shape
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Fig 3: A normal caecotroph consists of a mucus-coated
cluster of soft spheres
grapes); however, the shape may be distorted if the
rabbit has sat or stood on it (Fig 3). Caecotrophs are
normally ingested by the rabbit directly from the anus,
so they should be seen only occasionally. Abnormal
caecotrophs may be liquid and diarrhoea-like, or large
and voluminous, similar in appearance to cat faeces.
Faecal examination for parasites
Examination of direct smears of fresh faeces, or of
faeces suspended in 09 per cent sodium chloride, may
reveal the eggs of the nematode Passalurus ambiguus,
which are intermittently shed. Adult worms may also
be identified in fresh faecal smears. Normal caecal
protozoa may also be seen. Flotation techniques may
be necessary to identify coccidia and Cryptosporidium
species oocysts. Examination of these preparations
at a magnification of x1000 will be required to iden-
tify Cryptosporidium parvum as it is the smallest
of the coccidians. The use of immunofluorescence
and acid-fast stains will improve the sensitivity of
faecal examination as a diagnostic test.
Faecal bacterial culture
Bacterial pathogens of rabbits that may be cul-
tured from the faeces include Salmonella species,
Pseudomonas aeruginosa, Lawsonia intracellularis and
Yersinia pseudotuberculosis.
Faecal occult blood test
A faecal occult blood test can be useful in indicating
the possibility of a disorder that causes haemorrhage,
such as gastrointestinal ulceration.
Haematology, serum biochemistry
and urinalysis
Haematology may yield valuable additional informa-
tion. Suitable sites for blood sampling include the lat-
eral metatarsal vein (Fig 4), marginal ear vein, jugular
vein and cephalic vein. Normocytic and normochromic
anaemia are sometimes associated with chronic disease
or malnutrition. Microcytic hypochromic anaemia may
be found in rabbits with iron deficiency due to chronic
blood loss such as that associated with gastrointestinal
ulceration. Generalised leucoc ytosis or lymphocytosis
is suggestive of lymphoma and leukaemia.
Serum biochemistry and urinalysis can help to rule
out metabolic disorders such as renal failure and liver
disease.
Companion animal practice
Fig 4: The lateral metatarsal
vein is a suitable site for
blood sampling in rabbits. The
use of a butterfly catheter
will minimise movement of
the needle and so reduce
haematoma formation
Plain and contrast abdominal radiography
Plain abdominal radiographs may reveal signs com-
patible with ileus, obstructive bowel disease or ascites.
The use of upper gastrointestinal barium and/or a
barium enema can demonstrate neoplasia and severe
infiltrative disease.
Ultrasonography
Ultrasonography can be useful in assessing gastro
intestinal tract motility and the thickness of the
gastric and intestinal walls, and in identifying the
presence of neoplasms. However, the large amount of
gas that is often present in the gastrointestinal tract
of an abnormal rabbit can limit the usefulness of
ultrasonography.
Endoscopy and laparoscopy
Endoscopy of the distal colon can be very rewarding.
However, the stomach normally contains food and
fur, which can limit endoscopy of the stomach. The
tight pyloric sphincter of rabbits prevents endoscopy
of the small intestines.
Laparoscopy is also a useful technique in rabbits,
and can be used to inspect the whole bowel. As it is a
minimally invasive technique, it is associated with less
postoperative pain and a shorter recovery period than
more invasive procedures such as laparotomy. Rabbits
have a thin abdominal muscle wall, so it is important
to use threaded instrument ports that are secured with
a purse-string suture to maintain a seal and prevent
port slippage (Fig 5).
Fig 5: Laparoscopy of a
rabbit. The use of threaded
instrument ports will reduce
port slippage through the
thin abdominal muscles
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Companion animal practice
Intestinal biopsy
Samples of the mid- to distal small intestines, liver,
pancreas and mesenteric lymph nodes can be obtained
during endoscopy or laparoscopy. Laparotomy allows
similar biopsies to be taken but, as described above,
is a more invasive procedure. In addition, the forma-
tion of postoperative adhesions may increase the risk
of chronic ileus developing.
Response to treatment
A rabbits response to treatment may be useful in
helping to establish certain tentative diagnoses. For
example, a positive response to feeding a high-fibre
diet consisting only of hay, water and a high-fibre
recovery diet (eg, Critical Care; Oxbow) may help
to confirm a diagnosis of gastric stasis or ileus, while
a combination of fluid therapy, supportive nutri-
tion and treatment with gastroprotectants might be
used in suspected cases of gastric ulceration (see
below).
Diseases of the stomach
Gastric stasis and ileus
Gastric stasis is primarily an acquired disorder caused
by decreased motility of the stomach. Generalised ileus
is a common continuation of this condition, which may
arise as a result of mechanical obstruction or defective
propulsion. Mechanical obstruction (eg, due to the
presence of dehydrated, impacted ingesta secondary
to chronic dehydration, foreign bodies or infiltrative
lesions) will cause delayed emptying of the stomach.
Defective propulsion is seen in cases with defects in
the nerves or smooth muscles of the gastrointestinal
tract.
Table 1: Clinical differentiation of non-obstructive and obstructive ileus
Clinical finding Non-obstructive ileus Obstructive ileus
Attitude Bright and alert May initially appear bright, but
rapidly becomes depressed
Appetite Gradually reducing appetite Acute anorexia
Faecal volume and size Gradually reducing size and Acute history of no faeces
of droppings number of droppings being produced
A B
Fig 6: Lateral (a) and dorsoventral (b) abdominal radiographs from a rabbit, showing a gas halo around compacted
material in the stomach lumen. There is also excessive gas in the intestines
92 In Practice February 2012 | Volume 34 | 9096
Primary factors include:
Anorexia;
Feeding a high-carbohydrate/low-fibre diet;
Post-surgical adhesions;
Lack of exercise;
Toxin ingestion (most commonly lead).
Secondary factors include:
Pain;
Environmental or emotional stress. For example:
The presence of predator species or a dominant
rabbit;
Changes in routine;
Transport;
Extremes in temperature or humidity.
Anorexia and chronic dehydration can be both
causal factors and consequences of gastric stasis
and ileus. Systemic dehydration will lead to the gut
contents becoming dehydrated and the impaction of
normal stomach contents, which include loose hair
lattices or trichobezoars.
Diagnosis
The history and clinical findings of a firm, dough-like
stomach on palpation allow a presumptive diagnosis
of gastric stasis and ileus, and are suggestive of non-
obstructive disease (see Table 1). In advanced cases, it
may not be possible to differentiate between obstruc-
tive and non-obstructive stasis and ileus. Plain radi
ography in early cases will reveal a mass of hair and
food with a similar appearance to normal ingesta. As
the impaction in the stomach and, occasionally, cae-
cum develops, a gas halo is often seen around the com-
pacted material (Fig 6). A definitive diagnosis can be
made only on exploratory laparoscopy or laparotomy,
but these are high-risk procedures in these patients,
which are likely to be already metabolically unstable.
Treatment and prognosis
In rabbits with non-obstructive ileus, aggressive medi-
cal management is required to prevent further deterior
ation and death. Patients with obstructive ileus will
require surgery (see section on obstruction below).
Hepatic lipidosis is a common complication and cause
of death in rabbits with prolonged gastric stasis and
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Companion animal practice

ileus. Rehydration of both the patient and its stomach

contents, using both oral and intravenous fluids, may
be required, depending on the severity of the stasis or
ileus.
The use of analgesics, such as partial or full
opioids in the first instance and, once the patient has
been rehydrated, non-steroidal anti-inflammatory
drugs (NSAIDs), is also appropriate (see Table 2).
Prokinetics should be used to stimulate gastro
intestinal motility. Ranitidine, which has prokinetic
effects equal to those of cisapride (another prokinetic
agent) as well as antacid actions, is, in the authors
opinion, very useful in the treatment of gastric stasis
and ileus (Redfern and others 1991). Metoclopramide
is another option, but it is not as potent a prokinetic as
ranitidine, and its actions are limited to the proximal
gastrointestinal tract. Another prokinetic, domperi- Fig 7: Rabbit with a nasogastric feeding tube in place.
This animal did not need an Elizabethan collar
done, has been found to be very effective at stimulat-
ing contractions in the large intestines of rabbits, and
can be a good alternative in cases that respond poorly tube without the need to be fitted with an Elizabethan
to ranitidine or metoclopramide (Li and others 2009). collar; this will also enable eating and caecot rophy,
Nutritional support can be provided by syringe and is less stressful for the animal (Fig 7). Blended
feeding a commercially available high-fibre recovery and strained food can be fed via the tube. Flushing the
diet (eg, Critical Care; Oxbow) or pureed leafy vegeta- tube with 5ml of water before and after each feed will
bles and grass, four to five times a day. This helps to help to keep the tube patent. Nasogastric tubes can be
reverse the negative energy balance that will develop left in place for several days. Prophylactic antibiotic
in rabbits with gastric stasis and stimulate motility. treatment is recommended for these patients to help
A wide variety of fresh vegetation should be offered prevent rhinitis, which may develop if the nasal tissue
daily to encourage the rabbit to eat. was traumatised during tube placement.
In some cases, for example, a rabbit that resists Rehydration of patients with gastric stasis or ileus
being syringe fed, feeding via a nasogastric tube may is likely to be more beneficial than treatment with
be required. Nasogastric tubes can be easily placed liquid paraffin, papain enzyme, pineapple juice or
in a conscious calm or weak rabbit, in a similar man- bromelain, which may cause dysbiosis. Due to the
ner to that used in cats. It is advisable to radiograph tight cardiac sphincter of rabbits, it is debatable how
the patient after placing the tube to check that it is effective treatment with simeticone or dimeticone
in the correct position. Some rabbits will tolerate the would be in dispersing gastric gas.

Table 2: Drugs used in the treatment of gastric disease in rabbits

Dose and route of administration Comments
Analgesics
Carprofen 4 mg/kg every 24 hours, po or sc
Buprenorphine 003 to 005 mg/kg every 6 to 8 hours, po, iv, sc or im
Butorphanol 03 to 05 mg/kg every 4 to 6 hours, iv, sc or im
Morphine* 2 to 5 mg/kg every 2 to 4 hours, sc, im or iv
Pethidine* 5 to 10 mg/kg every 2 to 3 hours, sc or im
Prokinetics
Ranitidine* 4 to 6 mg/kg every 8 to 12 hours, po or sc Has a concentration-dependent prokinetic effect in rabbits
Metoclopramide* 05 mg/kg every 4 to 12 hours, po or sc Not as potent as ranitidine
Domperidone* 05 mg/kg every 12 hours, po
Treatments for gastrointestinal ulceration
Bismuth subsalicylate 03 to 06 ml/kg, po
Omeprazole 4 mg/kg every 24 hours, po Very effective at reducing acid production in rabbits
(Lee and others 1996, EMEA 2002)
Ranitidine* 4 to 6 mg/kg every 12 hours, po or sc Weaker effect of acid reduction than omeprazole
Sucralfate* 25 mg/kg every 8 to 12 hours, po Provides local protection. Not absorbed
Fluid therapy
Dextrose Add to maintenance fluids to make a
25 to 50 per cent solution, iv or io
Hartmanns solution 100 ml/kg/day maintenance rate,
100 ml/kg/hour shock rate, iv or io
Potassium chloride* 10 to 15 mmol/500 ml maintenance fluids, iv or io
im Intramuscularly, io intraosseously, iv intravenously, po orally, sc subcutaneously
*Not licensed for use in animals, so the prescribing cascade must be followed

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Companion animal practice
Gastric obstruction
Ingested objects such as matted hair, carpet, plastic
or rubber can pass down a rabbits oesophagus and
become a gastric or intestinal foreign body. The pylorus
is a common site of obstruction, and material or objects
lodged in this area can obstruct gastric outflow.
Rabbits with gastric obstruction may be asympto-
matic or show anorexia initially until acute abdominal
pain and hypovolaemic shock rapidly develop (within
24 to 48 hours). Death often occurs within 24 to 48
hours after acute abdomen develops. Liver lobe torsion
is the main differential diagnosis of acute abdomen in
rabbits (Wenger and others 2009).
Diagnosis
In patients with a gastric obstruction, the clinical signs
are usually indicative of the problem. Obstructions
can rarely be detected on abdominal palpation alone,
which in itself has a high risk of causing trauma to
the distended stomach and the liver, which may be
friable secondary to hepatic lipidosis. Plain and con-
trast radiographs can be difficult to interpret because
Box 1: Anaesthesia of rabbits for gastric surgery
The principles of good anaesthesia are to:
Provide excellent perioperative care;
Select agents suitable for the individual patient;
Ensure that the airway can be maintained and intermittent positive pressure
ventilation can be given in an emergency;
Ensure that intravenous access is available to enable intraoperative fluid therapy and
emergency drug administration;
Increase fluid therapy to 10 ml/kg/hour during anaesthesia.
Premedication and induction
It is vital to select a suitable anaesthetic regimen for a critically ill rabbit. The use of
a2-adrenoceptor agonists is contraindicated in these patients. Premedication with 02
to 03 ml/kg fentanyl/fluanisone administered intramuscularly, followed by induction
with 02 mg/kg midazolam given intravenously to effect 10 minutes later, will provide
a smooth induction and good muscle relaxation, facilitating endotracheal intubation.
Intubation
The rabbit should be preoxygenated before being intubated with a 2 to 35 mm
endotracheal tube using the blind or visual technique (Longley 2008). Applying a
lidocaine spray (eg, Intubeaze; Dechra Veterinary Products) to the glottis before
attempting intubation may reduce laryngeal spasm.
Maintenance
Anaesthesia should be maintained using an inhalational agent such as isoflurane or
sevoflurane. The use of local anaesthetic agents (eg, lidocaine or bupivacaine; see below)
will reduce the dose of general anaesthetics required, thus reducing the side effects of
these agents.
Analgesia
Local anaesthetic agents are very useful for providing local analgesia and can also provide
good postoperative analgesia. Bupivacaine (1 mg/kg) and lidocaine (1 mg/kg), when used
in combination, provide rapid-onset local anaesthesia and analgesia of long duration. The
maximum doses that should be used in rabbits are 2 mg/kg bupivacaine and 10 mg/kg
lidocaine. These agents can be injected into the midline skin and abdominal muscle at
the site of the incision. The rabbit can be given a top-up dose of 2 mg/kg morphine,
administered intravenously or intramuscularly, if additional analgesia is required during
longer surgical procedures; this can be repeated during surgery if required.
Reversal of anaesthesia
At the end of the procedure, the fentanyl/fluanisone can be reversed by giving 05 mg/kg
butorphanol, and the midazolam can be reversed with 005 mg/kg sarmazenil, both
administered intravenously. A dose of 005 mg/kg buprenorphine should be given two
hours after reversal, as butorphanol has a short half-life in rabbits, but is more effective
than buprenorphine at antagonising the fentanyl/fluanisone.
94 In Practice February 2012 | Volume 34 | 9096
ingesta are normally always present in the stomach
and caecum of rabbits. In addition, if barium contrast
agent is used, it may be recirculated if coprophagy/
caecotrophy occurs. In most cases, an exploratory
laparotomy is required to confirm the diagnosis.
Treatment and prognosis
Gastric obstruction is a life-threatening condition that
requires aggressive treatment. It is essential to stabilise
the rabbit before performing a gastrotomy to maxi
mise the chances of a successful outcome. Analgesia,
intravenous or intraosseous crystalloid fluids at
shock rates and systemic broad-spectrum antibiotics
should be administered. Prokinetics are contraindi-
cated in patients with an obstructive condition before
surgery, but are useful postoperatively to stimulate
gastrointestinal motility. Gastric decompression via
a nasogastric or orogastric tube should always be
attempted.
Where possible, the patients serum electrolyte
concentrations and acid-base status should be evalu-
ated, as acidosis and/or ketosis may be present. Systolic
arterial blood pressure should be measured using the
same technique as that employed for cats; the refer-
ence range for systolic blood pressure in rabbits is
927 to 135 mmHg (Reusch 2005). Fluid therapy
has been used to correct hypovolaemia in rabbits
following the same principles as those used in cats
and dogs.
Anaesthesia
Rabbits have an unnecessary reputation for being
difficult to anaesthetise. However, paying careful
attention to all aspects of the patients perioperative
care, addressing stress and treating underlying disease
will optimise the safety and success of anaesthesia (see
Box 1).
Surgery
Rabbits can be challenging surgical patients, but the
chance of a successful outcome can be maximised by
ensuring:
A good knowledge of the regional anatomy;
Adequate preparation of the patient;
The availability of suitable instrumentation;
That steps are taken to minimise the pain, fear and
stress experienced by the animal.
The basic principles of surgery in rabbits are the
same as those described for other domestic species.
However, the surgical techniques and considerations
may need to be modified to account for the unique
anatomy, physiology and behaviour of this spe-
cies. Box 2 outlines the procedure for performing a
gastrotomy in rabbits.
Postoperative care
The use of NSAIDs postoperatively has been shown to
minimise the development of postsurgical adhesions.
The rabbit should continue to receive supportive treat-
ment for ileus, as described above. The prognosis is
guarded to poor, as most rabbits with gastric obstruc-
tion have severe hepatic lipidosis, acidosis and ketosis.
They are also likely to have severe gastric ulceration,
which can progress to perforation with subsequent
peritonitis. If perforation occurs, the prognosis is
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Box 2: Step-by-step guide to
gastrotomy in rabbits
Step 1. Make a standard midline incision. As
the abdominal muscles and linea alba are very
thin, care must be taken to avoid lacerating the
abdominal organs on entering the peritoneal cavity
Step 2. Explore the abdomen fully
Step 3. Partially exteriorise the stomach. The
abdomen should be packed adequately to prevent
contamination
Step 4. Place stay sutures at the proposed incision
site. The incision should be made in a non-vascular
site along the greater curvature or between the
greater and lesser curvatures of the stomach
Step 5. Inspect the stomach contents, and visually
identify and remove any foreign material causing
an obstruction
Step 6. Close the stomach with one layer of sutures
placed in a simple continuous pattern followed
by another layer in an inverting pattern. Only
absorbable synthetic monofilament suture material
(eg, polydioxanone [PDS II; Ethicon]) should be used
for surgery in rabbits, as this species is very prone to
forming adhesions
Step 7. Close the linea alba using a continuous or
interrupted suture pattern
Step 8. Finally, close the skin with a simple
continuous subcuticular pattern
grave. Aggressive and early treatment will improve
the chances of the animal recovering.
Gastric ulceration
Gastric ulceration is a relatively common finding on
postmortem examination of rabbits. In patients with
gastric ulceration, other clinically significant disease
(eg, anorexia, enteritis, typhlitis, intussusception,
gastric impaction and bronchopneumonia) or peripar-
turient death are common. The prevalence of the con-
dition increases with age and it is seen more commonly
in female rabbits than males. Stress for example, as
a consequence of another disease has been suggested
as an aetiology for gastric ulceration. Perforation and
subsequent peritonitis have been found in 70 per cent
of rabbits with pyloric ulceration (Hinton 1980).
Anorexia and signs of pain, such as bruxism and
reluctance to move, can be the principal signs of gastric
ulceration. Melaena is rare in rabbits. In some cases,
clinical signs due to anaemia and hypoproteinaemia
may be seen (eg, pale mucous membranes, dyspnoea,
weakness, collapse and shock). Some ulcers may perfor
ate and then seal rapidly by forming adhesions, leading
to the development of abscesses within the gastric wall
(Fig 8).
Diagnosis
Signs of acute abdomen and sepsis may be observed
in rabbits with perforation and peritonitis, and there
may be evidence of peritonitis on plain radiography.
Ultrasonography can be useful in detecting thicken-
ing of the gastric wall, which may be associated with
chronic ulceration or abscessation. Endoscopy is the
most sensitive and specific tool for diagnosing gastric
ulceration in other species but, in rabbits, visualisa
tion of the gastric wall will be very limited due to the
ingesta normally present in the stomach.
Companion animal practice
Fig 8: Perforated gastric ulcer
in a rabbit that has healed
by adhesion but has started
forming an abscess within the
gastric wall. This was found
during exploratory laparotomy.
(Picture, K. Eatwell)
Treatment and prognosis
The treatment of gastric ulceration will depend on the
severity of the condition and whether the underlying
cause has been detected. As discussed earlier, rabbits
with gastric perforation and peritonitis have a grave
prognosis. Symptomatic or prophylactic treatment
could be considered in higher-risk cases such as female
rabbits in late gestation, or patients with anorexia,
enteritis or chronic disease. This involves decreasing
the production of stomach acid, protecting the ulcer-
ated mucosa, and providing fluid therapy, analgesia,
broad-spectrum antibiosis and supportive nutrition.
Gastric neoplasia
Primary tumours such as adenocarcinoma and leio
myosarcoma of the stomach have been reported in rab-
bits. Lymphoma is the most common tumour of male
rabbits and the second most common in female rabbits,
after uterine adenocarcinoma, and has been found to
infiltrate the stomach. Metastatic haemangiosarcoma
has also been seen in the stomach. There is a wide age
range in reported cases, although juvenile and young
adult rabbits appear to be predominantly affected.
Clinical signs shown by rabbits with gastric tumours
can include anorexia, depression, cutaneous nodules
(in cases of lymphoma), pallor, emaciation and per
ipheral lymphadenopathy. Some rabbits may show no
signs until the disease is advanced and sudden death
occurs. The duration of illness may range from one
week to 10 months.
Diagnosis
Iron deficiency anaemia and lymphocytosis, includ-
ing immature and atypical lymphocytes, have been
described in cases of lymphoma in rabbits. Bone
marrow biopsies may be required in suspicious cases
that have lymphocytosis without circulating atypical
lymphocytes. Plain and contrast imaging may reveal
gastric wall thickening. Ultrasound-guided fine needle
aspiration of thickened lesions in the gastric wall may
produce cytological preparations that are diagnostic.
However, an exploratory laparoscopy or laparotomy
to examine the stomach and take biopsies for histo-
logical evaluation are usually required for a definitive
diagnosis.
Treatment and prognosis
Most cases of adenocarcinoma are likely to be too
advanced for surgical resection, and these patients
have a grave prognosis.
In Practice February 2012 | Volume 34 | 9096 95
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Companion animal praCtiCe
Various chemotherapy and radiation therapy
protocols described for the treatment of lymphoma
in cats or dogs could be extrapolated to rabbits, espe-
cially as most chemotherapy drugs have been studied
and used in experimental rabbits. The prognosis would
depend on the stage of the disease when diagnosed and
its response to treatment.
Summary
Rapid diagnosis and appropriate treatment of gastric
diseases will increase the likelihood of a favourable
outcome in affected rabbits. A second article, to be
published in the March issue of In Practice, will discuss
the common causes, presentation, diagnosis and treat-
ment of intestinal diseases in this common companion
species.
References
EMEA (2002) Committee for Veterinary Medicinal Products.
Omeprazole summary report. June 2002. www.ema.europa.eu/
pdfs/vet/mrls/084102en.pdf. Accessed January 20, 2012
HINTON, M. (1980) Gastric ulceration in the rabbit. Journal
of Comparative Pathology 90, 475-481
LEE, M., KALLAL, S. M. & FELDMAN, M. (1996)
Omeprazole prevents indomethacin-induced gastric ulcers in
rabbits. Alimentary Pharmacology and Therapeutics 10, 571-576
LI, C., QIAN, W. & HOU, X. (2009) Effect of four medications
associated with gastrointestinal motility on Oddi sphincter in
the rabbit. Pancreatology 9, 615-620
LONGLEY, L. (2008) Anaesthesia and analgesia in rabbits and
rodents. In Practice 30, 92-97
REDFERN, J. S., LIN, H. J., MCARTHUR, K. E., PRINCE,
M. D. & FELDMAN, M. (1991) Gastric-acid and pepsin
hypersecretion in conscious rabbits. American Journal of
Physiology 261, G295-G304
REUSCH, B. (2005) Investigation and management of
cardiovascular disease in rabbits. In Practice 27, 418-425
WENGER, S., BARRETT, E. L., PEARSON, G. R., SAYERS, I.,
BLAKEY, C. & REDROBE, S. (2009) Liver lobe torsion in three
adult rabbits. Journal of Small Animal Practice 50, 301-305
96 In Practice February 2012 | Volume 34 | 9096
Further reading
CAPELLO, V., LENNOX, A. M. & WIDMER, W. (2008)
Rabbit. In Clinical Radiology of Exotic Companion Mammals.
Wiley. pp 54-167
DAVIES, R. R. (2006) Digestive system disorders.
In BSAVA Manual of Rabbit Medicine and Surgery, 2nd edn.
Eds A. Meredith and P. Flecknell. BSAVA Publications.
pp 74-84
HEDLEY, J. (2011) Critical care of the rabbit. In Practice 33,
386-391
OMALLEY, B. (2005) Rabbits. In Clinical Anatomy
and Physiology of Exotic Species. Elsevier Saunders.
pp 173-195
Self-assessment test:
Gastric diseases in rabbits
1. What are the four most important factors in
the supportive treatment of rabbits with
non-obstructive ileus?
2. What is the shock fluid rate for a rabbit?
3. What are the two main differential diagnoses
for acute abdomen in rabbits?
4. What is the treatment regimen for a rabbit
with suspected gastric ulceration?
5. What is the second most common tumour
in rabbits?
Answers
5. Lymphoma
spectrum antibiosis and supportive nutrition
mucosa, provide fluid therapy, analgesia, broad-
4. Decrease acid production, protect ulcerated
3. Obstructive ileus and liver lobe torsion
2. 100 ml/kg/hour
the administration of prokinetics
1. Analgesia, nutritional support, fluid therapy and
 Downloaded from inpractice.bmj.com on June 29, 2012 - Published by group.bmj.com

Gastrointestinal disease in rabbits 1. Gastric

diseases
Brigitte Lord

In Practice 2012 34: 90-96

doi: 10.1136/inp.e328

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