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Companion animal practice

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
Brigitte Lord graduated from challenge for the clinician. Diet- and stress-related problems predominate,
the Royal Veterinary College in and preventive treatment plays a large role in managing these conditions.
2002. After a period in exotic and However, gastric ulceration and bacterial, viral, parasitic, idiopathic and
small animal practice, she spent neoplastic diseases are also seen frequently in pet rabbits. This article
time at the Royal (Dick) School of provides an overview of the common gastric conditions seen in rabbits,
Veterinary Studies in Edinburgh including their diagnosis and the options for treatment. The common causes,
and the University of Bristol/ diagnosis and approach to the management of intestinal diseases will be
Bristol Zoo, and ran a rabbit and discussed in an article to be published in the March issue of In Practice.
exotics veterinary referral service in
south-west England. She returned
to Edinburgh in 2008 as a lecturer
in rabbit medicine and surgery, History and physical examination Diagnostic approach
and is now head of the universitys
exotic animal handling facility. When presented with a rabbit with gastrointestinal A presumptive diagnosis may be possible based on
She is also the veterinary adviser disease, it is important to obtain a complete history, as the history and clinical signs. However, rabbits
for the British Rabbit Council. this may indicate the duration and severity of the dis- presenting acutely depressed or with chronic gastro
She holds the RCVS certificate ease. Young rabbits are more likely to develop bacterial intestinal disease will need a complete diagnostic
in zoological medicine and is or parasitic disease and, unlike other species, are also work-up.
currently working towards the
more likely to be affected by neoplasia. The feeding his-
diploma in zoological medicine.
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
doi:10.1136/inp.e328 or complicating factor. than normal droppings and have an irregular shape

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Companion animal practice

Fig 4: The lateral metatarsal


Fig 3: A normal caecotroph consists of a mucus-coated vein is a suitable site for
cluster of soft spheres blood sampling in rabbits. The
use of a butterfly catheter
will minimise movement of
grapes); however, the shape may be distorted if the the needle and so reduce
rabbit has sat or stood on it (Fig 3). Caecotrophs are haematoma formation
normally ingested by the rabbit directly from the anus,
so they should be seen only occasionally. Abnormal Plain and contrast abdominal radiography
caecotrophs may be liquid and diarrhoea-like, or large Plain abdominal radiographs may reveal signs com-
and voluminous, similar in appearance to cat faeces. patible with ileus, obstructive bowel disease or ascites.
The use of upper gastrointestinal barium and/or a
Faecal examination for parasites barium enema can demonstrate neoplasia and severe
Examination of direct smears of fresh faeces, or of infiltrative disease.
faeces suspended in 09 per cent sodium chloride, may
reveal the eggs of the nematode Passalurus ambiguus, Ultrasonography
which are intermittently shed. Adult worms may also Ultrasonography can be useful in assessing gastro
be identified in fresh faecal smears. Normal caecal intestinal tract motility and the thickness of the
protozoa may also be seen. Flotation techniques may gastric and intestinal walls, and in identifying the
be necessary to identify coccidia and Cryptosporidium presence of neoplasms. However, the large amount of
species oocysts. Examination of these preparations gas that is often present in the gastrointestinal tract
at a magnification of x1000 will be required to iden- of an abnormal rabbit can limit the usefulness of
tify Cryptosporidium parvum as it is the smallest ultrasonography.
of the coccidians. The use of immunofluorescence
and acid-fast stains will improve the sensitivity of Endoscopy and laparoscopy
faecal examination as a diagnostic test. Endoscopy of the distal colon can be very rewarding.
However, the stomach normally contains food and
Faecal bacterial culture fur, which can limit endoscopy of the stomach. The
Bacterial pathogens of rabbits that may be cul- tight pyloric sphincter of rabbits prevents endoscopy
tured from the faeces include Salmonella species, of the small intestines.
Pseudomonas aeruginosa, Lawsonia intracellularis and Laparoscopy is also a useful technique in rabbits,
Yersinia pseudotuberculosis. and can be used to inspect the whole bowel. As it is a
minimally invasive technique, it is associated with less
Faecal occult blood test postoperative pain and a shorter recovery period than
A faecal occult blood test can be useful in indicating more invasive procedures such as laparotomy. Rabbits
the possibility of a disorder that causes haemorrhage, have a thin abdominal muscle wall, so it is important
such as gastrointestinal ulceration. to use threaded instrument ports that are secured with
a purse-string suture to maintain a seal and prevent
Haematology, serum biochemistry port slippage (Fig 5).
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. Fig 5: Laparoscopy of a
rabbit. The use of threaded
Serum biochemistry and urinalysis can help to rule
instrument ports will reduce
out metabolic disorders such as renal failure and liver port slippage through the
disease. thin abdominal muscles

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Companion animal practice

Intestinal biopsy Primary factors include:


Samples of the mid- to distal small intestines, liver, Anorexia;
pancreas and mesenteric lymph nodes can be obtained Feeding a high-carbohydrate/low-fibre diet;
during endoscopy or laparoscopy. Laparotomy allows Post-surgical adhesions;
similar biopsies to be taken but, as described above, Lack of exercise;
is a more invasive procedure. In addition, the forma- Toxin ingestion (most commonly lead).
tion of postoperative adhesions may increase the risk Secondary factors include:
of chronic ileus developing. Pain;
Environmental or emotional stress. For example:
Response to treatment The presence of predator species or a dominant

A rabbits response to treatment may be useful in rabbit;


helping to establish certain tentative diagnoses. For Changes in routine;

example, a positive response to feeding a high-fibre Transport;

diet consisting only of hay, water and a high-fibre Extremes in temperature or humidity.

recovery diet (eg, Critical Care; Oxbow) may help Anorexia and chronic dehydration can be both
to confirm a diagnosis of gastric stasis or ileus, while causal factors and consequences of gastric stasis
a combination of fluid therapy, supportive nutri- and ileus. Systemic dehydration will lead to the gut
tion and treatment with gastroprotectants might be contents becoming dehydrated and the impaction of
used in suspected cases of gastric ulceration (see normal stomach contents, which include loose hair
below). lattices or trichobezoars.

Diagnosis
Diseases of the stomach The history and clinical findings of a firm, dough-like
stomach on palpation allow a presumptive diagnosis
Gastric stasis and ileus of gastric stasis and ileus, and are suggestive of non-
Gastric stasis is primarily an acquired disorder caused obstructive disease (see Table 1). In advanced cases, it
by decreased motility of the stomach. Generalised ileus may not be possible to differentiate between obstruc-
is a common continuation of this condition, which may tive and non-obstructive stasis and ileus. Plain radi
arise as a result of mechanical obstruction or defective ography in early cases will reveal a mass of hair and
propulsion. Mechanical obstruction (eg, due to the food with a similar appearance to normal ingesta. As
presence of dehydrated, impacted ingesta secondary the impaction in the stomach and, occasionally, cae-
to chronic dehydration, foreign bodies or infiltrative cum develops, a gas halo is often seen around the com-
lesions) will cause delayed emptying of the stomach. pacted material (Fig 6). A definitive diagnosis can be
Defective propulsion is seen in cases with defects in made only on exploratory laparoscopy or laparotomy,
the nerves or smooth muscles of the gastrointestinal but these are high-risk procedures in these patients,
tract. which are likely to be already metabolically unstable.

Treatment and prognosis


Table 1: Clinical differentiation of non-obstructive and obstructive ileus In rabbits with non-obstructive ileus, aggressive medi-
Clinical finding Non-obstructive ileus Obstructive ileus cal management is required to prevent further deterior
Attitude Bright and alert May initially appear bright, but ation and death. Patients with obstructive ileus will
rapidly becomes depressed require surgery (see section on obstruction below).
Appetite Gradually reducing appetite Acute anorexia Hepatic lipidosis is a common complication and cause
Faecal volume and size Gradually reducing size and Acute history of no faeces of death in rabbits with prolonged gastric stasis and
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

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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 ingesta are normally always present in the stomach


Ingested objects such as matted hair, carpet, plastic and caecum of rabbits. In addition, if barium contrast
or rubber can pass down a rabbits oesophagus and agent is used, it may be recirculated if coprophagy/
become a gastric or intestinal foreign body. The pylorus caecotrophy occurs. In most cases, an exploratory
is a common site of obstruction, and material or objects laparotomy is required to confirm the diagnosis.
lodged in this area can obstruct gastric outflow.
Rabbits with gastric obstruction may be asympto- Treatment and prognosis
matic or show anorexia initially until acute abdominal Gastric obstruction is a life-threatening condition that
pain and hypovolaemic shock rapidly develop (within requires aggressive treatment. It is essential to stabilise
24 to 48 hours). Death often occurs within 24 to 48 the rabbit before performing a gastrotomy to maxi
hours after acute abdomen develops. Liver lobe torsion mise the chances of a successful outcome. Analgesia,
is the main differential diagnosis of acute abdomen in intravenous or intraosseous crystalloid fluids at
rabbits (Wenger and others 2009). shock rates and systemic broad-spectrum antibiotics
should be administered. Prokinetics are contraindi-
Diagnosis cated in patients with an obstructive condition before
In patients with a gastric obstruction, the clinical signs surgery, but are useful postoperatively to stimulate
are usually indicative of the problem. Obstructions gastrointestinal motility. Gastric decompression via
can rarely be detected on abdominal palpation alone, a nasogastric or orogastric tube should always be
which in itself has a high risk of causing trauma to attempted.
the distended stomach and the liver, which may be Where possible, the patients serum electrolyte
friable secondary to hepatic lipidosis. Plain and con- concentrations and acid-base status should be evalu-
trast radiographs can be difficult to interpret because 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
Box 1: Anaesthesia of rabbits for gastric surgery
927 to 135 mmHg (Reusch 2005). Fluid therapy
The principles of good anaesthesia are to: has been used to correct hypovolaemia in rabbits
Provide excellent perioperative care; following the same principles as those used in cats
Select agents suitable for the individual patient; and dogs.
Ensure that the airway can be maintained and intermittent positive pressure
ventilation can be given in an emergency;
Anaesthesia
Ensure that intravenous access is available to enable intraoperative fluid therapy and
emergency drug administration; Rabbits have an unnecessary reputation for being
Increase fluid therapy to 10 ml/kg/hour during anaesthesia. difficult to anaesthetise. However, paying careful
attention to all aspects of the patients perioperative
Premedication and induction care, addressing stress and treating underlying disease
It is vital to select a suitable anaesthetic regimen for a critically ill rabbit. The use of will optimise the safety and success of anaesthesia (see
a2-adrenoceptor agonists is contraindicated in these patients. Premedication with 02 Box 1).
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. Surgery
Rabbits can be challenging surgical patients, but the
Intubation chance of a successful outcome can be maximised by
The rabbit should be preoxygenated before being intubated with a 2 to 35 mm ensuring:
endotracheal tube using the blind or visual technique (Longley 2008). Applying a A good knowledge of the regional anatomy;
lidocaine spray (eg, Intubeaze; Dechra Veterinary Products) to the glottis before
Adequate preparation of the patient;
attempting intubation may reduce laryngeal spasm.
The availability of suitable instrumentation;
Maintenance That steps are taken to minimise the pain, fear and
Anaesthesia should be maintained using an inhalational agent such as isoflurane or stress experienced by the animal.
sevoflurane. The use of local anaesthetic agents (eg, lidocaine or bupivacaine; see below) The basic principles of surgery in rabbits are the
will reduce the dose of general anaesthetics required, thus reducing the side effects of same as those described for other domestic species.
these agents. However, the surgical techniques and considerations
may need to be modified to account for the unique
Analgesia
Local anaesthetic agents are very useful for providing local analgesia and can also provide anatomy, physiology and behaviour of this spe-
good postoperative analgesia. Bupivacaine (1 mg/kg) and lidocaine (1 mg/kg), when used cies. Box 2 outlines the procedure for performing a
in combination, provide rapid-onset local anaesthesia and analgesia of long duration. The gastrotomy in rabbits.
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 Postoperative care
the site of the incision. The rabbit can be given a top-up dose of 2 mg/kg morphine, The use of NSAIDs postoperatively has been shown to
administered intravenously or intramuscularly, if additional analgesia is required during
minimise the development of postsurgical adhesions.
longer surgical procedures; this can be repeated during surgery if required.
The rabbit should continue to receive supportive treat-
Reversal of anaesthesia ment for ileus, as described above. The prognosis is
At the end of the procedure, the fentanyl/fluanisone can be reversed by giving 05 mg/kg guarded to poor, as most rabbits with gastric obstruc-
butorphanol, and the midazolam can be reversed with 005 mg/kg sarmazenil, both tion have severe hepatic lipidosis, acidosis and ketosis.
administered intravenously. A dose of 005 mg/kg buprenorphine should be given two They are also likely to have severe gastric ulceration,
hours after reversal, as butorphanol has a short half-life in rabbits, but is more effective
which can progress to perforation with subsequent
than buprenorphine at antagonising the fentanyl/fluanisone.
peritonitis. If perforation occurs, the prognosis is

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Companion animal practice

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 Fig 8: Perforated gastric ulcer
abdomen should be packed adequately to prevent in a rabbit that has healed
contamination by adhesion but has started
forming an abscess within the
Step 4. Place stay sutures at the proposed incision
gastric wall. This was found
site. The incision should be made in a non-vascular during exploratory laparotomy.
site along the greater curvature or between the (Picture, K. Eatwell)
greater and lesser curvatures of the stomach
Step 5. Inspect the stomach contents, and visually
identify and remove any foreign material causing Treatment and prognosis
an obstruction The treatment of gastric ulceration will depend on the
Step 6. Close the stomach with one layer of sutures
severity of the condition and whether the underlying
placed in a simple continuous pattern followed
by another layer in an inverting pattern. Only cause has been detected. As discussed earlier, rabbits
absorbable synthetic monofilament suture material with gastric perforation and peritonitis have a grave
(eg, polydioxanone [PDS II; Ethicon]) should be used prognosis. Symptomatic or prophylactic treatment
for surgery in rabbits, as this species is very prone to could be considered in higher-risk cases such as female
forming adhesions rabbits in late gestation, or patients with anorexia,
Step 7. Close the linea alba using a continuous or
enteritis or chronic disease. This involves decreasing
interrupted suture pattern
the production of stomach acid, protecting the ulcer-
Step 8. Finally, close the skin with a simple
continuous subcuticular pattern ated mucosa, and providing fluid therapy, analgesia,
broad-spectrum antibiosis and supportive nutrition.

grave. Aggressive and early treatment will improve Gastric neoplasia


the chances of the animal recovering. Primary tumours such as adenocarcinoma and leio
myosarcoma of the stomach have been reported in rab-
Gastric ulceration bits. Lymphoma is the most common tumour of male
Gastric ulceration is a relatively common finding on rabbits and the second most common in female rabbits,
postmortem examination of rabbits. In patients with after uterine adenocarcinoma, and has been found to
gastric ulceration, other clinically significant disease infiltrate the stomach. Metastatic haemangiosarcoma
(eg, anorexia, enteritis, typhlitis, intussusception, has also been seen in the stomach. There is a wide age
gastric impaction and bronchopneumonia) or peripar- range in reported cases, although juvenile and young
turient death are common. The prevalence of the con- adult rabbits appear to be predominantly affected.
dition increases with age and it is seen more commonly Clinical signs shown by rabbits with gastric tumours
in female rabbits than males. Stress for example, as can include anorexia, depression, cutaneous nodules
a consequence of another disease has been suggested (in cases of lymphoma), pallor, emaciation and per
as an aetiology for gastric ulceration. Perforation and ipheral lymphadenopathy. Some rabbits may show no
subsequent peritonitis have been found in 70 per cent signs until the disease is advanced and sudden death
of rabbits with pyloric ulceration (Hinton 1980). occurs. The duration of illness may range from one
Anorexia and signs of pain, such as bruxism and week to 10 months.
reluctance to move, can be the principal signs of gastric
ulceration. Melaena is rare in rabbits. In some cases, Diagnosis
clinical signs due to anaemia and hypoproteinaemia Iron deficiency anaemia and lymphocytosis, includ-
may be seen (eg, pale mucous membranes, dyspnoea, ing immature and atypical lymphocytes, have been
weakness, collapse and shock). Some ulcers may perfor described in cases of lymphoma in rabbits. Bone
ate and then seal rapidly by forming adhesions, leading marrow biopsies may be required in suspicious cases
to the development of abscesses within the gastric wall that have lymphocytosis without circulating atypical
(Fig 8). lymphocytes. Plain and contrast imaging may reveal
gastric wall thickening. Ultrasound-guided fine needle
Diagnosis aspiration of thickened lesions in the gastric wall may
Signs of acute abdomen and sepsis may be observed produce cytological preparations that are diagnostic.
in rabbits with perforation and peritonitis, and there However, an exploratory laparoscopy or laparotomy
may be evidence of peritonitis on plain radiography. to examine the stomach and take biopsies for histo-
Ultrasonography can be useful in detecting thicken- logical evaluation are usually required for a definitive
ing of the gastric wall, which may be associated with diagnosis.
chronic ulceration or abscessation. Endoscopy is the
most sensitive and specific tool for diagnosing gastric Treatment and prognosis
ulceration in other species but, in rabbits, visualisa Most cases of adenocarcinoma are likely to be too
tion of the gastric wall will be very limited due to the advanced for surgical resection, and these patients
ingesta normally present in the stomach. have a grave prognosis.

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Companion animal praCtiCe

Various chemotherapy and radiation therapy Further reading


CAPELLO, V., LENNOX, A. M. & WIDMER, W. (2008)
protocols described for the treatment of lymphoma
Rabbit. In Clinical Radiology of Exotic Companion Mammals.
in cats or dogs could be extrapolated to rabbits, espe-
Wiley. pp 54-167
cially as most chemotherapy drugs have been studied DAVIES, R. R. (2006) Digestive system disorders.
and used in experimental rabbits. The prognosis would In BSAVA Manual of Rabbit Medicine and Surgery, 2nd edn.
depend on the stage of the disease when diagnosed and Eds A. Meredith and P. Flecknell. BSAVA Publications.
its response to treatment. pp 74-84
HEDLEY, J. (2011) Critical care of the rabbit. In Practice 33,
386-391
OMALLEY, B. (2005) Rabbits. In Clinical Anatomy
Summary and Physiology of Exotic Species. Elsevier Saunders.
pp 173-195
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 Self-assessment test:
species. Gastric diseases in rabbits
1. What are the four most important factors in
References
the supportive treatment of rabbits with
EMEA (2002) Committee for Veterinary Medicinal Products.
non-obstructive ileus?
Omeprazole summary report. June 2002. www.ema.europa.eu/
pdfs/vet/mrls/084102en.pdf. Accessed January 20, 2012 2. What is the shock fluid rate for a rabbit?
HINTON, M. (1980) Gastric ulceration in the rabbit. Journal
3. What are the two main differential diagnoses
of Comparative Pathology 90, 475-481
for acute abdomen in rabbits?
LEE, M., KALLAL, S. M. & FELDMAN, M. (1996)
Omeprazole prevents indomethacin-induced gastric ulcers in 4. What is the treatment regimen for a rabbit
rabbits. Alimentary Pharmacology and Therapeutics 10, 571-576 with suspected gastric ulceration?
LI, C., QIAN, W. & HOU, X. (2009) Effect of four medications
5. What is the second most common tumour
associated with gastrointestinal motility on Oddi sphincter in
in rabbits?
the rabbit. Pancreatology 9, 615-620
LONGLEY, L. (2008) Anaesthesia and analgesia in rabbits and
rodents. In Practice 30, 92-97 Answers
REDFERN, J. S., LIN, H. J., MCARTHUR, K. E., PRINCE, 5. Lymphoma
M. D. & FELDMAN, M. (1991) Gastric-acid and pepsin spectrum antibiosis and supportive nutrition
hypersecretion in conscious rabbits. American Journal of mucosa, provide fluid therapy, analgesia, broad-
Physiology 261, G295-G304 4. Decrease acid production, protect ulcerated
REUSCH, B. (2005) Investigation and management of 3. Obstructive ileus and liver lobe torsion
cardiovascular disease in rabbits. In Practice 27, 418-425 2. 100 ml/kg/hour
WENGER, S., BARRETT, E. L., PEARSON, G. R., SAYERS, I., the administration of prokinetics
BLAKEY, C. & REDROBE, S. (2009) Liver lobe torsion in three 1. Analgesia, nutritional support, fluid therapy and
adult rabbits. Journal of Small Animal Practice 50, 301-305

96 In Practice February 2012 | Volume 34 | 9096


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Gastrointestinal disease in rabbits 1. Gastric


diseases
Brigitte Lord

In Practice 2012 34: 90-96


doi: 10.1136/inp.e328

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