RABBIT GASTROINTESTINAL DISEASE: TEETH TO CECOTROPHS COPPER AITKEN - PALMER, DVM, MS, PHD, DACZM In this 1.5 hour webinar, Dr. Copper Aitken-Palmer focuses on gastrointestinal related disease as it is the most common presentation of a major disease in rabbits (often teeth related and GI stasis) but also discusses other common rabbit presentations.
KEY HIGHLIGHTS
8 Rabbits have 6 lobes of the liver and the stalk attachment of the caudate lobe of the liver makes it prone to torsion. So if you are seeing a very sick rabbit with an elevated ALT, ALP and AST (or even azotemia) that you thought had GI stasis that isn’t getting better despite treatment, get a stat ultrasound. Mini lops may be over- represented. 9 If you have a drooling rabbit (a.k.a. rabbit slobbers), think dental disease. A proper rabbit dental exam should ideally be done under general anesthesia to visualize caudal cheek teeth. Pre-sedation with midazolam/ buprenorphine will help with blind intubation after mask induction. Essential pieces of equipment for rabbit dentals include CHEEK SPREADERS, straight dental handpiece with shielded burr, head lamp, and magnifying glass (Rose Micro Solutions head loops are nice for working with rabbits because they have longer working distance, less $$). NEVER use clippers to trim rabbit teeth as this could lead to fractures and more serious complications, a dental burr is preferred. LEARN MORE
1 Take an extensive history which will help identify potential husbandry and lifestyle issues. During the physical exam, always look at the underside of the bunny by holding the feet rocked back in your arms to visualize the face and belly. A lot of things can be missed if you don’t turn the rabbit over. Check for nasal discharge on the nose and on the front paws; signs may be subtle but if any discharge is noted, then likely the bunny has a respiratory infection. Azithromycin is the antibiotic of choice for rabbit URI’s. AVOID oral cephalosporins, β -lactams, and Clavamox in rabbits, as these can lead to fatal dysbiosis. Parenteral (injectable) β -lactams do not cross the GI tract and are safe to use. 2 Diet should consist of grass hay which has higher silica content that helps to grind teeth, NOT legume hay (e.g. alfalfa) or pellets. Pellets are NOT necessary in any rabbit diet. 3 Ingestion of cecotrophs/cecotropes are an essential part of normal digestion and is unique to rabbits. Cecotrophs/cecotropes are soft pellets covered in mucus to protect essential microbes from the low pH of the stomach (pH=2) and are packed with B vitamins, short chain fatty acids, protein, sodium, potassium and water. 4 If you’re able to get bloodwork on a rabbit ( jugular or lateral saphenous veins are preferred). AVOID the ear vein which is marginal. Phlebotomy
of the central ear vessel which is an artery, can lead to thrombosis/ sloughing of the ear! 5 These are some helpful prognostic indicators to look at: • Glucose (normal 76-148 mg/dl) – if between 360-540 mg/dl = severe disease • Sodium (normal 136-147 mEq/L) – if <129 mEq/L has 2.3 increased mortality risk • Temperature is important to get as part of a routine exam, especially on sick rabbits: • Temperature (normal=100.4 °F to 103.8 °F). Hypothermia <100.4 °F is associated with increased morbidity/mortality. 6 If a rabbit presents to you sick with no feces in the carrier and or at home, the rabbit most likely has GI stasis and needs hospitalization. If hospitalizing, always ask about the water source as a rabbit may not drink out of a bowl in hospital if accustomed to using a drinker and vice versa. 7 The mainstays of treatment for GI stasis are HYDRATION (IV maintenance is 100ml/kg/day and use an e-collar to protect the IV catheter) and ANALGESIA, since pain promotes ileus. Buprenorphine (IM – lower dose, shorter duration; SC – higher dose, longer duration), Cerenia, and/ or Lidocaine CRI (100 μ g/kg/min – profound analgesia and MAC sparing). Avoid using Meloxicam until the rabbit is rehydrated.
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