This is a summary of a lecture presented by Dr James Haberfield at the 2018 UPAV conference.
The lecture discussed two common emergency conditions in rabbits:
- Gastrointestinal obstruction (bloat)
- Liver lobe torsion
Bloat
Common presentation in rabbits, especially when forming a trichobezoar (a compressed hair pellet) or other foreign bodies.
bstructions commonly lodge in the proximal duodenum, and as rabbits cannot vomit, the stomach quickly dilates.
Common presentation:
- Inappetance
- Hunched-over
- Depressed
Less commonly:
- Dyspnoea
- Hypothermia
- Poor peripheral perfusion.
Blood glucose measurement can be an important tool to help differentiate between gastrointestinal stasis and obstruction. A study in 2012 by Harcourt-Brown found that blood glucose can differ with obstructed rabbits versus rabbits with gastrointestinal stasis.
Obstructed rabbits – 24.7 mmol/L
Gastrointestinal stasis – 8.5 mmol/L
Diagnostics should also include abdominal radiographs – including lateral, ventrodorsal or dorsoventral.
Treatment – gastrointestinal stasis can be resolved medically, but obstructions can require surgery.
Medical treatment includes –
-
Patient Warming
-
IV fluids
-
Anti-ulcer medication
-
Analgesia
-
+/- prokinetics
Surgical management include-
-
Start with medical management to stabilize, then ex lap
-
Options (Szabo et al 2016)
-
Milk obstruction to large intestine
-
Milking the obstruction back to stomach – gastrotomy
-
Or enterotomy
-
Prognosis – full recovery should be possible, with increased risk of repeat blockages or adhesions.
Liver lobe torsion
Relatively uncommon- but is under diagnosed, and mimics gut stasis. The cause is often unknown, but is predisposed by trauma, congenital abscence of hepatic ligaments or stretching of hepatic ligaments. The caudate liver lobe is the most commonly affected lobe.
Torsion results in occlusion of venous blood supply, followed by the artery, leads to acute congestion and subsequent necrosis.
Clinical presentation and diagnosis:
-
Lethargy
-
Inappetant
-
Dehydrated
-
Crouched
-
Hunched
-
Painful abdomen
May feel a hard and painful torsed lobe – not normally palpable.
Biochemistry – ALT, ALP and AST may be elevated, however they are not liver specific, but multiple elevated enzymes increase likelihood that liver is the cause of the elevation.
Ultrasound can be performed, where you can detect hepatomegaly, rounded lobar margins, free peritoneal fluid, abnormal marked heterogenous of the liver.
Colour flow doppler can also be used, where reduced or absent flow confirms presence of torsion.
The surgery of liver lobe torsion removal is outlined in – Szabo Z, Bradley, K and Cahalane AK. 2016. Rabbit Soft Tissue Surgery. Vet Clin Exot Anim, 19;159-188.
Other adjunctive treatments to be used with surgery include:
- Fluid therapy
- Analgesia,
- Prophylactic broad spectrum antibiotics
- Prokinetics
- Anti-ulcer medications
- Supportive feeding
The prognosis for liver lobe torsion is good if promptly treated, with low risk of future complications.
Reference – UPAV-AAVAC 2018 Conference. Dr James Haberfield. Emergency Abdominal Surgery in Rabbits.
They really are an amazing clinic – check out their website here: https://www.unusualpetvets.com.au/
Exotics Vets 