•06/04/2015
The anorexic rabbit- when to worry
Some causes of anorexia • • • • • • • • • • • • • • • • •
Panicking owner Stress Pain e.g from arthritis or back pain Gut stasis Crown loss and inability to eat Dental spurs Soft tissue problem in mouth Jaw fractures Tooth fractures Respiratory disease VHD Moving intestinal foreign body Gastric ulceration Congestive heart failure Neoplasia Trauma Nasal or pharyngeal foreign body
• • • • • • • • • • • • • • • •
Enteritis Mucoid enteropathy Cystitis Sludgy urine Urethral obstruction Chronic renal failure Hepatic lipidosis Liver lobe torsion Septicaemia Ureteral obstruction Gastric dilation due to intestinal obstruction Acute enterotoxemia Acute renal failure Peritonitis Heavy metal poisoning Choke
How do you know if it is an emergency?
Frances Harcourt‐Brown BVSc FRCVS, RCVS Recognised Specialist in Rabbit Medicine and Surgery
Some causes of anorexia • • • • • • • • • • • • • • • • •
Panicking owner Stress Pain e.g from arthritis or back pain Gut stasis Crown loss and inability to eat Dental spurs Soft tissue problem in mouth Jaw fractures Tooth fractures Respiratory disease VHD Moving intestinal foreign body Gastric ulceration Congestive heart failure Neoplasia Trauma Nasal or pharyngeal foreign body
• • • • • • • • • • • • • • • •
Enteritis Mucoid enteropathy Cystitis Sludgy urine Urethral obstruction Chronic renal failure Hepatic lipidosis Liver lobe torsion Septicaemia Ureteral obstruction Gastric dilation due to intestinal obstruction Acute enterotoxemia Acute renal failure Peritonitis Heavy metal poisoning Choke
How do you know if it is an emergency?
Frances Harcourt‐Brown BVSc FRCVS, RCVS Recognised Specialist in Rabbit Medicine and Surgery
Cases that will wait until next day • • • • • • • • • • • • • • • • •
Panicking owner Stress Pain e.g from arthritis or back pain Gut stasis Crown loss and inability to eat Dental spurs Soft tissue problem in mouth Jaw fractures Tooth fractures Respiratory disease VHD Moving intestinal foreign body Gastric ulceration Congestive heart failure Neoplasia Trauma Nasal or pharyngeal foreign body
• • • • • • • • • • • • • • • •
Enteritis Mucoid enteropathy Cystitis Sludgy urine Urethral obstruction Chronic renal failure Hepatic lipidosis Liver lobe torsion Septicaemia Ureteral obstruction Gastric dilation due to intestinal obstruction Acute enterotoxemia Acute renal failure Peritonitis Heavy metal poisoning Choke
Rabbit is bright Frances Harcourt‐Brown BVSc FRCVS, RCVS Recognised Specialist in Rabbit Medicine and Surgery
Frances Harcourt‐Brown BVSc FRCVS, RCVS Recognised Specialist in Rabbit Medicine and Surgery
Absence of signs of abdominal catastrophe in rabbits • Don’t sweat • Can’t vomit • Normal heart rate is 150300bpm i.e. to fast to count easily • Pulse is hard to find • Hide and sit quietly when they are in pain • Any signs of colic are subtle
• Anorexia may be only sign that is obvious to the owner • Owners are allowed to panic- I do
Frances Harcourt‐Brown BVSc FRCVS, RCVS Recognised Specialist in Rabbit Medicine and Surgery
Assessing demeanour of anorexic rabbit
• Difficult to give any definite parameters • Nurses use BAR (bright and responsive) to describe an animal that looks OK Frances Harcourt‐Brown BVSc FRCVS, RCVS Recognised Specialist in Rabbit Medicine and Surgery
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•06/04/2015
Cases that will probably wait until next day • • • • • • • • • • • • • • • • •
Panicking owner Stress Pain e.g from arthritis or back pain Gut stasis Crown loss and inability to eat Dental spurs Soft tissue problem in mouth Jaw fractures Tooth fractures Respiratory disease VHD Moving intestinal foreign body Gastric ulceration Congestive heart failure Neoplasia Trauma Nasal or pharyngeal foreign body
• • • • • • • • • • • • • • • •
Enteritis Mucoid enteropathy Cystitis Sludgy urine Urethral obstruction Chronic renal failure Hepatic lipidosis Liver lobe torsion Septicaemia Ureteral obstruction Gastric dilation due to intestinal obstruction Acute enterotoxemia Acute renal failure Peritonitis Heavy metal poisoning Choke
Can give palliative care- syringe feeding, ?metacam Frances Harcourt‐Brown BVSc FRCVS, RCVS Recognised Specialist in Rabbit Medicine and Surgery
Emergencies i.e need to phone vet now • • • • • • • • • • • • • • • • •
Panicking owner Stress Pain e.g from arthritis or back pain Gut stasis Crown loss and inability to eat Dental spurs Soft tissue problem in mouth Jaw fractures Tooth fractures Respiratory disease VHD Moving intestinal foreign body Gastric ulceration Congestive heart failure Neoplasia Trauma Nasal or pharyngeal foreign body
• • • • • • • • • • • • • • • •
Enteritis Mucoid enteropathy Cystitis Sludgy urine Urethral obstruction Chronic renal failure Hepatic lipidosis Liver lobe torsion Septicaemia Ureteral obstruction Gastric dilation due to intestinal obstruction Acute enterotoxemia Acute renal failure Peritonitis Heavy metal poisoning Choke
Life threatening Frances Harcourt‐Brown BVSc FRCVS, RCVS Recognised Specialist in Rabbit Medicine and Surgery
Obvious clinical signs • Sudden onset breathing problems, especially if there is noise • Maybe foreign body (usually strand of hay) in nose or throat • Proper diarrhoea (not uneaten caecotrophs) is worrying if rabbit is not eating • Won’t be any normal faeces • May be blood Frances Harcourt‐Brown BVSc FRCVS, RCVS Recognised Specialist in Rabbit Medicine and Surgery
Home remedies? • Offer tempting foods • Pineapple juice won’t do any harm and might do some good • Simethicone won’t do any harm but won’t get rid of gas • Massaging stomach is maybe not a good idea • Making rabbit run around seems unfair if it is in pain Frances Harcourt‐Brown BVSc FRCVS, RCVS Recognised Specialist in Rabbit Medicine and Surgery
Life threatening emergencies with obvious clinical signs • • • • • • • • • • • • • • • • •
Panicking owner Stress Pain e.g from arthritis or back pain Gut stasis Crown loss and inability to eat Dental spurs Soft tissue problem in mouth Jaw fractures Tooth fractures Respiratory disease VHD Moving intestinal foreign body Gastric ulceration Congestive heart failure Neoplasia Trauma Nasal foreign body
• • • • • • • • • • • • • • • •
Enteritis Mucoid enteropathy Cystitis Sludgy urine Urethral obstruction Chronic renal failure Hepatic lipidosis Liver lobe torsion Septicaemia Ureteral obstruction Gastric dilation due to intestinal obstruction Acute enterotoxemia Acute renal failure Peritonitis Heavy metal poisoning Choke
Problems breathing, straining or diarrhoea Frances Harcourt‐Brown BVSc FRCVS, RCVS Recognised Specialist in Rabbit Medicine and Surgery
Oesophageal foreign bodies (choke) • Rabbits cannot vomit but can regurgitate • Green slime around nose and mouth • Can be due to foreign body or large lump of food in oesophagus • Sudden onset
Frances Harcourt‐Brown BVSc FRCVS, RCVS Recognised Specialist in Rabbit Medicine and Surgery
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•06/04/2015
Straining • Can be due to physical obstruction such as bladder stone • Or urethral stone
Frances Harcourt‐Brown BVSc FRCVS, RCVS Recognised Specialist in Rabbit Medicine and Surgery
How sediment becomes sludge
Or severe sludgy urine • Sludge can build up to point it obstructs ureter • Or it can cause nasty cystitis and straining • Owners may be unaware there was a problem
Frances Harcourt‐Brown BVSc FRCVS, RCVS Recognised Specialist in Rabbit Medicine and Surgery
Often associated with spinal problems
• Insufficient water intake and/or urine retention allows sediment to build up in bladder • Anatomy of rabbit allows urine to settle out in bladder so only supernatent is voided • Owner is not aware of problem because urine may not contain a lot of sediment • Bladder atony or another underlying problem is always present Frances Harcourt‐Brown BVSc FRCVS, RCVS Recognised Specialist in Rabbit Medicine and Surgery
Another cause of straining
Frances Harcourt‐Brown BVSc FRCVS, RCVS Recognised Specialist in Rabbit Medicine and Surgery
Emergencies without obvious clinical signs • • • • • • • • • • • • • • • • •
Panicking owner Stress Pain e.g from arthritis or back pain Gut stasis Crown loss and inability to eat Dental spurs Soft tissue problem in mouth Jaw fractures Tooth fractures Respiratory disease VHD Moving intestinal foreign body Gastric ulceration Congestive heart failure Neoplasia Trauma Nasal foreign body
• • • • • • • • • • • • • • •
Enteritis Mucoid enteropathy Cystitis Sludgy urine Urethral obstruction Chronic renal failure Hepatic lipidosis Liver lobe torsion Septicaemia Ureteral obstruction Gastric dilation due to intestinal obstruction Acute enterotoxemia Acute renal failure Peritonitis Heavy metal poisoning
Need to assess and examine the rabbit Frances Harcourt‐Brown BVSc FRCVS, RCVS Recognised Specialist in Rabbit Medicine and Surgery
Frances Harcourt‐Brown BVSc FRCVS, RCVS Recognised Specialist in Rabbit Medicine and Surgery
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Signs of trauma • Usually predator attack • Other causes are obvious (e.g trodden on by owner or bitten by dog) • Most predators go for head or neck • Wounds are not always obvious • Sudden anorexia and signs of shock or pain may be most obvious Frances Harcourt‐Brown BVSc FRCVS, RCVS Recognised Specialist in Rabbit Medicine and Surgery
Signs of acute pain in rabbits • Motionless • Unresponsive • Increased respiratory rate • Hiding • Piloerection • Total anorexia • Tooth grinding • Chewing paper Need to worry Frances Harcourt‐Brown BVSc FRCVS, RCVS Recognised Specialist in Rabbit Medicine and Surgery
Hypothermia • Can take rectal temperature (38.5-40oC) • Can also assess body temperature by feeling ears and limbs • Circulation in ears is how rabbits regulate body temperature • Warming a cold rabbit up can help- hot water bottles, hair dryer etc.
Frances Harcourt‐Brown BVSc FRCVS, RCVS Recognised Specialist in Rabbit Medicine and Surgery
Bleeding • Rabbit blood clots quickly • Don’t bleed to death often • Bleeding from nose can be a sign of VHD • Unspayed females can have aneurysms in the uterus that can rupture • Can worry about bleeding from vulva • No need to worry about torn claw Frances Harcourt‐Brown BVSc FRCVS, RCVS Recognised Specialist in Rabbit Medicine and Surgery
Signs of shock • Hypothermia • Poor circulation • Depression • Ataxia • Muscular weakness • Slow heart rate Really need to worry- rabbit is probably about to die
Frances Harcourt‐Brown BVSc FRCVS, RCVS Recognised Specialist in Rabbit Medicine and Surgery
Signs of abdominal pain • Dramatic sudden loss of appetite • Hiding • Flopping down • Pressing stomach to ground • Stretching • Trembling ? Palpate the rabbit’s abdomen
Frances Harcourt‐Brown BVSc FRCVS, RCVS Recognised Specialist in Rabbit Medicine and Surgery
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•06/04/2015
What you are feeling for:
What you are feeling for:
• Stomach- behind ribs on left • Painful liver lobe- behind ribs on right • Kidneys - Right behind ribs - Left in middle of abdomen • Bladder
• Stomach- behind ribs on left • Painful liver lobe- behind ribs on right • Kidneys - Right behind ribs - Left in middle of abdomen • Bladder
Frances Harcourt‐Brown BVSc FRCVS, RCVS Recognised Specialist in Rabbit Medicine and Surgery
Liver lobe torsion • Cause of sudden onset anorexia • Lobe may be palpable • Can be rapidly fatal or can recover • Severe anaemia in an acutely anorexic rabbit is very suggestive • VHD is main differential
Frances Harcourt‐Brown BVSc FRCVS, RCVS Recognised Specialist in Rabbit Medicine and Surgery
Topographical anatomy-right side Kidney Caudate liver lobe
Surgery is straightforward if condition is recognised early
Frances Harcourt‐Brown BVSc FRCVS, RCVS Recognised Specialist in Rabbit Medicine and Surgery
Torsion of caudate lobe • Usually caudal lobe • May be palpated on right behind ribs • Painful
Frances Harcourt‐Brown BVSc FRCVS, RCVS Recognised Specialist in Rabbit Medicine and Surgery
Rabbits have a liver lobe that is almost separated from rest of liver Frances Harcourt‐Brown BVSc FRCVS, RCVS Recognised Specialist in Rabbit Medicine and Surgery
What you are feeling for: • Stomach- behind ribs on left • Painful liver lobe- behind ribs on right • Kidneys - Right behind ribs - Left in middle of abdomen • Bladder
Frances Harcourt‐Brown BVSc FRCVS, RCVS Recognised Specialist in Rabbit Medicine and Surgery
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•06/04/2015
Gastric dilation
What you are feeling for: • Stomach- behind ribs on left • Painful liver lobe- behind ribs on right • Kidneys - Right behind ribs - Left in middle of abdomen • Bladder
Feels like a balloon in the abdomen Frances Harcourt‐Brown BVSc FRCVS, RCVS Recognised Specialist in Rabbit Medicine and Surgery
Ureteral obstruction • Ureter goes from kidney to bladder • Kidney stones are not uncommon in rabbits • Stones passing from kidney to bladder can be very painful • Kidney can become Any painful mass in enlarged if ureter is abdomen is a concern blocked completely Frances Harcourt‐Brown BVSc FRCVS, RCVS Recognised Specialist in Rabbit Medicine and Surgery
Hard painful bladder
Frances Harcourt‐Brown BVSc FRCVS, RCVS Recognised Specialist in Rabbit Medicine and Surgery
What you are feeling for: • Stomach- behind ribs on left • Painful liver lobe- behind ribs on right • Kidneys - Right behind ribs - Left in middle of abdomen • Bladder
Frances Harcourt‐Brown BVSc FRCVS, RCVS Recognised Specialist in Rabbit Medicine and Surgery
Palpate the abdomen gently
• Sludgy urine • Cystitis • Urethral obstruction
Abdominal abscess Frances Harcourt‐Brown BVSc FRCVS, RCVS Recognised Specialist in Rabbit Medicine and Surgery
Frances Harcourt‐Brown BVSc FRCVS, RCVS Recognised Specialist in Rabbit Medicine and Surgery
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Blood glucose measurement • Worth considering • Some practical difficulties with needles to get the sample • Probably better if it is performed at vet’s surgery where radiographs can be taken
Frances Harcourt‐Brown BVSc FRCVS, RCVS Recognised Specialist in Rabbit Medicine and Surgery
Conscious radiography using immobility response
Abdominal radiography • Very useful • Can be performed conscious • Sedation is necessary for some rabbits • Sedation means rabbit needs to be admitted • Cost considerations • Restraint for conscious radiography is controversial
Frances Harcourt‐Brown BVSc FRCVS, RCVS Recognised Specialist in Rabbit Medicine and Surgery
Immobility response • Gently turning a rabbit on to it’s back will evoke an immobility response • Easier in docile tame rabbits • Difficult/impossible in wild or lively rabbits- need to scruff them • Is this tonic immobility (TI)?
Frances Harcourt‐Brown BVSc FRCVS, RCVS Recognised Specialist in Rabbit Medicine and Surgery
Tonic immobility • Humans undergo tonic immobility when they are subjected to a serious attack (e.g. rape, murder or war injuries). • They find they are ‘unable and unwilling to use
Frances Harcourt‐Brown BVSc FRCVS, RCVS Recognised Specialist in Rabbit Medicine and Surgery
Tonic immobility? • Tonic means muscles are contracted i.e ‘Scared stiff’ • Tonic immobility can precedes death in rape or murder victims i.e ‘die of fright’
voluntary muscles during the event and feel neither anger nor pain. They are emotionally numb, as if anesthetized but the general impression conveyed by such patients is one of profound mental anguish and their immobility is induced by severe mental shock.’
Frances Harcourt‐Brown BVSc FRCVS, RCVS Recognised Specialist in Rabbit Medicine and Surgery
Frances Harcourt‐Brown BVSc FRCVS, RCVS Recognised Specialist in Rabbit Medicine and Surgery
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My opinion- from reading and personal observation:
Literature • Lots of conflicting information • Variability in validity of methods that were used • Difficult to separate effects of handling and taking blood samples from effects of turning rabbit on its back • Method of inducing ‘TI’ is often not described
• The ‘immobility response’ is not the same as ‘tonic immobility’ • Blood glucose levels do not rise in response to placing a rabbit on its back • Rabbits will accept food on their back Are rabbits on their back in a state of terror?
Frances Harcourt‐Brown BVSc FRCVS, RCVS Recognised Specialist in Rabbit Medicine and Surgery
Would I do it to my rabbit? • Yes-if it was required • Many benefits • Means that the fur from under the tail can be clipped off easily • Useful for vets to perform ultrasound exam and radiographs without sedation • I have more problems with the way rabbits are stressed by being picked up and handled badly Frances Harcourt‐Brown BVSc FRCVS, RCVS Recognised Specialist in Rabbit Medicine and Surgery
Firm restraint is also a bad idea
• Often said that rabbits must be restrained firmly • But injuries can result of rabbits kicking out when restrained across the shoulders Frances Harcourt‐Brown BVSc FRCVS, RCVS Recognised Specialist in Rabbit Medicine and Surgery
• Impossible to induce IR in wild rabbits or lively pet ones without terrifying them • Easy in docile pet rabbits Frances Harcourt‐Brown BVSc FRCVS, RCVS Recognised Specialist in Rabbit Medicine and Surgery
Picking rabbits up • Being grabbed is stressful • Grabbing by ears or scruff is definitely not a good idea • It is the way a predator would hold it • Never necessary
Frances Harcourt‐Brown BVSc FRCVS, RCVS Recognised Specialist in Rabbit Medicine and Surgery
Vertebral fractures and dislocations
• Vertebral column is relatively inflexible • Easily fractures or dislocates if rabbit kicks out
Frances Harcourt‐Brown BVSc FRCVS, RCVS Recognised Specialist in Rabbit Medicine and Surgery
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•06/04/2015
Correct (in my view) way to pick a rabbit up
The anorexic rabbit-when to worry • If anorexia is sudden • If rabbit is hiding • If stomach feels or looks bloated • If there are signs of abdominal pain • If any painful lumps can be felt in the abdomen
Not how a predator behaves Frances Harcourt‐Brown BVSc FRCVS, RCVS Recognised Specialist in Rabbit Medicine and Surgery
If you decide to measure blood glucose-
• If there are obvious signs such as respiratory noise, straining or bleeding Frances Harcourt‐Brown BVSc FRCVS, RCVS Recognised Specialist in Rabbit Medicine and Surgery
The end
•<2 Call the vet •2-4mmol/l- needs food (gut stasis) •4-8mmol- reassuringly normal •8-15mmol/l- probably due to stress •>15mmol/l – severe stress. Can start to worry. ?Repeat sample •>20mmol/l –Definitely need to call the vet
Frances Harcourt‐Brown BVSc FRCVS, RCVS Recognised Specialist in Rabbit Medicine and Surgery
Frances Harcourt‐Brown BVSc FRCVS, RCVS Recognised Specialist in Rabbit Medicine and Surgery
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